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Sample records for branch duct intraductal

  1. Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm

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    Hiroki Sakamoto; Masayuki Kitano; Takamitsu Komaki; Hajime Imai; Ken Kamata; Masatomo Kimura; Yoshifumi Takeyama; Masatoshi Kudo

    2009-01-01

    Endoscopic ultrasonography (EUS) is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas.Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS (CEH-EUS) which uses sonographic contrast agent for differentiation of a pancreatic mass.This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm (IPMN) in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the followup of the branch duct IPMN.A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body.She had been followedup by EUS every 6 mo.However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging.CHEUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma.The histopathological diagnosis was adenocarcinoma (10 mm) in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body.EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.

  2. A large mural nodule in branch duct intraductal papillary mucinous adenoma of the pancreas: a case report.

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    Haruki, Koichiro; Wakiyama, Shigeki; Futagawa, Yasuro; Shiba, Hiroaki; Misawa, Takeyuki; Yanaga, Katsuhiko

    2015-12-01

    Indications for resection of branch duct intraductal papillary mucinous neoplasms (IPMNs) remain controversial because of their low tendency to be malignant. Surgical resection should be recommended if any factors indicating malignancy are present. However, preoperative differentiation between benign and malignant tumors is very difficult, especially in cases of branch duct IPMNs. We herein report a case of branch duct intraductal papillary mucinous adenoma (IPMA) of the pancreas with a large mural nodule of 25 mm. A 74-year-old woman was admitted for examination and treatment for a cystic tumor in the head of the pancreas. Magnetic resonance cholangiopancreatography and computed tomography showed a cystic lesion, 50 mm in diameter, with an irregular mural nodule in the pancreatic head. Endoscopic ultrasonography demonstrated a multicystic tumor connected with the main pancreatic duct (MPD). The mural nodule had a diameter of 18 mm, and the MPD had a slight dilation of 6 mm. These findings suggested a high potential for malignancy. The patient underwent pancreaticoduodenectomy with lymph node dissection. The excised pancreas showed multiple cysts located in the branch pancreatic duct with a maximum diameter of 75 mm. The mural nodule had a maximum diameter of 25 mm. The tumor was diagnosed as an IPMA by pathological examination. After operation, the patient was discharged without any complications. Two years after resection, the patient remains in remission with no evidence of tumor recurrence.

  3. Small-Sized, Flat-Type Invasive Branch Duct Intraductal Papillary Mucinous Neoplasm: A Case Report

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    Koji Shindo

    2013-10-01

    Full Text Available Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs. International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer.

  4. Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

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    Kwang Yeol Paik; Seong Ho Choi

    2009-01-01

    AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in five patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, pre- and intra-operative definite localization and careful operative techniques are required.

  5. CT and MR imaging of multilocular acinar cell cystadenoma: comparison with branch duct intraductal papillary mucinous neoplasia (IPMNs)

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    Delavaud, Christophe; Assignies, Gaspard d' ; Vilgrain, Valerie; Vullierme, Marie-Pierre [Hopital Beaujon, Service de Radiologie, Clichy (France); Cros, Jerome [Hopital Beaujon, Service d' Anatomopathologie, Clichy (France); Ruszniewski, Philippe; Hammel, Pascal; Levy, Philippe [Hopital Beaujon, Service de Pancreato-Gastro-Enterologie, Clichy (France); Couvelard, Anne [Hopital Bichat, Service d' Anatomopathologie, Paris (France); Sauvanet, Alain; Dokmak, Safi [Hopital Beaujon, Service de Chirurgie Hepato-Pancreato-Biliaire, Clichy (France)

    2014-09-15

    To describe CT and MR imaging findings of acinar cell cystadenoma (ACC) of the pancreas and to compare them with those of branch duct intraductal papillary mucinous neoplasia (BD-IPMN) to identify distinctive elements. Five patients with ACC and the 20 consecutive patients with histologically proven BD-IPMN were retrospectively included. Clinical and biological information was collected and histological data reviewed. CT and MR findings were analysed blinded to pathological diagnosis in order to identify imaging diagnostic criteria of ACC. Patients with ACC were symptomatic in all but one case and were younger than those with BD-IPMN (p = 0.006). Four radiological criteria allowed for differentiating ACC from IPMN: five or more cysts, clustered peripheral small cysts, presence of cyst calcifications and absence of communication with the main pancreatic duct (p < 0.05). Presence of at least two or three of these imaging criteria had a strong diagnostic value for ACC with a sensitivity of 100 % and 80 % and a specificity of 85 % and 100 %, respectively. Preoperative differential diagnosis between ACC and BD-IPMN can be achieved using a combination of four CT and/or MR imaging criteria. Recognition of ACC patients could change patient management and lead to more conservative treatment. (orig.)

  6. The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

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    Stevanović Dejan

    2015-01-01

    Full Text Available Introduction. Intraductal papillary mucinous neoplasms (IPMN are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2, which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

  7. Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

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    Girometti, Rossano; Pravisani, Riccardo; Intini, Sergio Giuseppe; Isola, Miriam; Cereser, Lorenzo; Risaliti, Andrea; Zuiani, Chiara

    2016-01-01

    AIM To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up. METHODS We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes. RESULTS We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (IPMN appearance (P > 0.01). CONCLUSION Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy. PMID:27920477

  8. Cytological analysis of small branch-duct intraductal papillary mucinous neoplasms provides a more accurate risk assessment of malignancy than symptoms

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    Jill Ono

    2011-01-01

    Full Text Available Objectives: The Sendai guidelines for management of patients with clinically suspected intraductal papillary mucinous neoplasms (IPMN recommend resection of cysts > 30 mm, a dilated main pancreatic duct (MPD > 6 mm, a mural nodule (MN, symptoms or positive cytology. Although sensitive, asymptomatic cysts, nonspecific symptoms, and a high threshold for positive cytology limit the specificity of the guidelines. We have assessed the value of cytology relative to symptom for predicting malignancy in IPMNs without high-risk imaging features. Materials and Methods: We retrospectively reviewed the clinical, radiological, and cytological data of 31 small branch-duct IPMNs without a MN. The cytological presence of high-grade atypical epithelial cells (HGA was considered true positive, with a corresponding histology of high-grade dysplasia or invasive carcinoma. The performance of cytology versus symptoms was evaluated by calculating the sensitivity, specificity, negative predictive value (NPV, positive predictive value (PPV, and accuracy. Results: The sensitivity (0.80, specificity (0.85, and accuracy (0.84 of HGA were higher than the corresponding performance characteristics of symptoms (0.60, 0.45, and 0.48, respectively. The NPV of no HGA on cytology was > 95%. Conclusions: Cytology is a better predictor of malignancy than symptoms, for the conservative management of small branch-duct IPMNs. Cytology contributes to a highly accurate triple negative test for malignancy in small IPMN: No dilated MPD, MN or HGA.

  9. Multiple small "imaging" branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia?

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    Bartsch, D K; Dietzel, K; Bargello, M; Matthaei, E; Kloeppel, G; Esposito, I; Heverhagen, J T; Gress, T M; Slater, E P; Langer, P

    2013-03-01

    Most screening programs for familial pancreatic cancer are currently based on endoscopic ultrasonography and/or magnetic resonance imaging (MRI). Cystic lesions, especially those suspicious for small intraductal pancreatic mucinous neoplasms (IPMNs) of the branch ducts, can be visualized in up to 40 % of individuals at risk, but their pathological importance in the setting of FPC is yet not well established. Individuals at risk from a prospective screening program for familial pancreatic cancer with small "imaging" IPMNs of the branch-duct type (BD-IPMN) who underwent pancreatic resection were analysed regarding clinico-pathological data and the locations of pancreatic lesions. Five of 125 individuals at risk who underwent screening had multiple small (size 2-10 mm) unicystic lesions and/or multicystic single lesions in the pancreatic body and tail suspicious for BD-IPMNs upon MRI imaging and decided to undergo surgical resection after interdisciplinary counselling, although none fulfilled the consensus criteria for IPMN resection. Histological examination revealed BD-IPMNs with low or moderate dysplasia of the gastric type in combination with multifocal PanIN2 and PanIN3 lesions in 4 individuals. The remaining patient had only tiny ductectasias in the pancreatic tail with multifocal PanIN 2 lesions in the entire gland and one PanIN3 lesion in the pancreatic head. Intriguingly, the location of the most dysplastic histological lesions (PanIN3) did not correspond to the preoperatively detected lesions and were not visible in preoperative imaging. In the setting of FPC, the presence of multiple small "imaging" BD-IPMNs may indicate the presence of high-grade PanIN lesions elsewhere in the pancreas.

  10. Main-duct intraductal papillary mucinous adenoma of the pancreas

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    Takuma Kensuke

    2011-11-01

    Full Text Available Abstract Background The prevalence of carcinoma in main-duct intraductal papillary mucinous neoplasm (IPMN is high, and surgical resection is recommended for all patients with a main-duct IPMN. Results A main-duct IPMN with typical imagings including protruding lesions in the dilated main pancreatic duct was resected, but the histology was intraductal papillary mucinous adenoma of the pancreas. Discussion It has been reported that the presence of mural nodules and dilatation of MPD are significantly higher in malignant IPMNs. The presented case had protruding lesions in the dilated main pancreatic duct on endoscopic ultrasonography, but the histology was adenoma. Conclusion Preoperative distinction between benign and malignant IPMNs is difficult.

  11. Main-duct intraductal papillary mucinous neoplasm of the pancreas: a case report

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    Natalia Manetti

    2012-12-01

    Full Text Available Three distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN, serous cystic neoplasm (SCN and mucinous cystic neoplasm (MCN. IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.

  12. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

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    Vor Luvira

    2016-01-01

    Full Text Available Intraductal papillary neoplasm of the bile duct (IPNB is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P. This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

  13. Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

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    Cheema Muhammad

    2009-01-01

    Full Text Available Abstract Background Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka. Case presentation Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts. Conclusion Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.

  14. Imaging diagnosis of branch duct intraductal papillary mucinous tumors%分支胰管型胰腺导管内乳头状黏液性肿瘤影像学诊断

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    边云; 高振坡; 王莉; 陆建平

    2015-01-01

    Objective To explore the imaging findings of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods A total of 45 BD-IPMNs were confirmed by pathology after surgery.The clinical data and imaging findings were retrospec-tively reviewed.Image analysis included characteristics and the nature of the lesions.Finally,an ROC curve was performed to evaluate the differential diagnostic efficacy between benign and malignant lesions using the imaging findings.Results There were statistically significant differences for differential diagnosis of malignant and benign BD-IPMNs in the maximum diameter of the lesions and the MPD,walls,wall nodules,shape,and the atrophy of pancreatic parenchyma (P < 0.05 ).The diagnostic sensitivity,specificity, AUC and Kappa value of benign and malignant BD-IPMNs were 94.3%,90%,92.1% and 0.81 (P =0.000 1)respectively.Conclu-sion The imaging technology is valuable in diagnosing and differentiating malignant from benign BD-IPMNs.%目的:探讨影像学方法对分支胰管型胰腺导管内乳头状黏液瘤(BD-IPMNs)良恶性的诊断价值。方法回顾性分析经手术病理证实的45例 BD-IPMNs 患者的影像学资料。患者术前均行 CT、MRCP、MR 三者中的1种或2种以上检查。分析病变的各种影像学特征,对病变的良恶性进行影像学评分,并与病理分级进行对照。绘制 ROC 曲线来评价影像学方法对 BD-IPMNs 良恶性鉴别的诊断能力。结果主胰管的直径、囊肿直径、厚囊壁、壁结节、胰腺实质的萎缩对鉴别病变的良恶性有统计学意义。影像学诊断 BD-IPMNs 的敏感性94.3%,特异性90%,曲线下面积92.1%,Kappa 值为0.81,P 值为0.0001。结论影像学对于 BD-IPMNs 的诊断以及良恶性的鉴别都具有高度的敏感性,对术前诊断和随访具有一定的价值。

  15. Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm

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    Alistair J. Lawrence

    2015-01-01

    Full Text Available We report a unique first case of benign heterotopic pancreas arising within the proximal hepatic bile duct, containing a focus of intraductal papillary mucinous neoplasm (IPMN. The condition was diagnosed on pathological explant after left hepatic lobectomy with total extrahepatic bile duct excision.

  16. An Intraductal Papillary Neoplasm of the Bile Duct at the Duodenal Papilla

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    Yoshiaki Kawaguchi

    2014-07-01

    Full Text Available In recent years, the disease concept of intraductal papillary neoplasm of the bile duct (IPNB has been attracting attention as a biliary lesion that is morphologically similar to intraductal papillary mucinous neoplasm (IPMN, which is considered to be a counterpart of IPMN. However, there are few reports on IPNB, and a consensus regarding the features of this disease is thus lacking. We experienced an extremely rare case of IPNB occurring in the bile duct at the duodenal papilla, which is a tumor presentation that has not previously been reported. Herein, we report this interesting case and discuss the possible association between IPMN and IPNB.

  17. Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?

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    Barron, M R; Roch, A M; Waters, J A; Parikh, J A; DeWitt, J M; Al-Haddad, M A; Ceppa, E P; House, M G; Zyromski, N J; Nakeeb, A; Pitt, H A; Schmidt, C Max

    2014-03-01

    Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7%) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4%) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4%) had invasive carcinoma. Alternatively, 2/50 (4%) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25% of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.

  18. Prognosis of cancer with branch duct type IPMN of the pancreas

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    Nobuhito; Ikeuchi; Takao; Itoi; Atsushi; Sofuni; Fumihide; Itokawa; Takayoshi; Tsuchiya; Toshio; Kurihara; Kentaro; Ishii; Shujiro; Tsuji; Junko; Umeda; Fuminori; Moriyasu; Akihiko; Tsuchida; Kazuhiko; Kasuya

    2010-01-01

    AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of IPMN.RESULTS: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of ...

  19. Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct:A case report

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    Kohei; Tsuchida; Michiko; Yamagata; Yasuyuki; Saifuku; Dan; Ichikawa; Kazunari; Kanke; Toshimitsu; Murohisa; Masaya; Tamano; Makoto; Iijima; Yukiko; Nemoto; Wataru; Shimoda; Toshiaki; Komori; Hirokazu; Fukui; Kazuhito; Ichikawa; Hitoshi; Sugaya; Kazuhito; Miyachi; Takahiro; Fujimori; Hideyuki; Hiraishi

    2010-01-01

    Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection....

  20. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis

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    Lee, Linda S; Bellizzi, Andrew M.; Banks, Peter A.; Sainani, Nisha I.; Vivek Kadiyala; Shadeah Suleiman; Darwin L Conwell; Paulo, Joao A.

    2012-01-01

    Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patie...

  1. Unexpected metastasis of intraductal papillary mucinous neoplasm of the bile duct into thoracic cavity with direct extension: Case report

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    Kim, Eung Tae; Heo, Jeong Nam; Park, Choong Ki [Hanyang Univ. Guri Hospital, Guri (Korea, Republic of); Choi, Yo Won; Jeon, Seok Chol [Hanyang Univ. Seoul Hospital, Seoul (Korea, Republic of)

    2012-08-15

    Intraductal papillary mucinous neoplasm (IPMN) is known to arise from intraductal proliferation of mucinous cells with findings of marked dilatation of the biliary or pancreatic duct. There are reports of the metastasis and extension of pancreatic IPMN. However, cases of biliary IPMN with direct metastasis, or metastasis to distant locations, are rare. We present a case of metastasis of biliary IPMN with unexpected direct extension into the thoracic cavity, and we attempt to account for the mechanism of this extension.

  2. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN

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    OKABAYASHI, TAKEHIRO; Shima, Yasuo; KOSAKI, TAKUHIRO; SUMIYOSHI, TATSUAKI; KOZUKI, AKIHITO; IIYAMA, TASTUO; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-01-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We ...

  3. A case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm (IPMN).

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    Kawai, Yuichi; Nakamichi, Rei; Kamata, Noriko; Miyake, Hideo; Fujino, Masahiko; Itoh, Shigeki

    2015-03-01

    We report here a rare case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm. In an 80-year-old woman, an approximately 8-mm papillary mass was incidentally detected at the downstream edge of a dilatated main pancreatic duct lumen on CT and MRI. Main pancreatic duct dilatation in the pancreatic body and tail and parenchymal atrophy were observed in the upstream of the mass. Histopathologically, the tumor protruded into the downstream edge of the dilatated main pancreatic duct lumen in the pancreatic body. The tumor cells had highly atypical nuclei and abundant polymorphic structures, and showed positive staining for granulocyte colony-stimulating factor, which led to the diagnosis of undifferentiated carcinoma. A total of 13 cases of undifferentiated carcinoma with intraductal tumor growth have been reported to date. The case report by Bergmann et al. has been the smallest in histopathological specimen, and the present case is the smallest in size detected by radiological images. Since early undifferentiated carcinoma of the pancreas can resemble those of main-duct intraductal papillary mucinous neoplasm in cross-sectional images, we have to consider undifferentiated carcinoma in the differential diagnosis of the solitary and papillary mass with low contrast enhancement in early phase in the main pancreatic duct.

  4. Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN of the pancreas

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    Harimoto Norifumi

    2007-08-01

    Full Text Available Abstract Background Although intraductal papillary mucinous neoplasm (IPMN of the pancreas is acceptable as a distinct disease entity, the concept of mucin-secreting biliary tumors has not been fully established. Case presentation We describe herein a case of mucin secreting biliary neoplasm. Imaging revealed a cystic lesion 2 cm in diameter at the left lateral segment of the liver. Duodenal endoscopy revealed mucin secretion through an enlarged papilla of Vater. On the cholangiogram, the cystic lesion communicated with bile duct, and large filling defects caused by mucin were observed in the dilated common bile duct. This lesion was diagnosed as a mucin-secreting bile duct tumor. Left and caudate lobectomy of the liver with extrahepatic bile duct resection and reconstruction was performed according to the possibility of the tumor's malignant behavior. Histological examination of the specimen revealed biliary cystic wall was covered by micropapillary neoplastic epithelium with mucin secretion lacking stromal invasion nor ovarian-like stroma. The patient has remained well with no evidence of recurrence for 38 months since her operation. Conclusion It is only recently that the term "intraductal papillary mucinous neoplasm (IPMN," which is accepted as a distinct disease entity of the pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to be intraductal papillary neoplasm with prominent cystic dilatation of the bile duct.

  5. Diagnostic performance of CT and MRI in distinguishing intraductal papillary neoplasm of the bile duct from cholangiocarcinoma with intraductal papillary growth

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    Liu, Yubao; Zhong, Xiaomei; Yan, Lifen; Zheng, Junhui; Liu, Zaiyi; Liang, Changhong [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou (China)

    2015-07-15

    We aimed to evaluate the diagnostic performance of CT and MRI for distinguishing intraductal papillary neoplasm of the bile duct (IPNB) from cholangiocarcinoma (CC) with intraductal papillary growth (IPG). Forty-two patients with either IPNB or CC with IPG proven by histopathology were independently reviewed in retrospect. Strict criteria for diagnosis of IPNB included presence of the designated imaging features as follows: local dilatation of the bile duct, nodule within the dilated bile duct, growing along the interior wall of bile duct. Any lesion that was not consistent with the criteria was classified as CC with IPG. Sensitivity, specificity, positive and negative predictive values for characterization of IPNB were calculated, and k test was used to assess the level of agreement. Two imaging reviewers correctly identified 21 of 26 (80.8 %) and 22 of 26 (84.6 %) IPNB cases, respectively. Alternatively, they correctly identified 14 of 16 (87.5 %) and 15 of 16 (93.8 %) CC with IPG, respectively. Agreement between the two reviewers was perfect (k = 0.81) for the diagnosis of IPNB and differentiation from CC with IPG. By using our designated diagnostic criteria of CT and MRI, IPNB can be accurately identified and possible to be distinguished from CC with IPG. (orig.)

  6. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

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    Ravish Parekh

    2016-12-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses.

  7. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

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    Parekh, Ravish; Krol, Gregory; Piraka, Cyrus; Batra, Surinder

    2016-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT) imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses. PMID:28100995

  8. GNAS and KRAS mutations are common in intraductal papillary neoplasms of the bile duct.

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    Motoko Sasaki

    Full Text Available Intraductal papillary neoplasms of the bile duct (IPNB shows favorable prognosis and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm (IPMN of the pancreas. Although activating point mutations of GNAS at codon 201 have been detected in approximately two thirds of IPMNs of the pancreas, there have been few studies on GNAS mutations in IPNBs. This study investigates the status of GNAS and KRAS mutations and their association with clinicopathological factors in IPNBs. We examined the status of GNAS mutation at codon 201 and KRAS mutation at codon 12&13, degree of mucin production and immunohistochemical expressions of MUC mucin core proteins in 29 patients (M/F = 15/14 with IPNB in intrahepatic and perihilar bile ducts (perihilar IPNB and 6 patients (M/F = 5/1 with IPNB in distal bile ducts (distal IPNB. GNAS mutations and KRAS mutations were detected in 50% and 46.2% of IPNBs, respectively. There was no significant correlation between the status of GNAS mutation and clinicopathological factors in IPNBs, whereas, the status of KRAS mutation was significantly inversely correlated with the degree of MUC2 expression in IPNBs (p<0.05. All IPNBs with GNAS mutation only showed high-mucin production. Degree of mucin production was significantly higher in perihilar IPNBs than distal IPNBs (p<0.05. MUC2 and MUC5AC expression was significantly higher in IPNBs with high-mucin production than those with low-mucin production (p<0.01 and p<0.05, respectively. In conclusions, this study firstly disclosed frequent GNAS mutations in IPNBs, similarly to IPMNs. This may suggest a common histopathogenesis of IPNBs and IPMNs. The status of KRAS mutations was inversely correlated to MUC2 expression and this may suggest heterogeneous properties of IPNBs. IPNBs with high-mucin production are characterized by perihilar location and high expression of MUC2 and MUC5AC, irrespective of the status of GNAS and KRAS mutations.

  9. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN.

    Science.gov (United States)

    Okabayashi, Takehiro; Shima, Yasuo; Kosaki, Takuhiro; Sumiyoshi, Tatsuaki; Kozuki, Akihito; Iiyama, Tastuo; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-06-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We retrospectively reviewed a single institution's prospective pancreatic resection database to identify IPMN patients who underwent pancreatectomy with curative intent. The clinicopathological variables of 100 patients resected for IPMN were analyzed with a detailed review of histopathological results (borderline lesions, non-invasive carcinoma and invasive carcinoma) to determine the grade of IPMN malignancy based on transforming growth factor (TGF)-β/SMAD4 signaling. The incidence of malignant change was significantly higher in patients with main duct-type IPMN (69.7%) compared with branch duct-type IPMN cases (17.9%). However, patients with an invasive carcinoma had a significantly worse outcome if it was derived from branch duct-type IPMN compared with those derived from main duct-type IPMN, and TGF-β mRNA expression was significantly increased in the former patient group. Immunohistochemistry also showed higher numbers of SMAD4-positive cells in patients with carcinoma derived from branch duct-type IPMN. Our results demonstrated that invasive carcinoma derived from branch duct-type IPMN is more aggressive than that derived from main duct-type IPMN, once invasive morphological change takes place. Determining TGF-β and/or SMAD4 status at initial diagnosis may be useful for stratifying IPMN patients into treatment regimens.

  10. A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

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    Jo Sungho

    2009-12-01

    Full Text Available Abstract Background Because intraductal papillary mucinous neoplasm of the bile duct (IPMN-B is believed to show a better clinical course than non-papillary biliary neoplasms, it is important to make a precise diagnosis and to perform complete surgical resection. Case presentation We herein report a case of malignant IPMN-B treated by right trisectionectomy with caudate lobectomy and extrahepatic bile duct resection. Radiologic images showed marked dilatation of the left medial sectional bile duct (B4 resulting in a bulky cystic mass with multiple internal papillary projections. Duodenal endoscopic examination demonstrated very patulous ampullary orifice with mucin expulsion and endoscopic retrograde cholangiogram confirmed marked cystic dilatation of B4 with luminal filling defects. These findings suggested IPMN-B with malignancy potential. The functional volume of the left lateral section was estimated to be 45%. A planned extensive surgery was successfully performed. The remnant bile ducts were also dilated but had no macroscopic intraluminal tumorous lesion. The histopathological examination yielded the diagnosis of mucin-producing oncocytic intraductal papillary carcinoma of the bile duct with poorly differentiated carcinomas showing neuroendocrine differentiation. The tumor was 14.0 × 13.0 cm-sized and revealed no stromal invasiveness. Resection margins of the proximal bile duct and hepatic parenchyma were free of tumor cell. The patient showed no postoperative complication and was discharged on 10th postoperative date. He has been regularly followed at outpatient department with no evidence of recurrence. Conclusion Considering a favorable prognosis of IPMN-B compared to non-papillary biliary neoplasms, this tumor can be a good indication for aggressive surgical resection regardless of its tumor size.

  11. Intraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct

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    Norihiro Goto

    2012-01-01

    Full Text Available Context Intraductal papillary mucinous neoplasm (IPMN of the pancreas occasionally penetrates to others organs. We present a case of IPMN penetrating to the stomach and the common bile duct. Case report A 75-year-old man was admitted to the hospital because of epigastric pain. Computed tomography (CT showed a papillary tumor protruding into the markedly dilated main pancreatic duct and splenic vein obstruction. The tumor was diagnosed as IPMN arising in the main duct, but he rejected surgery and he was followed without treatment. One year later, gastroduodenoscopy revealed gastropancreatic fistula and we were able to pass an endoscope through the fistula and directly examine the lumen of the main pancreatic duct and the papillary tumor adjacent to the fistula. Absence of malignant cells on histopathology suggested mechanical penetration rather than invasive penetration. CT showed splenic vein reperfusion due to decreased inner pressure of the main pancreatic duct. Two and a half years later, CT revealed biliopancreatic fistula formation. Endoscope biliary drainage was performed but failed. Despite jaundice, he is still ambulatory and seen in the clinic three years after the first admission. Conclusions We have experienced a case of IPMN penetrating to the stomach and the common bile duct that has taken a slow course. It represents the importance of distinguishing mechanical penetration from invasive penetration as well as mechanical splenic vein obstruction from splenic vein invasion.

  12. Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment.

    Science.gov (United States)

    Natsume, Toshiyuki; Maruyama, Takashi; Kobayashi, Akitoshi; Shimizu, Shinichiro; Tanaka, Hajime; Matsuzaki, Hiroshi; Miyazaki, Akinari; Ohta, Takumi; Sato, Yayoi; Yamamoto, Yuji; Aikawa, Mizuho; Otsuka, Ryota; Yanagihara, Akitoshi

    2013-12-01

    Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.

  13. Endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for multiple intraductal papillary mucinous adenomas

    Institute of Scientific and Technical Information of China (English)

    Tamotsu Kuroki; Yoshitsugu Tajima; Ryuji Tsutsumi; Noritsugu Tsuneoka; Amane Kitasato; Tomohiko Adachi; Takashi Kanematsu

    2006-01-01

    In benign or low-grade malignant pancreatic tumors,complete removal of the lesion is sufficient for a cure,and thus minimal resection techniques with preservation of the pancreatic functional reserve have advantages over more extended pancreatic resections. However, a high incidence of postoperative pancreatic fistula in such procedures has been reported. Moreover, branch-type intraductal papillary mucinous neoplasms of the pancreas tend to locate in the head of the pancreas, and show less malignant potential. We describe an endoscopic nasopancreatic stent-guided single-branch resection of the pancreas for branch-type multiple intraductal papillary mucinous adenomas, along with a gastric wall-covering method for the prevention of pancreatic leakage.

  14. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis.

    Science.gov (United States)

    Lee, Linda S; Bellizzi, Andrew M; Banks, Peter A; Sainani, Nisha I; Kadiyala, Vivek; Suleiman, Shadeah; Conwell, Darwin L; Paulo, Joao A

    2012-01-01

    Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  15. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis

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    Linda S. Lee

    2012-01-01

    Full Text Available Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P<0.05 was present in higher concentrations in mixed IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  16. Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?

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    Purysko, Andrei S.; Gandhi, Namita S.; Veniero, Joseph C. [Cleveland Clinic, From the Abdominal Imaging Section, Imaging Institute, Cleveland, OH (United States); Walsh, R.M. [Cleveland Clinic, Department of General Surgery, Digestive Disease Institute, Cleveland, OH (United States); Obuchowski, Nancy A. [Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, OH (United States)

    2014-12-15

    To assess the value of secretin during magnetic resonance cholangiopancreatography (MRCP) in demonstrating communication between cystic lesions and the pancreatic duct to help determine the diagnosis of side-branch intraductal papillary mucinous neoplasm (SB-IPMN). This is an IRB-approved, HIPAA-compliant retrospective study of 29 SB-IPMN patients and 13 non-IPMN subjects (control) who underwent secretin-enhanced MRCP (s-MRCP). Two readers blinded to the final diagnosis reviewed three randomised image sets: (1) pre-secretin HASTE, (2) dynamic s-MRCP and (3) post-secretin HASTE. Logistic regression, generalised linear models and ROC analyses were used to compare pre- and post-secretin results. There was no significant difference in median scores for the pre-secretin [reader 1: 1; reader 2: 2 (range -2 to 2)] and post-secretin HASTE [reader 1: 1; reader 2: 1 (range -2 to 2)] in the SB-IPMN group (P = 0.14), while the scores were lower for s-MRCP [reader 1: 0.5 (range -2 to 2); reader 2: 0 (range -1 to 2); P = 0.016]. There was no significant difference in mean maximum diameter of SB-IPMN on pre- and post-secretin HASTE, and s-MRCP (P > 0.05). Secretin stimulation did not add to MRCP in characterising pancreatic cystic lesions as SB-IPMN. (orig.)

  17. Isolated Pancreatic Uncinate Duct IPMN.

    Science.gov (United States)

    Maker, Ajay V; Maker, Vijay K

    2017-04-01

    The ventral pancreas originally forms as an evagination of the common bile duct at 32 days gestation and its duct, the uncinate duct, eventually rotates with the ventral anlage to join the dorsal pancreas and fuse with the main pancreatic duct. Thus, though often considered a "branch" duct of the pancreas, embryologically, the uncinate duct is the "main" pancreatic duct of the ventral pancreas. This concept is not fully addressed in the current definitions of intraductal papillary mucinous neoplasms of the pancreas (IPMN) where international consensus guidelines consider the main-duct IPMN as high risk for malignancy and most small branch-duct IPMN as low risk for malignancy. Thus, it is important to recognize that isolated uncinate-duct IPMN can occur and, based on its embryologic origin and increased association with high-grade dysplasia and invasive cancer, may be managed conceptually as a main duct type of disease rather than a branch duct until better biomarkers of malignancy are discovered. The images provide an example of this unique disease process.

  18. 乳管镜用于乳腺导管内乳头状瘤的临床诊治研究%Application of Duct Endoscopy in Diagnosis and Therapy of Intraductal Papilloma

    Institute of Scientific and Technical Information of China (English)

    吴涛; 李怡; 何显力; 乔庆; 李金茂; 赵华栋

    2012-01-01

    目的:评价纤维乳管镜对乳管内乳头状瘤类疾病的诊断及治疗作用.方法:选取我科2009年8月-2011年8月经乳管镜诊断为导管内乳头状瘤患者144例,其中血性溢液78例,褐色溢液51例,深黄色溢液15例.回顾性分析其术前诊断及治疗过程.结果:所有病例在乳管镜下可见导管内肿物,并经镜下定位行病变腺叶切除,术后病理132例诊断为乳管内乳头状瘤,7例诊断为原位癌,3例为早期浸润性癌.结论:纤维光导乳管镜可准确诊断乳管内乳头状瘤,并进行定位切除.对此类疾病的诊治有重要应用价值.%Objective:To evaluate the application of duct endoscopy for diagnosis and therapy of intraductal papilloma. Methods; To Retrospectively analyze the data of 144 consecutive cases who had duct endoscopy for nipple discharge. Of 144 cases,the discharge was 78 bloodstained in 78 ,51 brown and 15 yellow in colour. Results: Intraductal goiter were detected by ductoscopy in all patients. Lesions were positioned by ductoscopy and excised with the Lo-bus glandularis. 132 cases were diagnosed as intraductal papilloma by pothology after operation, 7 intraductal carcinoma in situ and 3 breast cancer. Conclusion: Duct endoscopy is an only technique to diagnose intraductal papilloma accurately, and also to position and excise the lesions.

  19. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

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    Arshad Rashid

    2015-01-01

    Full Text Available Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47% patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

  20. Intraductal Papillary Mucinous Neoplasm of the Pancreas: An Update

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    Shu-Yuan Xiao

    2012-01-01

    Full Text Available Intraductal papillary mucinous neoplasm (IPMN is a cystic tumor of the pancreas. The etiology is unknown, but increasing evidence suggests the involvement of several tumorigenesis pathways, including an association with hereditary syndromes. IPMN occurs more commonly in men, with the mean age at diagnosis between 64 and 67 years old. At the time of diagnosis, it may be benign, with or without dysplasia, or frankly malignant with an invasive carcinoma. Tumors arising from the main pancreatic duct are termed main-duct IPMNs, those involving the branch ducts, branch-duct IPMNs. In general, small branch-duct IPMNs are benign, particularly in asymptomatic patients, and can be safely followed. In contrast, main-duct tumors should be surgically resected and examined carefully for an invasive component. In the absence of invasion, patient’s survival is excellent, from 94 to 100%. For patients with an IPMN-associated invasive carcinoma, the prognosis overall is better than those with a de novo pancreatic ductal adenocarcinoma, with a 5-year survival of 40% to 60% in some series. However, no survival advantage can be demonstrated if the invasive component in an IPMN patient is that of the conventional tubular type (versus mucinous carcinoma. Several histomorphologic variants are recognized, although the clinical significance of this “subtyping” is not well defined.

  1. Intraductal mucin-hypersecreting neoplasm of the pancreas : US, CT and ERP findings

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    Lee, Ki Yeol [Korea Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-08-01

    To evaluate US, CT and endoscopic retrograde pancreatography (ERP) findings of intraductal mucin-hypersecreting neoplasm(IMHN). We categorized an IMHN as belonging to a group of disease that can be clinically detected by the pooling of mucus produced by tumors inside the main duct or branch ducts of the pancreas, thus causing dilatation of these ducts. We retrospectively reviewed the US, CT and ERP findings of five patients(hyperplasia, 4;adenocarcinoma, 1). On US and/or CT, diffuse dilatation of the main pancreatic duct was demonstrated in five patients. In two cystic lesions corresponding to cystic dilatation of branch ducts were noted at the pancreatic head(n=1) and neck(n=1). In one patient, multiple cystic lesions were seen on CT along the entire pancreas, but these were not detected on US. In all patients, dilatation of the main duct and /or its branch ducts was seen on ERP. Filling defects resulting from mucin in the main duct or branch ducts were noted in all cases. Lymphadenopathy was not seen on US or CT, but carcinoma peritonei was found in the adenocarcinoma patient at the time of operation. IMHN usually shows smooth, diffuse dilatation of the main duct, and on US or CT, dilated branch ducts are occasionally noted. ERP findings are the most characteristic and conclusive;dilatation of the main duct and/or branch ducts is noted, with a filling defect corresponding to mucin. If overlooked during diagnosis, an IMHN might be interpreted simply as chronic pancreatitis, and so the recognition of this neoplasm is important.

  2. Deep sequencing of cancer-related genes revealed GNAS mutations to be associated with intraductal papillary mucinous neoplasms and its main pancreatic duct dilation.

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    Shinichi Takano

    Full Text Available BACKGROUND: To clarify the genetic mutations associated with intraductal papillary mucinous neoplasms (IPMN and IPMN-related pancreatic tumours, we conducted cancer-related gene profiling analyses using pure pancreatic juice and resected pancreatic tissues. METHODS: Pure pancreatic juice was collected from 152 patients [nine with a normal pancreas, 22 with chronic pancreatitis (CP, 39 with pancreatic ductal adenocarcinoma (PDAC, and 82 with IPMN], and resected tissues from the pancreas were collected from 48 patients (six IPMNs and 42 PDACs. The extracted DNA was amplified by multiplexed polymerase chain reaction (PCR targeting 46 cancer-related genes containing 739 mutational hotspots. The mutations were analysed using a semiconductor-based DNA sequencer. RESULTS: Among the 46 cancer-related genes, KRAS and GNAS mutations were most frequently detected in both PDAC and IPMN cases. In pure pancreatic juice, GNAS mutations were detected in 7.7% of PDAC cases and 41.5% of IPMN cases (p<0.001 vs. others. All PDAC cases with GNAS mutations (n = 3 were accompanied by IPMN. Multivariate analysis revealed that GNAS mutations in IPMN cases were associated with dilated main pancreatic ducts (MPD, p = 0.016, while no statistically independent associations with clinical variables were observed for KRAS mutations. In the resected pancreatic tissues, GNAS mutations were detected in 50% of PDAC cases concomitant with IPMN, 33.3% of PDAC cases derived from IPMN, and 66.7% of IPMN cases, while no GNAS mutations were detected in cases of PDAC without IPMN. CONCLUSIONS: The GNAS mutation was specifically found in the cases with IPMN and it was speculated that some PDACs might be influenced by the concomitant but separately-located IPMN in their pathogenic mechanism. Furthermore, the GNAS mutation was significantly associated with MPD dilatation in IPMN cases, suggesting its role in mucus hypersecretion.

  3. [Intraductal papillary mucinous tumor: diagnostic and therapeutic approach].

    Science.gov (United States)

    Seijo Ríos, Susana; Lariño Noia, José; Iglesias García, Julio; Lozano León, Antonio; Domínguez Muñoz, Juan Enrique

    2008-02-01

    Primary cystic pancreatic neoplasms are rare tumors, with an approximate prevalence of 10% of cystic pancreatic lesions. Most of these lesions correspond to mucinous cystic neoplasm, serous cystoadenoma and intraductal papillary mucinous tumor (IPMT). IPMT is characterized by diffuse dilatation of the main pancreatic duct and/or side branches with inner defects related to mucin or tumor, or mucin extrusion from a patent ampulla. IPMT has a low potential for malignancy, with a low growth rate, a low rate of metastatic spread and postsurgical recurrence. Over the last few years, major advances have been made in the diagnostic and therapeutic management of this tumor.

  4. Sub-branch and mixed-type intraductal papillary mucinous neoplasms of the pancreas: 2 case reports

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    Zafer Ozmen, MD

    2016-03-01

    Full Text Available Intraductal papillary mucinous neoplasia (IPMN is one of the cystic neoplasias of the pancreas. The imaging findings provide that these tumors are differentiated from the other cystic lesions of the pancreas, especially from the chronic pancreatitis, where the treatment protocol is completely different. Therefore, the correct diagnosis and classification of the IPMN ensures that the patient receives the correct approach and the appropriate surgery, if necessary. The purpose of this study is to emphasize the imaging findings of the different types of the IPMN and the changes in the management protocol of the patients according to these radiological findings.

  5. The clinicopathologic features of intraductal papillary mucinous neoplasms of the pancreas

    Institute of Scientific and Technical Information of China (English)

    QIN Xinyu; LIU Fenglin

    2007-01-01

    Since first described in 1982.intraductal papillary mucinous neoplasm(IPMN)has been the preferred term to describe the proliferation of the pancreatic ductal epithelium.It is totally different from pancreatic carcinoma in epidemiology,histology,pathology and prognosis.According to the site of involvement.IPMNS are classified into three caregories,i.e.main duct type,branch duct type,and combined type.Most branch duct IPMNS are benign.whereas the other two types are often malignant.A large branch duct IPMN and marked dilation of the main pancreatic duct indicate the presence of adenoma at least.The additional existence of large mural nodules increases the possibility of malignancy in all types.The prognosis is more favorable after complete resection of benign and non-invasive malignant IPMNs.Malignant IPMNS that become more aggressive after parenchymal invasion necessitate adequate lymph node dissection.On the other hand.asymptomatic branch duct IPMNS without mural nodules can be observed without the need for resection for a considerable period of time.Our review addresses available data,current understanding,controversy,and future directions about IPMNS.

  6. Intraductal papillary mucinous neoplasm of pancreas

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2015-01-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs of the pancreas are neoplasms that are characterized by ductal dilation, intraductal papillary growth, and thick mucus secretion. This relatively recently defined pathology is evolving in terms of its etiopathogenesis, clinical features, diagnosis, management, and treatment guidelines. A PubMed database search was performed. All the relevant abstracts in English language were reviewed and the articles in which cases of IPMN could be identified were further scrutinized. Information of IPMN was derived, and duplication of information in several articles and those with areas of persisting uncertainties were excluded. The recent consensus guidelines were examined. The reported incidence of malignancy varies from 57% to 92% in the main duct-IPMN (MD-IPMN and from 6% to 46% in the branch duct-IPMN (BD-IPMN. The features of high-risk malignant lesions that raise concern include obstructive jaundice in a patient with a cystic lesion in the pancreatic head, the findings on radiological imaging of a mass lesion of >30 mm, enhanced solid component, and the main pancreatic duct (MPD of size ≥10 mm; while duct size 5-9 mm and cyst size <3 mm are considered as "worrisome features." Magnetic resonance imaging (MRI and endoscopic ultrasound (EUS are primary investigations in diagnosing and following up on these patients. The role of pancreatoscopy and the analysis of aspirated cystic fluid for cytology and DNA analysis is still to be established. In general, resection is recommended for most MD-IPMN, mixed variant, and symptomatic BD-IPMN. The 5-year survival of patients after surgical resection for noninvasive IPMN is reported to be at 77-100%, while for those with invasive carcinoma, it is significantly lower at 27-60%. The follow-up of these patients could vary from 6 months to 1 year and would depend on the risk stratification for invasive malignancy and the pathology of the resected specimen. The

  7. TROP2 expressed in the trunk of the ureteric duct regulates branching morphogenesis during kidney development.

    Science.gov (United States)

    Tsukahara, Yuko; Tanaka, Minoru; Miyajima, Atsushi

    2011-01-01

    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2(high)) were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2(high) cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development.

  8. Extrahepatic intraductal ectopic hepatocellularcarcinoma:bileductifllingdefect

    Institute of Scientific and Technical Information of China (English)

    Moritz Schmelzle; Wolfram T. Knoefel; Claus F. Eisenberger; Hanno Matthaei; Nadja Lehwald; Andreas Raffel; Roy Y. Tustas; Natalia Pomjanski; Petra Reinecke; Marcus Schmitt; Jan Schulte am Esch

    2009-01-01

    BACKGROUND: Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial symptom. We report a rare case of an extrahepatic icteric type hepatocellular carcinoma. METHODS: A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma. A postoperative bile leakage was treated by placement of a decompressing stent in the common bile duct. Endoscopic retrograde choledochoscopy showed extended blood clots iflling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile duct. The level of alpha-fetoprotein (AFP) was only slightly elevated but that of CA19-9 was dramatically increased. Cholangiography showed an intraductal iflling defect typical of a cholangiocellular carcinoma. RESULTS: Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile duct. An extrahepatic bile duct resection was performed. Histological examination conifrmed the diagnosis of extrahepatic intraductal growth of hepatocellular carcinoma. CONCLUSION: Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct iflling defect.

  9. Intraductal Papillary Mucinous Neoplasms of the Pancreas (IPMNs: Epidemiology, Diagnosis and Future Aspects

    Directory of Open Access Journals (Sweden)

    Froso Konstantinou

    2013-03-01

    Full Text Available Intraductal papillary mucinous neoplasms of the pancreas (IPMNs are potentially malignant intraductal epithelial neoplasms which consist of columnar, mucin-containing cells and arise from the epithelium of the main pancreatic duct or its branches. IPMNs as well as pancreatic intraepithelial neoplasias (PanINs and mucinous cystic neoplasms represent noninvasive precursors of invasive ductal adenocarcinoma of the pancreas. The diagnosis of IPMNs includes radiographic (CT scanning, MRI, MRCP and endoscopic evaluation (ERCP, EUS, PET, as well as serum tumor markers and molecular markers. The Sendai Consensus Guidelines help guide surgical resection for patients with IPMN. The follow-up of these patients, as well as of those who do not undergo surgical resection, is of great importance, since patients with IPMN appear to be at risk for other malignancies. Herein, the authors summarize the data presented at the 2013 ASCO Gastrointestinal Cancers Symposium regarding incidence and clinicopathological characteristics of IPMN (Abstracts #324, #187 and #179.

  10. 胆管导管内乳头状黏液性肿瘤的影像表现和形态分型%Imaging findings and morphology classification of intraductal papillary mucinous neoplasm of the bile duct

    Institute of Scientific and Technical Information of China (English)

    应世红; 赵艺蕾; 滕晓东; 王照明; 汪启东; 陈峰; 肖文波

    2015-01-01

    Objective To investigate the CT and MRI features and morphology classification of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B).Methods A total of 18 patients with IPMN-B proved by pathology were retrospectively analyzed.Out of 18 patients,16 patients underwent enhanced and non-enhanced CT,13 underwent contrast enhanced MR,and 11 out of 13 underwent both CT and MRI.IPMN-B was classified into 4 types:typical IPMN-B,cystic-forming IPMN-B,non-tumor IPMN-B and invasive IPMN-B,according to imaging findings and gross pathological findings.Results Typical IPMN-B (9 cases):tumors were distributed along the bile ducts,both upstream and downstream bile ducts were obviously dilated.Cystic-forming IPMN-B (5 cases):single or multiple tumors were found in aneurysmal dilatation of bile ducts.Non-tumor 1PMN-B (2 cases):no mass was found in the widely dilated bile ducts with smooth bile duct wall.Invasive IPMN-B (2 cases):tumors protruded into the dilated bile ducts causing jagged wall of bile duct,with accompanied abnormal density or signal intensity outside the bile ducts.Bile duct dilatations were shown in all 18 cases,and tumors were shown in 16 cases.In 2 cases no mass was displayed in widely dilated bile ducts.CT density of the tumor was lower than that of liver parenchyma,and higher than that of the bile and intraductal mucin.Signal intensity of the tumor was higher than that of stones,and lower than that of bile and intraductal mucin at MR T2WI.All tumors showed high intensity on DWI.Tumors showed mild to moderate enhancement after injection of contrast agent,CT density or signal intensity of the tumors were lower than that of the liver parenchyma during all three phases of contrast-enhanced CT or MRI.Conclusion IPMN-B has some specific CT and MR imaging features,which are helpful for the diagnosis and classification of IPMN-B.%目的 探讨胆管导管内乳头状黏液性肿瘤(IPMN-B)的CT、MRI特征及其形态分型.方法 回顾性分

  11. Intraductal papillary mucinous neoplasm of the pancreas. Personal series and synthetic review

    Directory of Open Access Journals (Sweden)

    F. Gallucci

    2012-12-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are rare pancreatic tumors, accounting for less than 1-2% of all neoplasms of the pancreas. The main characteristic of IPMNs is their favorable prognosis, as these pre-malignant or malignant lesions are usually slow-growing tumors and radical surgery is frequently possible. According to the localization of the lesions, three different tumor types have been identified: the main-duct IPMN, the branch-duct IPMN and the mixed-type IPMN (involving both the main pancreatic duct and the side branches. IMPNs do not present pathognomonic signs or symptoms. The obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes. The tumor may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize an IPMN and assess its morphology and size. The choice between non-operative and surgical management depends on the risk of malignancy and on the definitive distinction between benign and malignant IPMNs. Main-duct IPMNs have a high risk of malignant degeneration, especially in older patients. The clinical and radiological features, as well as treatment and outcome, of eight patients with IPMN (five with main-duct, two with branch-duct and one with mixed-type observed by the authors over the last ten years are presented.

  12. 内镜胰管探查在精准胰腺导管内乳头状黏液瘤切除术中的应用%Application of endoscopic pancreatic duct exploration in precise pancreatectomy for intraductal papillary mucinous neoplasms

    Institute of Scientific and Technical Information of China (English)

    尚东; 张庆凯; 张桂信

    2012-01-01

    The diagnostic rate of intraductal papillary mucinous neoplasms (IPMNs) has been increased as the improvement of imaging and endoscopic techniques.All main duct type and mixed variant IPMNs should be resected as long as the patient is a good surgical candidate with reasonable life expectancy.Evaluation of resection margin ( especially circumferential margins) is very important to prevent the recurrence of IPMNs,and intraoperative pancreatoscopy plays an important role in determining the appropriate size for pancreatic resection.In this article,the experience in the treatment of 1 patient with IPMNs by precise pancreatectomy guided by endoscopy-assisted intraoperative pancreatic duct inspection was introducted.

  13. [Intraductal papillary mucinous neoplasm of the pancreas, IPMN].

    Science.gov (United States)

    Sirén, Jukka

    2013-01-01

    With the development and increasing use of imaging techniques, intraductal papillary mucinous neoplasm (IPMN) is being detected with increasing frequency. Two forms of the disease are distinguished, the rare main duct form and the common accessory pancreatic duct form. The former often progresses to malignancy, the latter only seldom. The mixed form of IPMN exhibits features of both forms. In main duct IPMN, mucin production obstructs the pancreatic duct causing its dilatation and often symptoms typical of chronic pancreatitis. Main duct IPMN is always an indication for surgery, whereas monitoring is often sufficient for side duct IPMN.

  14. Intraductal radiofrequency ablation for management of malignant biliary obstruction.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2014-11-01

    Self-expandable metal stents (SEMS) are the current standard of care for the palliative management of malignant biliary strictures. Recently, endoscopic ablative techniques with direct affect to local tumor have been developed to improve SEMS patency. Several reports have demonstrated the technical feasibility and safety of intraductal radiofrequency ablation (RFA), by both endoscopic and percutaneous approaches, in palliation of malignant strictures of the bile duct. Intraductal RFA has also been used in the treatment of occlusion of both covered and uncovered SEMS occlusion from tumor ingrowth or overgrowth. This article provides a comprehensive review of intraductal RFA in the management of malignant biliary obstruction.

  15. F18-FDG-PET/CT for evaluation of intraductal papillary mucinous neoplasms (IPMN): a review of the literature.

    Science.gov (United States)

    Bertagna, Francesco; Treglia, Giorgio; Baiocchi, Gian Luca; Giubbini, Raffaele

    2013-04-01

    Intraductal papillary mucinous neoplasms (IPMN) are intraductal mucin-producing neoplasms with tall columnar, mucin-containing epithelium, with or without papillary projections, involving the main pancreatic duct and/or major side branches. They account for approximately 25 % of all cystic neoplasms and can be subdivided into benign lesions, borderline lesions, and carcinoma. In this clinical scenario accurate preoperative diagnosis can eliminate unnecessary surgery, which is risky and potentially harmful, yet enable effective selection of patients who are candidates for surgery. In this review we try to provide a complete evaluation of the use of F18-FDG-PET/CT for diagnosis of this neoplasm on the basis of published papers. F18-FDG-PET/CT seems to be an useful technique for preoperative work-up of patients with suspected IPMN and is an improvement over conventional imaging in distinguishing benign from malignant lesions, especially for selecting patients for surgical treatment or for long-term follow-up.

  16. Intraductal papillary mucinous neoplasm (IPMN):UPDATE

    OpenAIRE

    木村, 理

    2015-01-01

    At present, IPMN is broadly divided into two main types: main duct and branch duct. However, as discussed below, the definition of mixed-type IPMN is gradually becoming accepted. In main duct IPMN, the main pancreatic duct is very dilated, while in branch duct IPMN, the branches of the pancreatic duct are dilated, resembling a bunch of grapes.IPMN is most frequently diagnosed in the elderly (around 65 years old), and the male to female ratio is 2:1, indicating that the incidence of the diseas...

  17. Status of Intraductal Therapy for Ductal Carcinoma in Situ

    Science.gov (United States)

    Flanagan, Meghan; Love, Susan

    2010-01-01

    The intraductal approach is particularly appealing in the setting of ductal carcinoma in situ (DCIS), a preinvasive breast neoplasm that is thought to be entirely intraductal in its extent. Based on an emerging understanding of the anatomy of the ductal system as well as novel techniques to leverage the access accorded by the intraductal approach, researchers are actively exploring how ductal lavage, ductoscopy, and intraductal infusion of therapeutic agents may enhance breast cancer treatment. Both cytologic and molecular diagnostics continue to improve, and work is ongoing to identify the most effective diagnostic biomarkers for DCIS and cancer, although optimal targeting of the diseased duct remains an important consideration. Ductoscopy holds potential in detection of occult intraductal lesions, and ductoscopically guided lumpectomy could increase the likelihood of a more comprehensive surgical excision. Exciting pilot studies are in progress to determine the safety and feasibility of intraductal chemotherapy infusion. These studies are an important starting point for future investigations of intraductal ablative therapy for DCIS, because as our knowledge and techniques evolve, it is likely that DCIS may be the target most amenable to treatment by intraductal therapy. If such studies are successful, these approaches will allow an important and meaningful transformation in treatment options for women diagnosed with DCIS. PMID:21124756

  18. Intraductal fibroadenoma under the nipple in an 11-year-old female.

    Science.gov (United States)

    Hayano, Fumiko; Yamada, Sohsuke; Nakano, Shigeo; Watanabe, Teruo; Sasaguri, Yasuyuki; Koga, Sunao

    2014-02-10

    Recently, Chung et al. have reported the detailed clinicopathological features of an extremely rare case sharing similar histopathological characteristics with fibroadenomas, phyllodes tumours, intraductal papillomas or ductal adenomas, given the name of intraductal fibroadenomatosis, as an unusual variant of intracanalicular fibroadenoma. Herein we demonstrated a very unusual case of intraductal fibroadenoma of the breast with admixture of components of intracanalicular type fibroadenoma or benign phyllodes tumour and a smaller amount of intraductal papilloma, occupying the one duct and some adjacent ductules, presenting as a well-demarcated nodule.

  19. An analysis of clinico-pathologic features of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    LOU Wenhui; JIN Dayong; WANG Dansong; XU Xuefeng; KUANG Tiantao; QIN Xinyu

    2007-01-01

    The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm(IPMN)of the pancreas were elucidated,and based on this,a retrospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed in our department from 1999 to June 2006.Pathologic rereview of each case was performed,and the clinico-pathologic features were examined.Student's T test and X2 analysis were used to identify factors associated with malignancy.Fifty-one patients were identified.There were 33 males and 18 females.One patient's pancreas was unresectable,two patients underwent a total pancreatectomy,42 patients had a pancreatecoduodenectomy and five patients had distal pancreatectomy.Main-duct type carcinoma was identified in 24 patients;branch-duct type in 15 patients,and mixed type in 12 patients.Invasive carcinoma was present in 35 patients.Weight loss and iaundice occurred more commonly in the invasive group.The average serum CA19-9 level was significantly higher in the invasive group(1542μ vs 94.5μ).The average diameter of the pancreatic duct was also wider in the invasive group (8.7 mm vs 4.3 mm).Significant predictors of malignant IPMNS included weight loss,iaundice,a high level of serum CA19-9.a large pancreatic duct and main-duct type carcinoma.

  20. Ultrasonographic Characteristics of Intraductal Papillary Mucinous Neoplasm of the Pancreas

    Institute of Scientific and Technical Information of China (English)

    Ke Lü; Qing Dai; Zhong-hui Xu; Yi-xiu Zhang; Li Tan; Yan Yuan; Yu-xin Jiang

    2010-01-01

    Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 (33.3%) with adenoma and 8 (66.7%) with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites: main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation be-tween ultrasonographic findings and histopathological results was analyzed.Results There were 9 men and 3 women with a mean age of 60.1±9.6 years (range, 32-73). Of all the 12 patients with IPMN, 9 (75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CAi9-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ul-trasonography. The mean diameters of the lesions were 1.4±0.8 cm (range, 0. 5-2.0) and 6.3±6.0 cm (range, 2.0-20.0) in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in ade-nomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm, respectively. Among the 4 adnomas, 3 (75.0%) cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 (62.5%) cases were classi-fied as main duct type, and 3 (37.5%) as combined type. In 7 of the 8 adenocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts. Some characteristics should be noticed as suggesting the possibility of malig-nancy: clinical

  1. Intraductal Papillary Mucinous Neoplasms of the Pancreas: Clinical Surveillance and Malignant Progression, Multifocality and Implications of a Field-Defect

    Directory of Open Access Journals (Sweden)

    Helen Elaine Remotti

    2012-03-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are a heterogeneous group of mucin producing cystic tumors that involve the main pancreatic duct and/or branch ducts and may be associated with invasive carcinoma. Predicting the risk of malignant transformation of an IPMN lesion can be challenging. The Sendai criteria, based in large part on radiographic imaging features, help guide surgical intervention based on the stratification of cysts into high and low risk lesions for malignancy. Invasive carcinoma may develop in the index IPMN lesion or in a separate site within the pancreas, supporting the concept of a field defect in IPMN tumorigenesis. This stresses the importance of evaluation of the entire pancreas upon diagnosis of IPMN and continued surveillance of the residual pancreas following resection. Herein, the authors summarize the data presented at the 2012 ASCO Gastrointestinal Cancers Symposium regarding prevalence and site of invasive carcinoma detected in patients undergoing surveillance for IPMN (Abstract #152.

  2. Intraductal papillary mucinous neoplasms of the pancreas: Correlation of helical CT features with pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Liu Yu; Lin Xiaozhu; Upadhyaya, Manavendra; Song Qi [Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (China); Chen Kemin, E-mail: keminchen@126.com [Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (China)

    2010-11-15

    Objective: To evaluate the CT features of intraductal papillary mucinous neoplasms of the pancreas (IPMNs), and to compare with pathological findings in order to identify CT features that can be helpful in differentiating benign IPMNs from malignant IPMNs. Materials and methods: The CT findings in 25 patients were reviewed for tumor location, tumor type, dilatation of the main pancreatic duct (MPD), MPD involvement, mural node or solid attenuating component, tumor size in branch duct or mixed duct type, dilatation of common bile duct (CBD) and invasion of surrounding structures. The data was subjected to Chi-Square Tests or Fisher's Exact Test using SPSS13.0 software with p value < 0.05 indicating significant statistical difference. Results: Presence of mural node or solid enhancing component, size of mural node or solid enhancing component {>=}7 mm, dilatation of CBD was more common in malignant IPMNs (p < 0.05). None of tumor location, tumor type, dilatation of MPD, MPD involvement, tumor size, and invasion of surrounding structures was statistically significant in differentiating benign from malignant IPMNs. Conclusions: CT features suggestive of malignant or invasive IPMNs include presence of mural node or solid enhancing component, size of mural node or solid enhancing component {>=}7 mm, and dilatation of CBD.

  3. Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Hiroya Iida; Chiaki Yasui; Tsukasa Aihara; Shinichi Ikuta; Hidenori Yoshie; Naoki Yamanaka

    2011-01-01

    Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer; however, one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver, which may cause postoperative liver failure. To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver, procedures to occlude the portal vein have been conventionally used prior to major hepatectomy. We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe. This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique, and to the best of our knowledge, it was used for the first time in the present case. Despite successful induction of liver volume shift as well as the following procedure, the patient died of subsequent liver failure after developing recurrent tumors. We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

  4. TROP2 Expressed in the Trunk of the Ureteric Duct Regulates Branching Morphogenesis during Kidney Development

    OpenAIRE

    Yuko Tsukahara; Minoru Tanaka; Atsushi Miyajima

    2011-01-01

    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureter...

  5. Diagnosis of intraductal papillary mucinous neoplasm of pancreas by computed tomography%胰腺导管内乳头状黏液瘤的CT诊断

    Institute of Scientific and Technical Information of China (English)

    谢敏; 唐志强

    2012-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a rare tumor which has malignant potential.Differentiating IPMN from other cystic lesions of the pancreas is difficult. Its clinical symptoms are nonspecific,including nausea,vomiting,abdominal pain,fever or jaundice,possibly accompanied by hyperamy lasemia of blood and urine.Some patients have acute pancreatitis or chronic cholecystitis.According to the result of a retrospective study on clinical and imaging data of 11 patients with IPMN,we drew a conclusion that cystic dilatation of the main or branch of pancreatic ducts and mural nodules,and cystic dilatation linked with the main pancreatic ducts are the characteristics of IPMN of the pancreas.Computed tomography diagnosis is feasible to provide important information for the diagnosis of IPMN of the pancreas.

  6. Phyllodes tumor showing intraductal growth.

    Science.gov (United States)

    Makidono, Akari; Tsunoda, Hiroko; Mori, Miki; Yagata, Hiroshi; Onoda, Yui; Kikuchi, Mari; Nozaki, Taiki; Saida, Yukihisa; Nakamura, Seigo; Suzuki, Koyu

    2013-07-01

    Phyllodes tumor of the breast is a rare fibroepithelial lesion and particularly uncommon in adolescent girls. It is thought to arise from the periductal rather than intralobular stroma. Usually, it is seen as a well-defined mass. Phyllodes tumor showing intraductal growth is extremely rare. Here we report a girl who has a phyllodes tumor with intraductal growth.

  7. A pancreatobiliary-type carcinoma in situ at the periphery of a mural nodule developed from a gastric adenoma in an intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Takasu, Naoki; Kimura, Wataru; Moriya, Toshiyuki; Takeshita, Akiko; Murayama, Saijiro; Hirai, Ichiro; Ogata, Shinya

    2010-08-01

    We report a rare case of an intraductal papillary mucinous neoplasm (IPMN) with a pancreatobiliary-type carcinoma in situ (CIS) that originated around a mural nodule formed in a gastric-type adenoma. A 64-year-old man was admitted to our hospital in December 2001 for dilation of the main pancreatic duct, detected on abdominal ultrasonography. Branch-duct-type IPMN (diameter 25 mm) was diagnosed, and because mural nodules were absent, the patient was annually followed up for 5 years. In 2006, computed tomography scans revealed thickening of the tumor wall and the development of a mural nodule (diameter approximately 6 mm); pancreatoduodenectomy with regional lymph-node dissection was performed. Histopathologic examination showed an intraductal papillary mucinous carcinoma arising from an adenoma. Hematoxylin and eosin (H&E) staining revealed that most of the tumor components, including the mural nodule, had adenomatous changes, indicating the tumor to be of the gastric type; however, immunohistochemistry showed positive MUC2 expression. Histologically, the tissues around the nodule, including those showing a cribriform pattern, were diagnosed as CIS. These tissues were classified as the pancreatobiliary-type on the basis of the results of both H&E staining and immunohistochemistry. The patient remained disease-free for 3 years after surgery.

  8. Multiple intraductal papillomas of breast clinically masquerading as malignancy

    Directory of Open Access Journals (Sweden)

    Singh Pallavi

    2010-01-01

    Full Text Available Background: Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. Conclusion: The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.

  9. Efficacy of intraductal cooling to prevent the bile duct injury during radiofrequency ablation associated with hepatic blood occlusion%胆管内冷盐水灌注冷却预防肝血流阻断合并射频消融术中胆管损伤的研究

    Institute of Scientific and Technical Information of China (English)

    李静怡; 苏永辉; 蔡潮农; 郭辉; 林宇静

    2014-01-01

    目的 评价活体兔肝予肝血流阻断合并射频消融(radiofrequency ablation,RFA)术中行胆管内冷盐水灌注冷却(intraductal chilled saline perfusion,ICSP)对胆管的保护作用.方法 新西兰大白兔16只,分为2组:ICSP组于RFA术前行胆总管置管,于RFA术中夹闭入肝血流,并经胆总管置管行ICSP;非ICSP组仅于RFA术中夹闭入肝血流.术中射频针针尖距肝门部主胆管距离约5 mm.RFA术后行超声造影比较两组消融灶大小;术后6周超声观察兔肝内胆管结构,并取肝大体标本,对两组消融灶旁主胆管行病理学检查以比较损伤程度.结果 RFA术后超声造影示两组间消融灶大小差异无统计学意义(P>0.05),RFA术后6周超声检查示非ICSP组胆管扩张较为明显(P<0.05),病理学检查示非ICSP组主胆管损伤程度较严重(P <0.05).结论 行入肝血流阻断合并肝脏RFA时,采用ICSP能有效预防术中胆道热损伤.%Objective To explore the efficacy of intraductal chilled saline perfusion (ICSP) to reduce the thermal bile duct injury during the treatment of radiofrequency ablation (RFA) associating with occlusion of hepatic blood supply in rabbits.Methods 16 healthy New Zealand white rabbits were divided into 2 groups.Rabbits of the ICSP group were placed tubes in the common bile duct after laparotomy,and ICSP was performed during the RFA procedure accompanied with hepatic blood occlusion.While for rabbits of the non-ICSP group,hepatic blood occlusion and RFA were performed without ICSP.RFA electrodes were placed about 5 mm away from the hilus hepatis approximately.Contrast-enhanced ultrasonography (CEUS) was administrated to evaluate the sizes of the ablative zones after the procedure.On post-procedure 6 week,ultrasonography was prerformed to evaluate the changes of the biliary structure,and liver specimens of rabbits wcrc obtained for histopathologic observation of main bile ducts.Results Post-procedure CEUS examination showed that there

  10. Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

    Institute of Scientific and Technical Information of China (English)

    Kun-Chun Chiang; Jun Te Hsu; Huang-Yang Chen; Shyh Chuan Jwo; Tsann-Long Hwang; Yi-Yin Jan; Chun-Nan Yeh

    2009-01-01

    Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas,papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982.It has been most commonly described in 60 to 70 years old males, and represents a relatively "new" but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.

  11. [Intraductal papillary mucinous pancreas tumor].

    Science.gov (United States)

    Maev, I V; Kaziulin, A N; Kucheriavyĭ, Iu A

    2008-01-01

    Data of the literature on the epidemiology, patogenesis, diagnosis, peculiarities of the symptoms and the treatment of the intraduct papillar pancreatic tumor, are analyzed in this review. These tumors are rare, there are up to 1% of the exocrine pancreatic tumors. Intraduct proliferation of the mucin producing cells, that are disposed as papillars is typical of these tumors. There are the symptoms of the acute or chronic pancreatitis, sometimes the diagnosis of this tumor is accidental. The main diagnostic methods are ultrasound (US) and computed tomography (CT). Endoluminal ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are the main methods to reveal the intraduct growth. The surgical treatment is necessary for these patients.

  12. Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

    Institute of Scientific and Technical Information of China (English)

    Tuenchit Khammapirad; Jenjeera Prueksadee; Concepcion Diaz-Arrastia; Shaleen K Botting; Morton Leonard; Louisea Bonoan-Deomampo; Mahmoud A Eltorky

    2011-01-01

    We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Branct at Galvestion. The modalities of breast imagings included mammography and ultrasongraphy. The method used for viral identification was Linear ArrayHPV genotyping test. Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed, obscured margins and clustered punctate microcalcifications on mammograms. Ultrasound showed as intraductal masses with dilated ducts. The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma.HPV DNA types16, 33, 58 and71 were detected after use of Linear ArrayHPV genotyping test.

  13. Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management.

    Science.gov (United States)

    Bassi, Claudio; Sarr, Michael G; Lillemoe, Keith D; Reber, Howard A

    2008-04-01

    Intraductal papillary mucinous neoplasms (IPMNs) show varying degrees of dysplasia throughout the neoplasm that can range from adenoma to invasive carcinoma, with dysplastic changes of borderline neoplasms and carcinoma in situ in between. An understanding of the natural history, and especially the required time to transform into either carcinoma in situ or an invasive adenocarcinoma, is critically important for management policy. This topic serves as the rationale for the present analysis. At the beginning of February 2007, using the key word "IPMN" in PubMed, we initially selected 119 publications using the principal criteria as defined by the WHO classification. We identified 20 appropriate original reports and one consensus paper. Neither randomized control trials (RCT) or systematic reviews of RCTs (level 1 evidence) nor cohort studies or reviews of cohort studies (level 2 evidence) have been published. Only one report fit the criteria for level 3 evidence (case control study). Nineteen papers satisfied criteria for level 4 (cases series) and two for level 5 (expert opinion publication). After additional review and analysis, we considered only six reports to be "cornerstone papers" of merit for the final review. Clues to the natural history of IPMNs can be gained by using several methods to examine the articles: (a) to verify different prognoses between main and side branch duct subtypes; (b) to compare the average age of patients with benign vs. malignant IPMNs; (c) to summarize the findings of nonoperative, observational studies based on follow up by clinical, biochemical, and imaging techniques without operative resection; (d) to determine the prognostic importance of the status of the resection margin; and (e) to follow patients clinically after surgical resection. Although important aspects of the natural history of IPMN are still unknown, the following conclusions can be drawn: (1) Branch-duct IPMNs are less aggressive than main-duct IPMNs. (2

  14. Intraductal membranous fat necrosis in a fibroadenoma of breast: a case report.

    Science.gov (United States)

    Coyne, John D

    2014-09-01

    Membranous fat necrosis is an unusual type of fat necrosis occurring in the breast and normally involves the parenchyma. This report describes an apparently unique intraductal focus in a fibroadenoma following prior needling. Displacement of fatty tissue in the form of membranous fat necrosis within ducts could be added to the list of histological features following core biopsy.

  15. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

    Science.gov (United States)

    Farnell, Michael B

    2008-03-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by papillary growths within the pancreatic ductal system that are at risk for undergoing malignant transformation. Main duct IPMN carries a significant risk of malignancy, and operation is recommended regardless of the presence of symptoms. The risk of malignancy is much lower for side branch IPMN, and current evidence suggests that, in the absence of symptoms, mural nodules, positive cytology, or cyst size less than 3 cm, observation is warranted. When operation is indicated, targeted pancreatic resection with frozen-section analysis of margins is recommended. Pancreatoduodenectomy or distal pacreatectomy is appropriate for the majority. Only in about 10% of patients is the disease so diffuse at presentation that total pancreatectomy is necessary. Survival following pancreatic resection for noninvasive IPMN is excellent. The risk of recurrence following pancreatic resection for invasive IPMN is significant. Surveillance is warranted both for patients subjected to pancreatic resection and for those under observation with side branch IPMN. Much is yet to be learned regarding this neoplasm, and surgical management remains in evolution.

  16. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Víctor; M; Castellano-Megías; Carolina; Ibarrola-de; Andrés; Guadalupe; López-Alonso; Francisco; Colina-Ruizdelgado

    2014-01-01

    Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity(≥ 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediategrade and high-grade dysplasia. Based on histological features and mucin(MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-, MUC2-, MUC5 AC +, MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-, MUC2 +, MUC5 AC +, MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +, MUC 2-, MUC5 AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to completely rule out

  17. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Castellano-Megías, Víctor M; Andrés, Carolina Ibarrola-de; López-Alonso, Guadalupe; Colina-Ruizdelgado, Francisco

    2014-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucin-producing cells arising in the main duct (MD) and/or branch ducts (BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity (≥ 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediate-grade and high-grade dysplasia. Based on histological features and mucin (MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells (MUC1 -, MUC2 -, MUC5AC +, MUC6 +) with the capacity to evolve to intestinal phenotype (intestinal pathway) (MUC1 -, MUC2 +, MUC5AC +, MUC6 - or weak +) or pancreatobiliary /oncocytic phenotypes (pyloropancreatic pathway) (MUC1 +, MUC 2-, MUC5AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises (about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to

  18. IDUS for Biliary and Pancreatic Duct Lesions

    Institute of Scientific and Technical Information of China (English)

    Takao ltoi

    2008-01-01

    @@ In the recent decade, wire-guided intraductal US(IDUS), which can be passed through the working channel of standard duodenoscopes to provide high-frequency ultrasound images, has been developed as a newly diagnostic tool for biliary and pancreatic duct lesions.

  19. Intraductal papilloma with bloody discharge from Montgomery's areolar tubercle examined by ductoscopy from the areola.

    Science.gov (United States)

    Sakai, Takehiko; Makita, Masujiro; Akiyama, Futoshi; Uehara, Kanou; Kasumi, Fujio; Horii, Rie; Sakamoto, Goi

    2006-01-01

    A patient with intraductal papilloma who had abnormal bloody discharge from Montgomery's areolar tubercle underwent mammary ductography, mammary ductoscopy from the tubercle, and microdochectomy.A 43-year-old woman who was being followed-up for left breast cancer noticed bloody discharge from Montgomery's areolar tubercle of the right breast. Because the discharge continued for 2 months, further examinations were conducted. Mammary ductoscopy of Montgomery's areolar tubercle showed a normal internal duct structure. The presence of yellowish superficial lesions suggested intraductal inflammation or superficial hyperplasia of the duct epithelium. Lavage cytology revealed benign papillary lesions. Since the discharge continued and we could not completely exclude malignancy, microdochectomy was performed. Histologically a lactiferous duct was connected to Montgomery's areolar tubercle and an intraductal papilloma was seen in part and considered to have caused the bloody discharge. Bloody discharge from Montgomery's areola tubercles is extremely rare, the present case was our first experience with ductoscopy of Montgomery's areolar tubercle out of 641 cases of mammary ductoscopy performed on patients with bloody nipple discharge from 1998 to 2004. In our case, Montgomery's areolar tubercles were connected to a lactiferous duct. Although there are a few breast carcinomas that cause bloody discharge and eruption of areola, areolar preservation should be performed with the knowledge that disease may also involve the areola through the lactiferous ducts.

  20. Implications of imaging criteria for the management and treatment of intraductal papillary mucinous neoplasms - benign versus malignant findings

    Energy Technology Data Exchange (ETDEWEB)

    Walter, Thula Cannon; Steffen, Ingo G.; Stelter, Lars H.; Hamm, Bernd; Denecke, Timm; Grieser, Christian [Charite - Universitaetsmedizin Berlin, Klinik fuer Radiologie, Campus Virchow-Klinikum, Berlin (Germany); Maurer, Martin H. [Universitaetsklinik Bern, Universitaetsinstitut fuer Radiologe, Inselspital, Bern (Switzerland); Bahra, Marcus; Faber, Wladimir; Klein, Fritz [Charite - Universitaetsmedizin Berlin, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie Campus Virchow-Klinikum, Berlin (Germany); Blaeker, Hendrik [Charite - Universitaetsmedizin Berlin, Institut fuer Pathologie, Campus Charite Mitte, Berlin (Germany)

    2015-05-01

    Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiation of pancreatic intraductal papillary mucinous neoplasm (IPMN) subtypes based on objective imaging criteria. Fifty-eight patients with 60 histologically confirmed IPMNs were included in this retrospective study. Eighty-three imaging studies (CT,n = 42; MRI,n = 41) were analysed by three independent blinded observers (O1-O3), using established imaging criteria to assess likelihood of malignancy (-5, very likely benign; 5, very likely malignant) and histological subtype (i.e., low-grade (LGD), moderate-grade (MGD), high-grade dysplasia (HGD), early invasive carcinoma (IPMC), solid carcinoma (CA) arising from IPMN). Forty-one benign (LGD IPMN,n = 20; MGD IPMN,n = 21) and 19 malignant (HGD IPMN,n = 3; IPMC,n = 6; solid CA,n = 10) IPMNs located in the main duct (n = 6), branch duct (n = 37), or both (n = 17) were evaluated. Overall accuracy of differentiation between benign and malignant IPMNs was 86/92 % (CT/MRI). Exclusion of overtly malignant cases (solid CA) resulted in overall accuracy of 83/90 % (CT/MRI). The presence of mural nodules and ductal lesion size ≥30 mm were significant indicators of malignancy (p = 0.02 and p < 0.001, respectively). Invasive IPMN can be identified with high confidence and sensitivity using CT and MRI. The diagnostic problem that remains is the accurate radiological differentiation of premalignant and non-invasive subtypes. (orig.)

  1. Intraductal papillary mucinous neoplasms of the pancreas: making a disposition using the natural history.

    Science.gov (United States)

    Traverso, L William; Moriya, Toshiyuki; Hashimoto, Yasushi

    2012-04-01

    The process of Intraductal papillary mucinous neoplasms (IPMN) follows the adenoma-to-carcinoma sequence. If it progresses to malignancy about 5 years is required. Even though the process is slow IPMN provides the clinician with the opportunity to avoid malignancy if the patient is at risk. The natural history as observed through Kaplan Meier event curves for occurrence of malignancy show the process to malignancy is much faster (50% within 2 years) if pancreatitis-like symptoms are present or if the main pancreatic duct (MPD) is involved. Almost all decisions to resect (95% in our experience) are based on the presence of symptoms or the MPD location. Cyst size is used infrequently. Every patient with an IPMN should always have a planned follow-up and the frequency depends on the perceived risk of malignancy-immediate imaging if becomes symptomatic to every 2 to 3 years if asymptomatic side branch lesions. The natural history provides modern guidelines for making decisions in patients with a newly discovered IPMN.

  2. Imaging Diagnosis of Intraductal Papillary Mucinous Neoplasm of the Pancreas%胰腺导管内乳头状黏液性肿瘤的影像学分析

    Institute of Scientific and Technical Information of China (English)

    朱磊; 潘保见; 王成刚; 胡国祥; 沈烨; 康琳

    2012-01-01

    目的:探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)的CT和磁共振成像(mag netic resonance imaging,MRI)影像学表现.方法:回顾性分析经手术病理证实的18例胰腺导管内乳头状黏液性肿瘤的影像资料与病理诊断.结果:主胰管型IPMN 3例,表现为主胰管扩张;分支胰管型IPMN 5例,表现为分叶状单发囊性病变或葡萄串样多发囊性病变伴腔内分隔;混合型IPMN 10例,表现为囊性病变伴主胰管扩张.结论:CT和MRI对胰腺IPMN的诊断具有重要价值.%Objective:To investigate the manifestations of CT and magnetic resonance imaging (MRI) in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Methods; The CT and MRI findings of 18 patients with pathologically confirmed IPMN of the pancreas were retrospectively analyzed. Results: Three cases of main-duct type pancreatic IPMN showed dilation of pancreatic main ducts. Five cases of branch-duct type pancreatic IPMN demonstrated solitary or multiple cystic lesions with septa. Ten cases of mixed-type pancreatic IPMN displayed dilation of pancreatic main ducts with cystic lesions. Conclusions: CT and MRI are helpful to the diagnosis of IPMN of the pancreas.

  3. Intraductal biliary and pancreatic endoscopy:An expanding scope of possibility

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2008-01-01

    Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts.For many years,technological challenges have made performing these procedures difficult.The "mother-baby" system and other various miniscopes have been developed,but routine use has been hampered due to complex setup,scope fragility and the time consuming,technically demanding nature of the procedure.Recently,the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options.The clinical utility of intraductal endoscopy is broad.It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue.Therapeutic interventions,such as electrohydraulic lithotripsy (EHL),laser lithotripsy,photodynamic therapy,and argon plasma coagulation (APC),may also be performed as part of intraductal endoscopy.Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP),and as technology progresses,it is likely that its utilization will only increase.In this review of intraductal endoscopy,we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.

  4. Intraductal Oncocytic Papillary Neoplasm Having Clinical Characteristics of Mucinous Cystic Neoplasm and a Benign Histology

    Directory of Open Access Journals (Sweden)

    Takatomi Oku

    2007-03-01

    Full Text Available Context An intraductal oncocytic papillary neoplasm is a rare pancreatic tumor which was first described by Adsay et al. in 1996. It has been defined as a new subgroup of IPMN. Case report We report the case of a 76-year-old woman who presented with nausea. Imaging studies revealed a cystic mass in the body of the pancreas. She underwent a successful distal pancreatectomy and splenectomy, and has subsequently remained well. Microscopically, the cyst was lined by columnar epithelium similar to pancreatic duct epithelium, and the nodular projection consisted of arborizing papillary structures, lined by plump cells with abundant eosinophilic cytoplasm. These eosinophilic cells were immunohistochemically positively stained with anti-mitochondrial antibody. The cellular atypism was mild and the proliferating index was low, compatible with adenoma of an intraductal oncocytic papillary neoplasm. Although no ovarian type stroma was identified, in our case, no communication to main pancreatic duct (located in the pancreatic body and rapid growth by intracystic hemorrhage were clinical characteristics of a mucinous cystic neoplasm, but not IPMN. Conclusion With only 17 cases reported to date, the clinical and pathological details of an intraductal oncocytic papillary neoplasm are still unclear. We herein add one case with different characteristics from those of the past reports. To our knowledge, this is the first case report of an intraductal oncocytic papillary neoplasm with the clinical characteristics of a mucinous cystic neoplasm.

  5. The Study of Fiberoptic Duct Endoscopy (FDS) Iodine Staining for the Diagnosis of Intraductal Proliferative Lesions%纤维乳腺导管镜下碘染色对导管内增生性病变的诊断研究

    Institute of Scientific and Technical Information of China (English)

    冯鑫至; 张凤霞; 林晓燕; 梅红; 赵斌

    2012-01-01

    Objective: To investigate the diagnostic value and clinical significance of fiberoptic duct endoscopy (FDS) iodine staining for the intraductal proliferative lesions. Methods: One hundred and seventy-seven patients with nipple discharge were included in this study. Patients were randomly divided into two groups and detected hy FDS. Ninety-two patients were conducted Lugol's solution staining under FDS (iodine staining group). Eighty-five patients were carried out routine FDS check without iodine staining (control group). All of suspicious lesions were cut and inspected with wire positioning, thus evaluating the clinical significance of Lugol's iodine staining for the diagnosis of intraductal proliferative lesions. Results: PAS staining was positive in mammary gland hyperplasia while PAS positive substance was gradually eliminated until the neglectable level. Mammary gland hyperplasia specimens took on a color of tan brown after supravital staining whereas the color of breast cancer samples after staining became significantly lighter or unstained. The diagnostic agreement rates were 97.82% and 88.24% for ductal intraepithelial neoplasia (DIN) of iodine staining group and control group respectively. The sensitivity was 98.83% and 89.16% in the two groups respectively, and the specificity was 83.33% and 50% respectively. The positive likelihood ratio was 5.93 and 1.78 respectively. The negative likelihood ratio was 0.014 and 0.217 respectively. Youden index was 0.822 and 0.392 respectively. The sensitivity and diagnostic coincidence were significantly higher in iodine staining group than those of control group (P < 0.05). Conclusion:The diagnosis for DIN of iodine staining under FDS is superior to the conventional FDS. This approach deserves to be widely applied.%目的:探讨纤维乳腺导管镜(FDS)下碘染色对乳腺导管内增生性病变的诊断价值及其临床意义.方法:选择177例乳头溢液患者行FDS检查,随机分为2组,碘染色组92

  6. Undifferentiated (Anaplastic Carcinoma of the Pancreas with Osteoclast-Like Giant Cells Showing Various Degree of Pancreas Duct Involvement. A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Vlad Maksymov

    2011-03-01

    Full Text Available Context Undifferentiated (anaplastic carcinoma of the pancreas with osteoclast-like giant cells is exceedingly rare. The prognosis of undifferentiated carcinoma is worse than that of poorly differentiated ductal adenocarcinoma of the pancreas; however, undifferentiated carcinoma with osteoclast-like giant cells might have a more favorable prognosis. Case report We report the case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, showing an intraductal growth pattern with various degree of pancreas duct involvement in the different areas. As a result, we were able to demonstrate the entire spectrum of changes, ranging from the early, minimal intraluminal growth to the partial or complete occlusion of the branches of the main pancreatic duct, and finally invasion and formation of the large necrotic/degenerated cysts. Conclusions Our findings support the epithelial origin of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. In early stages, the affected pancreatic duct epithelium was intermingled with nonepithelial component and had an immunoprofile distinctive from the epithelial lining of the uninvolved (normal pancreatic ducts. Distinctive immunoprofile (CK 5/6, p63 and p53 positive of the epithelial component and p63 and p53 positivity of the nonepithelial component should be explained and further investigated in the similar cases. Our findings support prior assertions that undifferentiated carcinoma of the pancreas with osteoclast-like giant cells may develop from carcinoma in situ within the main pancreatic duct or its branches

  7. Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

    Institute of Scientific and Technical Information of China (English)

    Ling Tan; Ya-E Zhao; Deng-Bin Wang; Qing-Bing Wang; Jing Hu; Ke-Min Chen; Xia-Xing Deng

    2009-01-01

    AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT).METHODS:A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study.Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired.Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system.The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM).Finally,the findings and diagnoses were compared with the pathologic results.RESULTS:The pathological study revealed 12 malignant IPMNs and eight benign IPMNs.The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P<0.05).The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs (P<0.05).Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P<0.05).Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination.Seven of them were identified from CTA and MPVR or CR images.From comparison with the pathological diagnosis,the sensitivity,specificity,and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%,87.5% and 95%,respectively.CONCLUSION:MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors.

  8. [A case of main-duct IPMN with multicentric invasive carcinoma].

    Science.gov (United States)

    Nakadai, Eri; Yoshitomi, Hideyuki; Shimizu, Hiroaki; Otsuka, Masayuki; Kato, Atsushi; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Suzuki, Daisuke; Nakajima, Masayuki; Okamura, Daiki; Sakai, Nozomu; Miyazaki, Masaru

    2014-11-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas often contains multifocal lesions, and total pancreatectomy is sometimes needed for curative resection. We report here our experience with a case of IPMN with multiple invasive carcinoma foci that was successfully treated with total pancreatectomy. A 66-year-old man had jaundice, and a computed tomography (CT) scan revealed a hypovascular mass in the pancreas head in conjunction with calcification and dilation of the entire main pancreatic duct. He was diagnosed with pancreas head cancer and chronic pancreatitis, and a pancreaticoduodenectomy was planned. Intraoperative pathological examination revealed papillary growth of high grade dysplasia in the main and branch duct epithelium and perineural invasion of the atypical glands. After 2 additional resections, we performed a total pancreatectomy. Pathological findings showed that the pancreas head tumor was an invasive carcinoma derived from main-duct IPMN of the pancreas. It was a mucinous carcinoma with calcification. Moreover, we found other multiple, discontinuous invasive foci in the body and tail of the pancreas which were undetectable by preoperative imaging. This case was highly suggestive for preoperative diagnosis for pancreas tumor and developmental pattern of main-duct IPMN.

  9. Progress in research of intraductal papillary mucinous neoplasms%胰腺导管内乳头状黏液瘤的研究进展

    Institute of Scientific and Technical Information of China (English)

    郭子皓; 张杰; 郝建宇

    2011-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) represent a spectrum of neoplasms arising from the main pancreatic duct or branch ducts and producing mucin and can be regarded as a type of precancerous lesions. Thanks to improvements in endoscopy and imaging techniques, IPMNs are being diagnosed with increasing frequency. However, there are currently no highly sensitive and specific preoperative criteria available to distinguish benign IPMNs from malignant ones. What's more, the necessity for EUS and ERCP in the diagnosis of IPMNs is still under debate. Here, we review recent advances in research of IPMNs and summarize potential differ-ences between benign and malignant IPMNs.%胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMNs)为来源于胰腺导管上皮的分化程度多样的胰腺肿瘤,位于主胰管或其分支内,可分泌黏液,为胰腺癌的癌前病变.区分IPMNs的良恶性对制定治疗方案,预估患者预后意义重大.随影像学和内镜的发展,IPMNs发现率逐年提高,但目前仍无敏感度和特异度均高的术前IPMNs良恶性评估标准.超声内镜引导下细针穿刺活检(endoscopic ultrasonography guided fine-needle aspiration,EUS-FNA)及内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)在IPMNs诊断中的应用逐渐增多,但必要性尚存在争议.本文对IPMN研究进展进行综述,并总结文献中良恶性IPMNs可能存在的差异.

  10. Pseudomyxoma peritonei caused by ruptured intraductal papillary mucinous neoplasm of the pancreas: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sun; Lee, Hae Kyung; Lee, Min Hee; Yi, Boem Ha; KIm, Hee Kyung; Jung, Jun Chul; Cha, Jang Gyu [Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2014-05-15

    Pseudomyxoma peritonei (PMP) is an uncommon disease characterized by the seeding of mucin-secreting tumor cells throughout the abdomen and accumulation of mucin in the abdominal and pelvic cavities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are defined as pancreatic neoplasms that accumulate mucin within dilated ducts. Only a few cases of pancreatic IPMNs are associated with extra-pancreatic mucin and lead to PMP. This manuscript describes an unusual case of PMP caused by ruptured pancreatic IPMN.

  11. Intraductal Papillary Mucinous Neoplasm (IPMN) and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports

    OpenAIRE

    Athanasios Petrou; Alexandros Papalambros; Nicholas Brennan; Evangelos Prassas; Thoedora Margariti; Konstadinos Bramis; Theofilos Rozemberg; Efstathios Papalambros

    2011-01-01

    Context Intraductal papillary mucinous neoplasms (IPMNs) are a recently classified pancreatic neoplasm with an increasing incidence. IPMN is often misdiagnosed as chronic pancreatitis because of symptoms of relapsing abdominal pain, pancreatitis, and steatorrhea and imaging findings of a dilated pancreatic duct of cystic lesions that are frequently confused with pseudocysts. Early recognition of IPMN allows for prompt surgical resection before malignant transformation. Case reports We report ...

  12. MRI features of intraductal papilloma of the breast: sheep in wolf's clothing?

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Kathinka D; Roy, Sumit (Dept. of Radiology, Stavanger Univ. Hospital, Stavanger (Norway)), e-mail: kurk@sus.no; Saleh, Andreas (Inst. of Diagnostic Radiology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Diallo-Danebrock, Raihana (Inst. of Pathology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Skaane, Per (Dept. of Radiology, Ullevaal Univ. Hospital, Univ. of Oslo, Oslo (Norway))

    2011-04-15

    Background: Intraductal papillomas often present as small, smooth masses, dilated ducts or microcalcifications at mammography and as smooth, hypoechoic masses at sonography. At magnetic resonance imaging (MRI), intraductal papillomas often present as small smooth masses, however, often with strong enhancement with type 2 or 3 time intensity curves. The result of the MR analysis is therefore not infrequently inconclusive in order to characterize the mass as benign or malignant. Purpose: To characterize the appearance of intraductal papillomas of the breast at MRI, and determine whether the application of diagnostic rules described in literature could contribute to correctly classifying the lesions as benign. Material and Methods: Twenty patients with histologically proven intraductal papillomas were included. Two radiologists independently reviewed the MR images of the breast. The BI-RADS nomenclature was used to describe morphology and contrast-enhancement kinetics. Interobserver agreement in the interpretation of the MR images by the two investigators was performed. Kappa coefficient was calculated as index for the level of agreement. Subsequently, three sets of diagnostic rules, including the Goettinger score described by Fischer and the interpretation flowcharts according to Kinkel and to Tozaki were applied to characterize whether a biopsy should be recommended or not. Results: All papillomas presented as masses on dynamic contrast-enhanced MRI. Only five papillomas showed a round, oval, or lobulated shape combined with smooth margins and continuous rise of the time intensity curve. Using the Goettinger score, biopsy would be recommended in 16 patients. Based on the interpretation flowcharts of Kinkel and of Tozaki, an additional 13 and 10 papillomas, respectively, were correctly classified as benign. Dilated ducts were visible in 10 patients. The interobserver agreement was good or excellent for all included variables. Conclusion: Including systematic analysis

  13. Anatomic relationship between first interlobar duct of superficial parotid and zygomatic branch of facial nerve%腮腺浅部第1叶间导管与面神经颧支的解剖学关系

    Institute of Scientific and Technical Information of China (English)

    罗特坚; 曹妍群; 刘冬强; 易德保

    2013-01-01

    目的探讨腮腺叶间导管转移治疗干眼病的解剖学基础。方法对5具(10侧)成人尸体标本头面部腮腺区进行局部解剖,观察腮腺第1叶间导管与面神经颧支的关系,测量两者的相关数据。结果腮腺浅部第1叶间导管长度为(37.51±1.23) mm,注入腮腺导管处的外径为(0.53±0.15) mm。面神经颧支与腮腺第1叶间导管逆向而行,两者解剖关系密切。结论腮腺叶间导管转位治疗干眼病手术方式可供临床参考。%Objective To provide the anatomic basis of transferring the lobe of parotid gland duct for the treatment of dry eye disease. Methods The first interlobar parotid gland duct and zygomatic branch of facial nerve were dissected and observed on parotid gland region of head and face of 5 (10 sides) of adult head specimens. the measurement data was recorded. Results The length of first interlobar duct of superficial parotid was (37. 51±1. 23) mm, the outside diameter of injected parotid duct was (0. 53±0. 15) mm. There was a close ana-tomical relationship between zygomatic branch of facial nerve and first interlobar duct of parotid gland. Conclusion the parotid interlobar duct transposition operation has the reference value in treatment of dry eye desease.

  14. Intraductal papillary mucinous neoplasms (IPMN of the pancreas: clinico-pathologic results Neoplasia papilar mucinosa intraductal del páncreas: resultados clínico-patológicos

    Directory of Open Access Journals (Sweden)

    J. A. Cienfuegos

    2010-05-01

    Full Text Available Background: intraductal papillary mucinous neoplasm (IPMN shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. Results: 6 patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. Conclusions: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.Introducción: la neoplasia papilar mucinosa intraductal (NPMI del páncreas comprende una serie de lesiones que evolucionan desde lesiones benignas

  15. A case report of hepatocellular carcinoma in common hepatic duct

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chi Sung; Park, In Ae; Choi, Sang Woon; Chung, Jung Kee [YongDeungPo City Hospital, Seoul (Korea, Republic of)

    1989-08-15

    We experienced a rare case of intraductal (common hepatic duct) hepatocellular carcinoma. Review of the literature disclosed 30 cases or less in which common duct involvement was a predominant clinical feature. Well demarcated, ovoid filling defect mass in CHD without parenchymal tumor mass was noted in ultrasound, PTC and CT study. The liver was cirrhotic, but {alpha}-fetoprotein level was normal. Differential diagnosis especially with Klatskin tumor is important and thought to be possible.

  16. Distinguishing benign from malignant main duct intraductal papillary mucinous tumors of the pancreas by CT and MRI%CT和MRI对主胰管型胰腺导管内乳头状黏液瘤良恶性鉴别的价值

    Institute of Scientific and Technical Information of China (English)

    边云; 李骁; 陈炜; 高振坡; 王莉; 陆建平

    2015-01-01

    Objective To evaluate the value of imaging studies in diagnosis and differentiating malignant from benign main duct intraductal papillary mucinous neoplasms (MD-IPMNs).Methods The imaging studies of a total of 31 patients with MD-IPMNs confirmed by pathology after surgery was retrospectively reviewed.All patients underwent either CT,MR or MRCP.Two radiologists observed the lesions' imaging feature,and then the lesions was scored,and the differentiation between malignant and benign was made.The Bland Altman method was used for evaluation of inter-observer agreement.The score of the lesions was compared with the pathological results.Finally,a ROC curve was used to calculate AUC,and to evaluate the role of the maximum diameter of the main pancreatic duct (MPD) obtained by imaging studies in differentiation of malignant and benign IPMNs,and to determine the best cut-off point,and sensitivity,specificity.Results Histological analysis revealed low grade dysplasia in 13 patients,middle grade dysplasia in 6 and high grade dysplasia in 5,and adenocarcinoma in 7.Imaging studies suggested benign lesions in 16,malignant lesions in 10 patients and disdiagnosis in 5.The inter-observer agreement on major imaging features was good.The maximum diameter of the MPD was clinically meaningful for distinguishing malignant from benign lesions,and the AUC was 83.8%,and the best cut-off value was 14.8 mm,the sensitivity and specificity was 66.7% and 100%.The presence of wall nodules could be an imaging feature for distinguishing malignant from benign lesions,but the size of nodules,location of nodules within pancreatic duct,the atrophy of pancreatic parenchyma,and dilated bile duct was not useful for differentiation.Conclusions The imaging studies are sensitive for diagnosis and differentiation between malignant and benign MD-IPMNs,and it is of clinical value for preoperative diagnosis and follow up.%目的 探讨影像学检查对主胰管型胰腺导管内乳头状瘤(MD-IPMN)诊

  17. Intraductal papillary mucinous neoplasm (IPMN) of the gastric-type with focal nodular growth of the arborizing papillae: a case of high-grade transformation of the gastric-type IPMN.

    Science.gov (United States)

    Ban, Shinichi; Naitoh, Yoshihisa; Ogawa, Fumihiro; Shimizu, Yoshihiko; Shimizu, Michio; Yasumoto, Akihiro; Koyama, Isamu

    2006-07-01

    We present a case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, demonstrating a process of high-grade transformation of the gastric-type IPMN. An 83-year-old Japanese woman underwent pylorus-preserving pancreatoduodenectomy for removal of a multicystic mass of the pancreas head, which had been followed up for 7 years. The removed tumor was a low-grade gastric-type IPMN spreading in the branch ducts, focally forming an intraluminal nodular lesion. The nodular lesion was comprised of arborizing papillotubular proliferation of cuboidal to columnar epithelia with high-grade atypia, and was characterized by diffuse MUC1 expression and a gastric mucin phenotype (focal MUC5AC and MUC6 expressions). Therefore, the nodular lesion was consistent with the pancreatobiliary-type IPMN, and the present case suggests that the low-grade gastric-type IPMN may progress to a focal intraductal carcinoma over the years, and the pancreatobiliary-type IPMN may be one of the forms of such high-grade transformation of the gastric-type IPMN. One of the cystic lesions was an oligocystic-type serous cystic neoplasm (serous cystadenoma), which might be an incidental concomitance or have a common basis.

  18. Intraductal location of the sclerosing adenosis of the breast.

    Science.gov (United States)

    Unal, Bulent; Gur, A Serhat; Bhargava, Rohit; Edington, Howard; Ahrendt, Gretchen; Soran, Atilla

    2009-01-01

    Sclerosing adenosis is a benign breast disease with non-specific images on ultrasound or mammogram. It can mimic infiltrating carcinoma when the above mentioned imaging techniques are used. Herein we present a patient with breast cancer who received neoadjuvant chemotherapy and subsequently underwent mastectomy. Ductoscopy was performed to the mastectomised breast specimen as per the ductoscopy research protocol. Ductoscopy revealed several nodular lesions in the duct with no additional demonstrable intraductal pathology. The lesions were reported as sclerosing adenosis by pathologist. As to our knowledge, this is the first case in literature that demonstrates the use of ductoscopy in diagnosing the sclerosing adenosis in the breast tissue. Ductoscopy and development of ductoscopy guided biopsy techniques may be used as an early diagnostic method for the ductal breast lesions (Fig. 2, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

  19. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review.

    Science.gov (United States)

    Tringali, Andrea; Lemmers, Arnaud; Meves, Volker; Terheggen, Grischa; Pohl, Jürgen; Manfredi, Guido; Häfner, Michael; Costamagna, Guido; Devière, Jacques; Neuhaus, Horst; Caillol, Fabrice; Giovannini, Marc; Hassan, Cesare; Dumonceau, Jean-Marc

    2015-08-01

    This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging. The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes. The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation. As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy. Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging. The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures). Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures.

  20. Clinical significance of main pancreatic duct dilation on computed tomography: Single and double duct dilation

    Institute of Scientific and Technical Information of China (English)

    Mark D Edge; Maarouf Hoteit; Amil P Patel; Xiaoping Wang; Deborah A Baumgarten; Qiang Cai

    2007-01-01

    AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful follow up since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.

  1. Biliary tract intraductal papillary mucinous neoplasm: A brief report and review of literature

    Directory of Open Access Journals (Sweden)

    Raveendran Subhash

    2014-01-01

    Full Text Available Biliary Tract Intraductal Papillary Mucinous Neoplasm (BT-IPMN is a very rare entity, gradually emerging into attention as sporadic cases are being reported worldwide. In this brief report we discuss about such an entity from our part of the world, based on a case from our institution. A 47-year-old female was referred to our department with jaundice, intermittent fever with chills and rigor of 6 weeks duration. Initial evaluation revealed obstructive jaundice with distended gall bladder. Imaging with ultrasonogram (USG and magnetic resonance imaging (MRI showed hugely dilated intra and extrahepatic biliary radicles with multiple and diffuse soft tissue lesions filling the common bile duct (CBD extending to the ductal system of left lobe of liver. A side viewing endoscopy demonstrated mucin extruding from a prominent ampulla of Vater. The patient was managed successfully by left hepatectomy with pancreaticoduodenectomy (HPD. Gross pathological examination of the specimen showed marked dilatation of intra and extra hepatic bile ducts with multiple polypoidal lesions and plenty of mucin filling the entire biliary ductal system. Histopathology revealed predominantly intraductal papillary mucinous adenocarcinoma at the hilum extending to left bile duct with diffuse dysplastic changes throughout the biliary tree. Thus the clinical, radiological and pathological features of this lesion clearly fit into the diagnosis of BT-IPMN, which is slowly being established as a definite clinical entity with features much similar to its pancreatic counterpart.

  2. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: A case report

    Institute of Scientific and Technical Information of China (English)

    Xiao-Wu Xu; Rong-Hua Li; Wei Zhou; Jie Wang; Ren-Chao Zhang; Ke Chen; Yi-Ping Mou

    2012-01-01

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas.Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail,which suggested an IPMN,and multiple intrahepatic duct stones in the left lateral lobe.The patient underwent a laparoscopic left lateral hepatolobectomy and spleenpreserving distal pancreatectomy.Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver.The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination.The patient was followed up for 6 mo without signs of recurrence.Although several cases of IPMN of liver without any pancreatic association have been reported,the simultaneous occurrence of IPMNs in the liver and pancreas is very rare.To the best of our knowledge,it is the first reported case treated by laparoscopic resection.

  3. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: a case report.

    Science.gov (United States)

    Xu, Xiao-Wu; Li, Rong-Hua; Zhou, Wei; Wang, Jie; Zhang, Ren-Chao; Chen, Ke; Mou, Yi-Ping

    2012-11-28

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail, which suggested an IPMN, and multiple intrahepatic duct stones in the left lateral lobe. The patient underwent a laparoscopic left lateral hepatolobectomy and spleen-preserving distal pancreatectomy. Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver. The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination. The patient was followed up for 6 mo without signs of recurrence. Although several cases of IPMN of liver without any pancreatic association have been reported, the simultaneous occurrence of IPMNs in the liver and pancreas is very rare. To the best of our knowledge, it is the first reported case treated by laparoscopic resection.

  4. Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

    Directory of Open Access Journals (Sweden)

    Vedita Dhull

    2016-07-01

    Results: 7/25 patients had intraductal papilloma as proven by surgery/ FNA. Mass lesion was identified in all 7 cases on sonography and MRI while it was detected in only 3 cases on mammography. Dilated ducts were demonstated in all 7 cases on sonography, in 6 cases on CE- MRI and 5 cases on mammography respectively. Conclusions: Mammography has limited diagnostic accuracy in patients with unexplained nipple discharge and MRI should be considered the diagnostic technique of choice in this clinical setting, with relevant corresponding area focussed on sonography. [Int J Res Med Sci 2016; 4(7.000: 2878-2882

  5. Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon

    Institute of Scientific and Technical Information of China (English)

    Mansour A Parsi; Tyler Stevens; John J Vargo

    2012-01-01

    AIM:To report our experience using a recently introduced anchoring balloon for diagnostic and therapeutic direct peroral cholangioscopy (DPOC).METHODS:Consecutive patients referred for diagnostic or therapeutic peroral cholangioscopy were evaluated in a prospective cohort study.The patients underwent DPOC using an intraductal anchoring balloon,which was recently introduced to allow consistent access to the biliary tree with an ultraslim upper endoscope.The device was later voluntarily withdrawn from the market by the manufacturer.RESULTS:Fourteen patients underwent DPOC using the anchoring balloon.Biliary access with an ultraslim upper endoscope was accomplished in all 14 patients.In 12 (86%) patients,ductal access required sphincteroplasty with a 10-mm dilating balloon.Intraductal placement of the ultraslim upper endoscope allowed satisfactory visualization of the biliary mucosa to the level of the confluence of the right and left hepatic ducts in 13 of 14 patients (93%).Therapeutic interventions by DPOC were successfully completed in all five attempted cases (intraductal biopsy in one and DPOC guided laser lithotripsy in four).Adverse events occurred in a patient on immunosuppressive therapy who developed an intrahepatic biloma at the site of the anchoring balloon.This required hospitalization and antibiotics.Repeat endoscopic retrograde cholangiopancreatography 8 wk after the index procedure showed resolution of the biloma.CONCLUSION:Use of this anchoring balloon allowed consistent access to the biliary tree for performance of diagnostic and therapeutic DPOC distal to the biliary bifurcation.

  6. 乳腺导管内隆起性病变的临床分析%Clinical analysis of breast intraductal eminence lesions

    Institute of Scientific and Technical Information of China (English)

    牛献勇

    2014-01-01

    目的 总结乳腺导管内隆起性病变在乳腺导管镜检查时的表现类型,指导临床对病变性质的判定.方法 对北京市大兴区妇幼保健院2009年1月至2013年1月的382例乳头溢液患者行乳腺导管镜检查,发现乳腺导管镜内隆起性病变153例(40.9%),均进行手术,分析乳腺导管镜诊断与病理组织学诊断的相互关系.结果 153例隆起性病变的镜下诊断:乳管内乳头状瘤124例,乳管内乳头状瘤病11例,乳腺导管内癌1例,浆细胞性乳腺炎伴局部增生17例.术后病理诊断:乳管内乳头状瘤122例,乳管内乳头状瘤恶变1例,乳管内乳头状瘤病11例;乳腺导管内癌1例,局部导管上皮增生3例(其中不典型增生1例),浆细胞性乳腺炎伴局部导管上皮增生15例.镜下诊断符合率:乳管内乳头状瘤98.4%;乳管内乳头状瘤病100.0%;乳管内癌100.0%;浆细胞性乳腺炎伴局部导管增生88.2%.结论 乳腺导管镜对乳管内隆起胜病变大部分能做出正确诊断,但应警惕癌前病变及恶变的误诊和漏诊.%Objective To observe the types of breast intraductal eminence lesions.Methods Three hundred and eighty-two patients with no breast milk sample of nipple discharge were examined using ductoscopy in Daxing materal and child health hospital in Beijing city from January 2009 to January 2013.Of them 153 patients were found suffering intraductal eminence lesions (40.9% of nipple discharge) and were treated with operation.Results The ductoscopy diagnosis of 153 patients with eminence lesions was as follows:124 cases of intraductal papilloma,11 cases of intraductal papillomatosis,1 case of intraductal carcinoma; 17 cases ofplasma cell mastitis with local hyperplasia.Post operation pathological diagnosis was as follows:122 cases of intraductal papilloma,1 case of intraductal papilloma with malignant transformation,11 cases of intraductal papillomatosis,1 case of intraductal carcinoma,3 cases of local duct

  7. 胰腺导管内乳头状黏液性肿瘤的MSCT和MRCP诊断%Multi-slice CT and MR cholangio-pancreatographic diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    张超; 弓静; 郭帅; 殷长均

    2011-01-01

    Objective To evaluate the multi- slice CT (MSCT) and magnetic resonance cholangio- pancreatography (MRCP) features of intraductal papillary mucinous neoplasm (IPMN) ofthe pancreas.Methods The CT and MRCP of 26 cases of IPMN including adenocarcinoma (6 cases), borderline malignancy (2), and adenoma (1) were reviewed.Results CT and MRI of IPMN in the pancreatic ductal branches (12 cases) showed solitary or multiple cystic lesions with septa or nodules in the ducts.In the 5 patients with main pancreatic duct IPMN, there was dilation of the main pancreatic duct with mural nodule.In 9 patients with mixed type pancreatic IPMN, dilation of the main pancreatic duct and cystic lesions were noted.Conclusion MSCT and MRCP are useful in the diagnosis ofpancreatic IPMN.%目的 探讨胰腺导管内乳头状黏液性肿瘤 (IPMN)的MSCT和MRCP影像学表现.方法 对26例经内镜或手术病理证实的IPMT患者的CT和MRCP表现进行回顾性分析.结果 分支胰管型IPMN12 例,表现为单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;主胰管型 IPMN 5 例,表现为主胰管扩张伴管壁结节样突起;混合型IPMN 9例,表现为主胰管扩张和囊性病变合并存在.9例手术病理结果为腺瘤1例,交界性肿瘤2例,腺癌6例.结论 MSCT和MRCP对发现和诊断胰腺 IPMN具有较高价值.

  8. Data analysis of 36 cases with intraductal papillary mucinous neoplasm of the pancreas for their clinicopathological features, diagnosis, and treatment

    Institute of Scientific and Technical Information of China (English)

    Yuan Chunhui; Xiu Dianrong; Tao Ming; Ma Zhaolai; Jiang Bin; Li Zhifei; Li Lei

    2014-01-01

    Background Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic cystic neoplasm,accounting for 1% of all exocrine pancreatic neoplasms.This study aimed to summarize the clinicopathological and biological behaviors,as well as the experience in diagnosis and treatment of IPMN.Methods Clinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery,Peking University Third Hospital from May 2001 to July 2011.Results The 36 cases of IPMN patients included 27 males and 9 females (M∶F=3∶1).The age of patients ranged from 52 to 78 years,with an average of 67.3 years.Regarding tumor location,20 tumors were located in pancreatic head,3 in pancreatic neck,10 in pancreatic body and tail,and 3 in the whole pancreas.All the 36 cases underwent surgical treatment,with 13 cases of pancreaticoduodenectomy,3 cases of middle pancreatectomy,7 cases of tumor resection plus pancreaticojejunostomy,3 cases of distal pancreatectomy,7 cases of distal pancreatectomy plus spleen resection,and 3 cases of total pancreaticoduodenectomy.Of the 36 patients,9 patients underwent the operations under laparoscopy.The 36 cases included main duct type (14 cases,38.9%),branch duct type (10 cases,27.7%),and mixed duct type (12 cases,33.3%).Pathologically,of the 36 cases,there were 7 IPMN adenomas,11 borderline IPMNs,6 IPMN with carcinomas in situ,and 12 IPMNs with invasive carcinomas.All the 36 cases were followed up.During an average of 42 months follow-up period (26-129 months),no recurrence occurred.Conclusions IPMN,which primarily occurs in male,is a low-grade malignancy which may involve any part of the pancreas,with specific clinicopathological features.IPMN is a different malignancy type from pancreatic ductal carcinoma.Imaging and laboratory examination are helpful for the diagnosis and differential diagnosis.The prediction of invasive IPMN is still difficult.Surgical resection is recommended as the first choice of

  9. Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology in the Diagnosis of Intraductal Papillary Mucinous Neoplasms of the Pancreas. A Study of 8 Cases

    Directory of Open Access Journals (Sweden)

    Charitini Salla

    2007-11-01

    Full Text Available Context Intraductal papillary mucinous neoplasm (IPMN is an increasingly recognized neoplasm of the pancreas, accounting for 5% of pancreatic neoplasms, it is considered difficult to diagnose by fineneedle aspiration (FNA cytology. Objective The aim of this study was to investigate the role of EUS-guided FNA cytology in the diagnosis of IPMN of the pancreas. Patients Eight cases of surgically proven IPMN with pre-operative endoscopic ultrasound-guided (EUS-guided FNA cytology were collected for retrospective analysis. Main outcome measures EUS-FNA cytology was performed with the on-site attendance of a cytopathologist in all cases. EUS/clinical findings, macroscopic/microscopic features of cell blocks and smears, and immunocytochemical stains accompanied by histopathologic diagnosis were recorded and studied. Results EUS revealed hypoechoic masses in the head of pancreas (n=6 and in the body/tail (n=2, measuring from 16.6 to 35.8 mm. In all cases, the hypoechoic mass had a distinctive distribution, involving the main pancreatic duct and/or the associated large branch ducts while intraductal nodules or multiple cysts were detected. Cytological specimens were characterized by a background containing abundant mucin in all cases and rarely by inflammation (neutrophils and histiocytes (n=4. Neoplastic cells were entrapped in a mucinous background either single or loosely cohesive, and forming papillae in 7 cases. Mucinous epithelium was observed in all cases. Single atypical and irregular clusters were found in 3 cases (which were cytologically described as highly suggestive malignant IPMNs, and were histologically confirmed. Two cases were diagnosed as benign IPMN and, in 3 cases, the biological behavior was not easy to determine by cytology alone (histologically diagnosed as borderline. The histological diagnosis confirmed the FNA cytology diagnosis: 3 malignant IPMNs, 2 benign IPMNs and 3 borderline IPMNs. Immunostains were available in 5 out of 8

  10. 高场强 MRCP在胰腺导管内乳头状黏液瘤的应用%The value of high-field-strength MRCP in diagnosing intraductal papillary mucinous neoplasms of pancreas

    Institute of Scientific and Technical Information of China (English)

    钱海珍; 林光武; 嵇鸣

    2014-01-01

    目的:探讨高场强 MRCP 在胰腺导管内乳头状黏液瘤(IPMNs)的应用价值。方法收集15例经手术病理证实的IPMNs 患者,回顾性分析其 MRI 表现,重点探讨 MRCP 的诊断价值。结果15例均为良性,其中主胰管型1例,分支胰管型8例,混合型6例。主胰管型表现为主胰管弥漫扩张,直径约14.5 mm,增强后未见明确强化。分支胰管型表现为分支胰管呈单发囊状或多发簇状扩张,囊灶与主胰管相通,增强后分隔、壁结节呈“轻-中”度强化。混合型表现为主胰管与分支胰管不同程度扩张,强化特点与分支胰管型相同。结论高场强 MRCP 对 IPMNs 的分型诊断、病变范围观测有重要价值,结合动态增强 MRI,有助于良恶性的鉴别。%Objective To explore the value of high-field-strength MRCP in diagnosing of intraductal papillary mucinous neoplasms (IPMNs)of pancreas.Methods Fifteen cases with IPMNs confirmed surgically and pathologically were recruited.The magnetic res-onance imaging (MRI)and MRCP findings were retrospectively analyzed.Results All cases were benign,including main pancreatic duct type (MPD)in 1,branch pancreatic duct type(BPD)in 8,and the combined type in 6.The MPD type showed diffuse dilation of main pancreatic duct which is about 14.5 mm with no enhancement.The BPD type displayed unilocular or multilocular cystic le-sions which showed communication with main pancreatic duct .The combined type demonstrated dilation of main pancreatic duct and branch pancreatic duct.The septa and mural nodule in the BPD type and the combined type were moderately enhanced.Conclusion MRCP is superior with regard to the diagnosis and classification of IPMN type and is helpful to differentiate malignant tumors from benign ones combined with routine contrast-enhanced.

  11. Intraductal papillary mucinous neoplasia (IPMN). Highlights from the "2010 ASCO Gastrointestinal Cancers Symposium". Orlando, FL, USA. January 22-24, 2010.

    Science.gov (United States)

    Bussom, Scott; Saif, Muhammad Wasif

    2010-03-05

    The diagnosis and treatment of intraductal papillary mucinous tumors (IPMN) of the pancreas has evolved over the last decade. IPMN is a disease of the ductal epithelium and represent a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. As with villous adenomas of the colon, not all IPMNs will develop into adenocarcinoma. Definitive management is surgical resection for appropriate candidates, as benign lesions harbor malignant potential. Growing controversy revolves around issues of natural history, management of small-branch-duct lesions, ability to predict malignancy and/or progression, and surveillance strategies. Given these controversies, novel methods are needed to help in detecting and classifying IPMNs' malignant potential so that appropriate treatment can be administered. The authors review abstracts from the 2010 ASCO Gastrointestinal Cancers Symposium held in January 2010, including biomarkers helping to classify IPMNs: IL-8 and IL-1beta from IPMN cyst aspirates (Abstract #133), and Foxp3/CD4/CD25 cells (Abstract #148) in peripheral blood. Future studies will hopefully provide insight into the many unanswered questions.

  12. Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the International Consensus Guidelines for the Management of IPMN.

    Science.gov (United States)

    Campbell, Naomi M; Katz, Seth S; Escalon, Joanna G; Do, Richard K

    2015-03-01

    Intraductal papillary mucinous neoplasms (IPMN) are being diagnosed with increasing frequency, necessitating an algorithm to help stratify patients into low- and high-risk groups, for follow-up versus more invasive evaluation. New evidence concerning their natural history and overall risk of malignancy has emerged since the 2006 International Association of Pancreatology consensus guidelines, prompting an update in 2012, that distinguishes radiologic 'worrisome features' from 'high-risk stigmata'. The aim of this article is to illustrate, with case examples, the variable imaging patterns of IPMN and how their radiologic features, such as cyst size and mural nodules, are interpreted in the context of the new 2012 guidelines. The 2012 and 2006 guidelines will be compared and discussed with reference to additional studies that have since been published. Despite these guidelines, lingering uncertainty remains about the natural history of IPMN, a source of unease to both radiologists and referring clinicians alike, mandating further refinement of clinical and radiologic parameters predictive of malignancy. Emerging data regarding the risk of extrapancreatic malignancy, as well as synchronous or metachronous pancreatic ductal adenocarcinoma remote in location from a branch duct IPMN are also reviewed. With the expanding research and evolving understanding of this clinicopathologic entity across the globe, radiologists will continue to play an important role in the management of patients with IPMN.

  13. Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Natalie E. Cookson

    2015-01-01

    Full Text Available Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT imaging revealed hyperdense material in the common bile duct (CBD compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient’s jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.

  14. Differential diagnosis of microcalcification. Micro-cyst (blunt duct) adenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lanyi, M.; Citoler, P.

    1981-03-01

    One hundred and thirty-five operations were carried out because of a finding of microcalcification in the breast. In 10% of these, the calcification was shown histologically to be within foci of micro-cyst (blunt duct) adenosis. Analysis of the radiographic appearances of the microcalcification revealed a characteristic radiographic pattern. The differential diagnosis of groups of calcification in intraduct carcinomas and in benign lesions is discussed.

  15. Intraductal delivery of adenoviruses targets pancreatic tumors in transgenic Ela-myc mice and orthotopic xenografts.

    Science.gov (United States)

    José, Anabel; Sobrevals, Luciano; Miguel Camacho-Sánchez, Juan; Huch, Meritxell; Andreu, Núria; Ayuso, Eduard; Navarro, Pilar; Alemany, Ramon; Fillat, Cristina

    2013-01-01

    Gene-based anticancer therapies delivered by adenoviruses are limited by the poor viral distribution into the tumor. In the current work we have explored the feasibility of targeting pancreatic tumors through a loco-regional route. We have taken advantage of the ductal network in the pancreas to retrogradelly inject adenoviruses through the common bile duct in two different mouse models of pancreatic carcinogenesis: The transgenic Ela-myc mice that develop mixed neoplasms displaying both acinar-like and duct-like neoplastic cells affecting the whole pancreas; and mice bearing PANC-1 and BxPC-3 orthotopic xenografts that constitute a model of localized human neoplastic tumors. We studied tumor targeting and the anticancer effects of newly thymidine kinase-engineered adenoviruses both in vitro and in vivo, and conducted comparative studies between intraductal or intravenous administration. Our data indicate that the intraductal delivery of adenovirus efficiently targets pancreatic tumors in the two mouse models. The in vivo application of AduPARTKT plus ganciclovir (GCV) treatment induced tumor regression in Ela-myc mice. Moreover, the intraductal injection of ICOVIR15-TKT oncolytic adenoviruses significantly improved mean survival of mice bearing PANC-1 and BxPC-3 pancreatic xenografts from 30 to 52 days and from 20 to 68 days respectively (p less than 0.0001) when combined with GCV. Of notice, both AduPARTKT and ICOVIR15-TKT antitumoral responses were stronger by ductal viral application than intravenously, in line with the 38-fold increase in pancreas transduction observed upon ductal administration. In summary our data show that cytotoxic adenoviruses retrogradelly injected to the pancreas can be a feasible approach to treat localized pancreatic tumors.

  16. 利用Excel设计多分支风道均匀吸风系统%The Design of Uniform Air Suction System of Multiple-branch Duct System by Excel

    Institute of Scientific and Technical Information of China (English)

    伍德满

    2011-01-01

    The paper analyses the principle of static regain method,lists relevant formulas of direct computational method of full pressure loss,analyses the methods and process of designing Excel computation sheets based on the said formulas,solves the computation problem of designing uniform air suction system of multi-branch duct system for carding machines,increase the operating efficiency,and improve the hydraulic balance and economic efficiency of the duct system.%分析了静压复得计算法的原理,列出了全压损失直接计算法相关公式。分析了利用这些有关公式设计出Excel计算表格的方法和过程,解决了梳棉机多分支风道均匀吸风系统设计计算难题,提高设计工作效率,改善了风道系统的平衡性和经济性。

  17. Stopping duct quacks: Longevity of residential duct sealants

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.; Dickerhoff, Darryl J.

    2000-08-01

    Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that these seals tend to fail over time periods ranging from days to years. We have used several test methods over the last few years to evaluate the longevity of duct sealants when subjected to temperatures and pressures representative of those found in the field. Traditional cloth duct tapes have been found to significantly under-perform other sealants and have been banned from receiving duct tightness credits in California's energy code (California Energy Commission 1998). Our accelerated testing apparatus has been redesigned since its first usage for improved performance. The methodology is currently under consideration by the American Society for Testing and Materials (ASTM) as a potential new test method. This report will summarize the set of measurements to date, review the status of the test apparatus and test method, and summarize the applications of these results to codes and standards.

  18. High resolution 3D MRI of mouse mammary glands with intra-ductal injection of contrast media.

    Science.gov (United States)

    Markiewicz, Erica; Fan, Xiaobing; Mustafi, Devkumar; Zamora, Marta; Roman, Brian B; Jansen, Sanaz A; Macleod, Kay; Conzen, Suzanne D; Karczmar, Gregory S

    2015-01-01

    The purpose of this study was to use high resolution three-dimensional (3D) magnetic resonance imaging (MRI) to study mouse mammary gland ductal architecture based on intra-ductal injection of contrast agents. Female FVB/N mice age 12-20 weeks (n=12), were used in this study. A 34G, 45° tip Hamilton needle with a 25μL Hamilton syringe was inserted into the tip of the nipple. Approximately 20-25μL of a Gadodiamide/Trypan blue/saline solution was injected slowly over one minute into the nipple and duct. To prevent washout of contrast media from ducts due to perfusion, and maximize the conspicuity of ducts on MRI, mice were sacrificed one minute after injection. High resolution 3D T1-weighted images were acquired on a 9.4T Bruker scanner after sacrifice to eliminate motion artifacts and reduce contrast media leakage from ducts. Trypan blue staining was well distributed throughout the ductal tree. MRI showed the mammary gland ductal structure clearly. In spoiled gradient echo T1-weighted images, the signal-to-noise ratio of regions identified as enhancing mammary ducts following contrast injection was significantly higher than that of muscle (pcontrast media (pcontrast agents to measure metabolism or target receptors in normal ducts and ducts with in situ cancers.

  19. [Intraductal papillary mucinous neoplasm and recurrent pancreatitis].

    Science.gov (United States)

    Gálvez, Eduardo; Gálvez, Gustavo; Barboza, Aurelio; Barboza, Eduardo; Combe, Juan Manuel; Combe, Mario R; Combe, Juan; Arias Stella C, Javier; Arias Stella, Javier

    2013-01-01

    Ohashi described for the first time the IPMN on 1982 as a pancreatic neoplasia with mucine cells forming papillae and producing dilatation of the main pancreatic duct or its branches. The IPMN represent the 1% of the pancreatic tumors and 5% of the cystic neoplasias. It is potentially malignant in a period of five years being more frequent in males between 60-70 and clinically these patients' presents as acute, recurrent or chronic pancreatitis, with an incidence of malignancy from 25% to 70%. CT scan and cholangio MRI allows the diagnosis, the variety, localization and possibility of determine malignancy. The treatment is the Whipple resection. We are reporting the case of an obese middle age male, being observed along the last 10 years because of recurrent pancreatitis with a cystic lesion of the head of the pancreas. The CT scan, endoscopic-ultrasound and the analysis of the liquid content suggested a mucinous lesion, reason why the patient underwent a pancreatic-duodenal resection. The histology study confirms the diagnosis of IPMN.

  20. A case of focal autoimmune pancreatitis (AIP) mimicking an intraductal papillary mucinous neoplasm (IPMN).

    Science.gov (United States)

    Nakaji, So; Hirata, Nobuto; Fujii, Hiroyuki; Iwaki, Kosuke; Shiratori, Toshiyasu; Kobayashi, Masayoshi; Wakasugi, Satoshi; Ishii, Eiji; Takeyama, Hiroyuki; Hoshi, Kazuei

    2013-08-01

    The present case involved a 76-year-old man with a cystic mass in the head of his pancreas. The cystic lesion, which measured 17.7 × 9.8 mm, was first detected by ultrasonography (US) at the age of 72 years. Follow-up endoscopic ultrasonography (EUS) performed at 4 years after the lesion had first been detected revealed a mural nodule measuring 14.0 × 8.4 mm in the cyst. Endoscopic retrograde pancreatography (ERP) imaging revealed that the main pancreatic duct was in communication with the cyst and that there was no irregular narrowing of the main pancreatic duct. On the basis of these results, the patient was diagnosed with an intraductal papillary mucinous neoplasm (IPMN), and stomach-preserving pancreaticoduodenectomy was performed. A histopathological examination revealed that the interior of the cystic part of the lesion was lined by a pancreatic ductal epithelium. A pathological examination of the nodular lesion detected storiform fibrosis, severe lymphoplasmacytic infiltration, and hyperplasia in the pancreatic duct epithelium together with a small amount of mucus. On immunohistological staining, the infiltrating lymphoplasmacytes were found to be positive for IgG4. Accordingly, the patient was diagnosed with focal autoimmune pancreatitis (AIP). In conclusion, we reported a case of focal AIP mimicking IPMN. This case showed neither enlargement of the pancreas nor irregular narrowing of the main pancreatic duct.

  1. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem.

    Science.gov (United States)

    Berger, Zoltán; De La Fuente, Hernán; Meneses, Manuel; Matamala, Fernanda; Sepúlveda, Makarena; Rojas, Claudia

    2017-01-01

    We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  2. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem

    Directory of Open Access Journals (Sweden)

    Zoltán Berger

    2017-01-01

    Full Text Available We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  3. Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Procacci, C.; Carbognin, G.; Biasiutti, C.; Guarise, A.; Ghirardi, C.; Schenal, G. [Dept. of Radiology, University Hospital ' ' GB Rossi' ' , Verona (Italy)

    2001-10-01

    The reports of intraductal papillary mucinous tumors (IPMT) of the pancreas are increasingly more frequent in the literature. The diagnosis by means of cross-sectional imaging of these tumors is not easy, especially in the early stages, when they can mimic an inflammatory disease of the pancreas. Prompt identification of the disease is nevertheless extremely important, especially in the case of tumors originating from the collateral branches, since its recognition can modify the management of the patient, in some cases obviating recourse to surgery. (orig.)

  4. Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Schizas Dimitrios

    2010-01-01

    Full Text Available Abstract A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall.

  5. [Experimental microendoscopy of the milk duct system (ductoscopy)].

    Science.gov (United States)

    Rimbach, S; Wallwiener, D; Fein, A; von Fournier, D; Bastert, G

    1995-01-01

    According to recent reports, the microendoscopic lactiferous duct investigation (ductoscopy) could improve diagnosis in case of pathological nipple discharge. However, the description of a reproducible and reliable methodology, suitable for thorough evaluation of the lactiferous duct is missing so far. Therefore, the pressure study developed a procedure, that may serve now as an experimental basis for further clinical evaluation. Access to the mamillary duct is primarily gained using atraumatic flexible teflon catheters. Corresponding to the diameter of the duct, either a semirigid 0.87 mm fiberendoscope can be successfully introduced via a 1.2 mm catheter, or a flexible 0.50 mm fiberendoscope via a 1.0 mm catheter. A controlled distension using few milliliters of ringer's lactate is the prerequisite for clear visualization of the intraductal space and protection against iatrogenic wall lesions. Metal microtocars are available as prototypes. They carry a somewhat higher risk to perforate, but are advantageous when pointing at an intraductal structure and using the microtrocar as a mark for microdochectomy.

  6. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  7. Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Naoto Egawa; Hitoshi Nakajima; Kouji Tsuruta; Atsutake Okamoto

    2005-01-01

    AIM: As intraductal papillary mucinous neoplasm (IPMN)has a favorable prognosis, associated malignancies have potential significance in these patients. We examined the incidence and characteristics of pre-existing, coexisting and subsequent malignancies in patients with IPMN. METHODS: Seventy-nine cases of IPMN were diagnosed by detection of mucous in the pancreatic duct during endoscopic retrograde pancreatography. Histological diagnosis was confirmed in 30 cases (adenoma (n = 19)and adenocarcinoma (n = 11). Other primary malignancies associated with IPMN, occurring in the prediagnostic or postdiagnostic period, were investigated. Postdiagnostic follow-up period was 3.3±0.5 years (range, 0.2-20 years).RESULTS: Other 40 malignancies occurred in 28 patients (35%). They were found before (n = 15), at (n = 19) and after (n = 6) the diagnosis of IPMT. Major associated malignancies were gastric cancer (n = 12), colonic cancer (n = 7), esophageal cancer (n = 4), pulmonary cancer (n = 4), and independent pancreatic cancer (n = 3).Pancreatic cancer was synchronous with IPMN in two patients and metachronous in one (3 years after diagnosis of IPMN). Thirty-one lesions were treated surgically or endoscopically. Fourteen patients died of associated cancers. Development of other malignancies was related to age (71.9±8.2 vs66.8±9.3, P<0.05), but not to gender or site of the tumor.CONCLUSION: IPMN is associated with a high incidence of other malignancies, particularly gastric and colonic cancers. Common genetic mechanisms between IPMN and other associated malignancies might be present. Clinicians should pay attention to the possibility of associated malignancies in preoperative screening and follow-up of patients with IPMN.

  8. A nomogram based on mammary ductoscopic indicators for evaluating the risk of breast cancer in intraductal neoplasms with nipple discharge.

    Science.gov (United States)

    Lian, Zhen-Qiang; Wang, Qi; Zhang, An-Qin; Zhang, Jiang-Yu; Han, Xiao-Rong; Yu, Hai-Yun; Xie, Si-Mei

    2015-04-01

    Mammary ductoscopy (MD) is commonly used to detect intraductal lesions associated with nipple discharge. This study investigated the relationships between ductoscopic image-based indicators and breast cancer risk, and developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge. A total of 879 consecutive inpatients (916 breasts) with nipple discharge who underwent selective duct excision for intraductal neoplasms detected by MD from June 2008 to April 2014 were analyzed retrospectively. A nomogram was developed using a multivariate logistic regression model based on data from a training set (687 cases) and validated in an independent validation set (229 cases). A Youden-derived cut-off value was assigned to the nomogram for the diagnosis of breast cancer. Color of discharge, location, appearance, and surface of neoplasm, and morphology of ductal wall were independent predictors for breast cancer in multivariate logistic regression analysis. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.36. Area under the curve values of 0.812 (95 % confidence interval (CI) 0.763-0.860) and 0.738 (95 % CI 0.635-0.841) was obtained in the training and validation sets, respectively. The accuracies of the nomogram for breast cancer diagnosis were 71.2 % in the training set and 75.5 % in the validation set. We developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge based on MD image findings. This model may aid individual risk assessment and guide treatment in clinical practice.

  9. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS),or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis,and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures,seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

  10. MR Imaging Features of Pancreas Intraductal Papillary Mucinous Neoplasm%胰腺导管内乳头状黏液性肿瘤的MRI表现

    Institute of Scientific and Technical Information of China (English)

    舒健; 赵建农; 郭大静; 谢微波; 陈维娟; 吴伟

    2009-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MRI特征.资料与方法 6例经病理或逆行性胆胰管造影(EBCP)证实的胰腺IPMN患者.MR扫描包括T_1WI、T_2WI、MRCP和动态增强.分析胰腺IPMN的MRI征象,并与临床及病理对照.结果 主胰管型、分支胰管型及混合型各2例,病灶主要位于胰头颈部,最大径(27.4±14.5)mm,呈分叶状,边缘清晰,T_1WI上呈低信号,T_2WI上呈高信号,增强后无强化或线状强化.2例病灶远端胰腺萎缩.2例分支胰管型主胰管最大径2.9 mm和2.2 mm,其余4例最大径(5.9 ±1.6)mm.结论 MRI对发现和正确诊断胰腺IPMN有较高价值.%Objective To assess the MR imaging features of pancreas intraductal papillary mucinous neoplasm (IPMN). Materials and Methods Six patients with IPMN proven by histopathology or ERCP underwent MR examination. The MR sequences included fast spoiled gradient echo (FSPGR) T_1 weighted (T_1W), fast recovery fast spin echo (FRFSE) T_2 weighted (T_2W),MRCP, and dynamic contrast-enhanced MR imaging. The M R imaging features of pancreatic IPMN were noted. Results IPMN in 6 patients showed as a cluster of cyst-like structures with a distinct rim in the head and neck of pancreas, The lesions were divided into main duct type in 2, branch duct type in 2, and combined type in 2.The mean and standard deviation of the maximum diameter of all IPMN was (27. 4± 14.5) nun. All IPMN were hypointensity on T_1 weighted images and hyperintensity on T_2 weighted images, with a thread like enhancement or no enhancement. The atrophy of pancreatic parenchyma was showed in 2 patients. The maximum diameter of main pancreatic duct in 2 patients of branch duct type was 2.9 mm and 2.2 mm,respectively,and the maximum diameter of main pancreatic duct in other 4 patients was (5.9 ± 1.6) mm. Conclusion MR imaging is very useful in the diagnosis of pancreas I PMN.

  11. Aberrant bile ducts, 'remnant surface bile ducts,' and peribiliary glands: descriptive anatomy, historical nomenclature, and surgical implications.

    Science.gov (United States)

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Heffron, Thomas G; Skandalakis, John E

    2011-05-01

    The term "aberrant bile ducts" has been used to designate three heterogeneous groups of biliary structures: (1) bile ducts degenerating or disappearing (unknown etiology, diverse locations); (2) curious biliary structures in the transverse fissure; and (3) aberrant right bile ducts draining directly into the common hepatic duct. We report our observations on these three groups. Twenty-nine fresh human livers of stillborns and adults were injected differentially with colored latex and dissected. Adult livers showed portal venous and hepatic arterial branches, and bile ducts not associated with parenchyma, subjacent to and firmly adherent with the liver capsule: elements of ramifications of normal sheaths were present on the liver's surface. These ramifications, having lost parenchyma associated with them, then sequentially lost their portal branches, bile ducts and arterial branches. This process affected the ramifications of the sheaths in the left triangular ligament, adjacent to the inferior vena cava, in the gallbladder bed and anywhere else on the liver's surface and resulted in the presence of bile ducts accompanied by portal venous and/or hepatic arterial branches and not associated with parenchyma for a period of time. This first group represented normal bile ducts that do not meet the criteria of aberration and could be appropriately designated "remnant surface bile ducts." Such changes were not found in the transverse fissures and review of the literature revealed that the curious biliary structures are the microscopic peribiliary glands. The third group met the criteria of aberration and the anatomy of a representative duct is described.

  12. Fiberoptic ductoscopy-guided intraductal biopsy for the diagnosis of intraductal lesions concomitant with pathologic nipple discharge%乳管镜直视下病灶活检在伴乳头溢液乳管疾病诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    凌泓; 柳光宇; 陆劲松; 徐晓莉; 徐维萍; 沈坤炜; 沈镇宙; 邵志敏

    2008-01-01

    目的 研究乳管镜直视下乳管内病灶活检的可行性和意义.方法 2006年5月至2007年4月,共51例有乳管内病灶的患者在复旦大学肿瘤医院接受了53次乳管镜直视下乳管内病灶活检术和随后的开放手术.结果 活检发现29例管内乳头状瘤、15例导管上皮增生、2例上皮重度不典型增生和2例恶性肿瘤.另有5例活检失败.开放手术后病理为12例单发管内乳头状瘤、12例多发性管内乳头状瘤、25例乳腺上皮增生、3例导管内癌、1例浸润性导管癌.结论 乳管镜直视下乳管内病灶活检不仅是微创、安全、方便可行、成功率高的诊断方法,还可部分替代现有开放手术.活检如发现上皮不典型增生或恶性肿瘤,则需进一步手术.%Objective To investigate the clinical significance of fiberoptic ductoscopy-guided intraductal biopsy in diagnosing nipple discharge.Methods From May 2006 to April 2007,screening fiberoptic ductoscopy was performed for intraductal papillary lesions in 53 ducts among 51 patients.Fiberoptic ductoscopy-guided intraductal biopsy was carried out followed by open microdochectomy. Results Except for a failure in 5 ducts,biopsy found papilloma in 29 cases,ductal hyperplasia in 15 cases,severe ductal hyperplasia in 2 and carcinoma in 2.Microdochectomy revealed 43 benign diseases (12 solitary intraductal papillomas,12 multiple intraductal papillomas,and 25 ductal hyperplasia)and 4 malignancies (3 ductal carcinoma in situ,1 invasive ductal carcinoma).Surgeries performed for the 5 ducts failing a biopsy attempt revealed papilloma in one and adenosis in 4.Compared with conventional microdochectomy,fiberoptic ductoscopy-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma(40.7% vs. 92.6%,P<0.05).It might also underestimate multiple intraductal papilloma and breast cancer. Conclusion Fiberoptic ductoscopy-guided intraductal biopsy is microinvasive,safe,convenient with a

  13. Concurrent fibroadenoma and intraductal papilloma - A recurring complex lesion in a premenarcheal girl.

    Science.gov (United States)

    Alessandrini, Lara; Gobbi, Dalia; Zanon, Giovanni Franco; Dall'Igna, Patrizia; Cecchetto, Giovanni; Alaggio, Rita

    2013-02-15

    Breast diseases are rare in childhood and adolescence, most lesions being fibroadenomas and papillomas. We report the case of an 11-year old girl with a complex breast lesion with hybrid features of fibroadenoma and intraductal papilloma with an early recurrence. Microscopically, the lesion was composed of dilated ducts showing intraluminal papillary projections with small to broad fibrovascular stalks. The typical leaf-like appearance of fibroadenoma was determined by the presence at the periphery of ducts compressed and distorted by the prominent stromal component. Despite its florid epithelial hyperplasia and mild cytological atypia (more evident in the relapse), immunohistochemical staining for p63 and smooth muscle actin highlighted a continuum outer myoepithelial layer, confirming the non-invasive appearance of the lesion. Two pathogenetic links have been hypothesized: one is based on the morphological continuum between these two entities, which may represent different evolutive stages in the same lesion; the other is based on epithelial/mesenchymal interactions. The possible malignant transformation of such complex lesion is also discussed, along with its differential diagnoses. The relevance of this case lies in its rarity, as well as in the therapeutic strategies related to its biological potential and to the necessity of a conservative treatment, due to the young age of the patient.

  14. Pancreatectomy for Intraductal Papillary Mucinous Neoplasm of the Pancreas: Could Pancreaticogastrostomy Be the Anastomosis of Choice?

    Directory of Open Access Journals (Sweden)

    Stavros Gourgiotis

    2010-07-01

    Full Text Available Dear Sir, Surgical resection is the treatment of choice for intraductal papillary mucinous neoplasms (IPMNs of the pancreas. The aim of resection in the management of IPMNs is to remove all the adenomatous or malignant mucosa and to minimize the chance of recurrence in the pancreatic remnant. However, even after partial pancreatectomy with negative surgical margins for non-invasive IPMN, the tumour can recur as disseminated disease or as locally invasive or noninvasive disease in the pancreatic remnant [1]. For non-invasive IPMNs, the overall disease recurrence rate reported is 1.3 to 9.3% while, for invasive IPMNs, the overall disease recurrence rate is 12 to 68% [2]. The overall recurrence rate for IPMNs varies from 7% to 43% [2]. Our question relates to the issue of the high risk of recurrence in both non-invasive and invasive IPMNs after partial pancreatectomy. Has pancreaticogastric anastomosis been utilized in patients with IPMNs and is it something we should all think about in patients who undergo resections of the head and require surveillance with subsequent endoscopic retrograde cholangiopancreatography (ERCP? Would pancreaticogastrostomy be something we should all be doing in order to follow-up patients having a pancreatic remnant with endoscopic surveillance? Several techniques of anastomosing the pancreatic remnant to the stomach have been proposed: invagination of the stump of the pancreas, implantation of the pancreatic duct, and anastomosis between the pancreatic duct and the gastric mucosa.

  15. Effect of portal hypertension and duct ligature on pancreatic fluid pressures in cats

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Heyeraas, K J

    1990-01-01

    In two groups of cats recordings were performed, during laparotomy, of pancreatic tissue fluid pressure measured by a needle technique, interstitial fluid pressure measured by micropipette technique, pancreatic intraductal pressure, and portal vein pressure. In one group of cats the pressures were...... measured before and after acutely induced portal hypertension; in the other group of cats the pressures were measured after an overnight ligature of the pancreatic main duct. At rest the needle pressure was equal to duct pressure but significantly lower than interstitial fluid pressure and portal pressure...

  16. Fiberoptic ductoscopy-guided intraductal biopsy improve the diagnosis of nipple discharge.

    Science.gov (United States)

    Ling, Hong; Liu, Guang-yu; Lu, Jin-song; Love, Susan; Zhang, Jia-xin; Xu, Xiao-li; Xu, Wei-ping; Shen, Kun-wei; Shen, Zhen-zhou; Shao, Zhi-min

    2009-01-01

    Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge. We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed. Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p < 0.05). It should be a routine procedure after intraductal lesion found by screening FDS. Since it would underestimate all multiple intraductal papilloma and some (50%) cancer, microdochectomy is inevitable if biopsies show atypical ductal hyperplasia.

  17. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  18. Magnetic Resonance Cholangiopancreatography with Secretin Stimulation in the Diagnosis of Intraductal Papillary Mucinous Neoplasm: A Paradigmatic Case Report

    Directory of Open Access Journals (Sweden)

    Elsa Iannicelli

    2014-01-01

    Full Text Available Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment.

  19. 胰腺导管内乳头状黏液性肿瘤的CT表现与病理对照分析%CT and pathological manifestations of intraductal papillary mucinous neoplasm of pancreas: a comparative study

    Institute of Scientific and Technical Information of China (English)

    张静; 黄宗良; 张炜; 王培军; 袁小东; 邵成伟; 赵小虎; 徐卫国; 董宁欣; 王国良; 邵志宏

    2008-01-01

    目的 分析胰腺导管内乳头状黏液性肿瘤(IPMN)的CT表现特征并与病理结果进行对照,探讨CT在胰腺IPMN诊断和鉴别诊断的价值.方法 分析39例临床资料齐全、手术病理证实为IPMN病例资料,将本组病例的CT表现分为3型:(1)单纯主胰管扩张型;(2)主胰管扩张伴胰腺囊性灶型;(3)单纯胰腺囊性灶型.分析CT分型与Takada病理分型(主胰管型、分支型、混合型)的对应关系;按病理结果将IPMN分为良性组和恶性/交界组,对病变的CT特征(有无壁结节、有无分隔、病灶大小、主胰管及胆总管扩张程度)进行统计学分析.结果 单纯主胰管扩张型对应于主胰管型,主胰管扩张伴胰腺囊性灶型主要对应于分支型和混合型,单纯囊性灶型对应于分支型(P<0.001).病灶内无壁结节时病理为良性的概率为92%,病灶内有壁结节时病理为良性的概率为42%,两者差异有统计学意义(P=0.003),病灶内是否出现分隔与肿瘤的良恶性无关(P=0.793),恶性/交界性病灶的最大径大于良性病灶,P=0.016,主胰管管径、胆总管管径在良性和恶性/交界两组间差异均无统计学意义,但在不考虑病理分组的情况下,全部病例主胰管管径大于胆总管管径(P=0.02).结论 IPMN CT表现的三种分型与病理分型有较好的对应关系,有利于IPMN CT征象的分析及提高诊断的准确性.IPMN的主胰管扩张程度常超过胆总管亦具有一定的特征,结合其他典型征象能够对IPMN做出较准确的诊断.%Objective To evaluate the diagnostic value of CT in pancreas intraductal papillary mucinous neoplasm(IPMN) by analyzing its CT feature and pathological findings. Methods The clinical and CT data was analyzed among 39 patients with IPMN whose diagnosis was confirmed by pathology. The CT manifestations were classified into 3 types: simple main pancreatic duct enlargement; main pancreatic duct enlargement combined with pancreatic cystic lesion; and

  20. Radiopaque intrahepatic duct stones in plain radiograph: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Suh, Chang Hae; Park, Chan Sup; Chung, Won Kyun [College of Medicine, Inha University, Seongnam (Korea, Republic of)

    1994-04-15

    We experienced 3 cases of intrahepatic duct stones detected on plain radiographs. The patients had history of multiple episodes of recurrent cholangitis. Radiographic characteristics of these stones included multiple, round or rectangular radiopaque densities surrounded by calcified rim; these densities showed a branching pattern along the intrahepatic ducts.

  1. A Rare Case of an Intraductal Papillary Mucinous Neoplasm of Pancreas Fistulizing Into Duodenum With Adult Polycystic Kidney Disease

    Science.gov (United States)

    Pipaliya, Nirav; Rathi, Chetan; Parikh, Pathik; Patel, Ruchir; Ingle, Meghraj; Sawant, Prabha

    2015-01-01

    Intraductal papillary mucinous neoplasm (IPMN) accounts for 20-50% of all cystic neoplasms of the pancreas. Rarely, IPMN, whether benign or malignant, can fistulize into adjacent organs like duodenum, stomach or common bile duct. IPMN can be associated with other diseases like Peutz-Jeghers syndrome and familial adenomatous polyposis. Association with adult polycystic kidney disease (ADPKD) is extremely rare. We report a case of a 60-year-old male with a large IPMN in the head of the pancreas diagnosed by magnetic resonance imaging, endoscopic ultrasound and cyst fluid analysis. It was complicated by fistula formation into the second part of the duodenum. Patient was simultaneously having adult polycystic kidney disease. There is only one case report of uncomplicated IPMN with ADPKD in the literature so far. And even rarer, there is no any case report of fistulizing IPMN with ADPKD reported so far, to the best of our knowledge. PMID:27785296

  2. Oncocytic-type intraductal papillary mucinous neoplasm (IPMN-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report

    Directory of Open Access Journals (Sweden)

    Chiang Kun-Chun

    2012-07-01

    Full Text Available Abstract Pancreatic cancer is a lethal disease without effective treatments at present. It ranks as s as 4th and 5th in cancer-related mortality in the western countries and worldwide. Locally advanced pancreatic duct carcinoma (PDAC and metastatic PDAC, usually found the metastases over liver, peritoneum, or lung, have been shown to be with dismal prognosis. Brain metastasis is a rare entity and most cases reported before were found post-mortem. Intraductal papillary mucinous neoplasms of the pancreas (IPMN has been deemed as a precursor of PDAC with very slow progression rate. Here we reported a case diagnosed with IPMN-derived PDAC with brain metastasis. After surgeries for PDAC and brain metastasis, subsequent chemotherapy and radiotherapy were also given. One and half year after surgery, this patient is still living with good performance status, which may warrant individualization of therapeutic strategy for PDAC with only brain metastasis.

  3. Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report.

    Science.gov (United States)

    Chiang, Kun-Chun; Yu, Chi-Chang; Chen, Jim-Ray; Huang, Yu-Ting; Huang, Cheng-Cheng; Yeh, Chun-Nan; Tsai, Chien-Sheng; Chen, Li-Wei; Chen, Hsien-Cin; Hsu, Jun-Te; Wang, Cheng-Hsu; Chen, Huang-Yang

    2012-07-09

    Pancreatic cancer is a lethal disease without effective treatments at present. It ranks as s as 4th and 5th in cancer-related mortality in the western countries and worldwide. Locally advanced pancreatic duct carcinoma (PDAC) and metastatic PDAC, usually found the metastases over liver, peritoneum, or lung, have been shown to be with dismal prognosis. Brain metastasis is a rare entity and most cases reported before were found post-mortem. Intraductal papillary mucinous neoplasms of the pancreas (IPMN) has been deemed as a precursor of PDAC with very slow progression rate. Here we reported a case diagnosed with IPMN-derived PDAC with brain metastasis. After surgeries for PDAC and brain metastasis, subsequent chemotherapy and radiotherapy were also given. One and half year after surgery, this patient is still living with good performance status, which may warrant individualization of therapeutic strategy for PDAC with only brain metastasis.

  4. Intraductal Papillary Mucinous Neoplasm (IPMN and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports

    Directory of Open Access Journals (Sweden)

    Athanasios Petrou

    2011-01-01

    Full Text Available Context Intraductal papillary mucinous neoplasms (IPMNs are a recently classified pancreatic neoplasm with an increasing incidence. IPMN is often misdiagnosed as chronic pancreatitis because of symptoms of relapsing abdominal pain, pancreatitis, and steatorrhea and imaging findings of a dilated pancreatic duct of cystic lesions that are frequently confused with pseudocysts. Early recognition of IPMN allows for prompt surgical resection before malignant transformation. Case reports We report two cases of patients with long histories of chronic pancreatitis (more than 15 years that went on to develop IPMN. Both patients presented with symptoms of abdominal pain, nausea, steatorrhoea and eventually weight loss. Biochemical and radiological findings were suggestive of chronic pancreatitis although no clear causes for this were identified. Both patients were followed up with multiple repeat scans with no reported sinister findings. Many years after the initial diagnosis of chronic pancreatitis, radiological investigations identified pathological changes suggestive of neoplastic development and histology confirmed IPMN. Conclusions The cases demonstrate the ongoing challenges in diagnosing and managing IPMN effectively; highlights the important aspects of epidemiology in differentiating chronic pancreatitis and IPMN; continues the discussion surrounding the relationship between IPMN and chronic pancreatitis.

  5. Intraductal Papillary Mucinous Tumors of the Pancreas. Surgical Treatment: At What Point Should We Stop?

    Directory of Open Access Journals (Sweden)

    Pederzoli P

    2005-01-01

    Full Text Available The intraoperative management of the margins of intraductal papillary mucinous tumors (IPMNs undergoing pancreatic resection is crucial. The surgeon must discontinue the resection whenever the pancreatic margin is negative and, of course, when a total pancreatectomy is indicated.Nevertheless, a wide gray area exists. The real surgical problems are represented by i IPMNs involving only a segment of the pancreatic gland, thus necessitating intraoperative histological examination of the resection and the decision as to "when to stop the resection"; ii the intraoperative management of those margins which are neither clearly negative nor clearly positive; iii the actual indications either for surgery or for follow-up in those patients affected by peripheral IPMNs.In the literature, negative resection margins have a range of between 49 to 81% with a pancreatic recurrence rate of from 0 to 25% in follow-ups ranging from 6 months to 11 years after the first operation.In general, in this disease which mainly involves the head and uncinate process of the gland, decisions are a "balance" between the patient and the disease. In fact, on the one hand, there is the usual elderly patient with possible comorbidities, symptoms and the presence of diabetes; on the other hand, the disease, which usually involves the head and the uncinate process of the gland, tends to grow along the duct and be potentially malignant if carcinoma is not already present.

  6. Intraductal papillary mucinous neoplasm of the pancreas (IPMN: clinico-pathological correlations and surgical indications

    Directory of Open Access Journals (Sweden)

    Cantù Massimiliano

    2010-04-01

    Full Text Available Abstract Background Intraductal papillary mucinous neoplasms (IPMNs are increasingly recognized entities, whose management remains sometimes controversial, due to the high rate of benign lesions and on the other side to the good survival after resection of malignant ones. Methods Retrospective analysis of a prospectively collected Western series of IPMN. Results Forty cases of IPMN were analysed (1992-2007. Most patients were symptomatic (72.5%; cholangio-MRI had the best diagnostic accuracy both for the tumour nature (83.3% and for the presence of malignancy (57.1%. ERCP was done in 8 cases (20%, and the results were poor. Thirteen patients were treated by pancreatic resection and 27 were maintained in follow-up. Total pancreatectomy was performed in 46% of the cases; in situ and invasive carcinoma were recognized in 15.4% and 38.4% of the cases, respectively. The mean follow-up was 42 months (range 12-72. One only patients with nodal metastases died 16 months after the operation for disease progression, while 91.6% of the operated patients are disease free. Out of the 27 not resected patients, 2 out of 4 presenting a lesion at high risk for malignancy died, while the remaining are in good conditions and disease free, with a mean follow-up of 31 months. Conclusion Therapeutic indication for IPMNs is mainly based upon radiological evaluation of the risk of malignancy. While the main duct tumours should be resected, preserving whenever possible a portion of the gland, the secondary ducts tumours may be maintained under observation, in absence of radiological elements of suspicion such as size larger than 3 cm, or a wall greater than 3 mm or nodules or papillae in the context of the cyst.

  7. Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

    Science.gov (United States)

    Fujita, Mitsuru; Itoi, Takao; Ikeuchi, Nobuhito; Sofuni, Atsushi; Tsuchiya, Takayoshi; Ishii, Kentaro; Kamada, Kentaro; Umeda, Junko; Tanaka, Reina; Tonozuka, Ryosuke; Honjo, Mitsuyoshi; Mukai, Shuntaro; Moriyasu, Fuminori

    2016-01-01

    Background and Objectives: There have been few studies to date evaluating the effectiveness of contrast-enhanced endoscopic ultrasound (CE-EUS) for detecting mural nodules in patients with branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. We aim to evaluate the effectiveness of CE-EUS for detecting mural nodules in BD-IPMN. Patients and Methods: Of the 427 BD-IPMN patients, 21 patients (4.9%) in whom the presence of mural nodules was suggested by CE computed tomography (CT) or magnetic resonance imaging (MRI), or in whom the presence of nodule-like lesions as shown by fundamental EUS, were examined by CE-EUS. Results: The mean diameter of cystic lesions was 29.8 ± 12.8 mm. The mean diameter of mural nodules was 9.5 ± 5.7 mm. BD-IPMN was detected in the pancreatic head in 16 cases, pancreatic body in 2 cases, and pancreatic tail in 3 cases. The mean follow-up period was 17.2 ± 11.9 months. The detection rates of mural nodule-like lesions in BD-IPMN patients on CT, MRI, and fundamental EUS were 36.8%, 63.2%, and 100%, respectively. The detection rates of true mural nodules in BD-IPMN patients on CT, MRI, and fundamental EUS were 85.7%, 71.4%, and 100%, respectively. The echo levels of mural nodule-like lesions on fundamental EUS were hyperechoic in 6 patients, isoechoic in 9 patients, and hypoechoic in 6 patients. The final diagnosis was mucus lumps in 14 patients and mural nodules in 7 patients. The contrast patterns observed were avascular, isovascular, and hypervascular in 14, 3, and 4 patients, respectively. No patients showed a hypovascular pattern. Fourteen patients showing an avascular pattern were diagnosed as having mucus lumps, and they were able to avoid surgical resection. Of the 7 patients who were diagnosed as having mural nodules, 5 underwent surgical resection. The pathological findings were adenocarcinoma in 2 patients and adenoma in 3 patients. Of the 3 adenoma patients, fundamental EUS demonstrated a hypoechoic

  8. A Case Report of Intraductal Papillary-Mucinous Neoplasm of the Pancreas Showing Morphologic Transformation during Followup Periods

    Directory of Open Access Journals (Sweden)

    Yuichi Sanada

    2009-01-01

    Full Text Available A 64-year-old man underwent MRCP for further examination of gallbladder stones and IPMN of branch-type (IPMN-Br was pointed out. Yearly MRCP had revealed the gradual increase of the cystic components, marked dilation of the main pancreatic duct (MPD, and filling defects in the MPD. After follow-up for three years, he underwent pancreatoduodenectomy. Histologically, the dilated MPD and connecting dilated branch ducts were filled with nodular growth of tumor cells consisting of gastric-type adenoma with pyloric gland-like structures. In the MPD, a transition from gastric-type adenoma to intestinal-type carcinoma was observed. In addition, in a dilated branch duct, some components of intestinal-type carcinoma with marked arborizing structures were observed. A minimally invasion was observed around branch ducts. Immunohistochemistry revealed diffuse nuclear accumulation of PCNA and Ki67 in the tumor cells of branch dusts. Our observations suggest that the secondary infiltration to the MPD of IPMN-Br and IPMN-Br possesses malignant potential for microinvasion.

  9. Early bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Jae Myung Cha; Myung-Hwan Kim; Se Jin Jang

    2007-01-01

    Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings,and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.

  10. Cellular and physical mechanisms of branching morphogenesis

    Science.gov (United States)

    Varner, Victor D.; Nelson, Celeste M.

    2014-01-01

    Branching morphogenesis is the developmental program that builds the ramified epithelial trees of various organs, including the airways of the lung, the collecting ducts of the kidney, and the ducts of the mammary and salivary glands. Even though the final geometries of epithelial trees are distinct, the molecular signaling pathways that control branching morphogenesis appear to be conserved across organs and species. However, despite this molecular homology, recent advances in cell lineage analysis and real-time imaging have uncovered surprising differences in the mechanisms that build these diverse tissues. Here, we review these studies and discuss the cellular and physical mechanisms that can contribute to branching morphogenesis. PMID:25005470

  11. Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas

    OpenAIRE

    Tanaka, Masao

    2015-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin‐producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to its histomorphological and immunohistochemical characteristics. Endoscopic retrograde cholangiopancreatography plays a crucial role in the evaluation of these features of IPMN. End...

  12. The value of diagnosis of intraductal papillary mucinous neoplasm of the pancreas by using MRI and MRCP%磁共振成像和磁共振胰胆管造影对胰腺导管内乳头状黏液性肿瘤的诊断价值

    Institute of Scientific and Technical Information of China (English)

    邓利猛; 廖伟华; 郑兴友; 刘慧

    2016-01-01

    Objective To investigate the diagnostic value of routine magnetic resonance imaging and MRCP for intraductal papillary mucinous tumor of pancreas (IPMNs). Methods Retrospectively analyzed the clinical data of 9 patients with IPMNs proved by surgery and pathology including routing magnetic resonance imaging and MRCP. Re-sults The study demonstrated that there were 3 cases of main duct type, MRI showed that the major performance were diffuse expansion of main pancreatic duct or segmental expansion, presented long T 1 low-signal,and long T2 high-signals,with or without intramural nodule which had mild or moderate enhancement. Four cases were branch duct type, located in uncinate process and head of pancreas. MRI showed multiple or single cystic lesion of clusters, pre-sented long T1 low-signal, and long T2 high-signals with short T2 low-signal septation. Two cases of mixed type, both the main pancreatic ducts and branch ducts have different levels of dilation. MRCP demonstrated clearly that the main pancreatic duct communicate with cystic tumor. Conclusion It may be effective to combine routine magnetic reso-nance imaging and MRCP in the diagnosis of IPMNs.%目的:探讨胰腺导管内乳头状黏液性肿瘤(IPMNs)的常规磁共振成像(MRI)和磁共振胰胆管造影(MRCP)表现。方法回顾性分析9例经手术病理证实的IPMNs患者的常规MRI和MRCP表现。结果主胰管型3例,表现为主胰管弥漫性或节段性扩张,呈长T1低信号长T2高信号,伴或不伴附壁结节,附壁结节呈轻中度强化;分支胰管型4例,病灶均位于胰头钩突处,表现为单发囊性病变或葡萄状多发囊性病变,呈长T1低信号长T2高信号,伴腔内分隔,分隔为短T2信号;混合型2例,表现主胰管和分支胰管均有不同程度扩张。 MRCP均可清晰显示扩张的管道及其交通。结论常规MRI联合MRCP对诊断胰腺IPMNs具有较高临床价值。

  13. MSCT features of intraductal papillary mucinous neoplasm in the pancreas%胰腺导管内乳头状黏液性肿瘤的 MSCT 征象

    Institute of Scientific and Technical Information of China (English)

    岳奎涛; 刘剑羽; 王智勇; 李磊; 刘从容

    2012-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点.方法 回顾性分析27例经病理证实的IPMN的MSCT表现.所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查.结果 27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化.分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈“葡萄串”样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化.混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化.7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通.结论 IPMN的MSCT表现具有一定特征.MSCT结合ERCP检查有助于术前准确诊断.%To analyze MSCT features of intraductal papillary mucinous neoplasms (IPMN)of the pancreas. Methods Totally 27 patients with IPMN confirmed by pathology were retrospectively analyzed. All patients underwent plain and contrast-enhance CT, 7 patients underwent ERCP. Results Among the 27 cases, 11 were interpreted as IPMN of the main pancreatic duct (MPD). Two of these 11 MPD were classified as borderline tumors, 4 were carcinomas, and 5 were adenocarcinoma. The atrophy of pancreas at different degrees and obvious dilation of MPD were demonstrated on CT, with solid mural nodules in the duct were seen in 8 cases, while 1 case had pancreatic calcification. Nine cases were interpreted as IPMN of the branch-duct type, 3 were classified as adenomas, 3 were borderline tumors, 1 was carcinomas, and 2 were adenocarcinoma. Among these 9 cases, 7 IPMN located in the pancreas head, displayed as cystic lesions linking to the main duct which shaped like grape

  14. The Role of Breast Fiberoptic Duct Endoscopy in the Diagnosis of 105 Breast Diseases with Abnormal Nipple Discharge%乳管镜在105例伴乳头溢液性疾病中的治疗价值分析

    Institute of Scientific and Technical Information of China (English)

    周树伟; 苏蓓蓓

    2015-01-01

    目的:探讨乳管镜在乳头溢液疾病中的价值。方法乳头溢液患者105例,自溢液管插入纤维乳管镜观察溢液乳管及其分支的结构及内容物状况,发现并确定病灶位置。结果乳管镜插入成功率100%,镜下发现乳管内肿物68例(64.76%);诊断为乳头状瘤53例,乳头状瘤病5例,乳腺导管癌7例(其中似原位导管癌3例),乳管扩张、炎症27例。手术92例,经病理证实对乳腺癌诊断的灵敏度87.5%(7/8),特异度98.82%(84/85)。结论乳管镜检查为乳头溢液病因诊断的首选方法,对导管癌及癌前病变的早期发现有重要价值。%Objective To evaluate the value of ifberoptic ductoscopy in diagnosis of nipple discharge diseases.Methods 105 patients with nipple discharge liquid were examined by ifberoptic ductoscopy, to investigate concerned duct with its branch and deifne location and extent of intraductal leisions.Results Breast duct endoscope insertion success rate 100%, endoscopic ifndings of intraductal tumor in 68 cases(64.76%); diagnosis of papillary tumor in 53 cases, 5 cases of papillary hyperplasia, 7 cases of ductal carcinoma of the breast(which resembles the ductal carcinoma in situ in 3 cases), inlfammation in 27 cases, breast duct dilatation. Operation in 92 cases conifrmed by pathology, 87.5% sensitivity in the diagnosis of breast cancer(7/8), a speciifcity of 98.82%(84/85). Conclusion Fiberoptic ductoscopy overlfow the preferred method for liquid etiological diagnosis of nipple, on early ductal carcinoma and precancerous lesions was found to have an important value.

  15. Individualized surgical treatment and prognosis of intraductal papillary mucinous neoplasms of the pancreas%胰腺导管内乳头状黏液性肿瘤的外科治疗及预后分析

    Institute of Scientific and Technical Information of China (English)

    田孝东; 吴广东; 庄岩; 郭晓超; 杨尹默

    2013-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的临床病理特征及预后.方法 回顾性研究2007年1月至2011年12月收治的56例胰腺IPMN患者的临床资料,分析不同类型IPMN的个体化治疗效果及预后.男性38例,女性18例,平均年龄(61±7)岁.其中主胰管型26例,分支胰管型18例,混合型12例.对累及主胰管或有临床症状的48例患者行手术治疗,包括胰十二指肠切除术29例,胰体尾切除术17例,全胰切除术2例.8例病灶最大径<3 cm且无任何临床表现的分支胰管型患者未行手术治疗,予定期观察.结果 术后总并发症发生率为27.1%(13/48),无围手术期死亡病例.术后病理证实非浸润性肿瘤31例;浸润性癌17例,其中淋巴结阳性7例.主胰管型、混合型和分支胰管型病例中浸润癌分别占46.2%(12/26)、3/12和2/18,组间比较差异有统计学意义(x2 =6.385,P =0.041).非浸润性肿瘤与浸润性癌患者术后5年生存率分别为100%和24.6%;淋巴结阳性患者术后生存期低于淋巴结阴性的浸润性癌患者(P =0.017).8例未行手术治疗患者随访期间病灶无明显变化.结论 IPMN恶性程度较低,进展缓慢,预后较好.累及主胰管的IPMN患者浸润性癌的比例较高,应积极手术治疗.最大径<3 cm的无症状分支胰管型患者可密切随访.%Objective To investigate the clinical manifestation,individualized surgical treatment,and prognosis of intraductal papillary mucinous neoplasms (IPMN) of pancreas.Methods The clinical data of 56 IPMN cases treated between January 2007 and December 2011 was retrospectively analyzed.Among the 56 patients (38 male and 18 female,mean age (61 ± 7) years),26 were main-duct type,18 were branch-duct type,12 were mixed type.Pancreatectomy was performed on 48 cases,including pancreaticoduodenectomy on 29 patients,distal pancreatectomy on 17 patients,and total pancreatectomy on 2 patients.Results The overall postoperative morbidity rate was 27

  16. Correlation between CT patterns and pathological classification of intraductal papillary mucinous neoplasm

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jing [Department of Imaging, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai 200065 (China)], E-mail: Zhangjingyxd@163.com; Wang Peijun [Department of Imaging, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai 200065 (China)], E-mail: Tongjipjwang@vip.sina.com; Yuan Xiaodong [Department of Radiology, Changhai Hospital of the Second Military Medical University, Shanghai 200433 (China)], E-mail: yuanxiaodongzj@163.com

    2010-01-15

    Objective: To examine CT patterns of intraductal papillary mucinous neoplasm (IPMN), analyze their correlation with pathologic classification, and discuss the value of CT in the diagnosis and differential diagnosis of IPMN. Methods: CT patterns of 39 IPMN patients, whose clinical data were complete and whose diagnosis was confirmed by surgery and pathology, were classified into three types: (1) simple main pancreatic duct (MPD) dilation type, (2) MPD dilation with pancreatic cystic lesion type, and (3) simple pancreatic cystic lesion type. Correlations between the three CT types and Takada pathologic classification (MPD type, furcation type and mixture type) were analyzed. The 39 IPMN cases were pathologically classified as the benign group and the malignant/borderline group. CT characteristics including the presence or absence of mural nodules, intrafocal partitions, focal size and the degree of MPD and common bile duct (CBD) dilation were analyzed statistically. Results: A correlation was found between the CT simple MPD dilation type and the pathological MPD type, between the MPD dilation with pancreatic cystic lesion type and the furcation and mixture types, and between the simple cystic lesion type and the furcation type (p < 0.001). The benign rate was 92% in patients without intrafocal mural nodules, and 42% in patients with intrafocal mural nodules. The difference between the two groups was statistically significant (p = 0.003). The presence or absence of intrafocal partitions was not correlated with benignancy or malignancy (p = 0.793). The maximum diameter of malignant/borderline lesions was bigger than that of benign ones (p = 0.016). There was no significant difference in MPD and CBD diameters between the benign and malignant/borderline groups. Regardless of pathological classification, the MPD diameter was larger than the CBD diameter in all cases (p = 0.02). Conclusion: The three CT types of IPMN well correlated with the pathologic classification

  17. Application of milk duct scope in bilateral nipple discharge patients with hypothyroidism or pituitary tumor%乳管内窥镜在合并甲状腺功能低下或垂体瘤的双侧乳头溢液中的应用

    Institute of Scientific and Technical Information of China (English)

    栾梅香; 樊珈榕; 温浩; 杨纾旖; 付艳; 木拉提; 刘丽

    2009-01-01

    Objective To investigate whether the bilateral nipple discharge with the background of hypothyroidism and pituitary tumor causes intraductal neoplasm. Methods Clinical data of 222 bilateral nipple discharge patients with hypothyroidism or pituitary tumor undergoing mammary ductoseopy (MDS) examination were analyzed. Those diagnosed as intraductal papilloma received surgery and pathological exam. 158 cases with inflammatory comedomastitis diagnosed by MDS received milk duct washing with gentamycin, dexamethasone and corresponding medical treatment. Results Among the 222 cases, 158 cases(71.17%) were diagnosed as inflammatory comedomastitis by MDS, 64 cases (28.83%) were diagnosed as intraduetal papilloma (64/222) by MDS and received operation,59 cases were pathologically diagnosed as intraductal papilloma,the other 5 cases were pathologically diagnosed as mammary duct ectasia. The pathological coincidence was 92.2% and no breast cancer was observed. 68.10% of inflammatory comedomastitis cases suffered from breast pain. There were no significant difference in the disease distribution of the ethnic groups. During pre-menopause period, the incidence of period neoplasia is higher in pituitary tumor than hypothyroidism; However, during the post-menopause the situation was vice versa. The color of niplle discharge is mostly milk-like in patients with pituitary tumor, while serous in patients with hypothyroidism. 71.19% of duct papilloma locate at the branch of the main duct. Conclusion The bilateral nipple discharge with hypothyroidism or pituitary are usually concomitant with intraduetal lesions. Mammary ductosopy is helpful to discover intraduetal neoplasia.%目的 探讨合并甲状腺功能低下或垂体瘤的双侧乳头溢液与乳腺导管内病变的关系.方法 对222例临床确诊的甲状腺功能低下(94例)和垂体瘤(128例)患者行乳管镜检查.结果 222例患者中有64例乳管镜诊断为乳腺导管内乳头状瘤,158

  18. The clinical assessment of intraductal ultrasonography in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To assess and compare the clinical value of intraductal ultrasonography (IDUS) in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis with conventional imaging methods. Methods: IDUS was carried out in eighteen patients with pancreatic carcinoma and chronic pancreatitis

  19. Study of Benign and Malignant Intraductal Lesions of the Breast by Fiberoptic Ductoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Xu; Qi Wang; Anqin Zhang; Wenping Li; Juntao Shi; Zhongyang Chen

    2005-01-01

    OBJECTIVE To observe and subtype the appearance of intraductal papilloma (lesions) and of infiltrating ductal carcinoma or early infiltrating ductal carcinoma using a fiberoptic ductoscope (FDS) examination, and to discuss the differentiation and diagnosis of benign and malignant tumors by FDS.METHODS The characteristics of FDS images and diagnostic data for 229patients with intraductal papilloma (lesions) and 50 patients with ductal carcinoma, who were confirmed by surgical pathology from October 1998 to December 2003, were analyzed retrospectively.RESULTS The appearance of the lesions observed by FDS were grouped into 4 types: a monothelia (type Ⅰ), polythelia (type Ⅱ), superficies (type Ⅲ)and a mixture (type Ⅳ). Intraductal papillomas (lesions) were more commonly seen in type Ⅰ and Ⅱ, and intraductal carcinomas or early infiltrating ductal carcinomas were more commonly seen in type Ⅲ and Ⅳ;there was a statistically significant difference in the distribution of the ductoscopic types, except in type Ⅱ, between the two types of lesions, P<0.001. The focal detection rate by FDS for intraductal papilloma and papillomatosis was 99.6% (228/229) and for breast cancer was 96.0% (48/50). The diagnostic accuracy was 97.8% (224/229) and 82.0% (41/50),respectively.CONCLUSION FDS can be a guide for the treament of benign and malignant intraductal tumors, with early discovery and accurate diagnosis.

  20. Curved-Duct

    Directory of Open Access Journals (Sweden)

    Je Hyun Baekt

    2000-01-01

    Full Text Available A numerical study is conducted on the fully-developed laminar flow of an incompressible viscous fluid in a square duct rotating about a perpendicular axis to the axial direction of the duct. At the straight duct, the rotation produces vortices due to the Coriolis force. Generally two vortex cells are formed and the axial velocity distribution is distorted by the effect of this Coriolis force. When a convective force is weak, two counter-rotating vortices are shown with a quasi-parabolic axial velocity profile for weak rotation rates. As the rotation rate increases, the axial velocity on the vertical centreline of the duct begins to flatten and the location of vorticity center is moved near to wall by the effect of the Coriolis force. When the convective inertia force is strong, a double-vortex secondary flow appears in the transverse planes of the duct for weak rotation rates but as the speed of rotation increases the secondary flow is shown to split into an asymmetric configuration of four counter-rotating vortices. If the rotation rates are increased further, the secondary flow restabilizes to a slightly asymmetric double-vortex configuration. Also, a numerical study is conducted on the laminar flow of an incompressible viscous fluid in a 90°-bend square duct that rotates about axis parallel to the axial direction of the inlet. At a 90°-bend square duct, the feature of flow by the effect of a Coriolis force and a centrifugal force, namely a secondary flow by the centrifugal force in the curved region and the Coriolis force in the downstream region, is shown since the centrifugal force in curved region and the Coriolis force in downstream region are dominant respectively.

  1. Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2008-01-01

    Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.

  2. THE EXPRESSION OF APOPTOSIS RELATED GENES IN THE PROCESS OF CANCERATION OF ATYPICAL HYPERPLASIA OF MAMMARY DUCT

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To investigate the expression of apoptosis related genes p53 and bcl-2 in atypical hyperplasia of mammary duct and the relationship between the gene expression and oncogenesis of breast. Methods: mRNA of apoptosis related gene p53 and bcl-2 were detected by in situ hybridization in 44 cases of atypical ductal hyperplasia. p53 protein expression was detected by immunohistochemistry. The data were compared with those of 6 cases of benign hyperplasia and 26 cases of breast carcinoma. Results: The expression of p53 mRNA was 66.7% in benign hyperplasia, 40% in atypical ductal hyperplasia (55.6% in mild, 41.7% in medium, 26.1% in severe) and 19.2% in carcinoma (of which 21.4% were intraductal carcinoma and 16.7% were invasive). The expression of p53 protein was negative in benign hyperplasia, 24% in atypical hyperplasia (mild 11.1%, medium 25%, severe 34.8%), 38.5% in carcinoma (intraductal carcinoma 35.7%, invasive ductal carcinoma 41.7%). The expression of bcl-2 was negative in benign hyperplasia, 78.6% in intraductal carcinoma, 83.3% in invasive ductal carcinoma. Conclusion: Loss and mutation of p53 gene and excessive expression bcl-2 mRNA were detected in severe atypical ductal hyperplasia.

  3. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark R.

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 {micro}m were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on

  4. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark Raymond [Univ. of California, Berkeley, CA (United States)

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 μm were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the

  5. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... Disorders Overview of Gallbladder and Bile Duct Disorders Cholecystitis Gallstones Biliary Pain Without Gallstones Narrowing of the ... ducts are blocked, the gallbladder may become inflamed ( cholecystitis ). Biliary pain without gallstones (acalculous biliary pain) can ...

  6. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Tae Kyoung; Kim, Kyoung Won; Kim, Ah Young; Kim, Pyo Nyun; Ha, Hyun Kwon; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-06-01

    To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3)

  7. Cornice Duct System

    Energy Technology Data Exchange (ETDEWEB)

    Wayne Place; Chuck Ladd

    2004-10-29

    SYNERGETICS, INC., has designed, developed, and tested an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building at the Daylighting Facility at North Carolina State University., Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. Patent Number US 6,511,373 B2 has been granted on the version of the device installed and tested in the laboratory house. (A copy of that patent is attached.) Refinements to the device have been carried through two additional design iterations, with a particular focus on reducing installation time and cost and refining the air control system. These new designs have been fabricated and tested and show substantial promise. Based on these design and testing iterations, a final design is proposed as part of this document. That final design is the basis for a continuation in part currently being filed with the U.5, Patent office.

  8. 14 CFR 25.1103 - Induction system ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction system ducts and air duct systems....1103 Induction system ducts and air duct systems. (a) Each induction system duct upstream of the first... auxiliary power unit bleed air duct systems, no hazard may result if a duct failure occurs at any...

  9. 3C DUCT DESIGN METHOD

    Institute of Scientific and Technical Information of China (English)

    Huan-RueiShiu; Feng-ChuOu; Sih-LiChen

    2002-01-01

    A new 3C duct design method is proposed for designing a high quality, energy-efficiency cost-effective air duct system. It not only considers the demand of volume flow rate, but also takes into consideration a number of issues including system pressure balance, noise, vibration, space limitation and total system cost. This new method comprises three major calculation procedures:initial computer-aided design (CAD), computer-aided simulation (CAS) and correction processes (CP). An example is presented in this study to understand the characteristics of 3C method. It shows that 3C duct design method provides a simple computation procedure for an optimum air duct system. It also shortens the design schedule, prevents human calculation errors, and reduces the dependence on designer experience. In addition to apply in a new duct system design, 3C duct design method is also a powerful design tool for the expansion of an existing duct system.

  10. Diagnostic and therapeutic endoscopic approaches to intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Turner, Brian G; Brugge, William R

    2010-10-27

    Pancreatic cystic lesions are increasingly identified on routine imaging. One specific lesion, known as intraductal papillary mucinous neoplasm (IPMN), is a mucinous, pancreatic lesion characterized by papillary cells projecting from the pancreatic ductal epithelium. The finding of mucin extruding from the ampulla is essentially pathognomonic for diagnosing these lesions. IPMNs are of particular interest due to their malignant potential. Lesions range from benign, adenomatous growths to high-grade dysplasia and invasive cancer. These mucinous lesions therefore require immediate attention to determine the probability of malignancy and whether observation or resection is the best management choice. Unresected lesions need long-term surveillance monitoring for malignant transformation. The accurate diagnosis of these lesions is particularly challenging due to the substantial similarities in morphology of pancreatic cystic lesions and limitations in current imaging technologies. Endoscopic evaluation of these lesions provides additional imaging, molecular, and histologic data to aid in the identification of IPMN and to determine treatment course. The aim of this article is to focus on the diagnostic and therapeutic endoscopic approaches to IPMN.

  11. Pancreatic Cysts

    Science.gov (United States)

    ... be cancerous when found. Intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. It occurs most ...

  12. 乳腺导管内乳头状瘤的MR表现及与乳管镜、超声检查的对比研究%A comparative study of MRI of intraductal papilloma of the breast with fiberoptic ductoscopy and ultrasound

    Institute of Scientific and Technical Information of China (English)

    董妍; 孙玲玲; 赵嫚; 岳玲

    2013-01-01

    Objective:To evaluate the MR value for diagnosis of intraductal papilloma of the breast,and discuss the superiority and deficiency of MR.Methods:To retrospectively analyze MR features of 16 cases of intraductal papilloma confirmed by pathology,and compared the results with fiberoptic ductoscopy and ultrasound.Results:The findings of MR and ultrasound revealed three patterns:mass in/beside the dilated duct;mass in breast without dilated duct;and dilated duct only.The imageing features of fiberoptic ductoscopy included mass in mammary duct and inflammation.The positive rates of MR,fiberoptic ductoscopy and ultrasound were 88.9%,80.0%,83.3%.Conclusion:All the MR,fiberoptic ductoscopy and ultrasound have high value in diagnosis of intraductal papilloma of the breast,but also have disadvantages.Combining the three methods will improve the diagnosis of intraductal papilloma.%目的:评价MR对乳腺导管内乳头状瘤的诊断价值及此种检查方法的优势与不足.方法:对16例经病理证实的乳腺导管内乳头状瘤患者的MR检查结果进行回顾性分析,并与乳管镜、超声检查结果进行对比.结果:MR与超声表现分为三种:扩张导管内或导管旁结节;乳腺内实性结节,不伴随导管扩张;单纯导管扩张,乳腺内无实性结节.而乳管镜检查主要表现为管腔内的新生物及管壁的炎性改变.MR、乳管镜、超声检查的阳性率分别为:88.9%、80.0%、83.3%.结论:MR、乳管镜及超声检查对导管内乳头状瘤的诊断均具有较高价值,但也各有弊端,将三种方法结合,有望提高导管内乳头状瘤患者的诊断水平.

  13. Monitoring the progression from intraductal carcinoma to invasive ductal carcinoma based on multiphoton microscopy

    Science.gov (United States)

    Wu, Yan; Fu, Fangmeng; Lian, Yuane; Nie, Yuting; Zhuo, Shuangmu; Wang, Chuan; Chen, Jianxin

    2015-09-01

    Intraductal carcinoma is a precancerous lesion of the breast and the immediate precursor of invasive ductal carcinoma. Multiphoton microscopy (MPM) was used to monitor the progression from intraductal carcinoma to invasive ductal carcinoma, which can improve early detection of precursor lesions and halt progression to invasive neoplastic disease. It was found that MPM has the capability to reveal the qualitative changes in features of cells, structure of basement membranes, and architecture of collagens during the development from intraductal carcinoma to invasive ductal carcinoma, as well as the quantitative alterations in nuclear area, circle length of basement membrane, and collagen density. Combined with intra-fiberoptic ductoscopy or transdermal biopsy needle, MPM has the potential to provide immediate histological diagnosis of tumor progression in the field of breast carcinoma.

  14. Salivary duct carcinoma

    DEFF Research Database (Denmark)

    Breinholt, Helle; Elhakim, Mohammad Talal; Godballe, Christian;

    2016-01-01

    1990 to 2005 were identified. Histological slides were reviewed, and data concerning demographics, tumour site, clinical stage, treatment profiles and follow-up were retrieved. Survival estimates and prognostic factors were evaluated by comparing Kaplan-Meier plots using the Mantel-Haenszel log......-rank test. RESULTS: Salivary duct carcinoma showed an incidence of 0.04/100.000 inhabitants/year. Distant recurrence was seen in 52% of patients. Five-year overall survival, disease-specific survival and recurrence-free survival were 32%, 42% and 35%, respectively. Univariate analyses suggested that overall...... stage (III/IV) and vascular invasion have a negative impact on all survival measures. Involved resection margins correlated with a poorer overall survival and disease-specific survival, whereas adjuvant radiotherapy improved overall survival and recurrence-free survival. CONCLUSIONS: Salivary duct...

  15. Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

    Science.gov (United States)

    Sarawagi, Radha; Sundar, Shyam; Raghuvanshi, Sameer; Gupta, Sanjeev Kumar; Jayaraman, Gopal

    2016-01-01

    Summary Background Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. Material/Methods This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. Results The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. Conclusions Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries. PMID:27298653

  16. Intraductal papillary mucinous carcinoma with atypical manifestations: Report of two cases

    Institute of Scientific and Technical Information of China (English)

    Seung Eun Lee; Jin-Young Jang; Sung Hoon Yang; Sun-Whe Kim

    2007-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are a well-characterized group of mucin-producing cystic neoplasms of the clear malignant potential type. We report here two cases of intraductal papillary mucinous carcinoma (IPMC) with atypical manifestations. In one case, we discussed a pseudomyxoma peritonei caused by a ruptured IPMC. In the other case we discussed the fistulization of IPMC into the stomach and duodenum. These two cases suggest that IPMN can either spontaneously rupture causing mucinous materials to spill into the free abdominal cavity or directly invade adjacent organs resulting in fistula development.

  17. Tumor Implantation into the Intrahepatic Bile Duct after Percutaneous Ethanol Injection Therapy for Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Shogo Tanaka

    2009-11-01

    Full Text Available A 74-year-old man who had undergone transcatheter arterial embolization for hepatitis C virus-related hepatocellular carcinoma (Couinaud’s segment III/IV in April 2003 and percutaneous ethanol injection for recurrence at the same site in February 2006 was found to have dilation of the intrahepatic bile duct by computed tomography in October 2008. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography showed a thrombosis occupying the left hepatic duct to the lateral branches with peripheral bile duct dilation. Serum concentration of alpha-fetoprotein was elevated. We performed a left hepatectomy under a preoperative diagnosis of hepatocellular carcinoma with bile duct invasion. The cut surface of the resected specimen showed a tumor thrombosis occupying the region between the left hepatic duct and lateral branches, but no tumor in the liver parenchyma. Histologic examination showed that the thrombosis in the intrahepatic bile duct was hepatocellular carcinoma. Since part of the hepatocellular carcinoma in the region treated with percutaneous ethanol injection was adjacent to the tumor thrombosis in the intrahepatic bile duct in diagnostic imaging, we diagnosed implantation into the intrahepatic bile duct due to percutaneous ethanol injection. The postoperative course was uneventful and the patient is doing well without recurrence 8 months after the operation.

  18. Pancreatic fistula through the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2002-01-01

    Full Text Available Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transaction. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical limphadenectomy. The patient was treated conservatively by elevation of the drain- age bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen.

  19. Noise reduction of spiral ducts.

    Science.gov (United States)

    Lapka, Wojciech; Cempel, Czesław

    2007-01-01

    The paper presents noise reduction (NR) of spiral ducts as a result of computational modeling of acoustic wave propagation. Three-dimensional models were created with the finite element method in COMSOL Multiphysics version 3.3. Nine models of spiral ducts with 1-9 spiral leads were considered. Time-harmonic analysis was used to predict NR, which was shown in spectral and interval frequency bands. Spiral duct performance can be seen as a comparison of NR before and after a change from a circular to a spiral duct.

  20. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  1. Collagen Type XI Alpha 1 Expression in Intraductal Papillomas Predicts Malignant Recurrence

    Directory of Open Access Journals (Sweden)

    Javier Freire

    2015-01-01

    Full Text Available Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1 expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P<0.0001 when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs.

  2. Development of Intraductal Technique for Breast Cancer Prevention, Diagnosis and Treatment (97 Breast)

    Science.gov (United States)

    1999-10-01

    Surgeons 2. Presentations: (1) Istituto Europeo di Oncologia ( Milan) Grand Rounds, "Intraductal approach to the breast," July 7, 1999. (2) Yale...in nipple aspirate fluid (NAF) using manual breast pumps (Petrakis et al and Sartorius et al), nipple aspiration is a relatively inefficient technique

  3. Collagen Type XI Alpha 1 Expression in Intraductal Papillomas Predicts Malignant Recurrence

    Science.gov (United States)

    Freire, Javier; García-Berbel, Lucia; García-Berbel, Pilar; Pereda, Saray; Azueta, Ainara; García-Arranz, Pilar; De Juan, Ana; Vega, Alfonso; Hens, Ángela; Enguita, Ana; Muñoz-Cacho, Pedro; Gómez-Román, Javier

    2015-01-01

    Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1) expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P < 0.0001) when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs. PMID:26448946

  4. MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, M. van [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium)]. E-mail: Mireille_Van_Goethem@hotmail.com; Schelfout, K. [Department of Pathology, University Hospital Antwerp, Antwerp (Belgium); Kersschot, E. [Department of Radiology, OLV Hospital Aalst, Aalst (Belgium); Colpaert, C. [Department of Pathology, University Hospital Antwerp, Antwerp (Belgium); Verslegers, I. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Biltjes, I. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Tjalma, W.A. [Department of Gynaecology and Gynaecological Oncology, University Hospital Antwerp, Antwerp (Belgium); De Schepper, A. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Weyler, J. [Department of Epidemiology and Social Medicine University Antwerp, Antwerp (Belgium); Parizel, P.M. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium)

    2007-05-15

    Purpose: To determine the role of magnetic resonance (MR) mammography in detection and assessment of extent of tumors with extensive intraductal component (EIC+). Material and methods: In a prospective study, 233 consecutive women with a suspicious lesion underwent preoperative MR mammography and 209 invasive ductal carcinomas were detected. We studied the prediction of intraductal spread on mammography (MX), ultrasound (US) and MR. We compared the size of the total lesion on MX, US and MR and correlated it with histopathology. Enhancement patterns on MR were described. Results: Of 209 invasive ductal carcinomas, 50 were EIC+ (24%). MX predicted intraductal spread in EIC+ carcinomas in 48.5%, US in 34.2% and MR in 68%. Compared to MX and US, MR was best in assessment of total tumor size. On MR, ductal spread in EIC+ tumors presented as ductal or linear enhancement, long spicules, a regional enhancing area or nodules adjacent to a mass. Conclusion: MR had the highest sensitivity to predict intraductal spread and was superior in assessing total tumor size.

  5. Fiberoptic ductoscopy in diagnosis and therapy of intraductal papilloma of the breast%乳管镜在乳腺导管内肿瘤诊断及治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    邹裷; 朱碧荣; 李丽

    2016-01-01

    目的:评价乳管镜在乳腺导管内肿瘤临床诊治中的作用及应用价值。方法:我科2013年1月-2014年6月经门诊乳管镜诊治乳头溢液患者共1709人次,其中诊断为乳腺导管内肿瘤患者123例,在我科行手术治疗患者105人,回顾性分析其术前诊断、术后病检及治疗过程。结果:123例患者在乳管镜下见乳腺导管内肿瘤样病变,105人行病变导管及所属腺叶部分切除术,术后病检85例确诊为乳腺导管内乳头状瘤,5例确诊为乳腺导管内原位癌,3例确诊为乳腺浸润性导管癌,12例确诊为乳腺囊肿等其他良性病变。结论:乳管镜可早期发现乳腺导管内肿瘤,是诊治及手术定位的重要辅助手段。%Objective:To evaluate the application of fiberoptic ductoscopy(FDS)in diagnosis and therapy of intra-ductal papilloma of the breast.Methods:To retrospectively analyze the data of 1 709 cases of nipple discharge diag-nosed and treated by FDS,123 were intraductal papilloma verified by FDS,105 had surgical therapy.Results:Intra-ductal lesions were verified by FDS in 123 cases,105 of them excised the diseased duct and lobus glandularis,85 ca-ses were diagnosed as intraductal papilloma by pothology after operation,5 ductal carcinoma in situ(DCIS),3 breast infitrative ductal carcinoma,12 galactoma and other were benign lesions.Conclusion:FDS is valuable and important in early diagnosis and location of intraductal papilloma.

  6. Surgery for Bile Duct (Cholangiocarcinoma) Cancer

    Science.gov (United States)

    ... Situation Bile Duct Cancer Treating Bile Duct Cancer Surgery for Bile Duct Cancer There are 2 general ... also help plan the operation to remove it. Surgery for resectable cancers For resectable cancers, the type ...

  7. Sound propagation through nonuniform ducts

    Science.gov (United States)

    Nayfeh, A. H.

    1976-01-01

    Methods of determining the transmission and attenuation of sound propagating in nonuniform ducts with and without mean flows are discussed. The approaches reviewed include purely numerical techniques, quasi-one-dimensional approximations, solutions for slowly varying cross sections, solutions for weak wall undulations, approximation of the duct by a series of stepped uniform cross sections, variational methods and solutions for the mode envelopes.

  8. Intrahepatic Transposition of Bile Ducts

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

  9. Propagation of sound waves in ducts

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2000-01-01

    Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described.......Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described....

  10. Transcatheter stenting of arterial duct in duct-dependent congenital heart disease

    Directory of Open Access Journals (Sweden)

    Đukić Milan

    2013-01-01

    Full Text Available Introduction. Critical congenital heart diseases (CHD are mostly duct-dependent and require stable systemic-pulmonary communication. In order to maintain patency of the ductus arteriosus (DA, the first line treatment is Prostaglandin E1 and the second step is the surgical creation of aortic-pulmonary shunt. To reduce surgical risk in neonates with the critical CHD, transcatheter stenting of DA can be performed in selected cases. Case Outline. A four-month old infant was diagnosed with the pulmonary artery atresia with ventricular septal defect (PAA/VSD. The left pulmonary artery was perfused from DA, and the right lung through three major aortopulmonary collaterals (MAPCAs. A coronary stent was placed in the long and critically stenotic DA, with final arterial duct diameter of 3.5 mm, and significantly increased blood supply to the left lung. After the procedure, the infant’s status was improved with regard to arterial oxygen saturation, feeding and weight gain. During the follow-up, one year later, aortography revealed in-stent stenosis. The left pulmonary artery, as well as the branches, was well-developed and the decision was made to proceed with further surgical correction. Conclusion. Stenting of DA can be an effective alternative to primary surgical correction in selected patients with duct-dependent CHD.

  11. Ascariasis of the pancreatic duct.

    Science.gov (United States)

    Klimovskij, Michail; Dulskas, Audrius; Kraulyte, Zita; Mikalauskas, Saulius

    2015-09-15

    Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

  12. Intraductal approach to breast cancer: the role of mammary ductoscopy.

    Science.gov (United States)

    Deshmane, Vinay

    2010-09-01

    Mammary ductoscopy is a recent advance enabling direct visualisation and sampling of human mammary ducts using a micro endoscope. The majority of pre malignant and malignant changes in the breast arise from the epithelium lining the duct lobular unit, and access to this region by ductoscopy has the potential to revolutionise breast cancer diagnosis and treatment. The ability to sample ductal epithelium may allow identification of early malignant and pre-malignant cytological changes and assist surgical excision, facilitating diagnosis of non palpable cancer before detection on current imaging modalities. Presently, there are three main indications for ductoscopy in clinical practice viz. determining extent of resection for breast cancer, assessment of high risk individuals and in the management of patients with pathological nipple discharge. Our initial experience with ductoscopy in patients with nipple discharge undergoing surgery has been rewarding. Ductoscopy was feasible in 92% of patients. Abnormal findings on ductoscopy were associated with DCIS in 37% and DCIS with early invasive breast cancer in 21%, while normal ductoscopy correlated with a normal pathological assessment.

  13. Intraductal Oncocytic Papillary Neoplasm of the Pancreas: A Case of a Second Neoplasm in a Pancreas Cancer Survivor

    Directory of Open Access Journals (Sweden)

    Mrinal S Garg

    2015-01-01

    Full Text Available Context Cystic neoplasms, which are less common forms of exocrine pancreatic neoplasms, consist of mainly intraductal papillary mucinous neoplasms (IPMN and mucinous cystic neoplasms. Mucinous cystic neoplasms, unlike IPMN, are not associated with ductal growth, are usually multilocular in nature, and have ovarian type stroma. Mucinous cystadenocarcinoma is a type of mucinous cystic neoplasm more commonly found in women. Intraductal oncocytic papillary neoplasms of the pancreas are the least common variant of IPMN. Despite this classification, intraductal oncocytic papillary neoplasms have been compared to mucinous cystic neoplasms in previous studies and the classification is still questioned. Case report We report a rare case of an intraductal oncocytic papillary neoplasm of the pancreas occurring in a 52-year-old male with a prior history of surgically excised mucinous cystadenocarcinoma. This is the first known case of an intraductal oncocytic papillary neoplasm occurring after a prior pancreatic neoplasm. Conclusion As the diagnosis of intraductal oncocytic papillary neoplasms are rare, having only a few case reports and small series on which to understand its disease process, it is imperative to discuss each case and detail possible correlations with other pancreatic cystic neoplasms as well as distinctions from its current association within IPMN.

  14. PMR Graphite Engine Duct Development

    Science.gov (United States)

    Stotler, C. L.; Yokel, S. A.

    1989-01-01

    The objective was to demonstrate the cost and weight advantages that could be obtained by utilizing the graphite/PMR15 material system to replace titanium in selected turbofan engine applications. The first component to be selected as a basis for evaluation was the outer bypass duct of the General Electric F404 engine. The operating environment of this duct was defined and then an extensive mechanical and physical property test program was conducted using material made by processing techniques which were also established by this program. Based on these properties, design concepts to fabricate a composite version of the duct were established and two complete ducts fabricated. One of these ducts was proof pressure tested and then run successfully on a factory test engine for over 1900 hours. The second duct was static tested to 210 percent design limit load without failure. An improved design was then developed which utilized integral composite end flanges. A complete duct was fabricated and successfully proof pressure tested. The net results of this effort showed that a composite version of the outer duct would be 14 percent lighter and 30 percent less expensive that the titanium duct. The other type of structure chosen for investigation was the F404 fan stator assembly, including the fan stator vanes. It was concluded that it was feasible to utilize composite materials for this type structure but that the requirements imposed by replacing an existing metal design resulted in an inefficient composite design. It was concluded that if composites were to be effectively used in this type structure, the design must be tailored for composite application from the outset.

  15. Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

    Directory of Open Access Journals (Sweden)

    Yasuda Yoshikazu

    2005-10-01

    Full Text Available Abstract Background Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. Case presentation A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract. Conclusion This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder.

  16. Magnetic resonance pancreatography: comparison of two- and three-dimensional sequences for assessment of intraductal papillary mucinous neoplasm of the pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin-Young; Choi, Sun Young [Yonsei University Health System, Department of Radiology, Research Institute of Radiological Science, Seoul (Korea); Lee, Jeong Min; Kim, Soo Jin; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology and Institute of Radiation Medicine, Seoul (Korea); Lee, Min Woo [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea); Kim, Ji Yang [Seoul National University Hospital, Healthcare System Gangnam Center, Seoul (Korea)

    2009-09-15

    The purpose was to compare two-dimensional (2D) magnetic resonance pancreatography (MRP) with 3D MRP to evaluate intraductal papillary mucinous neoplasm (IPMN). Thirty-four patients (22 men, 12 women; age range, 45-80 years) with IPMN (n = 40) were examined with MRP on 2D and 3D sequences. Two readers independently reviewed the images to assess the overall image quality, artifacts, lesion location, communication with main pancreatic duct, and potential for malignancy. The readers assigned their confidence level (1-5) for predicting ductal communication of the lesion. The results of MRP were compared with endoscopic retrograde pancreatography and surgical and histopathologic findings. Studies obtained with 3D MRP were of significantly higher technical quality than those obtained with 2D MRP. Although 3D MRP showed higher area under the ROC curve (Az) values for predicting ductal communication of the lesion, there was no statistical significance between Az values of 2D and 3D MRP (Az for 2D = 0.821, 0.864 for readers 1 and 2, respectively, and Az for 3D= 0.964, 0.921). Accuracies for discriminating benign from malignant lesions were 70 and 67.5% (reader 1 and 2, respectively, for 2D) and 62.5 and 80.1% (3D). 3D MRP showed superior image quality to that of 2D MRP but did not increase the diagnostic accuracy for predicting ductal communication of the lesion. (orig.)

  17. Positron Emission Tomography with 2-Deoxy-2-[18F] Fluoro-DGlucose in the Detection of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

    Directory of Open Access Journals (Sweden)

    Brian KP Goh

    2007-05-01

    Full Text Available A 79-year-old Indian male was admitted with upper abdominal discomfort of 1-year duration which was associated with loss of weight and appetite. Clinical examination of the abdomen did not reveal any palpable masses. Laboratory investigations including a complete blood count, liver function tests and serum amylase were unremarkable. Standard serum tumor markers were within normal limits: carbohydrate antigen (CA 19-9, 13.4 U/mL (reference range: 3-45 U/mL; carcinoembryonic antigen (CEA, 1.4 μg/L (reference range: 0.5-3.5 μg/L and alphafetoprotein, 1.3 μg/L (reference range: 1-10 μg/L. A contrast-enhanced computed tomographic (CT scan demonstrated a cystically dilated and tortuous pancreatic duct measuring 1.9 cm, suggestive of an intraductal papillary mucinous neoplasm (IPMN. The common bile duct was dilated up to the level of the ampulla and a 3.2x2.0 cm heterogeneous soft tissue mass was observed in the head of the pancreas which extended into the duodenum, suggestive of a malignant lesion (Images 1 and 2. Fusion positron emission tomography/computed tomography (PET/CT was subsequently performed with 12.7 mCi of 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG administered intravenously. A whole body PET/CT scan was performed 60 minutes later with CT data used for attenuation correction and anatomical correlation. This confirmed a metabolically active focus within the pancreatic head mass with a standard uptake value (SUVmax of 3.5 compatible with carcinoma (Image 3.

  18. 14 CFR 29.1103 - Induction systems ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction systems ducts and air duct systems. 29.1103 Section 29.1103 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF....1103 Induction systems ducts and air duct systems. (a) Each induction system duct upstream of the...

  19. Migratory intralaryngeal thyroglossal duct cyst

    Directory of Open Access Journals (Sweden)

    Karlatti Pradeep

    2010-01-01

    Full Text Available Intralaryngeal thyroglossal duct cysts are rare; a migrating one, rarer still. Such a case may be a cause for confusion and it is important to understand this entity and its typical findings.

  20. TWO NEW DUCT LEAKAGE TESTS

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    1998-12-01

    Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

  1. Duct Leakage Repeatability Testing

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sherman, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-01-01

    Duct leakage often needs to be measured to demonstrate compliance with requirements or to determine energy or Indoor Air Quality (IAQ) impacts. Testing is often done using standards such as ASTM E1554 (ASTM 2013) or California Title 24 (California Energy Commission 2013 & 2013b), but there are several choices of methods available within the accepted standards. Determining which method to use or not use requires an evaluation of those methods in the context of the particular needs. Three factors that are important considerations are the cost of the measurement, the accuracy of the measurement and the repeatability of the measurement. The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards.

  2. Pancreatic lipoma with a solid nodule mimicking invasion from adjoining intraductal papillary mucinous neoplasm

    Directory of Open Access Journals (Sweden)

    Yoko Namiki, MD

    2016-06-01

    Full Text Available A 74-year-old man was referred to our hospital for a mass in the pancreatic head found during screening chest computed tomography. Contrast computed tomography showed a 5-cm multicystic mass with an irregular border containing a solid component showing contrast enhancement. Caudal to this mass, a 5-cm solid mass of fat density with a nodular soft-tissue component was found. Cytology of the aspirated pancreatic fluid revealed malignant cells, and surgery was performed for suspected intraductal papillary mucinous carcinoma. Pathologic analysis of the resected specimen revealed a collision tumor of intraductal papillary mucinous neoplasm (IPMN with high-grade dysplasia and pancreatic lipoma. The soft-tissue component within the lipoma was a nodule consisting of pancreatic tissue with inflammatory infiltration and hyalinization and was not associated with IPMN invasion.

  3. Exploring the Functional Disorder and Corresponding Key Transcription Factors in Intraductal Papillary Mucinous Neoplasms Progression

    Directory of Open Access Journals (Sweden)

    Guiying Bai

    2015-01-01

    Full Text Available This study has analyzed the gene expression patterns of an IPMN microarray dataset including normal pancreatic ductal tissue (NT, intraductal papillary mucinous adenoma (IPMA, intraductal papillary mucinous carcinoma (IPMC, and invasive ductal carcinoma (IDC samples. And eight clusters of differentially expressed genes (DEGs with similar expression pattern were detected by k-means clustering. Then a survey map of functional disorder in IPMN progression was established by functional enrichment analysis of these clusters. In addition, transcription factors (TFs enrichment analysis was used to detect the key TFs in each cluster of DEGs, and three TFs (FLI1, ERG, and ESR1 were found to significantly regulate DEGs in cluster 1, and expression of these three TFs was validated by qRT-PCR. All these results indicated that these three TFs might play key roles in the early stages of IPMN progression.

  4. 胰管内乳头状黏液性肿瘤361例的临床特征%Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 361 patients

    Institute of Scientific and Technical Information of China (English)

    王雷; 邵成浩; 郑建明; 王莉; 李兆申; 夏天; 廖专; 邹多武; 金震东; 杜奕奇; 湛先保; 胡先贵; 金钢

    2012-01-01

    Objective To analyse the clinical characterization of intraductal papillary mucinous neoplasm of pancreas (IPMNs) and to improve the understanding of IPMNs.Methods Three hundred and sixty-one patients with IPMN at Shanghai Changhai Hospital between 1993 and 2012 were retrospectively analyzed.Results Among 361 cases of IPMNs,241 were men and 120 were female,with a female to male ratio of 2.6∶1.Mean age of the patients was 62 years old (16 ~ 87 years old).The duct type included the main duct in 102 patients (28.3%),a branch duct in 109 (30.2%),and mixed ducts in 150 (41.6%).The most common symptom at presentation is pancreatitis,which occur in 167 patients (46.3%).The sensitivity for the detection of IPMN was 80.2% by ERCP,76.9% by MRCP,63.9% by CT,and 50.5% by EUS.One hundred and twenty-nine patients (35.7%) were operated and diagnosed with 87 (67.2%) IPMA,21 (16.4%) IPMB,10(8.2%) IPMC(CIS) and 10 (8.2%) had invasive carcinomas.The 5-year survival rates of IPMA,IPMB,IPMC,and invasive carcinomas were 100%,100%,66.5%,and 44.7%,respectively.Conclusions IPMNs were fregrently occured is 60 years old,half of patients had acute pancreatitis history and the frequtly attack,mixed type is most anatomy type,and the outcome after surgery is good.%目的 分析胰管内乳头状黏液性肿瘤(IPMN)的临床特征,以提高对该病的认识.方法 采用单中心回顾性研究方法,分析长海医院1993年1月至2012年8月间收治的361例IPMN的临床资料,分析其临床特征.结果 361例IPMN中,男性261例,女性100例,男女比例为2.6∶1,平均年龄61岁(16 ~87岁).其中主胰管型102例(28.3%),分支胰管型109例(30.2%),混合型150例(41.6%).患者的症状主要为急性胰腺炎发作,共167例(46.3%).内镜下胰胆管造影术(ERCP)的诊断符合率最高,为80.2%(130/162),MRCP、CT、内镜超声(EUS)的检查阳性率分别为76.9%(160/208)、63.9%(159/249)、50.5%(53/105).手术治疗129

  5. 胆管内与胰腺导管内乳头状黏液性肿瘤的比较%Comparison between biliary tract intraductal papillary mucinous neoplasm and intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    王幸; 陈拥华; 蔡云强; 赵法之; 谭春露; 柯能文; 刘续宝

    2015-01-01

    Objective To compare biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) with intraductal papillary mucinous neoplasm of the pancreas (P-IPMN).Methods From January 2008 to December 2013,eleven (6.0%) cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors resected in our institution,while 50 cases underwent surgery for P-IPMN.The mean age of the 11 BT-IPMN cases was 57.3 years (range 40 to 74 years).There were 8 men (73.0%).The mean age of the 50 P-IPMN cases was 57.4 years (range 33 to 85 years).There were 34 men (68.0%).The clinical features,radiologic findings,pathology,surgical strategies,and long-term follow up outcomes between the 2 groups of patients were analyzed.Results There was no significant difference between BT-IPMN and P-IPMN in the following aspects:mean age,sex ratios and clinical presentation [including the most common presenting symptom abdominal pain (73.0% vs.68.0%),and elevated tumor markers (CEA and CA19-9)].The mean tumor size of BT-IPMN was significantly smaller than P-IPMN (1.7 vs.4.1 cm,P < 0.05).Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation (100%) and intraluminal masses (55.0%).Most cases (82.0%) involved the intrahepatic bile duct and hilum.For tumor clearance,we conducted left hepatectomy in most cases (64.0%).Only one patient underwent biopsy and choledochojejunostomy for multiple tumors involving the extrahepatic,right and left bile ducts.BT-IPMN was likely to have a higher risk of malignancy (55.0% vs.44.0%) and poorer prognosis (median survival,57 vs.63 months),although there was no significant difference (P > 0.05).The patient without tumor resection died of liver failure 22 months after palliative surgery.Conclusions BT-IPMNs are very rare and they had some similarity with P-IPMN.Complete resection of BT

  6. MIB-1 labeling index, Ki-67, is an indicator of invasive intraductal papillary mucinous neoplasm

    OpenAIRE

    Shimura, Tatsuo; Kofunato, Yasuhide; OKADA, Ryo; Yashima, Rei; Okada, Koji; Araki, Kenichiro; Hosouchi, Yasuo; Kuwano, Hiroyuki; Takenoshita, Seiichi

    2016-01-01

    Despite strict criteria for the observation of intraductal papillary mucinous neoplasm (IPMN), it remains difficult to distinguish invasive IPMN from non-invasive IPMN. The aim of the present study was to identify an indicator of invasive IPMN. The present study retrospectively evaluated 53 patients (28 with non-invasive and 25 with invasive IPMN) who underwent resection of IPMN, and examined the usefulness of the MIB-1 labeling index as an indicator of invasive IPMN. The MIB-1 labeling index...

  7. Predictive factors associated with malignancy of intraductal papillary mucinous pancreatic neoplasms

    Institute of Scientific and Technical Information of China (English)

    Jin; Hee; Lee; Kyu; Taek; Lee; Jongwook; Park; Sun; Youn; Bae; Kwang; Hyuck; Lee; Jong; Kyun; Lee; Kee-Taek; Jang; Jin; Seok; Heo; Seong; Ho; Choi; Dong; Wook; Choi; Jong; Chul; Rhee

    2010-01-01

    AIM:To identify preoperative predictive factors associated with malignancy of intraductal papillary mucinous neoplasms(IPMNs) of the pancreas.METHODS:Between April 1995 and April 2010,129 patients underwent surgical resection for IPMNs at our institute and had confirmed pathologic diagnoses.The medical records were retrospectively reviewed and immunohistochemical staining for mucin(MUC) in pancreatic tissues was performed.RESULTS:Univariate analysis showed that the following five variables were closely asso...

  8. 胆管损伤的预防与治疗指南(2008版)%Guideline for the prevention and management of bile duct injury (2008 edition)

    Institute of Scientific and Technical Information of China (English)

    中华医学会外科学分会胆道外科学组

    2008-01-01

    Bile duct injury is an important clinical problem associated with significantly high perioperative morbidity and mortality, reduced long-term survival and poor quality of life, as well as high rate of malpractice litigation following iatrogenic causes. The management of bile duct injury remains a considerable challenge for even the most skilled hepatobiliary surgeons. Based on this situation, the Biliary Surgery Group of Surgery Branch of Chinese Medical Association compiled the Guideline for the prevention and management of bile duct injury. The guideline systematically explains the concept, causes, classification, diagnosis and treatment of bile duct injury. Three categories of bile duct injury, including intrahepatic bile duct injury, extrahepatic bile duct injury and bile duct injury in the pancreaticoduodenal region are proposed according to the anatomical site, causes, pathological characters, prevention and treatment of bile duct injury. Four types and 4 subtypes of the extrahepatic bile duct injury are classified according to the anatomical plane of the injured bile duct and the pathological character of the main bile duct, respectively.

  9. Study of active noise control in ducts. Kanrokei ni okeru nodoteki soon seigyo hoho no kento

    Energy Technology Data Exchange (ETDEWEB)

    Nakao, Yoshiatsu

    1988-08-01

    On an active control to reduce noise in ducts, the theoretical and experimental studies of the energies ratio of the noise and the cancelling sound which should be produced by a speaker, were carried out. In case the cancelling sound was produced by the speaker which was set in the branch duct, the energies ratio varied with the setting position, the length and the cross section of the branch duct and the frequency of the noise. As the non-dimensional length of the branch duct was drawing near 0.5, the energies ratio became small. But when the non-dimensional length was 0, the ratio did not become smaller than 1. The experimental test confirmed that it was possible to reduce the noise by the cancelling sound which energies ratio was as small as about one hundredth of the noise. In case the noise was the pure sound, and the wave-length was over one fourth of the duct diameter, it was possible to reduce the noise more than 40 dB. And in case the wave-length was one eighth the reduction quantity was about 20 dB. Therefore, in case the noise is the pure sound or close to the pure sound, it is possible to apply the active noise control. 5 references, 23 figures.

  10. Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

    Science.gov (United States)

    Fan, Wenge; Zhang, Qingsong; Wang, Lin; Ye, Xun; Jiang, Tingwang

    2016-01-01

    No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (Pgonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions. PMID:27861521

  11. An isolated nasolacrimal duct osteoma.

    Science.gov (United States)

    Kim, Joo Yeon; Kwon, Jae Hwan

    2013-07-01

    Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature.

  12. State of the Science and the Intraductal Approach for Breast Cancer: Proceedings Summary of The Sixth International Symposium on the Intraductal Approach To Breast Cancer Santa Monica, California, 19–21 February 2009

    Directory of Open Access Journals (Sweden)

    Rochman Susan

    2009-07-01

    Full Text Available Abstract Researchers are using the intraductal approach to advance breast cancer risk assessment, prevention, diagnosis, and treatment. Procedures and technologies that can access and interrogate the ductal-alveolar systems include nipple aspiration, ductal lavage and ductoscopy. Ductoscopic papillectomy, ductoscopic margin evaluation, and intraductal therapy are considered promising investigational and innovative treatments. These techniques are used to explore the biology of the normal breast; collect and analyze breast fluid and cells to identify biomarkers that can be used in breast cancer detection and risk assessment; and to identify new ways to find and administer therapeutic and/or preventive agents to the breast tissue. This report summarizes the latest research findings in these areas, presented at The 6th International Symposium on the Intraductal Approach to Breast Cancer in 2009.

  13. State of the Science and the Intraductal Approach for Breast Cancer: Proceedings Summary of The Sixth International Symposium on the Intraductal Approach To Breast Cancer Santa Monica, California, 19–21 February 2009

    Science.gov (United States)

    Rochman, Susan; Mills, Dixie; Kim, Julian; Kuerer, Henry; Love, Susan

    2009-01-01

    Researchers are using the intraductal approach to advance breast cancer risk assessment, prevention, diagnosis, and treatment. Procedures and technologies that can access and interrogate the ductal-alveolar systems include nipple aspiration, ductal lavage and ductoscopy. Ductoscopic papillectomy, ductoscopic margin evaluation, and intraductal therapy are considered promising investigational and innovative treatments. These techniques are used to explore the biology of the normal breast; collect and analyze breast fluid and cells to identify biomarkers that can be used in breast cancer detection and risk assessment; and to identify new ways to find and administer therapeutic and/or preventive agents to the breast tissue. This report summarizes the latest research findings in these areas, presented at The 6th International Symposium on the Intraductal Approach to Breast Cancer in 2009.

  14. Fan/Ram Duct Program

    Science.gov (United States)

    1973-10-01

    mwm^mmmt c INPUT I ] H—f TRANSIENT ROUTINE P"" CONTROL """I FAN ] COMPRESSOR MAIN BURNER I DUCT HZ HIGH TURBINE in— LOW TURBINE I...and pressure ratio. 6. Low Turbine Low turbine characteristics, identical In form to those of the high turbine, are shown in figures 27 and 28. 7

  15. Vitellointestinal Duct Anomalies in Infancy

    Science.gov (United States)

    Kadian, Yogender Singh; Verma, Anjali; Rattan, Kamal Nain; Kajal, Pardeep

    2016-01-01

    Background: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5–9 of intrauterine life. Methods: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013. Results: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention. Conclusion: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality. PMID:27433448

  16. Fragmentation of common bile duct and pancreatic duct stones by extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan Junior College, Seoul (Korea, Republic of); Son, Soon Yong; Lee, Won Hong [Asan Medical Center, Seoul (Korea, Republic of)

    1998-06-01

    To determine its usefulness and safety of extracorporeal shock-wave lithotripsy in common bile duct and pancreatic duct stones, we analyzed the results of 13 patients with common bile duct stones and 6 patients with pancreatic duct stones which were removed by endoscopic procedures using the balloon or basket, who was performed the extracorporeal shock-wave lithotripsy using the ultrasonography for stone localization with a spark gap type Lithotriptor(Dornier MPL 9000, Germany). Fragmentation and complete clearance of the common bile duct and pancreatic duct stones were obtained in 19 of 19 patients(100%). Apart from transient attacks of fever in 2 of 13 patients with common bile duct stones(15%) and mild elevation of serum amylase and lipase in 2 of 6 patients with pancreatic duct stones(33%), no other serious side effects were observed. In our experiences, extracorporeal shock-wave lithotripsy is a safe and useful treatment for endoscopically unretrievable common bile duct and pancreatic duct stones.

  17. Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis: Egg or hen?

    Institute of Scientific and Technical Information of China (English)

    Evangelos Kalaitzakis; Barbara Braden; Palak Trivedi; Yalda Sharifi; Roger Chapman

    2009-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is an increasingly reported entity. Extensive pancreatic calcification is generally thought to be a sign of chronic pancreatitis, but it may occur simultaneously with IPMN leading to diagnostic difficulties. We report a case of a patient initially diagnosed with chronic calcifying pancreatitis who was later shown to have a malignant IPMN. This case illustrates potential pitfalls in the diagnosis of IPMN in the case of extensive pancreatic calcification as well as clues that may lead the clinician to suspecting the diagnosis. The possible mechanisms of the relation between pancreatic calcification and IPMN are also reviewed.

  18. Refractory Jaundice From Intraductal Papillary Mucinous Neoplasm Treated With Cholangioscopy-Guided Radiofrequency Ablation.

    Science.gov (United States)

    Brown, Nicholas G; Camilo, Joel; McCarter, Martin; Shah, Raj J

    2016-04-01

    Intraductal papillary mucinous neoplasms (IPMNs) are epithelial neoplasms treated with surgical resection when appropriate. We present a 79-year-old man with jandice refractory to endoscopic stenting. Biliary radiofrequency ablation (RFA) with cholangioscopy was used as palliation of obstructive jaundice due to a mucin-producing pancreatic IPMN with fistulous biliary communication. Clinical improvement permitted surgery, and he returned to pre-illness status at 17 months. The use of cholangioscopy in the setting of mucinous filling defects can guide over-the-wire RFA for palliation and may be a bridge to surgery.

  19. Intraductal papillary mucinous neoplasms of the pancreas: reporting clinically relevant features.

    Science.gov (United States)

    Del Chiaro, Marco; Verbeke, Caroline

    2016-11-22

    Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas can exhibit a wide spectrum of macroscopic and microscopic appearances. This not only causes occasional difficulties for the reporting pathologist in distinguishing these tumours from other lesions, but is also relevant clinically. As evidence accumulates, it becomes clear that multiple macroscopic and histological features of these neoplasms are relevant to the risk for malignant transformation and, consequently, of prime importance for clinical patient management. The need for detailed reporting is therefore increasing. This review discusses the panoply of gross and microscopic features of IPMN as well as the recommendations from recent consensus meetings regarding the pathology reporting on this tumour entity.

  20. Clinical application of localization needle under mammary ductoscopy for surgical excision of intraductal neoplasms%乳管镜下置定位针在乳管内肿瘤手术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    朱旬; 邢春根; 金涛; 蔡立春

    2010-01-01

    Objective To evaluate the clinical value of breast localization needle placed via mammary ductoscopy in surgical treatment of patients with intraductal neoplasms. Methods In this study,76 patients with intraductal neoplasms diagnosized by mammary ductoscopy from January 2009 to March 2010 in the Second Affiliated Hospital of Soochow University were randomly divided into two groups.For methylene blue group,ducts with the lesion were marked by methylene blue injection before operation.For localization needle group,ducts were marked by localization needle placed via ductoscopy.The operative time,specimen weight,incision length and diagnostic coincidence rate were compared among the two groups. Results Compared to the methylene blue group,the localization needle group had a significantly shorter operative time (31 ± 8 min vs.42 ± 9 min),lighter specimen weight (1.51 ± 1.36 g vs.2.95 ± 2.07 g),and shorter incision (23.2 ± 7.8 mm vs.34.4 ± 7.1 mm).All the breast cancer cases dianosised by mammary ductoscopy were confirmed by postoperative pathology,but the localization needle group had a higher diagnostic coincidence rate than the methylene blue group (94.7% vs. 76.3%). Conclusion Localization needle under mammary ductoscopy is a reliable technique for localizing intraductal neolasms.The surgical excision guided by localization needle is accurate and less traumatic,and should be a routine method marking the tumor involved duct before operation.%目的 探讨经乳管镜置定位针引导的方法在乳管内肿瘤手术中的应用价值.方法 2009年1月至2010年3月,苏州大学附属第二医院76例采用乳管镜检查发现乳管内肿瘤的患者随机分为2组,每组各38例,分别在美兰标记和置定位针后进行手术,比较两组手术时间、切除标本重量、切口长度及手术前后诊断符合率.结果 定位组手术时间短于美兰组(31±8 min vs.42±9 min);定位组手术切除标本重量轻于美兰组(1.51±1.36 g vs.2.95±2

  1. Evaluation of intraductal papillary mucinous neoplasms of the pancreas on MDCT and MRI%胰腺导管内乳头状黏液性肿瘤的影像学表现及其在术前诊断相关性浸润性癌中的应用价值

    Institute of Scientific and Technical Information of China (English)

    王大丽; 周健; 郑双丽; 夏建余; 胡红杰

    2014-01-01

    Objective The purpose of our study was to evaluate the predictive factors of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT and MRI.Methods Preoperative MDCT or/and MRI of 27 consecutive patients (19 men,8 women,mean age 61.3 years) who had undergone surgical resection and had a pathological diagnosis of IPMN were retrospectively assessed.The type of ductal involvement,solid appearance of the lesion,location,tumor size of branch duct type and combined type lesions,maximum diameter of the tumor,caliber of the main pancreatic duct and the extent of the common bile duct dilatation were assessed on CT and MRI and correlated with the pathological findings of the invasive carcinoma.Two abdominal radiologists reviewed all the images,and when discrepancies of the findings were found,the consensus was reached by discussion.Results Pathological analysis revealed carcinoma in situ in two patients and invasive carcinoma in 19 patients arising from the IPMN.The type of ductal involvement (P =0.038),a solid mass (P =0.003) and the common bile duct dilatation (≥ 15 mm,P =0.004) were correlated with the presence of associated invasive carcinoma.For the finding of solid and cystic mass in predicting invasive IPMN,the sensitivity was 66.7%(8/12) and specificity was 100.0% (8/8),and for bile duct diameter ≥15 mm,the sensitivity was 47.4% (9/19) and specificity was 100.0% (8/8).However,no association was found between the location of the lesion and associated invasive carcinoma.The caliber of the main pancreatic duct of patients with associated invasive carcinoma was significantly larger than that in the cases without invasive carcinoma (8.07 ± 2.23 mm vs.4.86 ± 1.86 mm,P =0.002).When using the main pancreatic duct dilatation ≥ 4 mm as the threshold,the sensitivity and specificity in predicting invasive IPMN were 94.7% (18/19) and 37.5% (3/8),respectively.For the branch duct type and

  2. FDG-PET Findings of Intraductal Oncocytic Papillary Neoplasms of the Pancreas: Two Case Reports

    Directory of Open Access Journals (Sweden)

    Takashi Kato

    2012-06-01

    Full Text Available Intraductal oncocytic papillary neoplasm (IOPN of the pancreas is a rare pancreatic tumor. To date, there have been three case reports of IOPN which showed strong positivity on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET, raising the possibility of distinguishing IOPNs from other intraductal papillary mucinous neoplasms (IPMNs using FDG-PET. However, all three cases had large tumors, approximately 10 cm in diameter, and there are no case reports of FDG-PET findings of small IOPNs, i.e. tumors the average size of malignant IPMNs (3–5 cm. We report two cases with IOPN of average size with FDG-PET findings. Computed tomography (CT showed a multilocular cystic lesion 4 cm in diameter with a mural nodule 1 cm in diameter (case 1 and a cystic lesion 5 cm in diameter with a papillary mural nodule 4 cm in diameter (case 2. FDG-PET showed abnormal uptake at the same location as the pancreatic tumor revealed by CT in both cases. The maximum standardized uptake values of the lesions were 3.4 and 4.2, respectively. Surgical resection was performed and the tumor was diagnosed as IOPN with carcinoma in situ (case 1 and IOPN with minimal invasion (case 2. FDG-PET may be useful for diagnosing malignancy in IOPN, as it is in IPMN. However, in our two cases, strong accumulation was not observed in the IOPNs, which were within the average size range of malignant IPMNs.

  3. [Intraductal papillary mucinous neoplasm of the pancreas (IPMN)--standards and new aspects].

    Science.gov (United States)

    Distler, M; Welsch, T; Aust, D; Weitz, J; Grützmann, R

    2014-06-01

    Intraductal papillary mucinous neoplasms (IPMN) of the pancreas belong to the heterogeneous group of cystic pancreatic lesions and have been diagnosed more frequently in recent years. Diagnosis and differentiation from other cystic lesions (pseudocysts, serous-cystic neoplasias [SCN], mucinous-cystic neoplasias [MCN], intraductal papillary-mucinous neoplasias [IPMN] and solid pseudopapillary neoplasias [SPN]) is often challenging. IPMN of the pancreas are considered as precursor lesions for the development of invasive pancreatic cancer. However, depending on the morphological (MD-IPMN, BD-IPMN) and histological subtype (intestinal, pancreatobiliary, oncocytic or gastric) the malignant potential of IPMNs varies significantly. Hence, early diagnosis and selection of the appropriate therapeutic strategy is necessary for optimal outcome and cure. There is a strong consensus for the resection of all MD-IPMN. Small BD-IPMN without signs of malignancy can be followed by observation. The increasing understanding of the histopathology and tumour biology of IPMN has led to an amendment of the 2006 International Association of Pancreatology (IAP) guidelines for the treatment of cystic pancreatic tumours. In consideration of recent data, recommendations for observation and/or follow-up of IPMN cannot be given definitely.

  4. Histochemical Study of N-acetylgalactosamine Containing Glycoconjugate in Intraductal Carcinoma of the Breast by HPA Lectin

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Arab

    2006-01-01

    Full Text Available Introduction: Glycoconjugates are a class of glycoproteins or glycolipids, their terminal sugars are responsible for cell-cell and/or cell-extracellular matrix interactions. Aberrant glycosylation of these compounds are one of the most important aspects of cellular transformation, metastasis and escape of tumoral cells from immune system and resistance to antineoplastic drugs. Recent studies showed that patients with HPA (helix pomatia agglutinin positive intraductal carcinoma cells have worse prognosis compared to patients with HPA negative cells. The aim of the present study was to define the presence of GalNac terminal sugar in glycoconjugate of different grades of intraductal breast carcinoma and to compare the degree and the pattern of reactivity of tumoral cells to HPA lectin. Materials and Methods: The paraffin blocks belonging to 20 patients of intraductal carcinoma was chosen from pathology archive of Khatam-Al-Anbia hospital in Zahedan and 5-7 micrometer sections were prepared. Two expert pathologists determined histopathological grading independently. The lectin histochemistry was performed using HPA. The same observers determined histochemical grading. Data were analyzed by NPAR (non-parametric test of Mann Whitney. Results: Results of this study revealed that the pattern and the degree of histochemical reactivity of neoplastic cells differ in all grades of intraductal carcinoma. Histochemical staining showed significant difference between grades of intraductal carcinoma of the breast (p<0.003. The lowest reactivity was seen in grade I and the highest in grade III. Furthermore, the reaction of tumoral cells was primarily confined to apical surfaces of cells in grade I, to the Golgi zone in grade II, and to a diffuse cytoplasmic distribution in grade III. Conclusion: Our data suggest that the HPA reactivity of tumoral cells were different in all grades of intraductal carcinoma. The tumor cells showed aberrant glycosylation, which

  5. Neuro-Oncology Branch

    Science.gov (United States)

    ... tumors of the brain and spinal cord. Neuro-Oncology Clinical Fellowship This is a joint program with ... NCINeuroOncology@mail.nih.gov . Our News The Neuro-Oncology Branch Welcomes Dr. Mark Gilbert as New Branch ...

  6. Current surgical treatment for bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Masatoshi Makuuchi

    2007-01-01

    Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

  7. European experts consensus statement on cystic tumours of the pancreas.

    Science.gov (United States)

    Del Chiaro, Marco; Verbeke, Caroline; Salvia, Roberto; Klöppel, Gunter; Werner, Jens; McKay, Colin; Friess, Helmut; Manfredi, Riccardo; Van Cutsem, Eric; Löhr, Matthias; Segersvärd, Ralf

    2013-09-01

    Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.

  8. Application value of fiberoptic ductoscopy in the treatment of intraductal space occupying lesions%纤维乳管镜对乳腺导管内占位性病变的诊断及辅助手术治疗的应用价值

    Institute of Scientific and Technical Information of China (English)

    赵嫚; 乔婉晴; 涂巍

    2011-01-01

    Objective To evaluate the application value of fiberoptic ductoscopy in the treatment of intraductal occupying lesions with nipple discharge. Methods From September 2005 to December 2009 a total of 523 nipple discharge patients were examined using fiberoptic ductoscopy (FDS) in our hospital, among them 209 patients were found suffering intraductal space occupying lesions with nipple discharge, with diagnostic rate of 39. 96% . Of the 209 patients, 193 had benign lesions and were treated with ductoscopically guided duct excision, and 16 patients had malignant lesions, including intraductal papilloma canceration in 6 cases, ductal carcinoma in situ in 3 cases, infiltrating duct carcinoma in 6 cases and intraductal papilloma with calcification, severe atypical hyperplasia of breast adenosis and local canceration in 1 case, and were managed with breast conserving surgery in 5 cases, simple mastectomy in 3, modified radical mastectomy in 4 and modified radical mastectomy plus immediate prosthesis implantation in 4. FDS plus probe location method was used for all operations. All patients were pathologically confirmed. The follow up time was 556 months with median time of 25 months. Results The 193 patients with benign lesions were all cured, and the follow up showed that except 2 patients lost to follow up, the rest had no recurrence. For the 16 patients with malignant lesions, no recurrence, metastasis or death was found. Conclusions FDS is of clinical value in diagnosing intraductal occupying lesions with nipple discharge, and help to obtain accurate location and satisfactory therapeutic effect.%目的 评价纤维乳管镜(FDS)对伴有乳头溢液的乳腺导管内占位性病变的诊治的应用价值.方法 2005年9月至2009年12月本院采用FDS检查乳头溢液患者523例,发现乳腺导管内占位性病变209例(39.96%).209例乳腺导管内占位性病变患者中,193例良性病变,均行手术治疗;16例恶性病变(乳头状瘤恶变6例,导管原

  9. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: Recommendations of verona consensus meeting

    NARCIS (Netherlands)

    V. Adsay (Volkan); M. Mino-Kenudson (Mari); T. Furukawa (Toru); O. Basturk (Olca); G. Zamboni (Giuseppe); G. Marchegiani (Giovanni); C. Bassi (Claudio); R. Salvia (Roberto); G. Malleo (Giuseppe); S. Paiella (Salvatore); C.L. Wolfgang (Christopher L.); H. Matthaei (Hanno); G.J.A. Offerhaus; I.M. Adham; M.J. Bruno (Marco); M.D. Reid (Michelle D.); A. Krasinskas (Alyssa); G. Kloppel (Günter); N. Ohike (Nobuyuki); T. Tajiri (Takuma); K.-T. Jang (Kee-Taek); J.C. Roa (Juan Carlos); P.J. Allen (Peter J.); C. Fernández-Del Castillo (Carlos); J.-Y. Jang (Jin-Young); D.S. Klimstra (David); R.H. Hruban (Ralph)

    2016-01-01

    textabstractBackground: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Res

  10. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract : Recommendations of verona consensus meeting

    NARCIS (Netherlands)

    Adsay, Volkan; Mino-Kenudson, Mari; Furukawa, Toru; Basturk, Olca; Zamboni, Giuseppe; Marchegiani, Giovanni; Bassi, Claudio; Salvia, Roberto; Malleo, Giuseppe; Paiella, Salvatore; Wolfgang, Christopher L.; Matthaei, Hanno; Offerhaus, G. Johan; Adham, Mustapha; Bruno, Marco J.; Reid, Michelle D.; Krasinskas, Alyssa; Klöppel, Günter; Ohike, Nobuyuki; Tajiri, Takuma; Jang, Kee Taek; Roa, Juan Carlos; Allen, Peter; Fernández-Del Castillo, Carlos; Jang, Jin Young; Klimstra, David S.; Hruban, Ralph H.

    2016-01-01

    Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results: (1) Cr

  11. [Morphologic, morphometric and immunohistochemical studies on pancreatic intraductal hyperplasia and infiltrating carcinoma].

    Science.gov (United States)

    Tomaszewska, R

    1999-01-01

    Pancreatic cancer belongs to the neoplasms which are characterised by increasing morbidity and mortality. Five-year survival rates of about 0.4% are the norm, and little has changed in the last 70 years. Important etiological factors are age, sex, diet, tobacco smoking, alcohol abuse, occupation and chemical exposure, hereditary chronic pancreatitis, and previous surgery (cholecystectomy and gastrectomy). The majority of exocrine tumours of the pancreas are malignant and 80-90% of them comprise ductal adenocarcinomas. The development and growth of pancreatic carcinoma appears to be caused by a progressive accumulation of multiple genetic abnormalities. This includes oncogene (K-ras) activation, loss of tumour-suppressor p53 gene function and overexpression of growth factors and their ligands. The morphological background for the development of pancreatic carcinoma is ductal epithelial hyperplasia. Current molecular studies have resulted in the identification of cell clones exhibiting the same genetic alterations (K-ras and p53 mutations) as in infiltrating pancreatic carcinoma. Pancreatic intraepithelial neoplasia is only partially defined. The purpose of our study was to evaluate Ki-67 proliferative index and HER-2/neu gene expression in pancreatic intraepithelial proliferative lesions as a sign of increasing epithelial proliferation and dysplasia. Additionally we made an attempt to apply morphometry in demarcating between intraepithelial proliferations of "reactive" type and proliferations with tendency towards progression to cancer. Another aim of the study was to evaluate the expression of bcl-2 and p53 genes in various types of pancreatic intraepithelial proliferations and in pancreatic cancer and to answer the question whether they interact in the process of pancreatic intraepithelial neoplasia. We have also undertaken investigations aiming at determination of the CD44s gene and its v6 isoform expression in intraductal and invasive pancreatic carcinoma

  12. Methods of evaluating cleanliness of ventilation ducts

    Institute of Scientific and Technical Information of China (English)

    曹勇; 罗运有; 于丹; 甘丽斯

    2009-01-01

    A testing system for evaluating cleanliness of ventilation ducts was constructed. Comparisons of four evaluation methods for quantifying the amount of dust on the inner surface of ventilation ducts are presented. The experimental results show that the wiping by solvent method is more efficient than that by the wiping method,especially used on low cleanliness duct surface. The gravimetric tape method is an efficient method of collecting dust samples on the duct surface with low amounts of dust,particularly used to check the cleanliness level after the cleaning work. The optical method can be set up rapidly and is useful for fieldwork measurements.

  13. Twenty-Year Outcome Following Central Duct Resection for Bloody Nipple Discharge

    Science.gov (United States)

    Nelson, R Scott; Hoehn, James L.

    2006-01-01

    Background: Patients found with pathologic nipple discharge present a diagnostic dilemma to surgeons. No one diagnostic test, including cytology or radiologic imaging, has proved superior to any other in the differentiation of benign versus malignant sources of pathologic nipple discharge. Ductoscopy has been introduced as a way to assist with identification of potential sources of pathologic nipple discharge. Ductoscopy is also useful in the resection of deep or peripheral masses that may be missed with standard blind resection. This report evaluates the risk of missed malignancy following central duct resection (CDR). Methods: Records of 56 patients who underwent CDR for pathologic nipple discharge greater than 15 years previous were reviewed. Data including type of nipple discharge, future biopsy, and pathology reports were all examined. Results: Of the 56 patients, 36 had bloody, 18 serous, and 2 green initial discharges. Fifty-seven percent were found to have intraductal papilloma as the source of discharge, with fibrocystic disease and ductal ectasia providing the next most common causes. One woman was found to have ductal cancer and one lobular carcinoma in situ at time of CDR. Patients were followed for a mean period of 22 years. Fourteen women required future biopsy. Of these, 10 had benign disease and 4 had cancer, 3 on the ipsilateral side. The 3 women with breast cancer were 9, 13, and 17 years from initial resection. Conclusions: CDR for pathologic nipple discharge is an effective way to diagnose and treat pathologic nipple discharge without missing underlying cancers. PMID:16552204

  14. Resistance Characteristics of Hydraulic Oil through Isodiametric T-type Duct with Sharp Corners

    Institute of Scientific and Technical Information of China (English)

    TANG Jinglin; WANG Liwei; LI Xia

    2009-01-01

    Rational determination and reduction of local energy loss of oil flow at pipe junctions are of important significance to improve hydraulic pipeline's work efficiency, especially for complex hydraulic pipeline connected by isodiametric T-type ducts with sharp comers to get combined and divided flow. From this point of view, the formulae of resistance loss for combined flow and divided flow through isodiametric T-type duct with sharp comers as well as the correlations of resistance loss coefficients in the branches of the duct are derived using energy method. On this basis, resistance characteristics of hydraulic oil in the duct are obtained by numerical simulation of different flow modes, which are commonly applied in hydraulic pipelines, using computational fluid dynamics (CFD) method, and the reasons for the resistance loss are analyzed based on the pressure change mechanism in the flow field. A part of simulation results was validated with the reference data. The research shows that for combined flows the resistance loss of symmetrical is lower than that of tmsymmetrical to obtain low speed in common branch, but to gain high speed is quite the contrary, for divided flows, the symmetrical is always a reasonable choice to reduce resistance loss. These conclusions can be applied to optimize the design of hydraulic pipeline.

  15. Malignant phyllodes tumor of the breast with liposarcomatous differentiation and intraductal hyperplasia.

    Science.gov (United States)

    Ayadi-Kaddour, Aïda; Zeddini, Abdelfatteh; Braham, Emna; Ismail, Olfa; Mlika, Mona; Guelmami, Karim; El Mezni, Faouzi

    2015-01-01

    Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. 10 to 20% of phyllodes tumor show malignant transformation, often in the form of stroma, which usually shows fibrosarcomatous differentiation and rarely heterologous sarcomatous elements. Liposarcomatous differentiation is not common among phyllodes tumors. The correct diagnosis of heterologous liposarcomatous differentiation in a malignant PT requires identification of the biphasic component of the tumor. We reported a case of malignant phyllodes tumor which initially transformed into liposarcoma, in addition to a very rare intraductal hyperplasia and flat epithelial atypia. The patient was a 75-year-old woman, with a lump in the left breast without axillary lymphadenopathy. She also have a positive family history of breast carcinoma. She underwent surgery and still alive and disease free after one year.

  16. Radiated noise of ducted fans

    Science.gov (United States)

    Eversman, Walter

    The differences in the radiated acoustic fields of ducted and unducted propellers of the same thrust operating under similar conditions are investigated. An FEM model is created for the generation, propagation, and radiation of steady, rotor alone noise and exit guide vane interaction noise of a ducted fan. For a specified number of blades, angular mode harmonic, and rotor angular velocity, the acoustic field is described in a cylindrical coordinate system reduced to only the axial and radial directions. It is found that, contrary to the usual understanding of the Tyler and Sofrin (1962) result, supersonic tip speed rotor noise can be cut off if the tip Mach number is only slightly in excess of unity and if the number of blades is relatively small. If there are many blades, the fundamental angular mode number is large, and the Tyler and Sofrin result for thin annuli becomes more relevant. Shrouding of subsonic tip speed propellers is a very effective means of controlling rotor alone noise.

  17. Measure Guideline: Sealing and Insulating of Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R.; Puttagunta, S.

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  18. Measure Guideline. Sealing and Insulating Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Puttagunta, S. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  19. Secretory Duct Structure and Phytochemistry Compounds of Yellow Latex in Mangosteen Fruit

    Directory of Open Access Journals (Sweden)

    DORLY

    2008-09-01

    Full Text Available Yellow latex is the main problem in mangosteen agribusiness, because it is one factor lowering the fruit quality. The structure of yellow latex secretory ducts in the flower and fruit as well as in the root, stem and leaf of mangosteen (Garcinia mangostana L. seedling and the qualitative phytochemistry of yellow latex were studied. The ducts were branched, canal-like type. They were found in the exocarp, mesocarp, endocarp, aril of the fruit, flower, stem, and leaf. In the fruit, the biggest diameter of the secretory ducts was found in the endocarp. There were continuous secretory ducts from fruit stalk to the fruit. Ultrastructural observation showed that the ducts surrounded by specific epithelial cells, which were living cells containing dense cytoplasm with plastid, mitochondria and golgi apparatus organelles. The qualitative test indicated that the yellow latex collected from stem bark, outer part of fruit, young fruit pericarp, mature aril and young aril contained terpenoid, flavonoid and tannin, but not alkaloid, saponin and steroid, except in the young aril containing the steroid.

  20. Applying micro-perforated panels in the measurement of sound source characteristics in a duct system

    Institute of Scientific and Technical Information of China (English)

    SHEN Su; Goran Pavic; LIU Bilong; LI Xiaodong; TIAN Jing

    2012-01-01

    In order to measure the acoustic characteristics of the sound source in a duct system effectively without destroying the main duct, micro-perforated panel structures were applied in the new method by attaching the side branch tubes. The effect and influence to change the acoustical impedance of the loads in a duct system was analyzed and simulated for using one layer and double-layer micro-perforated panel and back cavities with different parameters such as panel thickness, hole diameter, perforation ration, back depth and so on. The results show that the load's resistance can be changed efficiently by adjusting panel thickness, hole diameter, perforation ratio, the ratio of cross-section between ducts and tubes and other parameters; and the load's reactance can be changed efficiently by adjusting back depth and distance between micro-perforated panel and main duct. It is also found that combinative usage of one layer and double-layer of these structures can change the reactance substantially in broad frequency domain. The method and the efficient performance of the structures with micro-perforated panel in the measurement were verified by the experiment under the situations of flow and no- flow. Finally, suggestions to design and apply these structures in the above-mentioned method in application were given.

  1. Double-duct liquid metal magnetohydrodynamic engine

    Science.gov (United States)

    Haaland, Carsten M.

    1995-01-01

    An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has-four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal is forced to flow back and forth in the duct by the movement of the pistons, which are alternatively driven by an internal combustion process. In the MHD generator, the two LM-MHD ducts pass in close proximity through a Hartmann duct with output transformer. AC power is produced by operating the engine with the liquid metal in the two generator ducts always flowing in counter directions. The amount of liquid metal maintained in the ducts may be varied. This provides a variable stroke length for the pistons. The engine/generator provides variable AC power at variable frequencies that correspond to the power demands of the vehicular propulsion. Also the engine should maintain nearly constant efficiency throughout the range of power usage. Automobiles and trucks could be powered by the invention, with no transmission or power converter devices being required.

  2. A rare case of bile duct cyst

    Institute of Scientific and Technical Information of China (English)

    Qing-Gang Wang; Shu-Tian Zhang

    2009-01-01

    Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types Ⅱ and Ⅱ bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

  3. Pancreatic duct holder for facilitating duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy.

    Science.gov (United States)

    Sugiyama, Masanori; Suzuki, Yutaka; Abe, Nobutsugu; Ueki, Hisayo; Masaki, Tadahiko; Mori, Toshiyuki; Atomi, Yutaka

    2009-01-01

    Duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy may be technically difficult, particularly in cases in which the remnant pancreas is soft with a small main pancreatic duct. We devised a pancreatic duct holder for duct-to-mucosa pancreatojejunostomy. The holder has a cone-shaped tip. A one-third circle of the tip is cut away, which makes a slit. As the tip is inserted gently into the pancreatic duct, the duct can be adequately expanded. The holder provides a good surgical field for anastomosis. A slit of the tip allows needle insertion. The holder facilitates stitches of the jejunum also. Twelve patients underwent pancreatoduodenectomy, followed by duct-to-mucosa pancreatojejunostomy using the holder. The holder allowed 8 or more stitches in duct-to-mucosa anastomosis, even in patients with a small pancreatic duct. No patients developed prolonged pancreatic leakage or pancreatic fistula postoperatively. In conclusion, the pancreatic duct holder is a simple and useful tool for facilitating duct-to-mucosa pancreatojejunostomy.

  4. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results Neoplasia papilar mucinosa intraductal del páncreas: resultados clínico-patológicos

    OpenAIRE

    Cienfuegos, J.A. (Javier A.); Rotellar, F. (Fernando); P. Martí-Cruchaga; V. Valentí; G. Zozaya; Bueno, A.; N. Pedano; Lozano, M. D.; J. J. Sola; F. Pardo

    2010-01-01

    Background: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recomme...

  5. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Nagano; Kenichi Matsuo; Katsuya Gorai; Kazuya Sugimori; Chikara Kunisaki; Hideyuki Ike; Katsuaki Tanaka; Toshio Imada; Hiroshi Shimada

    2006-01-01

    We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.

  6. The Fourth International Symposium on the Intraductal Approach to Breast Cancer, Santa Barbara, California, 10–13 March 2005

    Science.gov (United States)

    King, Bonnie L; Love, Susan M; Rochman, Susan; Kim, Julian A

    2005-01-01

    Intraductal approaches encompass procedures and technologies that are designed to access and interrogate the ductal–alveolar systems of the human breast, and include nipple aspiration, ductal lavage, random periareolar fine needle aspiration, and ductoscopy. These approaches are being used to collect and analyze fluids and cells to develop methods for breast cancer detection and risk assessment; to introduce imaging technologies to explore the mammary tree for abnormalities; to administer therapeutic and/or preventive agents directly to the breast tissue; and to explore the biology of the normal mammary gland. The latest research findings in these areas, presented at The 4th International Symposium on the Intraductal Approach to Breast Cancer in 2005, are summarized in this report. PMID:16168138

  7. Diagnosis and management of intraductal papillary mucinous neoplasm in pancreas(IPMN)by endoscopy%内镜诊治胰腺导管内乳头状粘液性肿瘤的应用

    Institute of Scientific and Technical Information of China (English)

    杨蕾; 张斌; 李长铧; 邱云峰; 刘洋

    2012-01-01

    目的 探讨胰腺导管内乳头状粘液性肿瘤(IPMN)的诊断、内镜下治疗,以提高对该疾病的认识及内镜对其诊断及治疗的意义.方法 回顾性分析经内镜诊治的IPMN患者12例,总结并分析他们的一般情况、临床症状、影像学检查、实验室检查、内镜下治疗等方面资料.结果 12例IPMN患者以老年男性为主,无特异性临床表现,主要发生部位为胰头或钩突部,CT主要表现为囊实性低密度影,其内可有壁结节,胰管扩张伴或不伴胆管扩张,2例侵及胰腺实质.磁共振胰胆管造影(MRCP)主要表现为胰管扩张,胰腺萎缩,胰头部圆形高信号影.内镜下逆行胰胆管造影(ERCP)显示十二指肠乳头膨大,开口扩张,可见胶冻样粘液流出,胰管造影显示胰管全程扩张或胰头部囊状扩张,3例伴胆总管、肝内胆管扩张.9例行ERCP治疗,清除粘液栓并置入胰管支架,3例同时置入胆管支架.结论 IPMN是一种特殊类型的胰腺囊性疾病,影像学检查有其独特的表现,ERCP对其诊断及治疗有重要意义.%Objective To study the clinical diagnosis and treatment of intraductal papillary mucinous neoplasm in pancreas ( IPMN ) and evaluate the role of endoscopy in diagnosis and treatment. Methods The data of 12 patients with IPMN including general state of health, clinical characteristic of imaging findings, treatment by ERCP were retrospectively reviewed. Results This group is mainly of old men and no specific clinical information. CT demonstrated the cystic and solid lesion in the head or uncinate process of pancreas with mural nodules and dilatation of pancreatic duct. MRCP showed dilatation of pancreatic duct, high signal in the head of pancreas and atrophy of pancreas. ERCP was performed in all patients and found an abnormal protruding papilla of Vater with expulsion of mucous material, of whom 3 cases with dilatation of main pancreatic duct, 5 cases with cystic dilatation of head pancreatic duct, 3

  8. A case report: Cavitary infarction caused by pulmonary tumor thrombotic microangiopathy in a patient with pancreatic intraductal papillary mucinous neoplasm

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Kyoung Kyg; Kwon, Woon Jung; Choi, Seong Hoon; Lee, Jong Hwa; Cha, Hee Jeong [Ulsan University Hospital, University of Ulsan School of Medicine, Ulsan (Korea, Republic of)

    2015-08-15

    Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

  9. Melons are branched polymers

    CERN Document Server

    Gurau, Razvan

    2013-01-01

    Melonic graphs constitute the family of graphs arising at leading order in the 1/N expansion of tensor models. They were shown to lead to a continuum phase, reminiscent of branched polymers. We show here that they are in fact precisely branched polymers, that is, they possess Hausdorff dimension 2 and spectral dimension 4/3.

  10. Possible additional value of 18FDG-PET in managing pancreas intraductal papillary mucinous neoplasms: Preliminary results

    Directory of Open Access Journals (Sweden)

    Pizzocaro Claudio

    2008-06-01

    Full Text Available Abstract Although some clinical and radiological features may predict malignancy presence in intraductal papillary mucinous pancreas neoplasms, preoperative diagnosis remains difficult. In this study we present 7 patients with Intraductal Papillary Mucinous Neoplasm (IPMN studied both with 18FDG-PET and magnetic resonance cholangiopancreatography (MRCP. A focal hypermetabolism was documented in 2 patients (the standardized uptake value in the neoplastic foci was 6.7 and 9, while absence of FDG uptake in the neoplasm area was recorded in the remaining 5 cases. Mean follow-up was 27 months (range 21–34. The final judgement was benign IPMN in 5 cases and malignant IPMN in 2. PET scan always correctly predicted the presence or absence of malignancy, while MRCP failed to detect malignancy in 3/7 cases. In conclusion, this preliminary experience suggests that 18FDG-PET may prove useful for malignancy detection in IPMN, improving differential diagnosis with benign intraductal papillary growth by functional data.

  11. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  12. A case of eosinophilic cholangitis: Imaging findings of contrast-enhanced ultrasonography, cholangioscopy, and intraductal ultrasonography

    Institute of Scientific and Technical Information of China (English)

    Naoki Matsumoto; Masahiko Sugitani; Kiyoshi Yokoyama; Kazuhiko Nakai; Toshiki Yamamoto; Takeshi Otani; Masahiro Ogawa; Naohide Tanaka; Ariyoshi Iwasaki; Yasuyuki Arakawa

    2007-01-01

    A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils.Treatment was started with prednisolone 60 mg daily.The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile dud. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.

  13. High-frequency data observations from space shuttle main engine low pressure fuel turbopump discharge duct flex joint tripod failure investigation

    Science.gov (United States)

    Zoladz, T. F.; Farr, R. A.

    1991-01-01

    Observations made by Marshall Space Flight Center (MSFC) engineers during their participation in the Space Shuttle Main Engine (SSME) low pressure fuel turbopump discharge duct flex joint tripod failure investigation are summarized. New signal processing techniques used by the Component Assessment Branch and the Induced Environments Branch during the failure investigation are described in detail. Moreover, nonlinear correlations between frequently encountered anomalous frequencies found in SSME dynamic data are discussed. A recommendation is made to continue low pressure fuel (LPF) duct testing through laboratory flow simulations and MSFC-managed technology test bed SSME testing.

  14. Paraurethral Skene's duct cyst in a newborn

    Science.gov (United States)

    Moralioğlu, Serdar; Bosnalı, Oktav; Celayir, Ayşenur Cerrah; Şahin, Ceyhan

    2013-01-01

    Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage. PMID:24049387

  15. General Information about Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  16. Treatment Options for Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  17. Stages of Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  18. Treatment Option Overview (Extrahepatic Bile Duct Cancer)

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  19. Transmission of wave energy in curved ducts

    Science.gov (United States)

    Rostafinski, W.

    1973-01-01

    A formation of wave energy flow was developed for motion in curved ducts. A parametric study over a range of frequencies determined the ability of circular bends to transmit energy for the case of perfectly rigid walls.

  20. Ducted propagation of chorus waves: Cluster observations

    Directory of Open Access Journals (Sweden)

    K. H. Yearby

    2011-09-01

    Full Text Available Ducted propagation of whistler waves in the terrestrial magnetosphere-ionosphere system was discussed and studied long before the first in-situ spacecraft measurements. While a number of implicit examples of the existence of ducted propagation have been found, direct observation of ducts has been hampered by the low sampling rates of measurements of the plasma density. The present paper is based on Cluster observations of chorus waves. The ability to use measurements of the spacecraft potential as a proxy for high time resolution electron density measurements is exploited to identify a number of cases when increased chorus wave power, observed within the radiation belts, is observed simultaneously with density enchantments. It is argued that the observation of ducted propagation of chorus implies modification of numerical models for plasma-wave interactions within the radiation belts.

  1. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    Energy Technology Data Exchange (ETDEWEB)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A. [University of Pennsylvania Perelman School of Medicine, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Rambhatla, Siri J. [Beth Israel Medical Center, Department of Pediatrics, Newark, NJ (United States); Sreedharan, Ram R. [University of Pennsylvania, Departments of Gastroenterology, Hepatology and Nutrition, The Children' s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (United States)

    2015-08-15

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  2. Branching processes in biology

    CERN Document Server

    Kimmel, Marek

    2015-01-01

    This book provides a theoretical background of branching processes and discusses their biological applications. Branching processes are a well-developed and powerful set of tools in the field of applied probability. The range of applications considered includes molecular biology, cellular biology, human evolution and medicine. The branching processes discussed include Galton-Watson, Markov, Bellman-Harris, Multitype, and General Processes. As an aid to understanding specific examples, two introductory chapters, and two glossaries are included that provide background material in mathematics and in biology. The book will be of interest to scientists who work in quantitative modeling of biological systems, particularly probabilists, mathematical biologists, biostatisticians, cell biologists, molecular biologists, and bioinformaticians. The authors are a mathematician and cell biologist who have collaborated for more than a decade in the field of branching processes in biology for this new edition. This second ex...

  3. Transition duct assembly with modified trailing edge in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; Schott, Carl Gerard; Ingram, Clint Luigie; Siden, Gunnar Leif; Pierre, Sylvain

    2016-10-04

    Transition duct assemblies for turbine systems and turbomachines are provided. In one embodiment, a transition duct assembly includes a plurality of transition ducts disposed in a generally annular array and comprising a first transition duct and a second transition duct. Each of the plurality of transition ducts includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of each transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct assembly further includes an aerodynamic structure defined by the passages of the first transition duct and the second transition duct. The aerodynamic structure includes a pressure side, a suction side, and a trailing edge, the trailing edge having a modified aerodynamic contour.

  4. INTERIOR DUCT SYSTEM DESIGN, CONSTRUCTION, AND PERFORMANCE

    Energy Technology Data Exchange (ETDEWEB)

    Janet E.R. Mcllvaine; David Beal; Philip Fairey

    2001-10-10

    By removing air distribution and conditioning equipment from unconditioned spaces, homeowners stand to benefit substantially with respect to both energy savings and indoor air quality. Duct leakage introduces: Greater heating and cooling loads from air at extreme temperatures and humidity levels; Outside air and air from unconditioned spaces that may contain air borne contaminants, combustion gases, pollen, mold spores, and/or particles of building materials; and Higher whole-house infiltration/exfiltration rates. Exemplary studies conducted since 1990 have demonstrated the prevalence of duct leakage throughout the United States and measured energy savings of approximately 20% during both heating and cooling seasons from leakage reduction. These all dealt with duct leakage to and/or from unconditioned spaces. In the building science community, leakage within the conditioned space is generally presumed to eliminate the negative consequences of duct leakage with the exception of possibly creating pressure imbalances in the house which relates to higher infiltration and/or exfiltration. The practical challenges of isolating ducts and air handlers from unconditioned spaces require builders to construct an air-tight environment for the ducts. Florida Solar Energy Center researchers worked with four builders in Texas, North Carolina, and Florida who build a furred-down chase located either in a central hallway or at the edges of rooms as an architectural detail. Some comparison homes with duct systems in attics and crawl spaces were included in the test group of more than 20 homes. Test data reveals that all of the duct/AHU systems built inside the conditioned space had lower duct leakage to unconditioned spaces than their conventional counterparts; however, none of the homes was completely free of duct leakage to unconditioned spaces. Common problems included wiring and plumbing penetrations of the chase, failure to treat the chase as an air tight space, and misguided

  5. Branched Polymer Revisited

    CERN Document Server

    Aoki, H; Kawai, H; Kitazawa, Y; Aoki, Hajime; Iso, Satoshi; Kawai, Hikaru; Kitazawa, Yoshihisa

    2000-01-01

    We show that correlation functions for branched polymers correspond to those for $\\phi^3$ theory with a single mass insertion, not those for the $\\phi^3$ theory themselves, as has been widely believed. In particular, the two-point function behaves as 1/p^4, not as 1/p^2. This behavior is consistent with the fact that the Hausdorff dimension of the branched polymer is four.

  6. Gas Explosions Mitigation by Ducted Venting

    OpenAIRE

    2007-01-01

    The mitigation of effects of gas and dust explosions within industrial equipment is effective if venting the combustion products to safe location. The presence of relief duct is however likely to increase the severity of the explosion with respect to equipment vented to open atmosphere, due to secondary explosions occurring in the initial sections of duct, frictional drag and inertia of the gas column, acoustic and Helmholtz oscillations. The weights of these phenomena on explosion e...

  7. Effect of shear on duct wall impedance.

    Science.gov (United States)

    Goldstein, M.; Rice, E.

    1973-01-01

    The solution to the equation governing the propagation of sound in a uniform shear layer is expressed in terms of parabolic cylinder functions. This result is used to develop a closed-form solution for acoustic wall impedance which accounts for both the duct liner and the presence of a boundary layer in the duct. The effective wall impedance can then be used as the boundary condition for the much simpler problem of sound propagation in uniform flow.

  8. Energy Conservation Through Duct Leakage Reduction

    Science.gov (United States)

    2004-02-26

    Energy Conservation Through Duct Leakage Reduction February 26, 2004 Rich Glatt – Lindab Inc. Report Documentation Page Form ApprovedOMB No. 0704...4. TITLE AND SUBTITLE Energy Conservation Through Duct Leakage Reduction 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...Wall – DW that installs like SW - easiest installing DW system on the market – Eliminates the need for costly flanged connections – SMACNA Leakage

  9. Koenigs function and branching processes

    CERN Document Server

    Chikilev, O G

    2001-01-01

    An explicit solution of time-homogeneous pure birth branching processes is described. It gives alternative extensions for the negative binomial distribution (branching processes with immigration) and for the Furry-Yule distribution (branching processes without immigration).

  10. Double common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Srdjan P Djuranovic; Milenko B Ugljesic; Nenad S Mijalkovic; Viktorija A Korneti; Nada V Kovacevic; Tamara M Alempijevic; Slaven V Radulovic; Dragan V Tomic; Milan M Spuran

    2007-01-01

    Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

  11. A Comparison of Simulation Capabilities for Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Miller, William A [ORNL; Smith, Matt K [ORNL; Gu, Lixing [Florida Solar Energy Center (FSEC); New, Joshua Ryan [ORNL

    2014-11-01

    Typically, the cheapest way to install a central air conditioning system in residential buildings is to place the ductwork in the attic. Energy losses due to duct-attic interactions can be great, but current whole-house models are unable to capture the dynamic multi-mode physics of the interactions. The building industry is notoriously fragmented and unable to devote adequate research resources to solve this problem. Builders are going to continue to put ducts in the attic because floor space is too expensive to closet them within living space, and there are both construction and aesthetic issues with other approaches such as dropped ceilings. Thus, there is a substantial need to publicly document duct losses and the cost of energy used by ducts in attics so that practitioners, builders, homeowners and state and federal code officials can make informed decisions leading to changes in new construction and additional retrofit actions. Thus, the goal of this study is to conduct a comparison of AtticSim and EnergyPlus simulation algorithms to identify specific features for potential inclusion in EnergyPlus that would allow higher-fidelity modeling of HVAC operation and duct transport of conditioned air. It is anticipated that the resulting analysis from these simulation tools will inform energy decisions relating to the role of ducts in future building energy codes and standards.

  12. Pancreatic mucinous noncystic (colloid) carcinomas and intraductal papillary mucinous carcinomas are usually microsatellite stable.

    Science.gov (United States)

    Lüttges, Jutta; Beyser, Kurt; Pust, Susanne; Paulus, Anja; Rüschoff, Josef; Klöppel, Günter

    2003-06-01

    Pancreatic mucinous noncystic (colloid) carcinomas (MNCC) differ from the usual ductal adenocarcinomas in their mucin expression profile and share with many extrapancreatic mucinous carcinomas the expression of MUC2. Because mucinous carcinomas are frequently associated with mutations of the DNA mismatch repair genes, causing them to exhibit the so-called mutator phenotype, we decided to investigate whether MNCCs of the pancreas are characterized by microsatellite instability (MSI). Twelve carcinomas with a mucinous phenotype (8 mucinous noncystic carcinomas, 3 intraductal papillary-mucinous carcinomas with an invasive muconodular component, and 1 ductal adenocarcinoma with an extensive mucinous noncystic component) and 11 ductal adenocarcinomas were immunostained with monoclonal antibodies to the mismatch repair gene products hMLH1, hMSH2, and hMSH6. For MSI analysis, DNA was isolated from microdissected tissue, and five primary microsatellites (BAT 25, BAT 26, D5S346, D17S250, and D2S123) were analyzed. MSI was diagnosed in case a novel allele was found, compared with the normal tissue. The criterion for LOH was a 75% signal reduction. All carcinomas tested exhibited nuclear expression of mismatch repair gene products, except for one MNCC that also showed MSI at the molecular level. The data suggest that pancreatic carcinomas with a mucinous phenotype (MUC2+/MUC1-) do not appear to normally exhibit mutations in the mismatch repair genes and therefore differ in their carcinogenesis from those in other organs.

  13. Glycemic Control after Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Laith H. Jamil

    2012-01-01

    Full Text Available Background. Glycemic control following total pancreatectomy (TP has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM. Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P=0.52, 12 months (7.3% versus 8.0%, P=0.081, 18 months (7.7% and 7.6%, P=0.64, and at 24 months (7.3% versus 7.8%, P=0.10. Seven TP patients (50% experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P=0.38. Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.

  14. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.

  15. Damage Tolerance Assessment Branch

    Science.gov (United States)

    Walker, James L.

    2013-01-01

    The Damage Tolerance Assessment Branch evaluates the ability of a structure to perform reliably throughout its service life in the presence of a defect, crack, or other form of damage. Such assessment is fundamental to the use of structural materials and requires an integral blend of materials engineering, fracture testing and analysis, and nondestructive evaluation. The vision of the Branch is to increase the safety of manned space flight by improving the fracture control and the associated nondestructive evaluation processes through development and application of standards, guidelines, advanced test and analytical methods. The Branch also strives to assist and solve non-aerospace related NDE and damage tolerance problems, providing consultation, prototyping and inspection services.

  16. Right bundle branch block

    DEFF Research Database (Denmark)

    Bussink, Barbara E; Holst, Anders Gaarsdal; Jespersen, Lasse;

    2013-01-01

    AimsTo determine the prevalence, predictors of newly acquired, and the prognostic value of right bundle branch block (RBBB) and incomplete RBBB (IRBBB) on a resting 12-lead electrocardiogram in men and women from the general population.Methods and resultsWe followed 18 441 participants included.......5%/2.3% in women, P Right bundle branch block was associated with significantly.......60-1.62). The presence of IRBBB was not associated with any adverse outcome.ConclusionIn this cohort study, RBBB and IRBBB were two to three times more common among men than women. Right bundle branch block was associated with increased cardiovascular risk and all-cause mortality, whereas IRBBB was not. Contrary...

  17. Transurethral resection of the ejaculatory duct.

    Science.gov (United States)

    Paick, J S

    2000-05-01

    Complete bilateral ejaculatory duct obstruction has long been recognized as an uncommon, treatable form of male infertility. Partial ejaculatory duct obstruction reflects a disturbance of ejaculation where sperm quality is impaired during transit through the distal vas deferens and ejaculatory ducts. With the advent and increased use of high-resolution transrectal ultrasonography, abnormalities of the distal ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. In an infertile man with oligospermia or azoospermia with low ejaculate volume, normal secondary sexual characteristics, testes and hormonal profile and dilated seminal vesicles, midline cyst, or calcification on transrectal ultrasonography, ejaculatory duct obstruction is suggested. Of course, other causes of infertility may be concomitantly present and need to be searched for and treated as well. In selected cases, transurethral resection has resulted in marked improvement in semen parameters and pregnancies have been achieved. As is the case with all surgical procedures, proper patient selection and surgical experience are necessary to obtain optimal results. However, it appears that the treatments currently available for relief of ejaculatory obstruction are not optimally effective. Only approximately one half of treated patients will have an improvement in semen parameters and only about one quarter of treated patients will contribute to a pregnancy. What remains to be determined is how to manage the additional nearly 50% of patients who do not benefit from transurethral resection of ejaculatory obstruction. Based on my experience, I suggest that transrectal ultrasonography should be the first diagnostic procedure used when infertile men are suspected of having ejaculatory duct obstruction; however, vasography should still be considered for a more

  18. Salivary duct carcinoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Mona Mlika

    2012-01-01

    Full Text Available Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as "salivary duct carcinoma." The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis.

  19. Characterization of flow in a scroll duct

    Science.gov (United States)

    Begg, E. K.; Bennett, J. C.

    1985-01-01

    A quantitative, flow visualization study was made of a partially elliptic cross section, inward curving duct (scroll duct), with an axial outflow through a vaneless annular cutlet. The working fluid was water, with a Re(d) of 40,000 at the inlet to the scroll duct, this Reynolds number being representative of the conditions in an actual gas turbine scroll. Both still and high speed moving pictures of fluorescein dye injected into the flow and illuminated by an argon ion laser were used to document the flow. Strong secondary flow, similar to the secondary flow in a pipe bend, was found in the bottom half of the scroll within the first 180 degs of turning. The pressure field set up by the turning duct was strong enough to affect the inlet flow condition. At 90 degs downstream, the large scale secondary flow was found to be oscillatory in nature. The exit flow was nonuniform in the annular exit. By 270 degs downstream, the flow appeared unorganized with no distinctive secondary flow pattern. Large scale structures from the upstream core region appeared by 90 degs and continued through the duct to reenter at the inlet section.

  20. Numerical simulation of flow past circular duct

    Institute of Scientific and Technical Information of China (English)

    Ze-gao YIN; Xian-wei Cao; Hong-da SHI; Jian MA

    2010-01-01

    The Renormalization Group(RNG)k-ε turbulence model and Volume of Fluid(VOF)method were employed to simulate the flow past a circular duct in order to obtain and analyze hydraulic parameters.According to various upper and bottom gap ratios,the force on the duct was calculated.When the bottom gap ratio is 0,the drag force coefficient,lift force coefficient,and composite force reach their maximum values,and the azimuth reaches its minimum.With an increase of the bottom gap ratio from 0 to 1,the drag force coefficient and composite force decrease sharply,and the lift force coefficient does not decreases so much,but the azimuth increases dramatically.With a continuous increase of the bottom gap ratio from 1 upward,the drag force coefficient,lift force coefficient,composite force,and azimuth vary little.Thus,the bottom gap ratio is the key factor influencing the force on the circular duct.When the bottom gap ratio is less than 1,the upper gap ratio has a remarkable influence on the force of the circular duct.When the bottom gap ratio is greater than 1,the variation of the upper gap ratio has little influence on the force of the circular duct.

  1. Breast ductoscopy and the evolution of the intra-ductal approach to breast cancer.

    Science.gov (United States)

    Dooley, William C

    2009-01-01

    Interest in breast endoscopy came from Oriental investigators in the early 1990s where bloody nipple discharge is a more common presentation of breast cancer. The early techniques using a single microfiber scope without ductal distension was successful in navigating only the first 1-3 cm of the ducts and fraught with technical problems such as scope breakage and poor image quality. In spite of these barriers there has been increasing use of this technology in Japan and more widespread acceptance as the technology of scope design improved. Dooley and others tested a new method of obtaining a rich cytologic specimen from the ducts of high-risk women known as ductal lavage recently. The success of this procedure was that it detected severe cytologic and malignant atypia in clinically and radiographically normal breasts. Reproducibly, the same breast duct could be cannulated and severely atypical cytology obtained. The problem arose in identifying the lesion within the breast, which was the source for the atypia. New American multi-fiber microendoscopes were applied to solve this problem in an initial series of patients with abnormal cytology to identify the lesions. Success of that series lead to wider application of the imaging technology and eventual adoption of this imaging modality help to guide during all non-mastectomy breast surgery where fluid could be elicited from the nipple to identify the duct connecting to the lesion for which surgery was being performed. Initial reports have demonstrated the types of operative findings in certain sub-populations early in the use of this technology.

  2. Convolution seal for transition duct in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2015-05-26

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface feature for interfacing with an adjacent transition duct. The turbine system further includes a convolution seal contacting the interface feature to provide a seal between the interface feature and the adjacent transition duct.

  3. Management of pancreaticobiliary disease using a new intra-ductal endoscope: The Texas experience

    Institute of Scientific and Technical Information of China (English)

    Douglas S Fishman; Paul R Tarnasky; Sandeep N Patel; Isaac Raijman

    2009-01-01

    AIM: To evaluate a new single-operator mini-endoscope,Spyglass(R), for its performance, feasibility and safety in the management of pancreaticobiliary disease.METHODS: In a multicenter retrospective analysis of patients undergoing intraductal endoscopy, we evaluated 128 patients (71 men, mean age 57.6years). Indications were therapeutic (TX) in 72 (56%)and diagnostic (DX) in 56 (44%).RESULTS: Peroral endoscopy was performed in 121and percutaneous in seven. TX indications included CBD stones in 41, PD stones in six, and biliary strictures in 25. DX indications included abnormal LFT's in 15,abnormal imaging in 38 and cholangiocarcinoma staging in three. Visualization of the stone(s) was considered good in 31, fair in six, and poor in four.Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients. A holmium laser was used successfully in three patients. Ductal clearance was achieved in 37 patients after one procedure and in four patients after two procedures.Diagnosis of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/23. Of the modified patients, no diagnosis was available in 17. Spyglass(R) Demonstrated malignancy in 8/17 and non-malignancy in nine. Suspected pathology by imaging studies and abnormal LFT's was modified in 43/63 (66%). Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/3. There was no morbidity associated with the use of Spyglass(R).CONCLUSION: Spyglass Spyscope(R) Is a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.

  4. Diagnostic accuracy of fiberoptic ductoscopy plus in vivo iodine staining for intraductal proliferative lesions

    Institute of Scientific and Technical Information of China (English)

    FENG Xin-zhi; SONG Ying-hua; ZHANG Feng-xia; JIANG Chuan-wu; MEI Hong; ZHAO Bin

    2013-01-01

    Background lodine staining during endoscopy has been successfully used to detect early carcinomatous and precancerous lesions in the esophagus,cervix,and oral cavity.The objective of this study was to determine the diagnostic accuracy of fiberoptic ductoscopy (FDS) plus in vivo iodine staining for intraductal proliferative lesions of the breast.Methods We performed periodic acid-Schiff (PAS) and in vitro iodine staining on 52 and 64 specimens of benign mammary hyperplasia,respectively,and 57 and 53 specimens of ductal carcinoma in situ (DCIS),respectively.Next,FDS was performed on 177 recurrent nipple discharge patients who were randomly divided into two groups.One group was iodine-staining group in which 92 patients were randomly selected to undergo iodine staining during FDS,and the remaining 85 were assigned to the control group.Biopsy specimens of suspicious lesions were obtained and subjected to histopathological examination.Results Following PAS staining,benign mammary hyperplasia lesions were positively stained,while negligible PAS positivity was observed in the DCIS lesions (P <0.05).Following in vitro iodine staining,benign mammary hyperplasia specimens appeared dark brown,whereas DCIS samples appeared significantly lighter or unstained.Compared with the pathological examination results,FDS with iodine staining showed an agreement rate in the diagnosis of ductal intraepithelial neoplasia (DIN),sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and Youden index of 97.82%,98.83%,83.33%,5.93,0.014,and 0.8216,respectively; the corresponding values for FDS without iodine staining were 88.24%,89.16%,50.00%,1.78,0.217,and 0.3916,respectively.Conclusion FDS with iodine staining was superior to conventional FDS for the diagnosis of DIN and is valuable for breast cancer prevention.

  5. Significance of periductal lymphatic and blood vascular densities in intraductal carcinoma of the breast.

    Science.gov (United States)

    El-Gohary, Yasser M; Metwally, Ghada; Saad, Reda S; Robinson, Morton J; Mesko, Thomas; Poppiti, Robert J

    2009-01-01

    We investigated the significance of periductal lymphatic and blood vascular densities in intraductal carcinomas (IDC) of the breast. Thirty five cases of pure IDC treated by partial or total mastectomy were reviewed. Seven cases with normal breast tissue and 48 cases of invasive breast carcinoma were included as controls. All cases were immunostained with D2-40 and CD31. Positively stained microvessels were counted in densely vascular/lymphatic foci (hot spots) at 400x (=0.17 mm(2)) in the periductal areas. IDC without comedonecrosis showed a mean periductal D2-40 lymphatic microvessel density (LMD) of 5.8 +/- 5 (range 0-18), and a CD31 microvessel density (MD) of 14 +/- 8.9 (range 1-40). IDC with comedonecrosis showed periductal D2-40 LMD of 8.4 +/- 3.8 (range 4-18), and a CD31 MD of 24.3 +/- 7.6 (range 14-40). There was a significant difference between periductal D2-40 LMD and CD31 MD counts in IDC with and without comedonecrosis. There was a positive correlation of periductal D2-40 LMD and CD31 MD counts with high nuclear grade (r = 0.39 and 0.56) of IDC as well as with the presence of comedonecrosis (r = 0.49 and 0.59). Both D2-40 LMD and CD31 MD did not correlate significantly with tumor size, estrogen status, or progesterone status. As IDC with comedonecrosis and/or high nuclear grade has a worse prognosis than IDC without comedonecrosis and/or with low nuclear grade, it appears that lymphatic and blood vascular density evaluated by D2-40 and CD31, respectively, are independent prognostic indicators for patients with IDC of the breast and may be an indicator of early or unrecognized invasion or "regression."

  6. Radioiodinated branched carbohydrates

    Science.gov (United States)

    Goodman, Mark M.; Knapp, Jr., Furn F.

    1989-01-01

    A radioiodinated branched carbohydrate for tissue imaging. Iodine-123 is stabilized in the compound by attaching it to a vinyl functional group that is on the carbohydrate. The compound exhibits good uptake and retention and is promising in the development of radiopharmaceuticals for brain, heart and tumor imaging.

  7. Tracheobronchial Branching Anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Min Ji; Kim, Young Tong; Jou, Sung Shick [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of); Park, A Young [Soonchunhyang University College of Medicine, Asan (Korea, Republic of)

    2010-04-15

    There are various congenital anomalies with respect to the number, length, diameter, and location of tracheobronchial branching patterns. The tracheobronchial anomalies are classified into two groups. The first one, anomalies of division, includes tracheal bronchus, cardiac bronchus, tracheal diverticulum, pulmonary isomerism, and minor variations. The second one, dysmorphic lung, includes lung agenesis-hypoplasia complex and lobar agenesis-aplasia complex

  8. Multimode geodesic branching components

    Science.gov (United States)

    Schulz, D.; Voges, E.

    1983-01-01

    Geodesic branching components are investigated for multimode guided wave optics. Geodesic structures with particular properties, e.g. focussing star couplers, are derived by a synthesis technique based on a theorem of Toraldo di Francia. Experimentally, the geodesic surfaces are printed on acrylic glass and are spin-coated with organic film waveguides.

  9. FLUID FLOW IN ROTATING HELICAL SQUARE DUCTS

    Institute of Scientific and Technical Information of China (English)

    Chen Hua-jun; Zhang Ben-zhao; Zhang Jin-suo

    2003-01-01

    A numerical study is made for a fully developed laminar flow in rotating helical pipes.Due to the rotation, the Coriolis force can also contribute to the secondary flow.The interaction between rotation, torsion, and curvature complicates the flow characteristics.The effects of rotation and torsion on the flow transitions are studied in details.The results show that there are obvious differences between the flow in rotating ducts and in helical ducts without rotation.Certain hitherto unknown flow patterns are found.The effects of rotation and torsion on the friction factor are also examined.Present results show the characteristics of the fluid flow in rotating helical square ducts.

  10. Acoustic energy in ducts - Further observations

    Science.gov (United States)

    Eversman, W.

    1979-01-01

    The transmission of acoustic energy in uniform ducts carrying uniform flow is investigated with the purpose of clarifying two points of interest. The two commonly used definitions of acoustic 'energy' flux are shown to be related by a Legendre transformation of the Lagrangian density exactly as in deriving the Hamiltonian density in mechanics. In the acoustic case the total energy density and the Hamiltonian density are not the same which accounts for two different 'energy' fluxes. When the duct has acoustically absorptive walls neither of the two flux expressions gives correct results. A reevaluation of the basis of derivation of the energy density and energy flux provides forms which yield consistent results for soft walled ducts.

  11. Xylometazoline hydrochloride nasal spray combined with laser artificial nasolacrimal duct implantation for nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Xiao-Zhao Yang

    2017-02-01

    Full Text Available AIM: To study the role of xylometazoline hydrochloride nasal spray in combination therapy of nasolacrimal duct obstruction and to investigate the effect of nasal inflammation on nasolacrimal duct obstruction. METHODS: Totally 279 patients with nasolacrimal duct obstruction were collected, who received lacrimal passage irrigation, CT angiography for lacrimal passage and nasal endoscope before treated by lacrimal laser forming and artificial nasolacrimal duct implantation combined with xylometazoline hydrochloride nasal spray. In group A, 137 patients were treated with antibiotic eye drop and non-steroidal anti-inflammatory drugs after operations. In group B, 142 patients were treated with xylometazoline hydrochloride nasal spray besides the same treatment for group A. RESULTS:In the 279 patients 217(77.8%, in which 105 cases(76.6%were in group A and 112 cases(78.9%were in group B, were suffered with nasal inflammation, including nasal mucosal hyperemia, inferior turbinate hypertrophy, middle turbinate hypertrophy. At 3mo after the ducts were drawn, efficacy of group B was 95.8%, which was significant better than that of group A(86.1%, PCONCLUSION: Nasal inflammation was an important factor in the incidence of nasolacrimal duct obstruction, which shoud pay more attention in the process of diagnosis and treatment. Combination therapy could improve the cure rate of nasolacrimal duct obstruction.

  12. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  13. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  14. Nonlinear acoustic propagation in rectangular ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    The method of multiple scales is used to obtain a second-order uniformly valid expansion for nonlinear acoustic wave propagation in a rectangular duct whose walls are treated with a nonlinear acoustic material. The wave propagation in the duct is characterized by the unsteady nonlinear Euler equations. The results show that nonlinear materials attenuate sound more than linear materials except at high acoustic frequencies. The nonlinear materials produce higher and combination tones which have higher attenuation rates than the fundamentals. Moreover, the attenuation rates of the fundamentals increase with increasing amplitude.

  15. Preconditioning the Helmholtz Equation for Rigid Ducts

    Science.gov (United States)

    Baumeister, Kenneth J.; Kreider, Kevin L.

    1998-01-01

    An innovative hyperbolic preconditioning technique is developed for the numerical solution of the Helmholtz equation which governs acoustic propagation in ducts. Two pseudo-time parameters are used to produce an explicit iterative finite difference scheme. This scheme eliminates the large matrix storage requirements normally associated with numerical solutions to the Helmholtz equation. The solution procedure is very fast when compared to other transient and steady methods. Optimization and an error analysis of the preconditioning factors are present. For validation, the method is applied to sound propagation in a 2D semi-infinite hard wall duct.

  16. Inverse potential scattering in duct acoustics.

    Science.gov (United States)

    Forbes, Barbara J; Pike, E Roy; Sharp, David B; Aktosun, Tuncay

    2006-01-01

    The inverse problem of the noninvasive measurement of the shape of an acoustical duct in which one-dimensional wave propagation can be assumed is examined within the theoretical framework of the governing Klein-Gordon equation. Previous deterministic methods developed over the last 40 years have all required direct measurement of the reflectance or input impedance but now, by application of the methods of inverse quantum scattering to the acoustical system, it is shown that the reflectance can be algorithmically derived from the radiated wave. The potential and area functions of the duct can subsequently be reconstructed. The results are discussed with particular reference to acoustic pulse reflectometry.

  17. Higher order mode propagation in nonuniform circular ducts

    Science.gov (United States)

    Cho, Y. C.; Ingard, K. U.

    1980-01-01

    This paper presents an analytical investigation of higher order mode propagation in a nonuniform circular duct without mean flow. An approximate wave equation is derived on the assumptions that the duct cross section varies slowly and that mode conversion is negligible. Exact closed form solutions are obtained for a particular class of converging-diverging circular duct which is here referred to as 'circular cosh duct'. Numerical results are presentd in terms of the transmission loss for the various duct shapes and frequencies. The results are applicable to studies of multimodal propagation as well as single mode propagation. The results are also applicable to studies of sound radiation from certain types of contoured inlet ducts, or of sound propagation in a converging-diverging duct of somewhat different shape from a cosh duct.

  18. Should You Have the Air Ducts in Your Home Cleaned?

    Science.gov (United States)

    ... air ducts in your home cleaned. The U.S. Environmental Protection Agency (EPA) urges you to read this document in it entirety as it provides important information on the subject. Duct cleaning has never ...

  19. Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Jung Min; Cho, Na Ri Ya; Moon, Woo Kyung [Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jeong Seon [Hanyang University Hospital, Seoul (Korea, Republic of); Chung, Se Yeong [Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Jang, Mi Jung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2009-12-15

    To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

  20. Algebraically growing waves in ducts with sheared mean flow

    Science.gov (United States)

    Nayfeh, A. H.; Telionis, D. P.

    1974-01-01

    Analysis of the behavior of standing and traveling acoustic waves in a smooth duct with a fluid flow having a sheared mean velocity profile, when the waves grow algebraically as they travel along the duct axis. It is shown that standing waves growing algebraically with the axial distance cannot exist in a smooth duct when the duct wall have a finite resistance. The existence of traveling waves subject to the same law of growth is also dismissed under realistic flow conditions.

  1. Low frequency sound attenuation in a flow duct using a thin slow sound material

    CERN Document Server

    Auregan, Yves; Groby, Jean-Philippe

    2016-01-01

    We present a thin subwavelength material that can be flush mounted to a duct and which gives a large wide band attenuation at remarkably low frequencies in air flow channels. To decrease the material thickness, the sound is slowed in the material using folded side branch tubes. The impedance of the material is compared to the optimal value, which differs greatly from the characteristic impedance. In particular, the viscous and thermal effects have to be very small to have high transmission losses. Grazing flow on this material increases the losses at the interface between the flow and the material.

  2. Low frequency sound attenuation in a flow duct using a thin slow sound material.

    Science.gov (United States)

    Aurégan, Yves; Farooqui, Maaz; Groby, Jean-Philippe

    2016-05-01

    A thin subwavelength material that can be flush mounted in a duct and that gives an attenuation band at low frequencies in air flow channels is presented. To decrease the material thickness, the sound is slowed in the material using folded side branch tubes. The impedance of the material is compared to the optimal value given by the Cremer condition, which can differ greatly from the air characteristic impedance. Grazing flow on this material increases the losses at the interface between the flow and the material.

  3. Critical branching neural networks.

    Science.gov (United States)

    Kello, Christopher T

    2013-01-01

    It is now well-established that intrinsic variations in human neural and behavioral activity tend to exhibit scaling laws in their fluctuations and distributions. The meaning of these scaling laws is an ongoing matter of debate between isolable causes versus pervasive causes. A spiking neural network model is presented that self-tunes to critical branching and, in doing so, simulates observed scaling laws as pervasive to neural and behavioral activity. These scaling laws are related to neural and cognitive functions, in that critical branching is shown to yield spiking activity with maximal memory and encoding capacities when analyzed using reservoir computing techniques. The model is also shown to account for findings of pervasive 1/f scaling in speech and cued response behaviors that are difficult to explain by isolable causes. Issues and questions raised by the model and its results are discussed from the perspectives of physics, neuroscience, computer and information sciences, and psychological and cognitive sciences.

  4. Tau leptonic branching ratios

    CERN Document Server

    Buskulic, Damir; De Bonis, I; Décamp, D; Ghez, P; Goy, C; Lees, J P; Lucotte, A; Minard, M N; Odier, P; Pietrzyk, B; Ariztizabal, F; Chmeissani, M; Crespo, J M; Efthymiopoulos, I; Fernández, E; Fernández-Bosman, M; Gaitan, V; Garrido, L; Martínez, M; Orteu, S; Pacheco, A; Padilla, C; Palla, Fabrizio; Pascual, A; Perlas, J A; Sánchez, F; Teubert, F; Colaleo, A; Creanza, D; De Palma, M; Farilla, A; Gelao, G; Girone, M; Iaselli, Giuseppe; Maggi, G; Maggi, M; Marinelli, N; Natali, S; Nuzzo, S; Ranieri, A; Raso, G; Romano, F; Ruggieri, F; Selvaggi, G; Silvestris, L; Tempesta, P; Zito, G; Huang, X; Lin, J; Ouyang, Q; Wang, T; Xie, Y; Xu, R; Xue, S; Zhang, J; Zhang, L; Zhao, W; Bonvicini, G; Cattaneo, M; Comas, P; Coyle, P; Drevermann, H; Engelhardt, A; Forty, Roger W; Frank, M; Hagelberg, R; Harvey, J; Jacobsen, R; Janot, P; Jost, B; Kneringer, E; Knobloch, J; Lehraus, Ivan; Markou, C; Martin, E B; Mato, P; Minten, Adolf G; Miquel, R; Oest, T; Palazzi, P; Pater, J R; Pusztaszeri, J F; Ranjard, F; Rensing, P E; Rolandi, Luigi; Schlatter, W D; Schmelling, M; Schneider, O; Tejessy, W; Tomalin, I R; Venturi, A; Wachsmuth, H W; Wiedenmann, W; Wildish, T; Witzeling, W; Wotschack, J; Ajaltouni, Ziad J; Bardadin-Otwinowska, Maria; Barrès, A; Boyer, C; Falvard, A; Gay, P; Guicheney, C; Henrard, P; Jousset, J; Michel, B; Monteil, S; Montret, J C; Pallin, D; Perret, P; Podlyski, F; Proriol, J; Rossignol, J M; Saadi, F; Fearnley, Tom; Hansen, J B; Hansen, J D; Hansen, J R; Hansen, P H; Nilsson, B S; Kyriakis, A; Simopoulou, Errietta; Siotis, I; Vayaki, Anna; Zachariadou, K; Blondel, A; Bonneaud, G R; Brient, J C; Bourdon, P; Passalacqua, L; Rougé, A; Rumpf, M; Tanaka, R; Valassi, Andrea; Verderi, M; Videau, H L; Candlin, D J; Parsons, M I; Focardi, E; Parrini, G; Corden, M; Delfino, M C; Georgiopoulos, C H; Jaffe, D E; Antonelli, A; Bencivenni, G; Bologna, G; Bossi, F; Campana, P; Capon, G; Chiarella, V; Felici, G; Laurelli, P; Mannocchi, G; Murtas, F; Murtas, G P; Pepé-Altarelli, M; Dorris, S J; Halley, A W; ten Have, I; Knowles, I G; Lynch, J G; Morton, W T; O'Shea, V; Raine, C; Reeves, P; Scarr, J M; Smith, K; Smith, M G; Thompson, A S; Thomson, F; Thorn, S; Turnbull, R M; Becker, U; Braun, O; Geweniger, C; Graefe, G; Hanke, P; Hepp, V; Kluge, E E; Putzer, A; Rensch, B; Schmidt, M; Sommer, J; Stenzel, H; Tittel, K; Werner, S; Wunsch, M; Beuselinck, R; Binnie, David M; Cameron, W; Colling, D J; Dornan, Peter J; Konstantinidis, N P; Moneta, L; Moutoussi, A; Nash, J; San Martin, G; Sedgbeer, J K; Stacey, A M; Dissertori, G; Girtler, P; Kuhn, D; Rudolph, G; Bowdery, C K; Brodbeck, T J; Colrain, P; Crawford, G; Finch, A J; Foster, F; Hughes, G; Sloan, Terence; Whelan, E P; Williams, M I; Galla, A; Greene, A M; Kleinknecht, K; Quast, G; Raab, J; Renk, B; Sander, H G; Wanke, R; Van Gemmeren, P; Zeitnitz, C; Aubert, Jean-Jacques; Bencheikh, A M; Benchouk, C; Bonissent, A; Bujosa, G; Calvet, D; Carr, J; Diaconu, C A; Etienne, F; Thulasidas, M; Nicod, D; Payre, P; Rousseau, D; Talby, M; Abt, I; Assmann, R W; Bauer, C; Blum, Walter; Brown, D; Dietl, H; Dydak, Friedrich; Ganis, G; Gotzhein, C; Jakobs, K; Kroha, H; Lütjens, G; Lutz, Gerhard; Männer, W; Moser, H G; Richter, R H; Rosado-Schlosser, A; Schael, S; Settles, Ronald; Seywerd, H C J; Saint-Denis, R; Wolf, G; Alemany, R; Boucrot, J; Callot, O; Cordier, A; Courault, F; Davier, M; Duflot, L; Grivaz, J F; Heusse, P; Jacquet, M; Kim, D W; Le Diberder, F R; Lefrançois, J; Lutz, A M; Musolino, G; Nikolic, I A; Park, H J; Park, I C; Schune, M H; Simion, S; Veillet, J J; Videau, I; Abbaneo, D; Azzurri, P; Bagliesi, G; Batignani, G; Bettarini, S; Bozzi, C; Calderini, G; Carpinelli, M; Ciocci, M A; Ciulli, V; Dell'Orso, R; Fantechi, R; Ferrante, I; Foà, L; Forti, F; Giassi, A; Giorgi, M A; Gregorio, A; Ligabue, F; Lusiani, A; Marrocchesi, P S; Messineo, A; Rizzo, G; Sanguinetti, G; Sciabà, A; Spagnolo, P; Steinberger, Jack; Tenchini, Roberto; Tonelli, G; Triggiani, G; Vannini, C; Verdini, P G; Walsh, J; Betteridge, A P; Blair, G A; Bryant, L M; Cerutti, F; Gao, Y; Green, M G; Johnson, D L; Medcalf, T; Mir, L M; Perrodo, P; Strong, J A; Bertin, V; Botterill, David R; Clifft, R W; Edgecock, T R; Haywood, S; Edwards, M; Maley, P; Norton, P R; Thompson, J C; Bloch-Devaux, B; Colas, P; Emery, S; Kozanecki, Witold; Lançon, E; Lemaire, M C; Locci, E; Marx, B; Pérez, P; Rander, J; Renardy, J F; Roussarie, A; Schuller, J P; Schwindling, J; Trabelsi, A; Vallage, B; Johnson, R P; Kim, H Y; Litke, A M; McNeil, M A; Taylor, G; Beddall, A; Booth, C N; Boswell, R; Cartwright, S L; Combley, F; Dawson, I; Köksal, A; Letho, M; Newton, W M; Rankin, C; Thompson, L F; Böhrer, A; Brandt, S; Cowan, G D; Feigl, E; Grupen, Claus; Lutters, G; Minguet-Rodríguez, J A; Rivera, F; Saraiva, P; Smolik, L; Stephan, F; Apollonio, M; Bosisio, L; Della Marina, R; Giannini, G; Gobbo, B; Ragusa, F; Rothberg, J E; Wasserbaech, S R; Armstrong, S R; Bellantoni, L; Elmer, P; Feng, Z; Ferguson, D P S; Gao, Y S; González, S; Grahl, J; Harton, J L; Hayes, O J; Hu, H; McNamara, P A; Nachtman, J M; Orejudos, W; Pan, Y B; Saadi, Y; Schmitt, M; Scott, I J; Sharma, V; Turk, J; Walsh, A M; Wu Sau Lan; Wu, X; Yamartino, J M; Zheng, M; Zobernig, G

    1996-01-01

    A sample of 62249 \\tau-pair events is selected from data taken with the ALEPH detector in 1991, 1992 and 1993. The measurement of the branching fractions for \\tau decays into electrons and muons is presented with emphasis on the study of systematic effects from selection, particle identification and decay classification. Combined with the most recent ALEPH determination of the \\tau lifetime, these results provide a relative measurement of the leptonic couplings in the weak charged current for transverse W bosons.

  5. Electrochemical Energy Storage Branch

    Science.gov (United States)

    1985-01-01

    The activities of the Electrochemical Energy Storage Branch are highlighted, including the Technology Base Research and the Exploratory Technology Development and Testing projects within the Electrochemical Energy Storage Program for the 1984 fiscal year. General Headquarters activities are presented first; and then, a summary of the Director Controlled Milestones, followed by other major accomplishments. A listing of the workshops and seminars held during the year is also included.

  6. Generalized Markov branching models

    OpenAIRE

    Li, Junping

    2005-01-01

    In this thesis, we first considered a modified Markov branching process incorporating both state-independent immigration and resurrection. After establishing the criteria for regularity and uniqueness, explicit expressions for the extinction probability and mean extinction time are presented. The criteria for recurrence and ergodicity are also established. In addition, an explicit expression for the equilibrium distribution is presented.\\ud \\ud We then moved on to investigate the basic proper...

  7. Generalized Markov branching models

    OpenAIRE

    Li, Junping

    2005-01-01

    In this thesis, we first considered a modified Markov branching process incorporating both state-independent immigration and resurrection. After establishing the criteria for regularity and uniqueness, explicit expressions for the extinction probability and mean extinction time are presented. The criteria for recurrence and ergodicity are also established. In addition, an explicit expression for the equilibrium distribution is presented. We then moved on to investigate the basic proper...

  8. Laser-guided repair of complex bile duct strictures.

    NARCIS (Netherlands)

    Gulik, T. van; Beek, J.; Reuver, P. de; Aronson, D.C.; Delden, O. van; Busch, O.; Gouma, D.

    2009-01-01

    BACKGROUND: The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. AIM: We describe a technique to identify the prestenotic bile du

  9. A case of fascioliasis in common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Ham, Soo Youn; Park, Cheol Min; Chung, Kyu Byung; Lee, Chang Hong; Park, Seung Chul; Choi, Sang Yong; Lim, Han Jong [Korea University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    A case of Fascioliasis of common bile duct is confirmed by visualization of adult fluke. Fascioliasis caused by Fasciola hepatica, is common parasitic disease in cattle and sheep. Human is an accidental host. ERCP demonstrated irregular linear conglomerated filling defects in common bile duct. Through surgical intervention, we found adult flukes of F. hepatica and adenomatous hyperplasia of common bile duct.

  10. Surgical treatment of congenital biliary duct cyst

    Directory of Open Access Journals (Sweden)

    Wang De-chun

    2012-03-01

    Full Text Available Abstract Background It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision. Methods From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years, the immaturity group (3 18 years, and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups. Results Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p 0.05. Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05 between the laparoscopic and the open surgery groups. Conclusions We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.

  11. Idea Bank: Duct Tape Note Twister

    Science.gov (United States)

    McHenry, Molly

    2008-01-01

    In this article, the author relates how she observed a middle school math teacher deliver a miserable class. She realized that she did the same thing to her music students. To engage her students, she developed "Note Twister," a music reading game using duct tape to form musical notes and the basic premise behind the game, "Twister." She finds…

  12. Laser Beam Duct Pressure Controller System.

    Science.gov (United States)

    the axial flow of a conditioning gas within the laser beam duct, by matching the time rate of change of the pressure of the flowing conditioning gas...to the time rate of change of the pressure in the cavity of an operably associated laser beam turret.

  13. Familial occurrence of congenital bile duct dilatation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Congenital bile duct dilatation (CBD) that developed in a parent and son is presented.Familial occurrence of CBD is rare,with only a few male cases having been reported.Since the initial report of CBD occurring in siblings in 1981,a total of 20 cases (10 pairs) have been published as of 2007.Clinical and genetic features of CBD are discussed.

  14. Heat Transfer in a Superelliptic Transition Duct

    Science.gov (United States)

    Poinsatte, Philip; Thurman, Douglas; Hippensteele, Steven

    2008-01-01

    Local heat transfer measurements were experimentally mapped using a transient liquid-crystal heat transfer technique on the surface of a circular-to-rectangular transition duct. The transition duct had a length-to-diameter ratio of 1.5 and an exit-plane aspect ratio of 3. The crosssectional geometry was defined by the equation of a superellipse. The cross-sectional area was the same at the inlet and exit but varied up to 15 percent higher through the transition. The duct was preheated to a uniform temperature (nominally 64 C) before allowing room temperature air to be suddenly drawn through it. As the surface cooled, the resulting isothermal contours on the duct surface were revealed using a surface coating of thermochromic liquid crystals that display distinctive colors at particular temperatures. A video record was made of the surface temperature and time data for all points on the duct surfaces during each test. Using this surface temperature-time data together with the temperature of the air flowing through the model and the initial temperature of the model wall, the heat transfer coefficient was calculated by employing the classic one-dimensional, semi-infinite wall heat transfer conduction model. Test results are reported for inlet diameter-based Reynolds numbers ranging from 0.4x106 to 2.4x106 and two grid-generated freestream turbulence intensities of about 1 percent, which is typical of wind tunnels, and up to 16 percent, which may be more typical of real engine conditions.

  15. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  16. Performance Study and CFD Predictions of a Ducted Fan System

    Science.gov (United States)

    Abrego, Anita I.; Chang, I-Chung; Bulaga, Robert W.; Rutkowski, Michael (Technical Monitor)

    2002-01-01

    An experimental investigation was completed in the NASA Ames 7 by 10-Foot Wind Tunnel to study the performance characteristics of a ducted fan. The goal of this effort is to study the effect of ducted fan geometry and utilize Computational Fluid Dynamics (CFD) analysis to provide a baseline for correlation. A 38-inch diameter, 10-inch chord duct with a five-bladed fixed-pitch fan was tested. Duct performance data were obtained in hover, vertical climb, and forward flight test conditions. This paper will present a description of the test, duct performance results and correlation with CFD predictions.

  17. Transition duct with divided upstream and downstream portions

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; LeBegue, Jeffrey Scott; Maldonado, Jaime Javier; Dillard, Daniel Jackson; Flanagan, James Scott

    2015-07-14

    Turbine systems are provided. In one embodiment, a turbine system includes a transition duct comprising an inlet, an outlet, and a duct passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The duct passage includes an upstream portion extending from the inlet and a downstream portion extending from the outlet. The turbine system further includes a rib extending from an outer surface of the duct passage, the rib dividing the upstream portion and the downstream portion.

  18. The effect of duct surface character on methane explosion propagation

    Institute of Scientific and Technical Information of China (English)

    LIN Bai-quan; YE Qing; JIAN Cong-guang; WU Hai-jin

    2007-01-01

    The effect of duct surface character on methane explosion propagation was experimentally studied and theoretically analyzed. The roughness has effect on methane explosion propagation. The flame propagation velocity and the peak value pressure of methane explosion in rough duct are larger than the parameters in smooth duct. The heat exchange of the surface has effect on methane explosion propagation. The propagation velocity of flame and strength of explosion wave in the duct covered by heat insulation material are larger than those in duct with good heat transmittability.

  19. Prorenin receptor controls renal branching morphogenesis via Wnt/β-catenin signaling.

    Science.gov (United States)

    Song, Renfang; Janssen, Adam; Li, Yuwen; El-Dahr, Samir; Yosypiv, Ihor V

    2017-03-01

    The prorenin receptor (PRR) is a receptor for renin and prorenin, and an accessory subunit of the vacuolar proton pump H(+)-ATPase. Renal branching morphogenesis, defined as growth and branching of the ureteric bud (UB), is essential for mammalian kidney development. Previously, we demonstrated that conditional ablation of the PRR in the UB in PRR(UB-/-) mice causes severe defects in UB branching, resulting in marked kidney hypoplasia at birth. Here, we investigated the UB transcriptome using whole genome-based analysis of gene expression in UB cells, FACS-isolated from PRR(UB-/-), and control kidneys at birth (P0) to determine the primary role of the PRR in terminal differentiation and growth of UB-derived collecting ducts. Three genes with expression in UB cells that previously shown to regulate UB branching morphogenesis, including Wnt9b, β-catenin, and Fgfr2, were upregulated, whereas the expression of Wnt11, Bmp7, Etv4, and Gfrα1 was downregulated. We next demonstrated that infection of immortalized UB cells with shPRR in vitro or deletion of the UB PRR in double-transgenic PRR(UB-/-)/BatGal(+) mice, a reporter strain for β-catenin transcriptional activity, in vivo increases β-catenin activity in the UB epithelia. In addition to UB morphogenetic genes, the functional groups of differentially expressed genes within the downregulated gene set included genes involved in molecular transport, metabolic disease, amino acid metabolism, and energy production. Together, these data demonstrate that UB PRR performs essential functions during UB branching and collecting duct morphogenesis via control of a hierarchy of genes that control UB branching and terminal differentiation of the collecting duct cells.

  20. Combustion Branch Website Development

    Science.gov (United States)

    Bishop, Eric

    2004-01-01

    The NASA combustion branch is a leader in developing and applying combustion science to focused aerospace propulsion systems concepts. It is widely recognized for unique facilities, analytical tools, and personnel. In order to better communicate the outstanding research being done in this Branch to the public and other research organization, a more substantial website was desired. The objective of this project was to build an up-to-date site that reflects current research in a usable and attractive manner. In order to accomplish this, information was requested from all researchers in the Combustion branch, on their professional skills and on the current projects. This information was used to fill in the Personnel and Research sections of the website. A digital camera was used to photograph all personnel and these photographs were included in the personnel section as well. The design of the site was implemented using the latest web standards: xhtml and external css stylesheets. This implementation conforms to the guidelines recommended by the w3c. It also helps to ensure that the web site is accessible by disabled users, and complies with Section 508 Federal legislation (which mandates that all Federal websites be accessible). Graphics for the new site were generated using the gimp (www.gimp.org) an open-source graphics program similar to Adobe Photoshop. Also, all graphics on the site were of a reasonable size (less than 20k, most less than 2k) so that the page would load quickly. Technologies such as Macromedia Flash and Javascript were avoided, as these only function on some clients which have the proper software installed or enabled. The website was tested on different platforms with many different browsers to ensure there were no compatibility issues. The website was tested on windows with MS IE 6, MSIE 5 , Netscape 7, Mozilla and Opera. On a Mac, the site was tested with MS IE 5 , Netscape 7 and Safari.

  1. Dispersion properties of ducted whistlers, generated by lightning discharge

    Directory of Open Access Journals (Sweden)

    D. L. Pasmanik

    2005-06-01

    Full Text Available Whistler-mode wave propagation in magnetospheric ducts of enhanced cold plasma density is studied. The case of the arbitrary ratio of the duct radius to the whistler wavelength is considered, where the ray-tracing method is not applicable. The set of duct eigenmodes and their spatial structure are analysed and dependencies of eigenmode propagation properties on the duct characteristics are studied. Special attention is paid to the analysis of the group delay time of one-hop propagation of the whistler wave packet along the duct. We found that, in contrast to the case of a wide duct, the group delay time in a rather narrow duct decreases as the eigenmode number increases. The results obtained are suggested for an explanation of some types of multi-component whistler signals.

  2. Rationale for Measuring Duct Leakage Flows in Large Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Diamond, Richard C.; Sherman, Max H.

    2005-07-01

    Industry-wide methods of assessing duct leakage are based on duct pressurization tests, and focus on ''high pressure'' ducts. Even though ''low pressure'' ducts can be a large fraction of the system and tend to be leaky, few guidelines or construction specifications require testing these ducts. We report here on the measured leakage flows from ten large commercial duct systems at operating conditions: three had low leakage (less than 5% of duct inlet flow), and seven had substantial leakage (9 to 26%). By comparing these flows with leakage flows estimated using the industry method, we show that the latter method by itself is not a reliable indicator of whole-system leakage flow, and that leakage flows need to be measured.

  3. Curved Duct Noise Prediction Using the Fast Scattering Code

    Science.gov (United States)

    Dunn, M. H.; Tinetti, Ana F.; Farassat, F.

    2007-01-01

    Results of a study to validate the Fast Scattering Code (FSC) as a duct noise predictor, including the effects of curvature, finite impedance on the walls, and uniform background flow, are presented in this paper. Infinite duct theory was used to generate the modal content of the sound propagating within the duct. Liner effects were incorporated via a sound absorbing boundary condition on the scattering surfaces. Simulations for a rectangular duct of constant cross-sectional area have been compared to analytical solutions and experimental data. Comparisons with analytical results indicate that the code can properly calculate a given dominant mode for hardwall surfaces. Simulated acoustic behavior in the presence of lined walls (using hardwall duct modes as incident sound) is consistent with expected trends. Duct curvature was found to enhance weaker modes and reduce pressure amplitude. Agreement between simulated and experimental results for a straight duct with hard walls (no flow) was excellent.

  4. Cookie branching random walks

    CERN Document Server

    Bartsch, Christian; Kochler, Thomas; Müller, Sebastian; Popov, Serguei

    2011-01-01

    We consider a branching random walk on $\\Z$, where the particles behave differently in visited and unvisited sites. Informally, each site on the positive half-line contains initially a cookie. On the first visit of a site its cookie is removed and particles at positions with a cookie reproduce and move differently from particles on sites without cookies. Therefore, the movement and the reproduction of the particles depend on the previous behaviour of the population of particles. We study the question if the process is recurrent or transient, i.e., whether infinitely many particles visit the origin or not.

  5. Branch formation during organ development

    Science.gov (United States)

    Gjorevski, Nikolce; Nelson, Celeste M.

    2010-01-01

    Invertebrates and vertebrates use branching morphogenesis to build epithelial trees to maximize the surface area of organs within a given volume. Several molecular regulators of branching have recently been discovered, a number of which are conserved across different organs and species. Signals that control branching at the cellular and tissue levels are also starting to emerge, and are rapidly unveiling the physical nature of branch development. Here we discuss the molecular, cellular and physical processes that govern branch formation and highlight the major outstanding questions in the field. PMID:20890968

  6. The Dynamics of Controlled Flow Separation within a Diverter Duct Diffuser

    Science.gov (United States)

    Peterson, C. J.; Vukasinovic, B.; Glezer, A.

    2016-11-01

    The evolution and receptivity to fluidic actuation of the flow separation within a rectangular, constant-width, diffuser that is branched off of a primary channel is investigated experimentally at speeds up to M = 0.4. The coupling between the diffuser's adverse pressure gradient and the internal separation that constricts nearly half of the flow passage through the duct is controlled using a spanwise array of fluidic actuators on the surface upstream of the diffuser's inlet plane. The dynamics of the separating surface vorticity layer in the absence and presence of actuation are investigated using high-speed particle image velocimetry combined with surface pressure measurements and total pressure distributions at the primary channel's exit plane. It is shown that the actuation significantly alters the incipient dynamics of the separating vorticity layer as the characteristic cross stream scales of the boundary layer upstream of separation and of the ensuing vorticity concentrations within the separated flow increase progressively with actuation level. It is argued that the dissipative (high frequency) actuation alters the balance between large- and small-scale motions near separation by intensifying the large-scale motions and limiting the small-scale dynamics. Controlling separation within the diffuser duct also has a profound effect on the global flow. In the presence of actuation, the mass flow rate in the primary duct increases 10% while the fraction of the diverted mass flow rate in the diffuser increases by more than 45% at 0.7% actuation mass fraction. Supported by the Boeing Company.

  7. Effect of Resin Ducts and Sap Content on Infestation and Development of Immature Stages of Anastrepha obliqua and Anastrepha ludens (Diptera: Tephritidae) in Four Mango (Sapindales: Anacardiaceae) Cultivars.

    Science.gov (United States)

    Guillén, Larissa; Adaime, Ricardo; Birke, Andrea; Velázquez, Olinda; Angeles, Guillermo; Ortega, Fernando; Ruíz, Eliel; Aluja, Martín

    2017-01-10

    We determined the influence of resin ducts, sap content, and fruit physicochemical features of four mango cultivars (Criollo, Manila, Ataulfo, and Tommy Atkins) on their susceptibility to the attack of the two most pestiferous fruit fly species infesting mangoes in Mexico: Anastrepha ludens (Loew) and Anastrepha obliqua (Macquart). We performed three studies: 1) analysis of resin ducts in mango fruit exocarp to determine the density and area occupied by resin ducts in each mango cultivar, 2) assessment of mango physicochemical features including fruit sap content, and 3) a forced infestation trial under field conditions using enclosed fruit-bearing branches to expose mangoes to gravid A. ludens or A. obliqua females. Infestation rates, development time from egg to prepupae and pupae, pupal weight, and percent of adult emergence, were assessed. 'Ataulfo' and 'Tommy Atkins' cultivars exhibited the highest resin duct density and sap content, the lowest infestation rate, and had a negative effect on immature development and pupal weight. In sharp contrast, 'Manila' and 'Criollo' cultivars, with the lowest resin duct density and sap content, were highly susceptible to A. ludens and A. obliqua attack. We conclude that sap content and the number, size, and distribution of resin ducts as well as firmness in mango fruit exocarp are all involved in the resistance of mango to A. ludens and A. obliqua attack.

  8. Theoretical analysis of HVAC duct hanger systems

    Science.gov (United States)

    Miller, R. D.

    1987-01-01

    Several methods are presented which, together, may be used in the analysis of duct hanger systems over a wide range of frequencies. The finite element method (FEM) and component mode synthesis (CMS) method are used for low- to mid-frequency range computations and have been shown to yield reasonably close results. The statistical energy analysis (SEA) method yields predictions which agree with the CMS results for the 800 to 1000 Hz range provided that a sufficient number of modes participate. The CMS approach has been shown to yield valuable insight into the mid-frequency range of the analysis. It has been demonstrated that it is possible to conduct an analysis of a duct/hanger system in a cost-effective way for a wide frequency range, using several methods which overlap for several frequency bands.

  9. Acoustic Power Transmission Through a Ducted Fan

    Science.gov (United States)

    Envia, Ed

    2016-01-01

    For high-speed ducted fans, when the rotor flowfield is shock-free, the main contribution to the inlet radiated acoustic power comes from the portion of the rotor stator interaction sound field that is transmitted upstream through the rotor. As such, inclusion of the acoustic transmission is an essential ingredient in the prediction of the fan inlet noise when the fan tip relative speed is subsonic. This paper describes a linearized Euler based approach to computing the acoustic transmission of fan tones through the rotor. The approach is embodied in a code called LINFLUX was applied to a candidate subsonic fan called the Advanced Ducted Propulsor (ADP). The results from this study suggest that it is possible to make such prediction with sufficient fidelity to provide an indication of the acoustic transmission trends with the fan tip speed.

  10. Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas

    Science.gov (United States)

    Shimizu, Yuki; Imaizumi, Hiroshi; Yamauchi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kida, Mitsuhiro; Suzuki, Erina; Saegusa, Makoto; Koizumi, Wasaburo

    2017-01-01

    We herein report the first case of a pancreatic fistula extending into the thigh caused by the rupture of an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. An 80-year-old man was suspected to have necrotizing fasciitis because of right femoral pain. Computed tomography showed fluid retention from the pancreatic head to the right iliopsoas muscle and an IPMN at the pancreatic head. The findings of endoscopic retrograde pancreatography led to the suspicion of a minor leak and a pancreatic stent was placed. The patient died due to an uncontrollable infection. A pathological autopsy showed a pancreatic fistula extending into the thigh that had been caused by the rupture of the IPMN. PMID:28154275

  11. Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas.

    Science.gov (United States)

    Shimizu, Yuki; Imaizumi, Hiroshi; Yamauchi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kida, Mitsuhiro; Suzuki, Erina; Saegusa, Makoto; Koizumi, Wasaburo

    2017-01-01

    We herein report the first case of a pancreatic fistula extending into the thigh caused by the rupture of an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. An 80-year-old man was suspected to have necrotizing fasciitis because of right femoral pain. Computed tomography showed fluid retention from the pancreatic head to the right iliopsoas muscle and an IPMN at the pancreatic head. The findings of endoscopic retrograde pancreatography led to the suspicion of a minor leak and a pancreatic stent was placed. The patient died due to an uncontrollable infection. A pathological autopsy showed a pancreatic fistula extending into the thigh that had been caused by the rupture of the IPMN.

  12. Intraductal Papillary Mucinous Neoplasm Occurring In Pancreatic Heterotopia Of The Duodenum: Two Cases And A Review Of The Literature

    Directory of Open Access Journals (Sweden)

    Sarah M Choi

    2008-09-01

    Full Text Available Context Heterotopic pancreas is usually an incidental finding during pathologic evaluation of gastrointestinal polyps or lesions encoun-tered during endoscopy for nonspecific symptoms or unrelated conditions. However, the same neoplastic processes that occur in normal pancreas also can occur in pancreatic heterotopias. Case report We report two cases of intraductal papillary mucinous neoplasms arising in pancreatic heterotopia within the duodenum of two patients. These cases are among the first reports of neoplasia occurring in pancre-atic heterotopia of the duodenum. Both patients are being managed expectantly, as there is currently no consensus regarding the proper follow up in these cases, particularly those that have been incompletely excised. Conclusion These cases highlight the potential for neo-plasia in pancreatic heterotopia and emphasize the importance of careful evaluation of these lesions. Close clinical follow up and possible excision may be warranted in patients with concerning pathologic or clinical findings.

  13. Obstructive Chronic Pancreatitis and/or Intraductal Papillary Mucinous Neoplasms (IPMNs: A 21-Year Long Case Report

    Directory of Open Access Journals (Sweden)

    Mohammed Abu-Hilal

    2006-03-01

    Full Text Available Context :Intraductal papillary mucinous neoplasms of the pancreas (IPMNs, usually present with a picture of chronic pancreatitis and must be considered within the differential diagnosis of this condition. Case report :We report a long history of a 58- year-old male who presented with recurrent attacks of pancreatitis. He was treated for chronic pancreatitis until the age of 78 when the diagnosis of IPMN was made, but radical treatment was not possible and he was managed palliatively. The patient died of sepsis and multi-organ failure 21 years following his first presentation. Conclusion :This case highlights possible pitfalls in the diagnosis and treatment of IPMNs, suggests a very long natural history, proposes possible palliative treatment in selected cases and reflects about IPMNs biological position in the chronic pancreatitisductal adenocarcinoma chain.

  14. Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

    Science.gov (United States)

    Kamani, Fereshteh; Dorudinia, Atosa; Goravanchi, Farhood; Rahimi, Farzaneh

    2007-04-01

    Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.

  15. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor.

    Science.gov (United States)

    Ishiguro, Yasunao; Hyodo, Masanobu; Fujiwara, Takehito; Sakuma, Yasunaru; Hojo, Nobuyuki; Mizuta, Koichi; Kawarasaki, Hideo; Lefor, Alan T; Yasuda, Yoshikazu

    2010-08-07

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son, who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years. The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation. With the use of cholangiography at the time of surgery, we found the right anterior segmental duct (RASD) emptying directly into the cystic duct, and the catheter passed into the RASD. After repairing the incision in the cystic duct, transplantation was successfully performed. Her postoperative course was uneventful. Biliary anatomical variations were frequently encountered, however, this variation has very rarely been reported. If the RASD was divided, the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor. Meticulous preoperative evaluation of the living donor's biliary anatomy, especially using magnetic resonance cholangiography and careful intraoperative techniques, is important to prevent bile duct injury and avoid the risk to the healthy donor.

  16. Particle deposition in industrial duct bends.

    Science.gov (United States)

    Peters, Thomas M; Leith, David

    2004-07-01

    A study of particle deposition in industrial duct bends is presented. Particle deposition by size was measured by comparing particle size distributions upstream and downstream of bends that had geometries and flow conditions similar to those used in industrial ventilation. As the interior surface of the duct bend was greased to prevent particle bounce, the results are applicable to liquid drops and solid particles where duct walls are sticky. Factors investigated were: (i) flow Reynolds number (Re = 203 000, 36 000); (ii) particle Reynolds number (10 vertical); and (vii) construction technique (smooth, gored, segmented). Measured deposition was compared with models developed for bends in small diameter sampling lines (Re 20 microm, deposition was slightly greater in the horizontal-to-horizontal orientation than in the horizontal-to-vertical orientation due to gravitational settling. Penetration was not a multiplicative function of bend angle as theory predicts, due to the developing nature of turbulent flow in bends. Deposition in a smooth bend was similar to that in a gored bend; however, a tight radius segmented bend (R0 = 1.7) exhibited much lower deposition. For more gradual bends (3 < R0 < 12), curvature ratio had negligible effect on deposition.

  17. Endoscopic Management of Difficult Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    Christian Ell

    1992-01-01

    Full Text Available More than 90% of all common bile duct concrements can be removed via the endoscopic retrograde route via endoscopic sphincterotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones, however, often still resist conventional endoscopic therapy. Promising new or improved approaches for the treatment of these stones are intracorporeal or extracorporeal shock wave lithotripsy. Shockwave lithotriptors for extracorporeal shockwave lithotripsy are currently available worldwide. However, for the waterbath first generation devices, general anesthesia is required since shockwaves are very painful. Furthermore, an x-ray localization system is essential to visualize the stones after having filled the bile duct over a nasobiliary catheter. An average of two shockwave treatments with additional two to four endoscopic sessions are required. ln tracorporeal lithotripsy promises more comfort and less effort for the patient. Shockwaves are generated either by means of the spark gap principle (electrohydraulic probes or by laser-induced plasma generation. Laser-induced shockwave lithotripsy appears to be more safer, since with dye and solid state lasers, athermal, well-controlled shockwaves can be generateJ without the risks for duct perfo ration (as described for the electrohydraulic system. Furthermore, a recently developed stone-tissue detection system integrated in a new dye laser system enchances the safety of laser-induced lithotripsy. ln consequence, lithotripsy without direct endoscopic control appears possible in selected cases.

  18. Oncogenic Role of Skp2 and p27Kip1 in Intraductal Proliferative Lesions of the Breast

    Institute of Scientific and Technical Information of China (English)

    Yan Lv; Yun Niu; Xiu-min Ding; Xu-qi Xiao

    2012-01-01

    Objective To investigate whether the connection of p27Kip1 to S-phase kinase-associated protein 2 (Skp2) plays an oncogenic role in intraductal proliferative lesions of the breast.Methods Here we investigated the mechanism involved in association of Skp2's degradation of p27Kip1 With the breast carcinogenesis by immunohistochemical method through detection of Skp2 and p27Kip1 protein levels in 120 paraffin-embedded tissues of intraductal proliferative lesions including usual ductal hyperplasia (UDH,n=30),atypical ductal hyperplasia (n=30),flat epithelial atypia (FEA,n=30),and ductal carcinoma in situ (DCIS,n=30).Moreover,the expression status of Skp2 and p27Kip1 in 30 cases of the normal breast paraffin-embedded tissues were explored.Results The DCIS group was with the highest Skp2 level and the lowest p27Kip1 level,and the UDH group was with the lowest Skp2 level and the highest p27Kip1 level.Both Skp2 and p27Kip1 levels in the DCIS group were significantly different from those in the UDH group (all P<0.01).The levels of Skp2 and p27Kip1 in the FEA group were significantly different from both the DCIS and UDH groups (all P<0.05).p27Kip1 was negatively correlated with Skp2 in both the UDH group (r=-0.629,P=0.026) and DCIS group (r=-0.893,P=0.000).Conclusion Overexpression of Skp2 might be the mechanism underlying p27Kip1 over degradation.

  19. Path-valued branching processes and nonlocal branching superprocesses

    CERN Document Server

    Li, Zenghu

    2012-01-01

    A family of continuous-state branching processes with immigration are constructed as the solution flow of a stochastic equation system driven by time-space noises. The family can be regarded as an inhomogeneous increasing path-valued branching process with immigration. Two nonlocal branching immigration superprocesses can be defined from the flow. We identify explicitly the branching and immigration mechanisms of those processes. The results provide new perspectives into the tree-valued Markov processes of Aldous and Pitman [Ann. Inst. H. Poincare Probab. Statist. 34 (1998), 637--686] and Abraham and Delmas [Ann. Probab. To appear].

  20. Compact Buried Ducts in a Hot-Humid Climate House

    Energy Technology Data Exchange (ETDEWEB)

    Mallay, Dave [Home Innovation Research Labs, Upper Marlboro, MD (United States)

    2016-01-07

    "9A system of compact, buried ducts provides a high-performance and cost-effective solution for delivering conditioned air throughout the building. This report outlines research activities that are expected to facilitate adoption of compact buried duct systems by builders. The results of this research would be scalable to many new house designs in most climates and markets, leading to wider industry acceptance and building code and energy program approval. The primary research question with buried ducts is potential condensation at the outer jacket of the duct insulation in humid climates during the cooling season. Current best practices for buried ducts rely on encapsulating the insulated ducts with closed-cell spray polyurethane foam insulation to control condensation and improve air sealing. The encapsulated buried duct concept has been analyzed and shown to be effective in hot-humid climates. The purpose of this project is to develop an alternative buried duct system that performs effectively as ducts in conditioned space - durable, energy efficient, and cost-effective - in a hot-humid climate (IECC warm-humid climate zone 3A) with three goals that distinguish this project: 1) Evaluation of design criteria for buried ducts that use common materials and do not rely on encapsulation using spray foam or disrupt traditional work sequences; 2) Establishing design criteria for compact ducts and incorporate those with the buried duct criteria to further reduce energy losses and control installed costs; 3) Developing HVAC design guidance for performing accurate heating and cooling load calculations for compact buried ducts.

  1. Quiver Varieties and Branching

    Directory of Open Access Journals (Sweden)

    Hiraku Nakajima

    2009-01-01

    Full Text Available Braverman and Finkelberg recently proposed the geometric Satake correspondence for the affine Kac-Moody group Gaff [Braverman A., Finkelberg M., arXiv:0711.2083]. They conjecture that intersection cohomology sheaves on the Uhlenbeck compactification of the framed moduli space of Gcpt-instantons on $R^4/Z_r$ correspond to weight spaces of representations of the Langlands dual group $G_{aff}^{vee}$ at level $r$. When $G = SL(l$, the Uhlenbeck compactification is the quiver variety of type $sl(r_{aff}$, and their conjecture follows from the author's earlier result and I. Frenkel's level-rank duality. They further introduce a convolution diagram which conjecturally gives the tensor product multiplicity [Braverman A., Finkelberg M., Private communication, 2008]. In this paper, we develop the theory for the branching in quiver varieties and check this conjecture for $G = SL(l$.

  2. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

    Institute of Scientific and Technical Information of China (English)

    Yasunao; Ishiguro; Masanobu; Hyodo; Takehito; Fujiwara; Yasunaru; Sakuma; Nobuyuki; Hojo; Koichi; Mizuta; Hideo; Kawarasaki; Alan; T; Lefor; Yoshikazu; Yasuda

    2010-01-01

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son,who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years.The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation.With the use of cholangiography at the time of surgery,we found the right anterior segmental duct(RASD) emptying directly into the cystic duct,and the catheter passed into the RASD.After repairing the inci...

  3. Methods and Technologies Branch (MTB)

    Science.gov (United States)

    The Methods and Technologies Branch focuses on methods to address epidemiologic data collection, study design and analysis, and to modify technological approaches to better understand cancer susceptibility.

  4. Omphalomesenteric duct cyst with gastric mocosa: A case report

    OpenAIRE

    2006-01-01

    Persistance of the omphalomesenteric duct may lead to several anomalies including umblical sinus, umblical cyst, MeckeVs diverticulum or patent omphalomesenteric duct fistula. Clinical manifestations of umblical disorders are usually nonspecific; use of cross-sectional imaging can help identify most of these entities because of their typical locations and distributions in continuity with the other organs and guide therapy. A case of omphalomesenteric duct cyst are presented and analysed toget...

  5. Climate analysis of evaporation ducts in the South China Sea

    OpenAIRE

    McKeon, Brian D.

    2013-01-01

    Approved for public release; distribution is unlimited. Evaporation ducts have important implications for U.S. Naval activities involving electromagnetic propagation. The presence of an evaporation duct can affect naval operations involving communications, surveillance, electronic warfare, and detection of low-flying missiles, surface ships, or submarine periscopes. We conducted a climate scale analysis of evaporation duct heights (EDH) in the northern South China Sea (SCS), including how ...

  6. Breast ductoscopy with a 0.55-mm mini-endoscope for direct visualization of intraductal lesions.

    Science.gov (United States)

    Jacobs, Volker R; Kiechle, Marion; Plattner, Birgit; Fischer, Thorsten; Paepke, Stefan

    2005-01-01

    Standard radiologic examinations of breast duct lesions can give only indirect information. Mini-endoscopy with a breast ductoscope of only 0.55 mm offers direct visualization of the lesion and helps in the decision to perform or avoid exploratory breast tissue resection. We used a LaDuScope (PolyDiagnost, Pfaffenhofen, Germany) with a 0.55- or 0.95-mm outer diameter and a 75-mm working length from October 2003 through July 2004 on 11 women (average age of 48.3 years [range 36-69 years]) with suspicious nipple discharge. The optics have zero-degree direct view, 70-degree field vision, and 3000 or 6000 pixel resolution. Breast ducts and walls could be easily inspected; and irrigation of breast ducts, aspiration, and use of cytology brush were possible under visual control. We had no intraoperative or postoperative complications. The new procedure of mini-ductoscopy is feasible, safe, and helpful as an additional ambulatory diagnostic method for visual inspection of breast ducts. This instrument demonstrates the latest advances of technology and a trend toward less-invasive diagnostics for breast duct lesions.

  7. Leaf seal for transition duct in turbine system

    Science.gov (United States)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2013-06-11

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface member for interfacing with a turbine section. The turbine system further includes a leaf seal contacting the interface member to provide a seal between the interface member and the turbine section.

  8. Convolution seal for transition duct in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2015-03-10

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface member for interfacing with a turbine section. The turbine system further includes a convolution seal contacting the interface member to provide a seal between the interface member and the turbine section.

  9. Duct injection technology prototype development: Evaluation of engineering data

    Energy Technology Data Exchange (ETDEWEB)

    1990-07-01

    The objective of the Duct Injection Technology Prototype Development Project is to develop a sound design basis for applying duct injection technology as a post-combustion SO{sub 2}emissions control method to existing coal-fired power plants. The necessary engineering design and scale-up criteria will be developed for the commercialization of duct injection technology for the control of SO{sub 2} emissions from coal-fired boilers in the utility industry. The primary focus of the analyses summarized in this Topical Report is the review of the known technical and economic information associated with duct injection technology. (VC)

  10. Experimental investigation of a rapidly rotating turbulent duct flow

    Energy Technology Data Exchange (ETDEWEB)

    Maartensson, G.E.; Johansson, A.V. [Department of Mechanics, KTH, 10044 Stockholm (Sweden); Gunnarsson, J. [Bombardier Transportation, Vaesteraas (Sweden); Moberg, H. [Alfa Laval, 14780 Tumba (Sweden)

    2002-09-01

    Rapidly rotating duct flow is studied experimentally with Rotation numbers in the interval. To achieve this, in combination with relatively high Reynolds numbers (5,000-30,000 based on the hydraulic radius), water was used as the working medium. Square and rectangular duct cross-sections were used and the angle between the rotation vector and the main axis of the duct was varied. The influence of the rotation on the pressure drop in the duct was investigated and suitable scalings of this quantity were studied. (orig.)

  11. Method for Observing Intravascular BongHan Duct

    CERN Document Server

    Jiang, X; Shin, H; Lee, B; Choi, C; Soh, K; Cheun, B; Baik, K; Soh, K; Jiang, Xiaowen; Kim, Hee-kyeong; Shin, Hak-soo; Lee, Byong-chon; Choi, Chunho; Soh, Kyung-soon; Cheun, Byeung-soo; Baik, Ku-youn; Soh, Kwang-sup

    2002-01-01

    A method for observing intra blood vessel ducts which are threadlike bundle of tubules which form a part of the BongHan duct system. By injecting 10% dextrose solution at a vena femoralis one makes the intravascular BongHan duct thicker and stronger to be easily detectable after incision of vessels. The duct is semi-transparent, soft and elastic, and composed of smaller tubules whose diameters are of 10$\\mu$m order, which is in agreement with BongHan theory.

  12. Tau hadronic branching ratios

    CERN Document Server

    Buskulic, Damir; De Bonis, I; Décamp, D; Ghez, P; Goy, C; Lees, J P; Lucotte, A; Minard, M N; Odier, P; Pietrzyk, B; Ariztizabal, F; Chmeissani, M; Crespo, J M; Efthymiopoulos, I; Fernández, E; Fernández-Bosman, M; Gaitan, V; Martínez, M; Orteu, S; Pacheco, A; Padilla, C; Palla, Fabrizio; Pascual, A; Perlas, J A; Sánchez, F; Teubert, F; Colaleo, A; Creanza, D; De Palma, M; Farilla, A; Gelao, G; Girone, M; Iaselli, Giuseppe; Maggi, G; Maggi, M; Marinelli, N; Natali, S; Nuzzo, S; Ranieri, A; Raso, G; Romano, F; Ruggieri, F; Selvaggi, G; Silvestris, L; Tempesta, P; Zito, G; Huang, X; Lin, J; Ouyang, Q; Wang, T; Xie, Y; Xu, R; Xue, S; Zhang, J; Zhang, L; Zhao, W; Bonvicini, G; Cattaneo, M; Comas, P; Coyle, P; Drevermann, H; Engelhardt, A; Forty, Roger W; Frank, M; Hagelberg, R; Harvey, J; Jacobsen, R; Janot, P; Jost, B; Kneringer, E; Knobloch, J; Lehraus, Ivan; Markou, C; Martin, E B; Mato, P; Minten, Adolf G; Miquel, R; Oest, T; Palazzi, P; Pater, J R; Pusztaszeri, J F; Ranjard, F; Rensing, P E; Rolandi, Luigi; Schlatter, W D; Schmelling, M; Schneider, O; Tejessy, W; Tomalin, I R; Venturi, A; Wachsmuth, H W; Wiedenmann, W; Wildish, T; Witzeling, W; Wotschack, J; Ajaltouni, Ziad J; Bardadin-Otwinowska, Maria; Barrès, A; Boyer, C; Falvard, A; Gay, P; Guicheney, C; Henrard, P; Jousset, J; Michel, B; Monteil, S; Pallin, D; Perret, P; Podlyski, F; Proriol, J; Rossignol, J M; Saadi, F; Fearnley, Tom; Hansen, J B; Hansen, J D; Hansen, J R; Hansen, P H; Nilsson, B S; Kyriakis, A; Simopoulou, Errietta; Siotis, I; Vayaki, Anna; Zachariadou, K; Blondel, A; Bonneaud, G R; Brient, J C; Bourdon, P; Passalacqua, L; Rougé, A; Rumpf, M; Tanaka, R; Valassi, Andrea; Verderi, M; Videau, H L; Candlin, D J; Parsons, M I; Focardi, E; Parrini, G; Corden, M; Delfino, M C; Georgiopoulos, C H; Jaffe, D E; Antonelli, A; Bencivenni, G; Bologna, G; Bossi, F; Campana, P; Capon, G; Chiarella, V; Felici, G; Laurelli, P; Mannocchi, G; Murtas, F; Murtas, G P; Pepé-Altarelli, M; Dorris, S J; Halley, A W; ten Have, I; Knowles, I G; Lynch, J G; Morton, W T; O'Shea, V; Raine, C; Reeves, P; Scarr, J M; Smith, K; Smith, M G; Thompson, A S; Thomson, F; Thorn, S; Turnbull, R M; Becker, U; Braun, O; Geweniger, C; Graefe, G; Hanke, P; Hepp, V; Kluge, E E; Putzer, A; Rensch, B; Schmidt, M; Sommer, J; Stenzel, H; Tittel, K; Werner, S; Wunsch, M; Beuselinck, R; Binnie, David M; Cameron, W; Colling, D J; Dornan, Peter J; Konstantinidis, N P; Moneta, L; Moutoussi, A; Nash, J; San Martin, G; Sedgbeer, J K; Stacey, A M; Dissertori, G; Girtler, P; Kuhn, D; Rudolph, G; Bowdery, C K; Brodbeck, T J; Colrain, P; Crawford, G; Finch, A J; Foster, F; Hughes, G; Sloan, Terence; Whelan, E P; Williams, M I; Galla, A; Greene, A M; Kleinknecht, K; Quast, G; Raab, J; Renk, B; Sander, H G; Wanke, R; Van Gemmeren, P; Zeitnitz, C; Aubert, Jean-Jacques; Bencheikh, A M; Benchouk, C; Bonissent, A; Bujosa, G; Calvet, D; Carr, J; Diaconu, C A; Etienne, F; Thulasidas, M; Nicod, D; Payre, P; Rousseau, D; Talby, M; Abt, I; Assmann, R W; Bauer, C; Blum, Walter; Brown, D; Dietl, H; Dydak, Friedrich; Ganis, G; Gotzhein, C; Jakobs, K; Kroha, H; Lütjens, G; Lutz, Gerhard; Männer, W; Moser, H G; Richter, R H; Rosado-Schlosser, A; Schael, S; Settles, Ronald; Seywerd, H C J; Saint-Denis, R; Wolf, G; Alemany, R; Boucrot, J; Callot, O; Cordier, A; Courault, F; Davier, M; Duflot, L; Grivaz, J F; Heusse, P; Jacquet, M; Kim, D W; Le Diberder, F R; Lefrançois, J; Lutz, A M; Musolino, G; Nikolic, I A; Park, H J; Park, I C; Schune, M H; Simion, S; Veillet, J J; Videau, I; Abbaneo, D; Azzurri, P; Bagliesi, G; Batignani, G; Bettarini, S; Bozzi, C; Calderini, G; Carpinelli, M; Ciocci, M A; Ciulli, V; Dell'Orso, R; Fantechi, R; Ferrante, I; Foà, L; Forti, F; Giassi, A; Giorgi, M A; Gregorio, A; Ligabue, F; Lusiani, A; Marrocchesi, P S; Messineo, A; Rizzo, G; Sanguinetti, G; Sciabà, A; Spagnolo, P; Steinberger, Jack; Tenchini, Roberto; Tonelli, G; Triggiani, G; Vannini, C; Verdini, P G; Walsh, J; Betteridge, A P; Blair, G A; Bryant, L M; Cerutti, F; Gao, Y; Green, M G; Johnson, D L; Medcalf, T; Mir, L M; Perrodo, P; Strong, J A; Bertin, V; Botterill, David R; Clifft, R W; Edgecock, T R; Haywood, S; Edwards, M; Maley, P; Norton, P R; Thompson, J C; Bloch-Devaux, B; Colas, P; Emery, S; Kozanecki, Witold; Lançon, E; Lemaire, M C; Locci, E; Marx, B; Pérez, P; Rander, J; Renardy, J F; Roussarie, A; Schuller, J P; Schwindling, J; Trabelsi, A; Vallage, B; Johnson, R P; Kim, H Y; Litke, A M; McNeil, M A; Taylor, G; Beddall, A; Booth, C N; Boswell, R; Cartwright, S L; Combley, F; Dawson, I; Köksal, A; Letho, M; Newton, W M; Rankin, C; Thompson, L F; Böhrer, A; Brandt, S; Cowan, G D; Feigl, E; Grupen, Claus; Lutters, G; Minguet-Rodríguez, J A; Rivera, F; Saraiva, P; Smolik, L; Stephan, F; Apollonio, M; Bosisio, L; Della Marina, R; Giannini, G; Gobbo, B; Ragusa, F; Rothberg, J E; Wasserbaech, S R; Armstrong, S R; Bellantoni, L; Elmer, P; Feng, Z; Ferguson, D P S; Gao, Y S; González, S; Grahl, J; Harton, J L; Hayes, O J; Hu, H; McNamara, P A; Nachtman, J M; Orejudos, W; Pan, Y B; Saadi, Y; Schmitt, M; Scott, I J; Sharma, V; Turk, J; Walsh, A M; Wu Sau Lan; Wu, X; Yamartino, J M; Zheng, M; Zobernig, G

    1996-01-01

    From 64492 selected \\tau-pair events, produced at the Z^0 resonance, the measurement of the tau decays into hadrons from a global analysis using 1991, 1992 and 1993 ALEPH data is presented. Special emphasis is given to the reconstruction of photons and \\pi^0's, and the removal of fake photons. A detailed study of the systematics entering the \\pi^0 reconstruction is also given. A complete and consistent set of tau hadronic branching ratios is presented for 18 exclusive modes. Most measurements are more precise than the present world average. The new level of precision reached allows a stringent test of \\tau-\\mu universality in hadronic decays, g_\\tau/g_\\mu \\ = \\ 1.0013 \\ \\pm \\ 0.0095, and the first measurement of the vector and axial-vector contributions to the non-strange hadronic \\tau decay width: R_{\\tau ,V} \\ = \\ 1.788 \\ \\pm \\ 0.025 and R_{\\tau ,A} \\ = \\ 1.694 \\ \\pm \\ 0.027. The ratio (R_{\\tau ,V} - R_{\\tau ,A}) / (R_{\\tau ,V} + R_{\\tau ,A}), equal to (2.7 \\pm 1.3) \\ \\%, is a measure of the importance of Q...

  13. Autoimmune Pancreatitis Presenting a Short Narrowing of Main Pancreatic Duct with Subsequent Progression to Diffuse Pancreatic Enlargement over 24 Months; Natural History of Autoimmune Pancreatitis

    Directory of Open Access Journals (Sweden)

    Shuichiro Umemura

    2014-05-01

    Full Text Available Context Initial pancreatogram and natural history of autoimmune pancreatitis (AIP have not been clarified, and there were few recent studies concerning the association between AIP and intraductal papillary mucinous neoplasm (IPMN. Case report We report an 81-yearold man with AIP associated with IPMN. Although the initial pancreatogram was normal, a short narrowing of the main pancreatic duct (MPD appeared during a follow-up for IPMN after 6 months, which was highly suggestive of pancreatic cancer. A narrowing of the MPD extended after 15 months, and this progressed to diffuse narrowing of the MPD with an elevation in the serum IgG4 levels after 24 months. Finally, the patient was diagnosed with diffuse-type AIP, according to the Japanese diagnostic criteria 2011 and the International Consensus Diagnostic Criteria. Considering the natural history of AIP, this marked change of the MPD is indicative of this condition. Conclusion Wereport a case of AIP presenting with a short narrowing of the MPD with subsequent progression to diffuse pancreatic enlargement during a follow-up for IPMN.

  14. NONLINEAR ELASTICITY OF BLOOD ARTERIAL DUCT

    Institute of Scientific and Technical Information of China (English)

    黄孟才; 顾忠; 沈俊; 唐复勇

    1991-01-01

    The paper deals with nonlinear elasticity of blood arterial duct, in which the artery is modeled to bea locally triclinic, transverse isotropic, incorapressible, axisymmetric and thickwalled tube with large deformations, The nonlinear coustitutive relationship of arterial tissues is based on the theorv of Green and Adkins. A nonlinear strain energy density function is introduced for nonlinear stress-strain relationship of second order, in which the coefficient of each term is expressed by means of a Lame’s constant, The elasticity constants are nqcessary to describe such a uonlinear finite strain etastieity of the second order, These constants are determined by means of the stress-strain increment theory.

  15. Classification and management of bile duct injuries

    OpenAIRE

    2011-01-01

    To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases...

  16. Radiation of sound from unflanged cylindrical ducts

    Science.gov (United States)

    Hartharan, S. L.; Bayliss, A.

    1983-01-01

    Calculations of sound radiated from unflanged cylindrical ducts are presented. The numerical simulation models the problem of an aero-engine inlet. The time dependent linearized Euler equations are solved from a state of rest until a harmonic solution is attained. A fourth order accurate finite difference scheme is used and solutions are obtained from a fully vectorized Cyber-203 computer program. Cases of both plane waves and spin modes are treated. Spin modes model the sound generated by a turbofan engine. Boundary conditions for both plane waves and spin modes are treated. Solutions obtained are compared with experiments conducted at NASA Langley Research Center.

  17. Live 3D image overlay for arterial duct closure with Amplatzer Duct Occluder II additional size.

    Science.gov (United States)

    Goreczny, Sebstian; Morgan, Gareth J; Dryzek, Pawel

    2016-03-01

    Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.

  18. Effectiveness of duct sealing and duct insulation in multi-family buildings. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Karins, N.H.; Tuluca, A.; Modera, M.

    1997-07-01

    This research investigated the cost-effectiveness of sealing and insulating the accessible portions of duct systems exposed to unconditioned areas in multifamily housing. Airflow and temperature measurements were performed in 25 apartments served by 10 systems a 9 multi-family properties. The measurements were performed before and after each retrofit, and included apartment airflow (supply and return), duct system temperatures, system fan flow and duct leakage area. The costs for each retrofit were recorded. The data were analyzed and used to develop a prototypical multifamily house. This prototype was used in energy simulations (DOE-2.1E) and air infiltration simulations (COMIS 2.1). The simulations were performed for two climates: New York City and Albany. In each climate, one simulation was performed assuming the basement was tight, and another assuming the basement was leaky. Simulation results and average retrofit costs were used to calculate cost-effectiveness. The results of the analysis indicate that sealing leaks of the accessible ductwork is cost-effective under all conditions simulated (simple payback was between 3 and 4 years). Insulating the accessible ductwork, however, is only cost-effective for buildings with leaky basement, in both climates (simple paybacks were less than 5 years). The simple payback period for insulating the ducts in buildings with tight basements was greater than 10 years, the threshold of cost-effectiveness for this research. 13 refs., 5 figs., 27 tabs.

  19. [A Case of Invasive Intraductal Papillary Mucinous Carcinoma, Penetrating the Stomach, Colon, and Jejunum].

    Science.gov (United States)

    Goto, Tadahiro; Toyama, Hirochika; Asari, Sadaki; Terai, Sachio; Kinoshita, Hisoka; Matsumoto, Taku; Kuramitsu, Kaori; Tanaka, Motofumi; Takebe, Atsushi; Kido, Masahiro; Matsumoto, Ippei; Ajiki, Tetsuo; Fukumoto, Takumi; Ku, Yonson

    2015-11-01

    A 69-year-old woman was admitted to a nearby clinic complaining of abdominal pain. Abdominal CT showed a 10 cm diameter huge cystic lesion in the body and tail of the pancreas. The patient was referred to our institution for treatment. Endoscopic ultrasonography (EUS) revealed a cystic mass with a solid lesion. Endoscopic retrograde pancreatography(ERP) demonstrated mucous at the opening of the papilla of Vater and dilatation of the pancreatic duct with a solid nodule. Contrast radiography revealed a fistula from the tumor to the jejunum. A biopsy specimen from the lesion showed adenocarcinoma. Intraoperative findings showed a tumor occupying the pancreas body and tail with suspected invasion to the stomach, jejunum, and transverse colon. We performed distal pancreatectomy with partial resection of stomach, jejunum, and colon. Pathological findings showed an invasive type of IPMC, with invasion to the subserosal layer of the stomach and colon and the mucous layer of the jejunum. While IPMC is recognized as a slow growing malignancy, some cases of invasive carcinoma with fistulation into adjacent organs have been reported. To our knowledge, a case of IPMC penetrating to 3 adjacent organs is rare.

  20. A genome-wide investigation of microRNA expression identifies biologically-meaningful microRNAs that distinguish between high-risk and low-risk intraductal papillary mucinous neoplasms of the pancreas.

    Directory of Open Access Journals (Sweden)

    Jennifer Permuth-Wey

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are pancreatic ductal adenocarcinoma (PDAC precursors. Differentiating between high-risk IPMNs that warrant surgical resection and low-risk IPMNs that can be monitored is a significant clinical problem, and we sought to discover a panel of mi(croRNAs that accurately classify IPMN risk status.In a discovery phase, genome-wide miRNA expression profiling was performed on 28 surgically-resected, pathologically-confirmed IPMNs (19 high-risk, 9 low-risk using Taqman MicroRNA Arrays. A validation phase was performed in 21 independent IPMNs (13 high-risk, 8 low-risk. We also explored associations between miRNA expression level and various clinical and pathological factors and examined genes and pathways regulated by the identified miRNAs by integrating data from bioinformatic analyses and microarray analysis of miRNA gene targets. Six miRNAs (miR-100, miR-99b, miR-99a, miR-342-3p, miR-126, miR-130a were down-regulated in high-risk versus low-risk IPMNs and distinguished between groups (P<10-3, area underneath the curve (AUC = 87%. The same trend was observed in the validation phase (AUC = 74%. Low miR-99b expression was associated with main pancreatic duct involvement (P = 0.021, and serum albumin levels were positively correlated with miR-99a (r = 0.52, P = 0.004 and miR-100 expression (r = 0.49, P = 0.008. Literature, validated miRNA:target gene interactions, and pathway enrichment analysis supported the candidate miRNAs as tumor suppressors and regulators of PDAC development. Microarray analysis revealed that oncogenic targets of miR-130a (ATG2B, MEOX2, miR-342-3p (DNMT1, and miR-126 (IRS-1 were up-regulated in high- versus low-risk IPMNs (P<0.10.This pilot study highlights miRNAs that may aid in preoperative risk stratification of IPMNs and provides novel insights into miRNA-mediated progression to pancreatic malignancy. The miRNAs identified here and in other recent investigations warrant evaluation

  1. Imaging diagnosis progress of intraductal papillary mucinous neoplasm of pancreas%胰腺导管内乳头状黏液瘤的影像学诊断进展

    Institute of Scientific and Technical Information of China (English)

    周英文; 征锦

    2015-01-01

    With the continuous improvement of medical imaging technology , intraductal papillary mucinous neoplasm ( IPMN) of pancreas is being known by people .As IPMN of pancreas is a rare tumor which has malignant potential ,so early diagnosis and treatment are significantly important for patients .In order to improve the diagnosis and understand more about this disease ,we will talk about IPMN from different imaging methods.The sensitivity of endoscopic ultrasonography (EUS)is better,which can find the lesions safely and performe needle biopsy .CT and MRI can find the cystic lesions with separation in pancreas .Magnetic resonance cholangiopancreatography ( MRCP ) can show the communication between lesions and pancreatic duct system .Diffusion weighted imaging of MR can determine the branchedness dysplasia IPMN .PET-CT can be used to diagnose the early and systemic metastases of IPMN .%随着医学影像技术的不断提高,胰腺导管内乳头状黏液瘤( IPMN)也进一步被人们认识,由于导管内乳头状黏液瘤是少见肿瘤且具有潜在恶变的特性,所以早期诊断并早期治疗对患者有重要意义。为提高诊断水平和对该病的认识,我们回顾并分析了该病最新的影像诊断进展。超声内镜对该病的敏感度较强,能安全地够检出病变并能穿刺活检;CT及MRI能发现胰腺的具有分隔的囊性病变;磁共振胰胆管造影能无创地显示病变与胰管系统交通的情况;MR的弥散加权成像可以确定分支型发育不良的IPMN;PET-CT多用于该病发生恶变后早期及全身的转移的诊断。

  2. 胰腺导管内管状乳头状肿瘤三例临床病理学特征%Clinicopathological analysis of 3 cases of intraductal tubulopapillary neoplasm of the pancreas and literature review

    Institute of Scientific and Technical Information of China (English)

    陈颖; 陈星晔; 朱明华

    2014-01-01

    Objective To analyze the clinical symptoms,pathological features and K-ras mutation alterations of intraductal tubulopapillary neoplasm (ITPN),and to better understand ITPN.Methods We collected the clinical data of 3 cases of ITPNs of Changhai Hospital and 16 cases in literature,and analyzed the morphology,K-ras mutation,immunophenotype of tumor cells by routine H&E staining,immonohistochemistry,and fluorescence PCR.Then it was compared with 81 cases of intraductal papillary mucinous tumor (IPMT).Results All the 3 patients of ITPN were male,with a median age of 43 years.Two lesions were located in pancreatic head and 1 case in pancreatic body and tail.ITPNs presented as intraductal solid masses,and consisted of cells with uniformly median-to-high grade nuclear atypia,and tumor cells were arranged as glandular and cribriform.One case was accompanied with invasive ductal adenocarcinoma and peripancreatic lymph node metastasis.All tumor cells of epithelial marker cytokeratin was positively expressed,and p53 was positively expressed in some tumor cells.However,CHR,NSE,MUC2 and MUC5AC were negatively expressed,and K-ras mutation was not detected.The tumor cells of IPMT were presented as papillary pattern and cribriform structure was observed.The majority of cells were mucous epithelium,or goblet cells (intestinal type),a few were eosinophilic epithelium (eosinophilic cells type) and cuboidal epithelium (pancreatic,biliary duct type),MUC2 and MUC5AC was positively expressed,and K-ras mutation rate was 50%.Conclusions As a new tumor entity of pancreas,ITPNs show distinctive features with IPMTs.%目的 分析胰腺导管内管状乳头状肿瘤(ITPN)的临床特征、病理形态学特征以及K-ras 基因突变状况,以提高对该病的认知度.方法 收集上海长海医院3例ITPN,并综合文献报道的16例资料,分析它们的临床表现、肿瘤的大体及病理组织学改变、免疫表型、K-ras基因突变状况,并与81例胰腺导管内黏液性乳

  3. Sound waves in two-dimensional ducts with sinusoidal walls

    Science.gov (United States)

    Nayfeh, A. H.

    1974-01-01

    The method of multiple scales is used to analyze the wave propagation in two-dimensional hard-walled ducts with sinusoidal walls. For traveling waves, resonance occurs whenever the wall wavenumber is equal to the difference of the wavenumbers of any two duct acoustic modes. The results show that neither of these resonating modes could occur without strongly generating the other.

  4. Cystic duct closure by sealing with bipolar electrocoagulation

    DEFF Research Database (Denmark)

    Schulze, S; Damgaard, B; Jørgensen, Lars Nannestad;

    2010-01-01

    BACKGROUND: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure) for closure of the cystic duct. METHODS: The records from consecutive laparoscopic cholecystectomies performed i...

  5. Sound Radiation Characteristics of a Rectangular Duct with Flexible Walls

    Directory of Open Access Journals (Sweden)

    Praveena Raviprolu

    2016-01-01

    Full Text Available Acoustic breakout noise is predominant in flexible rectangular ducts. The study of the sound radiated from the thin flexible rectangular duct walls helps in understanding breakout noise. The current paper describes an analytical model, to predict the sound radiation characteristics like total radiated sound power level, modal radiation efficiency, and directivity of the radiated sound from the duct walls. The analytical model is developed based on an equivalent plate model of the rectangular duct. This model has considered the coupled and uncoupled behaviour of both acoustic and structural subsystems. The proposed analytical model results are validated using finite element method (FEM and boundary element method (BEM. Duct acoustic and structural modes are analysed to understand the sound radiation behaviour of a duct and its equivalence with monopole and dipole sources. The most efficient radiating modes are identified by vibration displacement of the duct walls and for these the radiation efficiencies have been calculated. The calculated modal radiation efficiencies of a duct compared to a simple rectangular plate indicate similar radiation characteristics.

  6. Chloride and potassium conductances of cultured human sweat ducts

    DEFF Research Database (Denmark)

    Novak, I; Pedersen, P S; Larsen, Erik Hviid

    1992-01-01

    The purpose of this study was to characterize the ion conductances, in particular those for Cl- and K+, of human sweat duct cells grown in primary culture. Sweat duct cells from healthy individuals were grown to confluence on a dialysis membrane, which was then mounted in a mini-Ussing chamber...

  7. Continuous-state branching processes

    CERN Document Server

    Li, Zenghu

    2012-01-01

    These notes were used in a short graduate course on branching processes the author gave in Beijing Normal University. The following main topics are covered: scaling limits of Galton--Watson processes, continuous-state branching processes, extinction probabilities, conditional limit theorems, decompositions of sample paths, martingale problems, stochastic equations, Lamperti's transformations, independent and dependent immigration processes. Some of the results are simplified versions of those in the author's book "Measure-valued branching Markov processes" (Springer, 2011). We hope these simplified results will set out the main ideas in an easy way and lead the reader to a quick access of the subject.

  8. Scaling Behaviors of Branched Polymers

    CERN Document Server

    Aoki, H; Kawai, H; Kitazawa, Y; Aoki, Hajime; Iso, Satoshi; Kawai, Hikaru; Kitazawa, Yoshihisa

    2000-01-01

    We study the thermodynamic behavior of branched polymers. We first study random walks in order to clarify the thermodynamic relation between the canonical ensemble and the grand canonical ensemble. We then show that correlation functions for branched polymers are given by those for $\\phi^3$ theory with a single mass insertion, not those for the $\\phi^3$ theory themselves. In particular, the two-point function behaves as $1/p^4$, not as $1/p^2$, in the scaling region. This behavior is consistent with the fact that the Hausdorff dimension of the branched polymer is four.

  9. Duct thermal performance models for large commercial buildings

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.

    2003-10-01

    Despite the potential for significant energy savings by reducing duct leakage or other thermal losses from duct systems in large commercial buildings, California Title 24 has no provisions to credit energy-efficient duct systems in these buildings. A substantial reason is the lack of readily available simulation tools to demonstrate the energy-saving benefits associated with efficient duct systems in large commercial buildings. The overall goal of the Efficient Distribution Systems (EDS) project within the PIER High Performance Commercial Building Systems Program is to bridge the gaps in current duct thermal performance modeling capabilities, and to expand our understanding of duct thermal performance in California large commercial buildings. As steps toward this goal, our strategy in the EDS project involves two parts: (1) developing a whole-building energy simulation approach for analyzing duct thermal performance in large commercial buildings, and (2) using the tool to identify the energy impacts of duct leakage in California large commercial buildings, in support of future recommendations to address duct performance in the Title 24 Energy Efficiency Standards for Nonresidential Buildings. The specific technical objectives for the EDS project were to: (1) Identify a near-term whole-building energy simulation approach that can be used in the impacts analysis task of this project (see Objective 3), with little or no modification. A secondary objective is to recommend how to proceed with long-term development of an improved compliance tool for Title 24 that addresses duct thermal performance. (2) Develop an Alternative Calculation Method (ACM) change proposal to include a new metric for thermal distribution system efficiency in the reporting requirements for the 2005 Title 24 Standards. The metric will facilitate future comparisons of different system types using a common ''yardstick''. (3) Using the selected near-term simulation approach

  10. Hepatobiliary Scan in Infantile Spontaneous Perforation of Common Bile Duct

    Energy Technology Data Exchange (ETDEWEB)

    Zeon, Seok Kil; Ryu, Jong Gul; Lee, Eun Young [Keimyung University School of Medicine, Taegu (Korea, Republic of); Lee, Jong Gil [Taegu Fatima Hospital, Taegu (Korea, Republic of)

    1996-03-15

    Spontaneous perforation of CBD in infant is a rare but fatal disease. We report a case of bile leakage from common bile duct in 11 months old girl with progressive abdominal distension and vomiting, preoperatively diagnosed by hepatobiliary scan with Tc-99m-DISIDA, which was confirmed by surgery. Operative cholangiogram showed a small perforation at the confluence of cystic duct and common bile duct with mild fusiform dilatation, and no definite abnormality in confluence of the common bile duct and pancreatic duct. Simple drainage of the free peritoneal bilous fluid and T-tube drainage were performed without any evidence of the complication. Patient was inevitable for 6 months OPD follow-up examination.

  11. Heat Transfer in Conical Corner and Short Superelliptical Transition Ducts

    Science.gov (United States)

    Poinsatte, Philip; Thurman, Douglas; Hippensteele, Steven

    2008-01-01

    Local surface heat transfer measurements were experimentally mapped using a transient liquid-crystal heat-transfer technique on the surface of two circular-to-rectangular transition ducts. One has a transition cross section defined by conical corners (Duct 1) and the other by an elliptical equation with changing coefficients (Duct 2). Duct 1 has a length-to-diameter ratio of 0.75 and an exit plane aspect ratio of 1.5. Duct 2 has a length-to-diameter ratio of 1.0 and an exit plane aspect ratio of 2.9. Test results are reported for various inlet-diameter-based Reynolds numbers ranging from 0.45 106 to 2.39 106 and two freestream turbulence intensities of about 1 percent, which is typical of wind tunnels, and up to 16 percent, which may be more typical of real engine conditions.

  12. Cystic duct remnant mucocele in a liver transplant recipient

    Energy Technology Data Exchange (ETDEWEB)

    Ahlawat, Sushil K. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ (United States); Fishbien, Thomas M. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); Haddad, Nadim G. [Georgetown University Hospital, Department of Surgery, Division of Transplant Surgery, Washington, DC (United States)

    2008-08-15

    Cystic duct remnant mucocele is an extremely rare complication of liver transplantation in children. Surgical correction is usually required for cystic duct remnant mucocele when it causes biliary obstruction. We describe a 14-month-old liver transplant recipient who presented with biliary obstruction 1 month after orthotopic liver transplantation with an end-to-end choledochocholedocal biliary anastomosis for hepatoblastoma. US, CT and cholangiography findings were consistent with mucocele of the allograft cystic duct remnant. Surgery was not needed in our patient because the mucocele and biliary obstruction had resolved on repeat imaging most likely due to guidewire manipulation during cholangiography, resulting in opening of the cystic duct remnant orifice and drainage into the common duct. (orig.)

  13. Lacrimal Duct Occlusion Is Associated with Infectious Keratitis

    Science.gov (United States)

    Li, Guigang; Guo, Jingmin; Liu, Rong; Hu, Weikun; Xu, Lingjuan; Wang, Juan; Cai, Subo; Zhang, Hong; Zhu, Yingting

    2016-01-01

    Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction

  14. Successful treatment of plastic bronchitis with low fat diet and subsequent thoracic duct ligation in child with fontan physiology.

    Science.gov (United States)

    Parikh, K; Witte, M H; Samson, R; Teodori, M; Carpenter, J B; Lowe, M C; Morgan, W; Hardin, C; Brown, M; Naughton, Y; Sinha, S; Barber, B J

    2012-06-01

    Plastic bronchitis is a rare condition characterized by the formation and expectoration of long, branching bronchial casts that develop in the tracheobronchial tree and cause airway obstruction. Plastic bronchitis has become increasingly recognized as a feared complication of the Fontan operation with a mortality of up to 50%. We report an 11 year old boy who developed severe plastic bronchitis following Fontan repair and the successful long-term control of cast formation utilizing a low-fat diet and subsequent thoracic duct ligation.

  15. Left bundle-branch block

    DEFF Research Database (Denmark)

    Risum, Niels; Strauss, David; Sogaard, Peter;

    2013-01-01

    The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently...

  16. Novel side branch ostial stent.

    Science.gov (United States)

    Chen, Shao-Liang; Lv, Shu-Zheng; Kwan, Tak W

    2009-04-01

    Bifurcation lesions are technically challenging and plagued by a high incidence of restenosis, especially at the side branch orifice, which results in a more frequent need for revascularization during the follow-up period. This report discusses two clinical experiences with a novel side branch ostial stent, the BIGUARD stent, designed for the treatment of bifurcation lesions; procedural success with no in-hospital complications was observed in types IVb and Ia lesions.

  17. Lessons from McCune-Albright syndrome-associated intraductal papillary mucinous neoplasms: : GNAS-activating mutations in pancreatic carcinogenesis.

    Science.gov (United States)

    Parvanescu, Alina; Cros, Jérôme; Ronot, Maxime; Hentic, Olivia; Grybek, Virginie; Couvelard, Anne; Levy, Philippe; Chanson, Philippe; Ruszniewski, Philippe; Sauvanet, Alain; Gaujoux, Sebastien

    2014-08-01

    GNAS-activating mutations are reported in intraductal papillary mucinous neoplasms (IPMNs) and in McCune-Albright syndrome, characterized by fibrous dysplasia, precocious puberty, and café au lait spots. Recently, IPMNs have been described as a McCune-Albright syndrome-associated tumor, present in about 15% of patients. The aim of the present work was to assess the prevalence of polyostotic fibrous dysplasia and McCune-Albright syndrome among patients operated on for presumptive sporadic IPMNs. All patients operated on for IPMNs between January 1, 2007, and December 31, 2012, with available imaging were retrospectively screened for polyostotic fibrous dysplasia based on their preoperative abdominal or thoracoabdominal spiral computed tomography images. Systematic screening of 272 patients operated on for IPMNs revealed 1 patient with axial and peripheral polyostotic fibrous dysplasia and café au lait spots on clinical examination suggestive of McCune-Albright syndrome. This patient had been operated on for an unusually large invasive colloid adenocarcinoma (pT3N0M0 R0) derived from an intestinal subtype GNAS-mutated IPMN. The patient underwent adjuvant chemotherapy with gemcitabine for 6 months and was alive without recurrence 6 years later. Besides providing additional evidence of a syndromic IPMN as a feature of McCune-Albright syndrome, this observation is further evidence of the functional oncogenic consequences of GNAS mutations in the pancreas.

  18. Presence of extensive intraductal component in patients undergoing breast conservative surgery predicts presence of residual disease in subsequent completion mastectomy

    Institute of Scientific and Technical Information of China (English)

    Christopher C. P. Yiu; Wings T. Y. Loo; C. K. Lam; Louis W. C. Chow

    2009-01-01

    Background Local recurrence remains a serious problem among patients undergoing breast conservative surgery. This study aimed at identifying risk factors for residual disease after breast conservative surgery.Methods This retrospective study was based on patients with invasive breast cancer who have received breast conservative surgery and subsequent completion mastectomy. All patients had a clear resection margin in the initial operation. We analyzed the association between the presence of residual disease during completion mastectomy and the following risk factors: T staging, young age, and presence of extensive intraductal component (EIC), a close margin, lymphovascular permeation (LVP), positivity of estrogen receptor, progesterone receptor, and c-erbB-2.Results Residual disease was encountered in 21 (45.7%) of 46 patients; EIC was present in 28 patients (60.9%), of whom 17 had residual disease. Presence of EIC during breast conservation surgery was associated with a higher risk of residual disease during completion mastectomy (P=0.011). Other variables were not statistically significant risk factors for presence of residual disease. No local recurrence was recorded in our cohort, and the disease-free survival and overall survival after completion mastectomy were similar for patients who had residual disease and those who had not.Conclusions The presence of EIC is a significant risk factor for residual disease in patients after breast conservative surgery. Our findings may suggest the indicated value of completion mastectomy in patients with EIC during initial breast conservative surgery to decrease the risk of subsequent local failure.

  19. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Hsiao, Chih-Yang; Yang, Ching-Yao; Wu, Jin-Ming; Kuo, Ting-Chun; Tien, Yu-Wen

    2016-01-01

    Abstract This study aimed to evaluate the utility of the 2006 Sendai and 2012 Fukuoka guidelines for differentiating malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas from benign IPMN. Between January 2000 and March 2015, a total of 138 patients underwent surgery and had a pathologically confirmed pancreatic IPMN. Clinicopathological parameters were reviewed, and all patients were classified according to both the 2006 Sendai and 2012 Fukuoka guidelines. Univariate and multivariate analyses were used for identifying significant factors associated with malignancy in IPMN. There were 9 high-grade dysplasia (HGD) and 37 invasive cancers (ICs) in the 138 patients. The positive predictive value (PPV) and negative predictive value (NPV) of the Sendai and Fukuoka guidelines for HGD/IC was 35.1%, 43.3%, 100%, and 85.4%, respectively. Of the 36 patients with worrisome features using the Fukuoka guideline, 7 patients had HGD/IC in their IPMNs. According to the multivariate analysis, jaundice, tumors of ≥3 cm, presence of mural nodule on imaging, and aged IPMN. The Sendai guideline had a better NPV, but the Fukuoka guideline had a better PPV. We suggest that patients with worrisome features based on the Fukuoka guideline be aggressively managed. PMID:27661043

  20. Radiation effects on branched polysilanes

    Energy Technology Data Exchange (ETDEWEB)

    Maeda, K.; Seki, S.; Tagawa, S. [Osaka Univ., Ibaraki (Japan). Inst. of Scientific and Industrial Research; Shibata, H.; Iwai, T. [Tokyo Univ. (Japan). Research Center for Nuclear Science and Technology

    2000-03-01

    We observed crosslinking and scission caused by gamma radiation in linear and branched polysilanes which have from 5% to 33% of the branching points. The crosslinking reactions become predominant for the irradiation with branching density increasing. The cleavage did not take place exclusively at the branching points and branching polysilanes are sensitive to radiation extraordinary as compared with linear polysilane from a careful study of the radiolysis products of a series of polysilanes. This is due to the increasing Si {center_dot} contributing to the crosslinking reaction and that they are not resonance-stabilized by double bonds as the reaction mechanism in the irradiated polysilanes. However, the gelation curve in linear PMPS irradiated by 2 MeV He{sup +} is almost consistent with that in branching PMPS, indicating that the size of chemical track is responsible for the gel fraction. The crosslinking G value for high molecular weight PMPS irradiated by 2 MeV He{sup +} was drastically decreased as compared with that for low molecular weight. It suggests that there are a large number of intramolecular crosslinking points for high molecular weight PMPS. (author)

  1. Altered collecting duct adenylyl cyclase content in collecting duct endothelin-1 knockout mice

    Directory of Open Access Journals (Sweden)

    Kohan Donald E

    2007-05-01

    Full Text Available Abstract Background Endothelin-1 (ET-1 inhibition of vasopressin (AVP-stimulated water reabsorption by the inner medullary collecting duct (IMCD is associated with reduced cAMP accumulation. To determine the effect of ET-1 deficiency, AVP-stimulated cAMP responsiveness was assessed in IMCD from mice with collecting duct-specific deletion of ET-1 (CD ET-1 KO and from control animals. Methods Cyclic AMP production, adenylyl cyclase (AC mRNA, and AC protein were measured in acutely isolated IMCD. Results CD ET-1 KO IMCD had enhanced AVP-stimulated cAMP accumulation. Inhibition of calcium-stimulated AC using BAPTA did not prevent enhanced AVP responsiveness in CD ET-1 KO IMCD. Factors known to be modified by ET-1, including nitric oxide, cyclooxygenase metabolites, and superoxide did not affect the increased AVP responsiveness of CD ET-1 KO IMCD. Differential V2 receptor or G-protein activity was not involved since CD ET-1 KO IMCD had increased cAMP accumulation in response to forskolin and/or cholera toxin. CD ET-1 KO did not affect mRNA or protein levels of AC3, one of the major known collecting duct AC isoforms. However, the other known major collecting duct AC isoform (AC5/6 did have increased protein levels in CD ET-1 KO IMCD, although AC5 (weak signal and 6 mRNA levels were unchanged. Conclusion ET-1 deficiency increases IMCD AC5/6 content, an effect that may synergize with acute ET-1 inhibition of AVP-stimulated cAMP accumulation.

  2. Clinical experience on breast fiberoptic ductoscopy from 1 368 re-ported cases of patients with breast intraductal lesion%1368例乳管镜治疗乳管内病变的临床应用经验

    Institute of Scientific and Technical Information of China (English)

    吴唯; 钱立元; 丁波泥; 岳红

    2014-01-01

    目的:总结乳管镜(fiberoptic ductoscopy,FDS)治疗乳管内病变临床应用经验。方法:回顾性分析中南大学湘雅三医院近10年来使用FDS检查的1368例乳头溢液病例的临床资料。结果:不同性状的溢液FDS诊断有着显著的差异,血性和浆液性溢液组肿瘤性疾病检出率明显高于水样和乳汁样溢液组;对于非肿瘤性乳头溢液,FDS下灌洗治疗能取得较好的治疗效果;FDS定位下手术组较传统切除手术组,FDS诊断病理符合率更高(χ2=10.56,P=0.001)。结论:FDS不仅是诊断乳头溢液病因的可靠方法,而且可以对非肿瘤性乳头溢液进行有效的灌洗治疗;对于肿瘤性疾病引起的乳头溢液,FDS下定位切除手术能够避免手术盲目性,为病灶的切除提供可靠的帮助。%Objective:To consolidate ten years of clinical experience on the application of breast fiberoptic ductoscopy (FDS) in breast intra-ductal lesion. Methods:The clinical data of 1 368 cases of patients with nipple discharge were retrospectively collected and analyzed. Results:Significant differences were observed in the FDS diagnoses of patients with nipple discharge. The rates of tumor de-tection by FDS diagnosis were significantly higher when bloody and serous nipple discharge was used rather than milky and watery nip-ple discharge. For non-tumor nipple discharge, local drug perfusion via FDS was an effective treatment. A total of 303 patients had tu-mor resection or segmentectomy under localization via FDS, and 44 had segmentectomy after breast duct infusion of methylene blue. The diagnostic rate of localization via FDS (97.0%) was higher than that of breast duct infusion of methylene blue (86.4%). Conclu-sion:FDS is an accurate method for diagnosing patients with nipple discharge. In addition, it is also a good local drug perfusion method for patients with breast inflammatory nipple discharge ductoscopy. For patients with tumorous nipple

  3. Hybrid noise control in a duct using a light micro-perforated plate.

    Science.gov (United States)

    Wang, X N; Choy, Y S; Cheng, L

    2012-12-01

    A plate silencer consists of an expansion chamber with two side-branch cavities covered by light but extremely stiff plates. It works effectively with a wide stopband from low-to-medium frequencies only if the plate is extremely stiff, to ensure a strong reflection of acoustic wave to the upstream in the duct. However, a plate with a slightly weak bending stiffness will result in non-uniform transmission loss (TL) spectra with narrowed stopband. In this study, a hybrid silencer is proposed by introducing micro-perforations into the plate to elicit the sound absorption in order to compensate for the deficiency in the passband caused by the insufficient sound reflection in a certain frequency range due to weaker plate stiffness. A theoretical model, capable of dealing with the strong coupling between the vibrating micro-perforated plate and sound fields inside the cavity and the duct, is developed. Through proper balancing between the sound absorption and reflection, the proposed hybrid silencer provides a more flattened and uniform TL and a widened stopband by more than 20% while relaxing the harsh requirement on the bending stiffness of the plate. Theoretical predictions are validated by experimental data, with phenomenon explained through numerical analyses.

  4. Mechanical properties of the porcine bile duct wall

    Directory of Open Access Journals (Sweden)

    Andersen Helle

    2004-07-01

    Full Text Available Abstract Background and Aim The function of the common bile duct is to transport bile from the liver and the gall bladder to the duodenum. Since the bile duct is a distensible tube consisting mainly of connective tissue, it is important to obtain data on the passive mechanical wall properties. The aims of this study were to study morphometric and biomechanical wall properties during distension of the bile duct. Methods Ten normal porcine common bile ducts were examined in vitro. A computer-controlled volume ramp infusion system with concomitant pressure recordings was constructed. A video camera provided simultaneous measurement of outer dimensions of the common bile duct. Wall stresses and strains were computed. Results The common bile duct length increased by 25% from 24.4 ± 1.8 mm at zero pressure to 30.5 ± 2.0 mm at 5 kPa (p (βε - 1. The circumferential stress-strain curve was shifted to the left when compared to the longitudinal stress-strain curve, i.e. the linear constants (α values were different (p 0.5. Conclusion The porcine bile duct exhibited nonlinear anisotropic mechanical properties.

  5. Development of a new duct leakage test: DeltaQ

    Energy Technology Data Exchange (ETDEWEB)

    Walker,I.S.; Sherman,M.H.; Wempen, J.; Wang, D.; McWilliams, J.A.; Dickerhoff, D.J.

    2001-08-01

    Duct leakage is a key factor in determining energy losses from forced air heating and cooling systems. Several studies (Francisco and Palmiter 1997 and 1999, Andrews et al. 1998, and Siegel et al. 2001) have shown that the duct system efficiency cannot be reliably determined without good estimates of duct leakage. Specifically, for energy calculations, it is the duct leakage air flow to outside at operating conditions that is required. Existing test methods either precisely measure the size of leaks (but not the flow through them at operating conditions), or measure these flows with insufficient accuracy. The DeltaQ duct leakage test method was developed to provide improved estimates of duct leakage during system operation. In this study we developed the analytical calculation methods and the test procedures used in the DeltaQ test. As part of the development process, we have estimated uncertainties in the test method (both analytically and based on field data) and designed automated test procedures to increase accuracy and reduce the contributions of operator errors in performing field tests. In addition, the test has been evaluated in over 100 houses by several research teams to show that it can be used in a wide range of houses and to aid in finding limits or problems in field applications. The test procedure is currently being considered by ASTM as an update of an existing duct leakage standard.

  6. Flow Development through a Duct and a Diffuser Using CFD

    Directory of Open Access Journals (Sweden)

    Prasanta K.Sinha

    2017-01-01

    Full Text Available In the present paper an extensive study of rectangular cross-sectioned C-duct and C-diffuser is made by the help of 2-D mean velocity contours. Study of flow characteristics through constant area duct is a fundamental research area of basic fluid mechanics since the concepts of potential flow and frictional losses in conduit flow were established. C-ducts are used in aircraft intakes, combustors, internal cooling systems of gas turbines, ventilation ducts, wind tunnels etc., while diffuser is mechanical device usually made in the form of a gradual conical expander intended to raise the static pressure of the fluid flowing through it. Flow through curved ducts is more complex compared to straight duct due to the curvature of the duct axis and centrifugal forces are induced on the flowing fluid resulting in the development of secondary motion (normal to the primary flow direction which is manifested in the form of a pair of contra-rotating vortices. For a diffuser in addition to the secondary flow, the diverging flow passage, which causes an adverse stream wise pressure gradient, can lead to flow separation. The combined effect may result n non uniformity of total pressure and total pressure loss at the exit. A comparative study of different turbulent models available in the Fluent using y  as guidance in selecting the appropriate grid configuration and turbulence models are done. Standard k-ε model and RSM models are used to solve the closure problem for both the constant area duct and the diffuser. It has been observed that the Standard k-e model predicts the flow through the constant area duct and the diffuser within a reasonable domain ofthe y  range.

  7. Flow in Idealised Compliant Human Cystic Duct Models

    Science.gov (United States)

    Al-Atabi, M.; Chin, S. B.; Beck, S.; Luo, X. Y.

    The functions of the cystic duct and the role of its complicated geometry (in particular the valves of Heister), in the delivery of bile flow have always been a subject of speculation. This paper reports on an experimental investigation of the flow in idealised, compliant cystic duct models. The valves of Heister were idealised using eight semi-circular alternating baffles fitted inside the compliant tubes. These tubes were arranged in configurations representing the anatomical configurations of real cystic ducts. Models both with and without baffles were tested for comparison. The results show that the valves of Heister seem to play a role in facilitating both the filling and emptying of the gallbladder.

  8. Finite-amplitude waves in cylindrical lined ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    A second-order uniformly valid expansion is obtained for nonlinear waves propagating in a cylindrical duct lined with a point-reacting acoustic material that consists of a porous sheet followed by honey-comb cavities and backed by the impervious walls of the duct. The effect of the liner is taken into account by coupling the waves in the duct with those in the liner. As in the two-dimensional case, the nonlinearity increases the attenuation rate at all frequencies except in narrow bandwidths around the resonant frequencies, irrespective of the geometrical dimensions of the liner or the acoustic properties of the porous sheet.

  9. BACTERIOLOGICAL INVESTIGATION ON Fasciola hepatica AND CATTLE BILIARY DUCTS

    Directory of Open Access Journals (Sweden)

    A. Panebianco

    2009-03-01

    Full Text Available The aim of this work was to investigate the occurrence of bacteria in Fasciola hepatica and into cattle biliary ducts containing the parasite. A total of 24 liver and 58 F. hepatica samples were analysed. In all biliary ducts and in 62,06% of parasite Enterobacteriaceae were isolated. The bacterial specie more frequently isolated from parasite were Citrobacter freundii (34%, Proteus mirabilis (18%, Providencia rettgeri (12%, Staphylococcus spp. (18%, Enterobacter spp. (12%. There doesn’t appear to be a correlation between bacterial specie from parasite and ducts. The Authors conclude with some related inspective consideration.

  10. Paraurethral Skene′s duct cyst in a newborn

    Directory of Open Access Journals (Sweden)

    Serdar Moralioglu

    2013-01-01

    Full Text Available Paraurethral or Skene′s duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene′s duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene′s duct cyst in a newborn which was treated by incision and drainage.

  11. Transition duct with late injection in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    LeBegue, Jeffrey Scott; Pentecost, Ronnie Ray; Flanagan, James Scott; Kim, Won -Wook; McMahan, Kevin Weston

    2015-09-15

    A system for supplying an injection fluid to a combustor is disclosed. The system includes a transition duct comprising an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The passage defines a combustion chamber. The system further includes a tube providing fluid communication for the injection fluid to flow through the transition duct and into the combustion chamber.

  12. Spontaneous common bile duct perforation due to periampullary growth

    Directory of Open Access Journals (Sweden)

    Pandiaraja Javabal

    2014-06-01

    Full Text Available Spontaneous common bile duct perforations are an unusual cause of acute abdomen. In spontaneous common bile duct perforation, malignant growth is even rare. It is a rare entity usually reported in infants and children due to congenital anomalies. It is rarely reported in adults. In this case report, a 55 - year - old male patient who was diagnosed as a duodenal perforation in the pre - operative period, but the intra - operative findings was common bile duct perforation due to periampullary growth, is reported

  13. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

    Science.gov (United States)

    Aydin, Unal; Yazici, Pinar; Coker, Ahmet

    2007-01-01

    Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

  14. EFFECT OF AIRFLOW AND HEAT INPUT RATES ON DUCT EFFICIENCY.

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    2003-05-28

    Reducing the airflow and heat input rates of a furnace that is connected to a duct system in thermal contact with unconditioned spaces can significantly reduce thermal distribution efficiency. This is a straightforward theoretical calculation based on the increased residence time of the air in the duct at the lower flow rate, which results in greater conduction losses. Experimental tests in an instrumented residential-size duct system have confirmed this prediction. Results are compared with the heat-loss algorithm in ASHRAE Standid 152P. The paper concludes with a discussion of possible remedies for this loss of efficiency in existing systems and optional design strategies in new construction.

  15. [Inadvertent thoracic duct puncture during right axially central venous cannulation].

    Science.gov (United States)

    Kawashima, Shingo; Itagaki, Taiga; Adachi, Yushi; Ishii, Yasuhiro; Taniguchi, Midzuki; Doi, Matsuyuki; Sato, Shigehito

    2010-10-01

    A case of inadvertent thoracic duct puncture during right axially central venous cannulation is reported. The catheterization was performed under the real time ultrasound guidance technique and the coronal view image was continuously displayed. After confirming the feelings of venous puncture, clear yellow fluid was aspired into the connected syringe to the needle. Initially, an accidental thoracic puncture with subsequent pleural fluid aspiration was suspected;however, no finding of pleural effusion was observed with ultrasound imaging and computed tomography. Thus, an accidental thoracic duct puncture and the subsequent lymph fluid aspiration were suspected. Even in a right side approach for central venous catheterization, thoracic duct injury might ensure.

  16. Thermo-chemo-radiotherapy for advanced bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Naoto Egawa; Katsuyuki Karasawa; Tadayoshi Matsuda; Kouji Tsuruta; Atsutake Okamoto

    2005-01-01

    AIM: Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dismal prognosis,with a life expectancy of about 6 mo to 1 year. To improve the treatment results of locally advanced bile duct carcinoma, we have been conducting a clinical trial using regional hyperthermia in combination with chemoradiation therapy.METHODS: Eight patients complaining of obstructive jaundice with advanced extrahepatic bile duct underwent thermo-chemo-radiotherapy (TCRT). All tumors were located in the upper bile duct and involved hepatic bifurcation, and obstructed the bile duct completely.Radiofrequency capacitive hyperthermia was administered simultaneously with chemotherapeutic agents once weekly immediately following radiotherapy at 2 Gy.We administered heat to the patient for 40 min after the tumor temperature had risen to 42 ℃. The chemotherapeutic agents employed were cis-platinum (CDDP,50 mg/m2) in combination with 5-fluorouracil (5-FU,800 mg/m2) or methotrexate (MTX, 30 mg/m2) in combination with 5-FU (800 mg/m2). Number of heat treatments ranged from 2 to 8 sessions. The bile duct at autopsy was histologically examined in three patients treated with TCRT.RESULTS: In respect to resolution of the bile duct, there were three complete regression (CR), two partial regression (PR), and three no change (NC). Mean survival was 13.2±10.8 mo (mean±SD). Four patients survived for more than 20 mo. Percutaneous transhepatic biliary drainage (PTBD) tube could be removed in placement of self-expandable metallic stent into the patency-restored bile duct after TCRT. No major side effects occurred. At autopsy, marked hyalinization or fibrosis with necrosis replaced extensively bile duct tumor and wall, in which suppressed cohesiveness of carcinoma cells and degenerative cells were sparsely observed.CONCLUSION: Although the number of cases is

  17. A procedure for the calculation of flow through axisymmetric ducts

    Directory of Open Access Journals (Sweden)

    P. S. Heyns

    1983-03-01

    Full Text Available A procedure for the calculation of flow through axisymmetric ducts as are typically found in turbomachines, is presented. The procedure is based on a streamline curvature method with the governing equations formulated along quasi-orthogonals in the flow field. This formulation allows the procedure to be used for segments of a duct wherein the flow direction is predominantly radial. It is assumed that the flow on specific stream surfaces is isentropic, but normal entropy gradients may exist because of processes which took place upstream of the duct.

  18. [A case of metachronous invasive ductal carcinoma concomitant with intraductal papillary-mucinous neoplasm (IPMN) of the pancreas, which could not be detected in contrast-enhanced CT scan performed 3 months ago].

    Science.gov (United States)

    Hasebe, Osamu; Ochi, Yasuhide; Hara, Etsuo; Suzawa, Kenichi; Seki, Ayako; Nagaya, Tadanobu; Tatai, Toshiharu; Jimbo, Yoko; Hosaka, Noriko

    2011-09-01

    A 61-year-old man had been followed up in another hospital under diagnosis of branch duct type IPMN for 4 years. Contrast-enhanced CT scan for regular check performed 3 months ago revealed no increase of IPMN and no pancreatic tumor. However, he complained of back pain after that, MRI was performed. It revealed a solid tumor in size of 25mm diameter at the head of pancreas. The tumor was apparent from IPMN in several imaging modalities. Pancreatoduodenectomy was performed under diagnosis of invasive ductal carcinoma concomitant with IPMN. Post-operative pathological findings revealed IPMN was adenoma with mild atypia, and solid tumor was diagnosed invasive ductal carcinoma with solitary minute liver metastasis.

  19. Experimental study on inhibitory effect of bridgy duct of hepatic artery on apoptosis of liver and bile duct cells

    Institute of Scientific and Technical Information of China (English)

    Hongwei Lu; Yiming Li; Hong Ji; Jinkai Xu

    2006-01-01

    Objective: To investigate whether the method of bridgy duct established between the recipient's spleen artery and the donor's gastroduodenal artery could inhibit the apoptosis of liver and bile duct cells caused by hepatic artery ischemia.Methods: Twenty-four mongrel dogs from Xi'an area were used to establish simplified models of dog orthotopic liver transplantation and divided into three groups randomly: HAI group (hepatic artery ischemia group),BBB group (bypassing the blood by a bridgy duct) and control group. After cold perfusion, The samples were collected from liver and bile duct in each group at different time and fixed in glutaraldehyde and 4% polyformaldehyde respectively. At last, the apoptosis of liver and bile duct cells were observed and the apoptotic indexes were calculated. Results: Two hours after cold perfusion, apoptotic phenomenon was common in HAI group, rare in BBB group, while no apoptotic phenomenon was observed in control group. TUNEL staining showed that there was no significant difference in apoptotic index among the three groups immediately after cold perfusion. However, with time going, the apoptotic cells were increased in three groups, and the difference in apoptotic index was significant among three groups (P < 0.01 ). Conclusion: Bridgy duct of hepatic artery can inhibit the apoptosis of liver and bile duct cells caused by HAI significantly.

  20. [Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas Showing High Accumulation of 18F-Fluorodeoxyglucose (FDG)--A Case Report].

    Science.gov (United States)

    Kubota, Masaru; Nishimura, Masashige; Nakatsuka, Rie; Miyazaki, Susumu; Danno, Katsuki; Motoori, Masaaki; Matsuda, Chu; Fujitani, Kazumasa; Iwase, Kazuhiro

    2015-11-01

    The diagnosis of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas includes radiographic (CT, MRI) and endoscopic evaluation (ERCP, EUS). The treatment strategy is outlined in the 2012 International Consensus Guidelines (ICG). Herein, we report a case initially not indicated for surgery. Four months after the initial diagnosis, the cystic lesion transformed into a solid mass-like lesion visible on CT. FDG-PET showed abnormal FDG uptake at the same location. Surgical resection was performed immediately, and the tumor was diagnosed as IPMN with inflammation. FDG-PET showed a false-positive diagnosis for the malignancy in this case of IPMN.

  1. Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction.

    Science.gov (United States)

    Pauleau, Ghislain; Commandeur, Diane; Andro, Christophe; Chapellier, Xavier

    2012-07-11

    Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

  2. Warped branches of flux compactifications

    CERN Document Server

    Lim, Yen-Kheng

    2012-01-01

    We consider Freund-Rubin-type compactifications which are described by (p+q)-dimensional Einstein gravity with a positive cosmological constant and a q-form flux. Using perturbative expansions of Kinoshita's ansatz for warped dS_pxS^q and AdS_pxS^q spacetimes, we obtain analytical solutions describing the warped branches and their respective phase spaces. These equations are given by inhomogeneous Gegenbauer differential equations which can be solved by the Green's function method. The requirement that the Green's functions are regular provides constraints which determine the structure of the phase space of the warped branches. We apply the perturbation results to calculate the thermodynamic variables for the warped dS_pxS^q branch. In particular, the first law of thermodynamics can be reproduced using this method.

  3. Multiple pathways regulate shoot branching

    Directory of Open Access Journals (Sweden)

    Catherine eRameau

    2015-01-01

    Full Text Available Shoot branching patterns result from the spatio-temporal regulation of axillary bud outgrowth. Numerous endogenous, developmental and environmental factors are integrated at the bud and plant levels to determine numbers of growing shoots. Multiple pathways that converge to common integrators are most probably involved. We propose several pathways involving not only the classical hormones auxin, cytokinins and strigolactones, but also other signals with a strong influence on shoot branching such as gibberellins, sugars or molecular actors of plant phase transition. We also deal with recent findings about the molecular mechanisms and the pathway involved in the response to shade as an example of an environmental signal controlling branching. We propose the TCP transcription factor TB1/BRC1 and the polar auxin transport stream in the stem as possible integrators of these pathways. We finally discuss how modeling can help to represent this highly dynamic system by articulating knowledges and hypothesis and calculating the phenotype properties they imply.

  4. ß-adrenergic regulation of ion transport in pancreatic ducts: Patch-clamp study of isolated rat pancreatic ducts

    DEFF Research Database (Denmark)

    Novak, I

    1998-01-01

    much smaller effects. At comparable concentrations, it depolarized Vm by a few millivolts. Neither agonist had significant effects on intracellular Ca2+. CONCLUSIONS: This study provides the first direct evidence that adrenergic stimulation, namely, that of beta-adrenoceptors, controls ion transport....... METHODS: Small intralobular ducts were isolated from rat pancreas and studied in vitro by the whole-cell patch clamp technique. Cell membrane voltages and currents were indicators of cellular ion transport. In some ducts, intracellular Ca2+ activity was measured by fluorescence optical methods. RESULTS...... in pancreatic ducts. Similar to secretin, isoproterenol stimulation leads to opening of luminal Cl- channels, and HCO3- enters the lumen in exchange for Cl-....

  5. 30 CFR 56.6403 - Branch circuits.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Branch circuits. 56.6403 Section 56.6403... Blasting § 56.6403 Branch circuits. (a) If electric blasting includes the use of branch circuits, each branch shall be equipped with a safety switch or equivalent method to isolate the circuits to be used....

  6. 30 CFR 57.6403 - Branch circuits.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Branch circuits. 57.6403 Section 57.6403... Blasting-Surface and Underground § 57.6403 Branch circuits. (a) If electric blasting includes the use of branch circuits, each branch shall be equipped with a safety switch or equivalent method to isolate...

  7. A comparison of localization by ductoscopy-guided wire and conventional methods in terminal duct excision for women with pathological nipple discharge%乳管内视镜定位在乳导管解剖术中的应用

    Institute of Scientific and Technical Information of China (English)

    徐晓洲; 王靖; 王仲照; 张柏林; 张宏图; 王翔; 魏艳辉; 张保宁

    2008-01-01

    Objective To evaluate and compare localization by ductoscopy-guided wire with localization by conventional methods in the terminal duct excision for women with pathological nipple discharge.Methods Breast terminal duct excision were performed in 174 consecutive patients with intraductal lesions diagnosed by mammary ductoscopy.Sixty-eight of those underwent ductoscopy-guided wire localization for more accurate duetal excision.The patients received mammary ductoscopy and a hooked wire was anchored at the intraductal lesions under endoscopic surveillance just before the operation.Then a biopsy resection of wire-guided terminal duct and frozen section were done.The other 106 patients received terminal duct excision under localization with conventional methods without ductoscopy either by puncturing a needle or injection of blue dye through the duct with pathological discharge.Results Of the 68 patients with ductoscopy-guided duct excision,64 had intraductal papillomas and 4 duct carcinoma in situ proved by pathology.All the lesions in these 68 patients were completely resected during biopsy without extra extended resection,and the concordance rate of the pathological result with ductoscopic diagnosis was 100.0%.None of them developed a postoperative breast distortion.In the conventional method localization group,there were 96 intraductal papilloma,6 duct carcinoma in situ and 4 adenosis.Only 77.4% of the lesions were excised in the primary biopsy,and 22.6% needed extended resection.The concordance rate of the pathological diagnosis with ductoscopic diagnosis was 96.2%.Twenty-six patients had a deformed breast postoperatively.Conclusion Ductoscopy-guided wire localization is superior to the conventional localization method in the surgical terminal duct excision for women with spontaneous nipple discharge.It is not only helpful for more accurate localization and resection as well as pathologic sampling,but also is minimally invasive.Further studies are still required and

  8. Molecular basis of potassium channels in pancreatic duct epithelial cells

    DEFF Research Database (Denmark)

    Hayashi, M.; Novak, Ivana

    2013-01-01

    Potassium channels regulate excitability, epithelial ion transport, proliferation, and apoptosis. In pancreatic ducts, K channels hyperpolarize the membrane potential and provide the driving force for anion secretion. This review focuses on the molecular candidates of functional K channels...

  9. Iatrogenic nasolacrimal duct obstruction following tooth extraction in a cat.

    Science.gov (United States)

    Paiva, Sávia Calline C S; Froes, Tilde R; Lange, Rogério Ribas; Machado, Marcello; Pachaly, José Ricardo; Montiani-Ferreira, Fabiano

    2013-01-01

    A 10-year-old DSH cat was referred for a dental evaluation and extraction procedure. Subsequently, the animal developed an acute onset of ocular discharge. Ophthalmologic examination revealed presence of unilateral ocular mucoid discharge leading to a diagnosis of epiphora secondary to nasolacrimal duct obstruction. Dacryocystorhinography was performed and confirmed the presence of a nasolacrimal duct obstruction, presumably acquired after an invasive dental procedure. Additionally, a vinyl cast in situ study of the nasolacrymal apparatus was performed to demonstrate the route of the nasolacrimal duct in the cat and its relationship to oral dental structures. This report documents an unusual case in which excessive inflammation/edema following tooth extraction caused acute epiphora secondary to extraluminal compression of the distal nasolacrimal duct.

  10. Measure Guideline: Buried and/or Encapsulated Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, C. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Zoeller, W. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Mantha, P. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2013-08-01

    Buried and/or encapsulated ducts (BEDs) are a class of advanced, energy-efficiency strategies intended to address the significant ductwork thermal losses associated with ducts installed in unconditioned attics. BEDs are ducts installed in unconditioned attics that are covered in loose-fill insulation and/or encapsulated in closed cell polyurethane spray foam insulation. This Measure Guideline covers the technical aspects of BEDs as well as the advantages, disadvantages, and risks of BEDs compared to other alternative strategies. This guideline also provides detailed guidance on installation of BEDs strategies in new and existing homes through step-by-step installation procedures. Some of the procedures presented here, however, require specialized equipment or expertise. In addition, some alterations to duct systems may require a specialized license.

  11. Sound transmission through ducts and aircraft noise prediction, volume 1

    Science.gov (United States)

    Schauer, J. J.; Datko, J. T.; Guyton, R. W.

    1982-01-01

    Aircraft engine acoustical lining impedance models, ray acoustics, hydrodynamic modes, and transient analysis of sound propagation in variable area duct studies were applied to aircraft noise prediction. The effects of several duct lining configurations in a TF33 P5 and a CFM56 engined KC-135B aircraft were predicted. The prediction was based on a model corrected to fit flight noise data and modified by including theoretical duct noise attenuation predictions. The transient solution of variable area ducts permitted the prediction of sound propgation in bullet nose inlets for no low and was moderately successful when a potential flow was included with low Mach numbers. Volume 1 contains the technical report and analysis. Volume 2 contains the user's manuals and listings of the computer codes developed.

  12. Extrahepatic right hepatic duct diverticulum:a rare entity

    Institute of Scientific and Technical Information of China (English)

    Eduardo SM Fernandes; Raquel L Bernardo; Moacir M Fernandes; Rogério MC Araújo; Renato Sebbe; Asterio Monte; José F Coelho; Antonio AP Souza; Joaquim Ribeiro Filho

    2010-01-01

    BACKGROUND: Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classiifcation in 1977. The classiifcation is the most extensively used, but does not include some rare variations. We present a case of hepatic duct diverticulum, one of the variations, and discuss its diagnosis and treatment. METHODS: A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting. She was ifnally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT: The patient underwent resection of the hepatic duct diverticulum and cholecystectomy, and was asymptomatic 26 months after surgery. CONCLUSIONS: Hepatic duct diverticulum is a rare form of choledochal cyst, not included in Todani's classiifcation. Todani's classiifcation including this and other uncommon variations of choledochal cysts must be reviewed. The best diagnostic imaging methods and treatment for choledochal cysts must be deifned.

  13. Scattering matrices in non-uniformly lined ducts

    Science.gov (United States)

    Demir, Ahmet

    2017-02-01

    Sudden area expansion and sudden area contraction in an infinitely long duct with discontinuous locally reacting lining are defined by respective mixed boundary value problems. In the absence of a sudden area change, a separate problem with an infinite duct having bifid lining on its wall is described. Introducing Fourier transform along the duct axis boundary value problems is solved by the well-known Wiener-Hopf technique, and then, corresponding scattering matrices are constructed. To show the proper use of scattering matrices in the case of several discontinuities and also validation and comparison purposes, transmitted field in a duct with an inserted expansion chamber whose walls are treated by acoustically absorbent material is derived by the help of the relevant scattering matrices. A perfect agreement is observed when the transmitted fields are compared numerically with a similar work exists in the literature.

  14. Persistent omphalomesenteric duct causing small bowel obstruction in an adult

    Institute of Scientific and Technical Information of China (English)

    Haridimos Markogiannakis; Dimitrios Theodorou; Konstantinos G Toutouzas; Panagiotis Drimousis; Sotirios Georgios Panoussopoulos; Stilianos Katsaragakis

    2007-01-01

    An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction.Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops;an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

  15. Nasolacrimal Duct Mucocele: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Britto, Fernanda Carneiro Corujeira de

    2014-02-01

    Full Text Available Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium. Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access.

  16. Low Cost/Low Noise Variable Pitch Ducted Fan Project

    Data.gov (United States)

    National Aeronautics and Space Administration — ACI proposes a design for a Propulsor (Low Cost/Low Noise Variable Pitch Ducted Fan) that has wide application in all sectors of Aviation. Propulsor hardware of this...

  17. Design requirement on KALIMER control rod assembly duct

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, W.; Kang, H. Y.; Nam, C.; Kim, J. O.; Kim, Y. J

    1998-03-01

    This document establishes the design guidelines which are needs for designing the control rod assembly duct of the KALIMER as design requirements. it describes control rod assembly duct of the KALIMER and its requirements that includes functional requirements, performance requirements, interfacing systems, design limits and strength requirements, seismic requirements, structural requirements, environmental requirements, reliability and safety requirements, standard and codes, QA programs, and other requirements. The control rod system consists of three parts, which are drive mechanism, drive-line, and absorber bundle. This report deals with the absorber bundle and its outer duct only because the others are beyond the scope of fuel system design. The guidelines for design requirements intend to be used for an improved design of the control rod assembly duct of the KALIMER. (author). 19 refs.

  18. Heat Transfer Augmentation in Developing Flow Through a Ribbed Square Duct

    Institute of Scientific and Technical Information of China (English)

    Khan R K; Ali M.A.T; Akhanda M.A.R

    2006-01-01

    An experimental study is conducted to investigate the heat transfer augmentation in developing turbulent flow through a ribbed square duct. The duct is made of 16mm thick bakelite sheet. The bottom surface of the ribbed wall having rib pitch to height ratio of 10 is heated by passing a c current to the heater placed under it. The uniform heating is controlled using a digital temperature controller and a variac. The results of ribbed duct are compared with the results of a smooth duct under the same experimental conditions. It is observed that the heat transfer augmentation in ribbed duct is better than that of the smooth duct. At Re=5.0 × 104 , the mean temperature of air flowing through the ribbed duct increases by 2.45 percent over the smooth duct, whereas in the ribbed duct Nusselt number increases by 15.14 percent than that of the smooth duct with a 6 percent increase in pressure drop.

  19. Acoustic propagation in partially choked converging-diverging ducts

    Science.gov (United States)

    Kelly, J. J.; Nayfeh, A. H.; Watson, L. T.

    1982-01-01

    A computer model based on the wave-envelope technique is used to study acoustic propagation in converging-diverging hard walled and lined circular ducts carrying near sonic mean flows. The influences of the liner admittance, boundary layer thickness, spinning mode number, and mean Mach number are considered. The numerical results indicate that the diverging portion of the duct can have a strong reflective effect for partially choked flows.

  20. A case of peribiliary cysts accompanying bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Tadahiro Takada; Hodaka Amano; Masahiro Yoshida; Takahiro Isaka; Naoyuki Toyota; Keita Wada; Kenji Takagi; Kenichiro Karo

    2006-01-01

    A rare case of peribiliary cysts accompaying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken.Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided.

  1. BETTER DUCT SYSTEMS FOR HOME HEATING AND COOLING.

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.

    2001-01-01

    This is a series of six guides intended to provide a working knowledge of residential heating and cooling duct systems, an understanding of the major issues concerning efficiency, comfort, health, and safety, and practical tips on installation and repair of duct systems. These guides are intended for use by contractors, system designers, advanced technicians, and other HVAC professionals. The first two guides are also intended to be accessible to the general reader.

  2. Bile duct hamar tomas-the von Meyenburg complex

    Institute of Scientific and Technical Information of China (English)

    Valdemir José Alegre Salles; Alexandre Marotta; Jorge Miguel Kather Netto; Manlio Basílio Speranzini; Marcos Roberto Martins

    2007-01-01

    Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by ifbrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

  3. Renal Collecting Duct Cancer: a Report of 2 Cases

    Institute of Scientific and Technical Information of China (English)

    Shiying Zhou

    2005-01-01

    @@ Renal collecting duct cancer is a rare malignant tumor, which accounts for 1% to 2% of epithelial kidney tumors,[1] Its pathological appearance has been easily misdiagnosed as a mammilliform renal cell carcinoma or as other tumors. The malignancy of renal collecting duct cancer is high, with early metastasis and poor prognosis. The clinical data for 2 cases of the tumor are discussed in this report, including reports on the histopathology and the changes in immunohistochemistry.

  4. Development and regression of the thyroglossal duct in mice.

    Science.gov (United States)

    Inoue, Katsuyuki; Bando, Yasuhiko; Sakiyama, Koji; Takizawa, Shota; Sakashita, Hideaki; Kondo, Hisatake; Amano, Osamu

    2015-07-01

    The thyroid anlage develops in the foramen caecum area of the tongue, and migrates through the anterior neck towards its final position in front of the laryngeal cartilages. During migration, the thyroglossal duct, a temporary structure connecting the thyroid anlage and the foramen caecum, is recognized. In the present study, chronological changes and apoptosis in the thyroglossal duct of mice were investigated histochemically using an antibody against Nkx2-1, initially identified as a thyroid transcription factor 1 (TTF1), and the TUNEL reaction in consecutive serial sagittal sections. At embryonic day 10.00 (E10.00), the thyroid anlage was Nkx2-1-immunoreactive and located just below the foramen caecum. As the thyroid anlage descended, the thyroglossal duct was formed at E10.25, being less than 10μm in diameter. By E10.75, the Nkx2-1-positive thyroglossal duct had progressively elongated up to 100μm. At E11.00 the thyroglossal duct began to disappear, beginning in its mid-portion, and finally became invisible at E11.50. At E11.00-12.00, apoptotic cells were found in an area where the thyroglossal duct was partially discontinuous. After E12.00, cartilaginous tissue of the hyoid bone anlage developed in the mid-portion of the area where the thyroglossal duct had regressed. Immunoreactivity for thyroglobulin, a marker of differentiated thyroid endocrine cells, was detected at E13.00. These results strongly suggest that the mouse thyroglossal duct disappears as a result of apoptosis before differentiation of the endocrine thyroid.

  5. Compact Buried Ducts in a Hot-Humid Climate House

    Energy Technology Data Exchange (ETDEWEB)

    Mallay, D. [Home Innovation Research Labs, Upper Marlboro, MD (United States)

    2016-01-01

    A system of compact, buried ducts provides a high-performance and cost-effective solution for delivering conditioned air throughout the building. This report outlines research activities that are expected to facilitate adoption of compact buried duct systems by builders. The results of this research would be scalable to many new house designs in most climates and markets, leading to wider industry acceptance and building code and energy program approval.

  6. On One-dimensional Sound Analysis of a Duct Network with Helmholtz Resonators

    OpenAIRE

    寺尾, 道仁; Terao, Michihito; 関根, 秀久; Sekine, Hidehisa; 大川, 真平; Okawa, Shinpei; 林, 大志; Hayashi, Daiji

    2002-01-01

    The outer orifice correction for Helmholtz resonators attached to the sidewall ofcircular ducts was studied. For the outer orifice correction when the axis direction ofthe orifice coincides with that of the duct, .explicit expressions were given by Ingard and Rschevkin. But their application to duct sections with duct-sidewall resonators is beyond their premise. An explicit expression ofthe outer orifice correction for duct-sidewall resonators was derived by conducting three-dimensionalbounda...

  7. Note on reflection and transmission coefficients for converging-diverging ducts

    Science.gov (United States)

    Durbin, P. A.

    1981-09-01

    Simple formulas for calculating acoustic reflection and transmission coefficients for converging-diverging ducts are derived; they extend the method of Cho and Ingard to arbitrary, slowly varying ducts. These formulas involve two parameters. The first is a function of duct shape and the second is the ratio of the duct radius downstream of the throat to that upstream of the throat to the upstream of the throat. An extension of the method to include mean flow is made for symmetric ducts.

  8. Measure Guideline: Buried and/or Encapsulated Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, C.; Zoeller, W.; Mantha, P.

    2013-08-01

    Buried and/or encapsulated ducts (BEDs) are a class of advanced, energy-efficiency strategies intended to address the significant ductwork thermal losses associated with ducts installed in unconditioned attics. BEDs are ducts installed in unconditioned attics that are covered in loose-fill insulation and/or encapsulated in closed cell polyurethane spray foam insulation. This Measure Guideline covers the technical aspects of BEDs as well as the advantages, disadvantages, and risks of BEDs compared to other alternative strategies. This guideline also provides detailed guidance on installation of BEDs strategies in new and existing homes through step-by-step installation procedures. This Building America Measure Guideline synthesizes previously published research on BEDs and provides practical information to builders, contractors, homeowners, policy analysts, building professions, and building scientists. Some of the procedures presented here, however, require specialized equipment or expertise. In addition, some alterations to duct systems may require a specialized license. Persons implementing duct system improvements should not go beyond their expertise or qualifications. This guideline provides valuable information for a building industry that has struggled to address ductwork thermal losses in new and existing homes. As building codes strengthen requirements for duct air sealing and insulation, flexibility is needed to address energy efficiency goals. While ductwork in conditioned spaces has been promoted as the panacea for addressing ductwork thermal losses, BEDs installations approach - and sometimes exceed - the performance of ductwork in conditioned spaces.

  9. An evaporation duct prediction model coupled with the MM5

    Institute of Scientific and Technical Information of China (English)

    JIAO Lin; ZHANG Yonggang

    2015-01-01

    Evaporation duct is an abnormal refractive phenomenon in the marine atmosphere boundary layer. It has been generally accepted that the evaporation duct prominently affects the performance of the electronic equipment over the sea because of its wide distribution and frequent occurrence. It has become a research focus of the navies all over the world. At present, the diagnostic models of the evaporation duct are all based on the Monin-Obukhov similarity theory, with only differences in the flux and character scale calculations in the surface layer. These models are applicable to the stationary and uniform open sea areas without considering the alongshore effect. This paper introduces the nonlinear factorav and the gust wind itemwg into the Babin model, and thus extends the evaporation duct diagnostic model to the offshore area under extremely low wind speed. In addition, an evaporation duct prediction model is designed and coupled with the fifth generation mesoscale model (MM5). The tower observational data and radar data at the Pingtan island of Fujian Province on May 25–26, 2002 were used to validate the forecast results. The outputs of the prediction model agree with the observations from 0 to 48 h. The relative error of the predicted evaporation duct height is 19.3% and the prediction results are consistent with the radar detection.

  10. WAVE PROPAGATION in the HOT DUCT of VHTR

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz; Jim C. P. Liou

    2013-07-01

    In VHTR, helium from the reactor vessel is conveyed to a power conversion unit through a hot duct. In a hypothesized Depressurized Conduction Cooldown event where a rupture of the hot duct occurs, pressure waves will be initiated and reverberate in the hot duct. A numerical model is developed to quantify the transients and the helium mass flux through the rupture for such events. The flow path of the helium forms a closed loop but only the hot duct is modeled in this study. The lower plum of the reactor vessel and the steam generator are treated as specified pressure and/or temperature boundary to the hot duct. The model is based on the conservation principles of mass, momentum and energy, and on the equations of state for helium. The numerical solution is based on the method of characteristics with specified time intervals with a predictor and corrector algorithm. The rupture sub-model gives reasonable results. Transients induced by ruptures with break area equaling 20%, 10%, and 5% of the duct cross-sectional area are described.

  11. Energy efficient engine: Turbine transition duct model technology report

    Science.gov (United States)

    Leach, K.; Thurlin, R.

    1982-01-01

    The Low-Pressure Turbine Transition Duct Model Technology Program was directed toward substantiating the aerodynamic definition of a turbine transition duct for the Energy Efficient Engine. This effort was successful in demonstrating an aerodynamically viable compact duct geometry and the performance benefits associated with a low camber low-pressure turbine inlet guide vane. The transition duct design for the flight propulsion system was tested and the pressure loss goal of 0.7 percent was verified. Also, strut fairing pressure distributions, as well as wall pressure coefficients, were in close agreement with analytical predictions. Duct modifications for the integrated core/low spool were also evaluated. The total pressure loss was 1.59 percent. Although the increase in exit area in this design produced higher wall loadings, reflecting a more aggressive aerodynamic design, pressure profiles showed no evidence of flow separation. Overall, the results acquired have provided pertinent design and diagnostic information for the design of a turbine transition duct for both the flight propulsion system and the integrated core/low spool.

  12. Natural convection heat transfer along vertical rectangular ducts

    Science.gov (United States)

    Ali, M.

    2009-12-01

    Experimental investigations have been reported on steady state natural convection from the outer surface of vertical rectangular and square ducts in air. Seven ducts have been used; three of them have a rectangular cross section and the rest have square cross section. The ducts are heated using internal constant heat flux heating elements. The temperatures along the vertical surface and the peripheral directions of the duct wall are measured. Axial (perimeter averaged) heat transfer coefficients along the side of each duct are obtained for laminar and transition to turbulent regimes of natural convection heat transfer. Axial (perimeter averaged) Nusselt numbers are evaluated and correlated using the modified Rayleigh numbers for laminar and transition regime using the vertical axial distance as a characteristic length. Critical values of the modified Rayleigh numbers are obtained for transition to turbulent. Furthermore, total overall averaged Nusselt numbers are correlated with the modified Rayleigh numbers and the area ratio for the laminar regimes. The local axial (perimeter averaged) heat transfer coefficients are observed to decrease in the laminar region and increase in the transition region. Laminar regimes are obtained at the lower half of the ducts and its chance to appear decreases as the heat flux increases.

  13. Measure Guideline: Summary of Interior Ducts in New Construction, Including an Efficient, Affordable Method to Install Fur-Down Interior Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Beal, D. [BA-PIRC, Cocoa, FL (United States); McIlvaine, J. [BA-PIRC, Cocoa, FL (United States); Fonorow, K. [BA-PIRC, Cocoa, FL (United States); Martin, E. [BA-PIRC, Cocoa, FL (United States)

    2011-11-01

    This document illustrates guidelines for the efficient installation of interior duct systems in new housing, including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces.

  14. Branching of keratin intermediate filaments.

    Science.gov (United States)

    Nafeey, Soufi; Martin, Ines; Felder, Tatiana; Walther, Paul; Felder, Edward

    2016-06-01

    Keratin intermediate filaments (IFs) are crucial to maintain mechanical stability in epithelial cells. Since little is known about the network architecture that provides this stiffness and especially about branching properties of filaments, we addressed this question with different electron microscopic (EM) methods. Using EM tomography of high pressure frozen keratinocytes, we investigated the course of several filaments in a branching of a filament bundle. Moreover we found several putative bifurcations in individual filaments. To verify our observation we also visualized the keratin network in detergent extracted keratinocytes with scanning EM. Here bifurcations of individual filaments could unambiguously be identified additionally to bundle branchings. Interestingly, identical filament bifurcations were also found in purified keratin 8/18 filaments expressed in Escherichia coli which were reassembled in vitro. This excludes that an accessory protein contributes to the branch formation. Measurements of the filament cross sectional areas showed various ratios between the three bifurcation arms. This demonstrates that intermediate filament furcation is very different from actin furcation where an entire new filament is attached to an existing filament. Instead, the architecture of intermediate filament bifurcations is less predetermined and hence consistent with the general concept of IF formation.

  15. Risk Factor Assessment Branch (RFAB)

    Science.gov (United States)

    The Risk Factor Assessment Branch (RFAB) focuses on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.

  16. NCI: DCTD: Biometric Research Branch

    Science.gov (United States)

    The Biometric Research Branch (BRB) is the statistical and biomathematical component of the Division of Cancer Treatment, Diagnosis and Centers (DCTDC). Its members provide statistical leadership for the national and international research programs of the division in developmental therapeutics, developmental diagnostics, diagnostic imaging and clinical trials.

  17. Strigolactone inhibition of shoot branching

    NARCIS (Netherlands)

    Gomez-Roldan, M.V.; Fermas, S.; Brewer, P.B.; Puech-Pages, V.; Dun, E.A.; Pillot, J.P.; Letisse, F.; Matusova, R.; Danoun, S.; Portais, J.C.; Bouwmeester, H.J.; Becard, G.; Beveridge, C.A.; Rameau, C.; Rochange, S.F.

    2008-01-01

    A carotenoid-derived hormonal signal that inhibits shoot branching in plants has long escaped identification. Strigolactones are compounds thought to be derived from carotenoids and are known to trigger the germination of parasitic plant seeds and stimulate symbiotic fungi. Here we present evidence

  18. Cash efficiency for bank branches.

    Science.gov (United States)

    Cabello, Julia García

    2013-01-01

    Bank liquidity management has become a major issue during the financial crisis as liquidity shortages have intensified and have put pressure on banks to diversity and improve their liquidity sources. While a significant strand of the literature concentrates on wholesale liquidity generation and on the alternative to deposit funding, the management of an inventory of cash holdings within the banks' branches is also a relevant issue as any significant improvement in cash management at the bank distribution channels may have a positive effect in reducing liquidity tensions. In this paper, we propose a simple programme of cash efficiency for the banks' branches, very easy to implement, which conform to a set of instructions to be imposed from the bank to their branches. This model proves to significantly reduce cash holdings at branches thereby providing efficiency improvements in liquidity management. The methodology we propose is based on the definition of some stochastic processes combined with renewal processes, which capture the random elements of the cash flow, before applying suitable optimization programmes to all the costs involved in cash movements. The classical issue of the Transaction Demand for the Cash and some aspects of Inventory Theory are also present. Mathematics Subject Classification (2000) C02, C60, E50.

  19. Numerical Simulation of Multiplicity and Stability of Mixed Convection in Rotating Curved Ducts

    Directory of Open Access Journals (Sweden)

    Wang Liqiu

    2005-01-01

    Full Text Available A numerical study is made on the fully developed bifurcation structure and stability of the mixed convection in rotating curved ducts of square cross-section with the emphasis on the effect of buoyancy force. The rotation can be positive or negative. The fluid can be heated or cooled. The study reveals the rich solution and flow structures and complicated stability features. One symmetric and two symmetric/asymmetric solution branches are found with seventy five limit points and fourteen bifurcation points. The flows on these branches can be symmetric, asymmetric, 2-cell, and up to 14-cell structures. Dynamic responses of the multiple solutions to finite random disturbances are examined by the direct transient computation. It is found that possible physically realizable fully developed flows evolve, as the variation of buoyancy force, from a stable steady multicell state at a large buoyancy force of cooling to the coexistence of three stable steady multicell states, a temporal periodic oscillation state, the coexistence of periodic oscillation and chaotic oscillation, a chaotic temporal oscillation, a subharmonic-bifurcation-driven asymmetric oscillating state, and a stable steady 2-cell state at large buoyancy force of heating.

  20. Diagnostic value of fiberoptic ductoscopy for bilateral multiple ductal nipple discharge with intraductal space occupying lesions%乳管镜对双乳多孔溢液乳管内占位的诊断与价值

    Institute of Scientific and Technical Information of China (English)

    郭丽英; 马方婧; 迪丽米娜·伊拉木

    2011-01-01

    Objective To investigate the diagnostic value of fiberoptic ductoscopy ( FDS ) for cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions. Methods The clinical data of 135 cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions treated in our center, from June 2004 to May 2009, were analyzed retrospectively. Results The coincidence rate between FDS and pathological diagnosis was 75. 0% for bilateral intraductal papilloma and 78.2% for unilateral intraductal papilloma. The total coincidence rate between FDS and pathological diagnosis was 82.2%. In cases of bilateral intraductal papilloma, the yellow nipple discharge was significantly more frequent than other qualities of discharges (x2 = 23. 5675, P < 0.05 ). Conclusions FDS diagnosis for intraductal space occupying lesions has high consistency with the postoperative pathological diagnosis, and it can be used as the first choice for nipple discharge diagnosis. Special attention shoud be paid to the yellow nipple discharge, which accounts for a larger proportion of bilateral multiple ductal nipple discharge due to bilateral intraductal papilloma.%目的 探讨纤维乳管内视镜(乳管镜)对双乳多孔溢液乳管内占位的诊断的价值.方法 回顾性分析2004年6月-2009年5月诊治的双乳多孔溢液乳管内占位性病变135例患者的临床资料.结果 乳管镜诊断双乳乳管内乳头状瘤与病理符合率为75.0%,单乳乳管内乳头状瘤与病理符合率为78.2%,病理总符合率为82.2%,对于双乳乳管内乳头状瘤,黄色溢液较其他性质溢液明显为多(X=23.5675,P<0.05).结论 乳管镜对乳管内占位诊断符合率高,在乳头溢液的诊断上可作为首选检查方法,双乳多孔溢液中黄色溢液的双乳乳管内乳头状瘤所占比例较大,应予重视.

  1. ATP release, generation and hydrolysis in exocrine pancreatic duct cells.

    Science.gov (United States)

    Kowal, J M; Yegutkin, G G; Novak, I

    2015-12-01

    Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan-1, and online luminescence measurement, we detected fast ATP release in response to pH changes, bile acid, mechanical stress and hypo-osmotic stress. ATP release following hypo-osmotic stress was sensitive to drugs affecting exocytosis, pannexin-1, connexins, maxi-anion channels and transient receptor potential cation channel subfamily V member 4 (TRPV4) channels, and corresponding transcripts were expressed in duct cells. Direct stimulation of intracellular Ca(2+) and cAMP signalling and ethanol application had negligible effects on ATP release. The released ATP was sequentially dephosphorylated through ecto-nucleoside triphosphate diphosphohydrolase (NTPDase2) and ecto-5'-nucleotidase/CD73 reactions, with respective generation of adenosine diphosphate (ADP) and adenosine and their maintenance in the extracellular medium at basal levels. In addition, Capan-1 cells express counteracting adenylate kinase (AK1) and nucleoside diphosphate kinase (NDPK) enzymes (NME1, 2), which contribute to metabolism and regeneration of extracellular ATP and other nucleotides (ADP, uridine diphosphate (UDP) and uridine triphosphate (UTP)). In conclusion, we illustrate a complex regulation of extracellular purine homeostasis in a pancreatic duct cell model involving: ATP release by several mechanisms and subsequent nucleotide breakdown and ATP regeneration via counteracting nucleotide

  2. Diagnosis and Management of Anatomic Variations of the Cystic Duct during Laparoscopic Cholecystectomy%腹腔镜胆囊切除术中胆囊管解剖变异的诊断及处理

    Institute of Scientific and Technical Information of China (English)

    龚解其; 严斌; 陈伟新; 沈卫星

    2014-01-01

    Objective:To explore the diagnosis and management of anatomic variation of the cystic duct during laparoscopic cholecystectomy(LC) .Methods :From Jan 1999 to Dec 2013 ,4652 cases of LC ,which were performed in Qingpu Branch of Zhongshan Hospital ,Fudan University ,were retrospectively analyzed .A total of 34 cases of anatomic variation of the cystic duct were found .Among the 34 cases of anatomic variation of the cystic duct ,11 cases had thick and short cystic duct ,7 cases had a cystic duct converged into right hepatic duct ,6 cases had cystic duct converged into lower part of common hepatic duct ,1 case had cystic duct pronated forward and converged into common hepatic duct from left side ,3 cases had cystic duct that paral-lel itself with common hepatic duct and then converged into common bile duct ,4 cases were diagnosed with Mrizzi syndrome ,2 cases had situs viscera inversus .Results:Among the 34 cases with anatomic variations of cystic duct ,22 cases successfully un-derwent LC ,the other 12 cases were converted to open cholecystectomy .All the complications were biliary duct injury that re-covered well after treatment .Conclusions :Anatomic variation of the cystic duct is hard to diagnose preoperatively .Paying More attention to the anatomic variation during LC ,dissecting calot′s triangle carefully ,and identifying the relationship between the various pipeline is the key to prevent and reduce the biliary duct injury .%目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy ,LC )中胆囊管解剖变异的诊断及处理。方法:回顾分析1999年1月-2013年12月在复旦大学附属中山医院青浦分院行LC的4652例患者的临床资料,其中胆囊管发生解剖变异者34例,包括胆囊管异常粗、短11例,高位汇入右肝管7例,低位汇入肝总管下端6例,从肝总管前方绕至左侧汇入肝总管1例,与肝总管并行一段后汇入胆总管3例,M rizzi综合征4例,内脏反位2

  3. BDC 500 branch driver controller

    CERN Document Server

    Dijksman, A

    1981-01-01

    This processor has been designed for very fast data acquisition and date pre-processing. The dataway and branch highway speeds have been optimized for approximately 1.5 mu sec. The internal processor cycle is approximately 0.8 mu sec. The standard version contains the following functions (slots): crate controller type A1; branch highway driver including terminator; serial I/O port (TTY, VDU); 24 bit ALU and 24 bit program counter; 16 bit memory address counter and 4 word stack; 4k bit memory for program and/or data; battery backup for the memory; CNAFD and crate LAM display; request/grant logic for time- sharing operation of several BDCs. The free slots can be equipped with e.g. extra RAM, computer interfaces, hardware multiplier/dividers, etc. (0 refs).

  4. Isolation and characterization of portal branch ligation-stimulated Hmga2-positive bipotent hepatic progenitor cells

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Hiroshi [Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 (Japan); Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, 4259 B51, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503 (Japan); Tagawa, Yoh-ichi, E-mail: ytagawa@bio.titech.ac.jp [Frontier Research Center, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503 (Japan); Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, 4259 B51, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503 (Japan); PRESTO, Japan Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama 332-0012 (Japan); Tamai, Miho [Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, 4259 B51, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503 (Japan); Motoyama, Hiroaki [Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 (Japan); Ogawa, Shinichiro [Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 (Japan); McEwen Center for Regenerative Medicine, University Health Network, 190 Elizabeth Street, Toronto, Ont., Canada M5G 2C4 (Canada); Soeda, Junpei; Nakata, Takenari; Miyagawa, Shinichi [Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 (Japan)

    2010-12-17

    Research highlights: {yields} Hepatic progenitor cells were isolated from the portal branch-ligated liver of mice. {yields} Portal branch ligation-stimulated hepatic progenitor cells (PBLHCs) express Hmga2. {yields} PBLHCs have bidirectional differentiation capability in vitro. -- Abstract: Hepatic stem/progenitor cells are one of several cell sources that show promise for restoration of liver mass and function. Although hepatic progenitor cells (HPCs), including oval cells, are induced by administration of certain hepatotoxins in experimental animals, such a strategy would be inappropriate in a clinical setting. Here, we investigated the possibility of isolating HPCs in a portal branch-ligated liver model without administration of any chemical agents. A non-parenchymal cell fraction was prepared from the portal branch-ligated or non-ligated lobe, and seeded onto plates coated with laminin. Most of the cells died, but a small number were able to proliferate. These proliferating cells were cloned as portal branch ligation-stimulated hepatic cells (PBLHCs) by the limiting dilution method. The PBLHCs expressed cytokeratin19, albumin, and Hmga2. The PBLHCs exhibited metabolic functions such as detoxification of ammonium ions and synthesis of urea on Matrigel-coated plates in the presence of oncostatin M. In Matrigel mixed with type I collagen, the PBLHCs became rearranged into cystic and tubular structures. Immunohistochemical staining demonstrated the presence of Hmga2-positive cells around the interlobular bile ducts in the portal branch-ligated liver lobes. In conclusion, successful isolation of bipotent hepatic progenitor cell clones, PBLHCs, from the portal branch-ligated liver lobes of mice provides the possibility of future clinical application of portal vein ligation to induce hepatic progenitor cells.

  5. Solid State Photovoltaic Research Branch

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    This report summarizes the progress of the Solid State Photovoltaic Research Branch of the Solar Energy Research Institute (SERI) from October 1, 1988, through September 30,l 1989. Six technical sections of the report cover these main areas of SERIs in-house research: Semiconductor Crystal Growth, Amorphous Silicon Research, Polycrystalline Thin Films, III-V High-Efficiency Photovoltaic Cells, Solid-State Theory, and Laser Raman and Luminescence Spectroscopy. Sections have been indexed separately for inclusion on the data base.

  6. Branching processes and neutral evolution

    CERN Document Server

    Taïb, Ziad

    1992-01-01

    The Galton-Watson branching process has its roots in the problem of extinction of family names which was given a precise formulation by F. Galton as problem 4001 in the Educational Times (17, 1873). In 1875, an attempt to solve this problem was made by H. W. Watson but as it turned out, his conclusion was incorrect. Half a century later, R. A. Fisher made use of the Galton-Watson process to determine the extinction probability of the progeny of a mutant gene. However, it was J. B. S. Haldane who finally gave the first sketch of the correct conclusion. J. B. S. Haldane also predicted that mathematical genetics might some day develop into a "respectable branch of applied mathematics" (quoted in M. Kimura & T. Ohta, Theoretical Aspects of Population Genetics. Princeton, 1971). Since the time of Fisher and Haldane, the two fields of branching processes and mathematical genetics have attained a high degree of sophistication but in different directions. This monograph is a first attempt to apply the current sta...

  7. Effect of herpesvirus infection on pancreatic duct cell secretion

    Institute of Scientific and Technical Information of China (English)

    Péter Hegyi; András Varró; Mária K Kovács; Mike A Gray; Barry E Argent; Zsolt Boldogk(o)i; Balázs (O)rd(o)g; Zoltán Rakonczai Jr; Tamás Takács; János Lonovics; Annamária Szabolcs; Réka Sári; András Tóth; Julius G Papp

    2005-01-01

    AIM: To examine the effect of acute infection caused by herpesvirus (pseudorabies virus, PRV) on pancreatic ductal secretion.METHODS: The virulent Ba-DupGreen (BDG) and nonvirulent Ka-RREpOlacgfp (KEG) genetically modified strains of PRV were used in this study and both of them contain the gene for green fluorescent protein (GFP). Small intra/interlobular ducts were infected with BDG virus (107 PFU/mL for 6 h) or with KEG virus (1010 PFU/mL for 6 h), while non-infected ducts were incubated only with the culture media. The ducts were then cultured for a further 18 h.The rate of HCO3- secretion [base efflux -J(B-)] was determined from the buffering capacity of the cells and the initial rate of intracellular acidification (1) after sudden blockage of basolateral base loaders with dihydro-4,4,-diisothiocyanatostilbene-2,2,-disulfonic acid (500 μmol/L)and amiloride (200 μmol/L), and (2) after alkali loading the ducts by exposure to NH4Cl. All the experiments were performed in HCO3--buffered Ringer solution at 37 ℃ (n = 5ducts for each experimental condition). Viral structural proteins were visualized by immunohistochemistry. Virallyencoded GFP and immunofluorescence signals were recorded by a confocal laser scanning microscope.RESULTS: The BDG virus infected the majority of accessible cells of the duct as judged by the appearance of GFP and viral antigens in the ductal cells. KEG virus caused a similarly high efficiency of infection. After blockage of basolateral base loaders, BDG infection significantly elevated -J(B-) 24 h after the infection, compared to the non-infected group. However, KEG infection did not modify -J(B-). After alkali loading the ducts, -J(B-) was significantly elevated in the BDG group compared to the control group 24 h after the infection. As we found with the inhibitor stop method, no change was observed in the group KEG compared to the non-infected group.CONCLUSION: Incubation with the BDG or KEG strains of PRV results in an effective

  8. Extracorporeal shock-wave lithotripsy of bile duct stones

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kim, Myung Joon; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Moo Sang; Jo, Jang Hwan; Kim, Byung Ro [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    During the past one and half year, we performed ESWL therapy in 13 patients with common bile duct and intrahepatic duct stones, applying Lithostar-R (Siemens co. West Germany) and analyzed their results. In 13 patients, 9 residual common bile duct stones and 7 intrahepatic duct stones were selected postoperatively. The size of stones were ranged from 0.7 cm to 3.5 cm in diameter. 2 stones were multiple and the remained 14 were single in number. The visualization of stones were done with fluoroscopy after the injection of contrast media via cholangiographic T-tube or ERCP. ESWL were applied continuously until stone disintegration was visible, or upto maximum number of 3500 discharge of shock wave. If not disintegrated upto 3500, patients were underwent second or third lithotripsy session with interval of one week. Our results showed that among 9 common bile duct stones, 4 were completely disintegrated and passed out spontaneously, but 3 partially fragmented and removed by the additional procedure. 2 were failed. Among 7 intrahepatic stones, 3 completely and 2 partially were succeeded. One stone partially fragmented were retained without removal and other one were failed. Skin petechia in all patients were revealed on the entry port of shock wave, but no serous complication was not occurred.

  9. Measure Guideline: Optimizing the Configuration of Flexible Duct Junction Boxes

    Energy Technology Data Exchange (ETDEWEB)

    Beach, R.; Burdick, A.

    2014-03-01

    This measure guideline offers additional recommendations to heating, ventilation, and air conditioning (HVAC) system designers for optimizing flexible duct, constant-volume HVAC systems using junction boxes within Air Conditioning Contractors of America (ACCA) Manual D guidance (Rutkowski, H. Manual D -- Residential Duct Systems, 3rd edition, Version 1.00. Arlington, VA: Air Conditioning Contractors of America, 2009.). IBACOS used computational fluid dynamics software to explore and develop guidance to better control the airflow effects of factors that may impact pressure losses within junction boxes among various design configurations (Beach, R., Prahl, D., and Lange, R. CFD Analysis of Flexible Duct Junction Box Design. Golden, CO: National Renewable Energy Laboratory, submitted for publication 2013). These recommendations can help to ensure that a system aligns more closely with the design and the occupants' comfort expectations. Specifically, the recommendations described herein show how to configure a rectangular box with four outlets, a triangular box with three outlets, metal wyes with two outlets, and multiple configurations for more than four outlets. Designers of HVAC systems, contractors who are fabricating junction boxes on site, and anyone using the ACCA Manual D process for sizing duct runs will find this measure guideline invaluable for more accurately minimizing pressure losses when using junction boxes with flexible ducts.

  10. High-Performance Ducts in Hot-Dry Climates

    Energy Technology Data Exchange (ETDEWEB)

    Hoeschele, Marc [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Chitwood, Rick [National Renewable Energy Laboratory (NREL), Golden, CO (United States); German, Alea [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Weitzel, Elizabeth [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2015-07-30

    Duct thermal losses and air leakage have long been recognized as prime culprits in the degradation of heating, ventilating, and air-conditioning (HVAC) system efficiency. Both the U.S. Department of Energy’s Zero Energy Ready Home program and California’s proposed 2016 Title 24 Residential Energy Efficiency Standards require that ducts be installed within conditioned space or that other measures be taken to provide similar improvements in delivery effectiveness (DE). Pacific Gas & Electric Company commissioned a study to evaluate ducts in conditioned space and high-performance attics (HPAs) in support of the proposed codes and standards enhancements included in California’s 2016 Title 24 Residential Energy Efficiency Standards. The goal was to work with a select group of builders to design and install high-performance duct (HPD) systems, such as ducts in conditioned space (DCS), in one or more of their homes and to obtain test data to verify the improvement in DE compared to standard practice. Davis Energy Group (DEG) helped select the builders and led a team that provided information about HPD strategies to them. DEG also observed the construction process, completed testing, and collected cost data.

  11. Sensor-based navigation of air duct inspection mobile robots

    Science.gov (United States)

    Koh, Kyoungchul; Choi, H. J.; Kim, Jae-Seon; Ko, Kuk Won; Cho, Hyungsuck

    2001-02-01

    12 This paper deals with an image sensor system and its position estimation algorithm for autonomous duct cleaning and inspection mobile robots. For the real application, a hierarchical control structure that consists of robot motion controller and image sensor system is designed considering the efficient and autonomous motion behaviors in narrow space such as air ducts. The sensor's system consists of a CCD camera and two laser sources to generate slit beams. The image of the structured lights is used for calculating the geometric parameters of the air ducts which are usually designed with a rectangular section. With the acquired 3D information about the environment, the mobile robot with two differential driving wheels is able to autonomously navigates along the duct path without any human intervention. For real time navigation, the relative position estimation of the robot are performed from 3D image reconstructed by the sensor system. The calibration and image processing methods used for the sensor system are presented with the experimental data. The experimental results show the possibility of the sensor based navigation which is important for effective duct cleaning by small mobile robots.

  12. Mechanical properties of branched actin filaments

    CERN Document Server

    Razbin, Mohammadhosein; Benetatos, Panayotis; Zippelius, Annette

    2015-01-01

    Cells moving on a two dimensional substrate generate motion by polymerizing actin filament networks inside a flat membrane protrusion. New filaments are generated by branching off existing ones, giving rise to branched network structures. We investigate the force-extension relation of branched filaments, grafted on an elastic structure at one end and pushing with the free ends against the leading edge cell membrane. Single filaments are modeled as worm-like chains, whose thermal bending fluctuations are restricted by the leading edge cell membrane, resulting in an effective force. Branching can increase the stiffness considerably; however the effect depends on branch point position and filament orientation, being most pronounced for intermediate tilt angles and intermediate branch point positions. We describe filament networks without cross-linkers to focus on the effect of branching. We use randomly positioned branch points, as generated in the process of treadmilling, and orientation distributions as measur...

  13. An Exact Transfer Matrix Formulation of Plane Sound Wave Transmission in Inhomogeneous Ducts

    Science.gov (United States)

    Dockumaci, E.

    1998-11-01

    The impedance, or the reflection coefficient, of plane sound waves in inhomogeneous ducts satisfies a Riccati equation. The present paper shows that the duct impedance matrix, or the scattering matrix, can be related explicitly to the solutions of the associated linear equation of the Riccati equation for duct impedance, or reflection coefficient, respectively. New exact analytical scattering matrix solutions, which follow as consequences of this connection, are given for two significant duct acoustics problems, namely, the sound transmission in non-uniform ducts carrying an incompressible subsonic low Mach number mean flow transmission of sound in uniform ducts with a full quadratic axial mean temperature gradient.

  14. Ret and Etv4 Promote Directed Movements of Progenitor Cells during Renal Branching Morphogenesis.

    Directory of Open Access Journals (Sweden)

    Paul Riccio

    2016-02-01

    Full Text Available Branching morphogenesis of the epithelial ureteric bud forms the renal collecting duct system and is critical for normal nephron number, while low nephron number is implicated in hypertension and renal disease. Ureteric bud growth and branching requires GDNF signaling from the surrounding mesenchyme to cells at the ureteric bud tips, via the Ret receptor tyrosine kinase and coreceptor Gfrα1; Ret signaling up-regulates transcription factors Etv4 and Etv5, which are also critical for branching. Despite extensive knowledge of the genetic control of these events, it is not understood, at the cellular level, how renal branching morphogenesis is achieved or how Ret signaling influences epithelial cell behaviors to promote this process. Analysis of chimeric embryos previously suggested a role for Ret signaling in promoting cell rearrangements in the nephric duct, but this method was unsuited to study individual cell behaviors during ureteric bud branching. Here, we use Mosaic Analysis with Double Markers (MADM, combined with organ culture and time-lapse imaging, to trace the movements and divisions of individual ureteric bud tip cells. We first examine wild-type clones and then Ret or Etv4 mutant/wild-type clones in which the mutant and wild-type sister cells are differentially and heritably marked by green and red fluorescent proteins. We find that, in normal kidneys, most individual tip cells behave as self-renewing progenitors, some of whose progeny remain at the tips while others populate the growing UB trunks. In Ret or Etv4 MADM clones, the wild-type cells generated at a UB tip are much more likely to remain at, or move to, the new tips during branching and elongation, while their Ret-/- or Etv4-/- sister cells tend to lag behind and contribute only to the trunks. By tracking successive mitoses in a cell lineage, we find that Ret signaling has little effect on proliferation, in contrast to its effects on cell movement. Our results show that Ret

  15. Finite amplitude waves in two-dimensional lined ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    A second-order uniform expansion is obtained for nonlinear wave propagation in a two-dimensional duct lined with a point-reacting acoustic material consisting of a porous sheet followed by honeycomb cavities and backed by the impervious wall of the duct. The waves in the duct are coupled with those in the porous sheet and the cavities. An analytical expression is obtained for the absorption coefficient in terms of the sound frequency, the physical properties of the porous sheet, and the geometrical parameters of the flow configuration. The results show that the nonlinearity flattens and broadens the absorption vs. frequency curve, irrespective of the geometrical dimensions or the porous material acoustic properties, in agreement with experimental observations.

  16. Developing active noise control systems for noise attenuation in ducts

    Science.gov (United States)

    Campos, Rosely V.; Ivo, Rodrigo C.; Medeiros, Eduardo B.

    2002-11-01

    The present work describes some of the research effort on Active Noise Control (ANC) being jointly developed by the Catholic University of Minas Gerais (PUC-MINAS) and the Federal University of Minas Gerais (UFMG). Considerations about the implementation of Digital Signal Processing for noise control in ducts has been presented. The objective is to establish a study on Active Noise Control in ducts combining geometry and acoustic parameters modification together with adaptive digital filtering implementation. Both algorithm and digital signal processing details are also discussed. The main results for a typical application where real attenuation has been obtained are presented and considered according to their use in developing real applications. The authors also believe that the present text should provide an interesting overview for both designers and students concerned about Active Noise Control in ducts. (To be presented in Portuguese.)

  17. Papillary carcinoma of the thyroglossal duct cyst: case report.

    Directory of Open Access Journals (Sweden)

    Nasrollah Maleki

    2015-04-01

    Full Text Available Thyroglossal duct cysts are the most common form of congenital cysts on the neck. The incidence of thyroid papillary carcinoma in thyroglossal duct cyst is less than 1%. In most cases the diagnosis is made postoperatively. We present a 22-year-old female with thyroid papillary carcinoma arising from thyroglossal duct cyst,identified in pathologic study after sistrunk operation.In our case there was neither invasion to adjacent tissue nor lymph node involvement.The patient then underwent total thyroidectomy and bilateral neck dissection. The patient was treated with radioactive iodide and thyroid suppression therapy was given as adjuvant treatment.The patient has been following for two years without any metastasis.

  18. Molecular basis of potassium channels in pancreatic duct epithelial cells

    DEFF Research Database (Denmark)

    Hayashi, M.; Novak, Ivana

    2013-01-01

    Potassium channels regulate excitability, epithelial ion transport, proliferation, and apoptosis. In pancreatic ducts, K channels hyperpolarize the membrane potential and provide the driving force for anion secretion. This review focuses on the molecular candidates of functional K channels...... in pancreatic duct cells, including KCNN4 (K 3.1), KCNMA1 (K1.1), KCNQ1 (K7.1), KCNH2 (K11.1), KCNH5 (K10.2), KCNT1 (K4.1), KCNT2 (K4.2), and KCNK5 (K5.1). We will give an overview of K channels with respect to their electrophysiological and pharmacological characteristics and regulation, which we know from...... other cell types, preferably in epithelia, and, where known, their identification and functions in pancreatic ducts and in adenocarcinoma cells. We conclude by pointing out some outstanding questions and future directions in pancreatic K channel research with respect to the physiology of secretion...

  19. Narrow sidebranch arrays for low frequency duct noise control.

    Science.gov (United States)

    Tang, S K

    2012-11-01

    The present study investigates the sound transmission loss across a section of an infinitely long duct where one or more narrow sidebranch tubes are installed flushed with the duct wall. The finite-element method is used to compute the wave propagation characteristics, and a simplified theoretical analysis is carried out at the same time to explain the wave mechanism at frequencies of high sound reduction. Results show that the high sound transmission loss at a particular frequency is due to the concerted actions of three consecutive sidebranch tubes with the most upstream one in the resonant state. The expansion chamber effect of the setup also plays a role in enhancing sound attenuation at non-resonance frequencies. Broadband performance of the device can be greatly enhanced by appropriate arrangements of tube lengths and/or by coupling arrays on the two sides of the duct.

  20. Biliary endoprostheses in tumors at the hepatic duct bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Lammer, J.; Neumayer, K.; Steiner, H.

    1986-11-01

    In 51 patients with tumors at the hepatic duct bifurcation, endoprostheses were transhepatically inserted into the bile ducts. Patients with Bismuth-3-tumors (i.e. bilateral biliary obstruction) were treated by insertion of 2 or more endoprostheses. Long-term success presumed drainage of all obstructed ducts, because cholangitis has been a common problem secondary to undrained segments. Furthermore the debris and the high viscosity of infected bile increased the risk for obstruction of the endoprostheses, which was observed in 6%. The mean time of survival was 7 months with a maximum of 26 months. In our experience endoprostheses can be used successfully in unresectable Klatskin tumours, which increases the comfort for the patients in their last months of life.

  1. [Postoperative handling in biliodigestive derivation by iatrogenic bile duct injury].

    Science.gov (United States)

    Domínguez, I; Mercado, M A

    2008-01-01

    Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.

  2. Intracellular pH in rat pancreatic ducts

    DEFF Research Database (Denmark)

    Novak, I; Hug, M; Greger, R

    1997-01-01

    In order to study the mechanism of H+ and HCO3- transport in a HCO3- secreting epithelium, pancreatic ducts, we have measured the intracellular pH (pHi) in this tissue using the pH sensitive probe BCECF. We found that exposures of ducts to solutions containing acetate/acetic acid or NH4+/NH3...... buffers (20 mmol/l) led to pHi changes in accordance with entry of lipid-soluble forms of the buffers, followed by back-regulation of pHi by duct cells. In another type of experiment, changes in extracellular pH of solutions containing HEPES or HCO3-/CO2 buffers led to significant changes in pHi that did....... Under some conditions, these exchangers can be invoked to regulate cell pH....

  3. Observationally constrained modeling of sound in curved ocean internal waves: examination of deep ducting and surface ducting at short range.

    Science.gov (United States)

    Duda, Timothy F; Lin, Ying-Tsong; Reeder, D Benjamin

    2011-09-01

    A study of 400 Hz sound focusing and ducting effects in a packet of curved nonlinear internal waves in shallow water is presented. Sound propagation roughly along the crests of the waves is simulated with a three-dimensional parabolic equation computational code, and the results are compared to measured propagation along fixed 3 and 6 km source/receiver paths. The measurements were made on the shelf of the South China Sea northeast of Tung-Sha Island. Construction of the time-varying three-dimensional sound-speed fields used in the modeling simulations was guided by environmental data collected concurrently with the acoustic data. Computed three-dimensional propagation results compare well with field observations. The simulations allow identification of time-dependent sound forward scattering and ducting processes within the curved internal gravity waves. Strong acoustic intensity enhancement was observed during passage of high-amplitude nonlinear waves over the source/receiver paths, and is replicated in the model. The waves were typical of the region (35 m vertical displacement). Two types of ducting are found in the model, which occur asynchronously. One type is three-dimensional modal trapping in deep ducts within the wave crests (shallow thermocline zones). The second type is surface ducting within the wave troughs (deep thermocline zones).

  4. CASE STUDY OF DUCT RETROFIT OF A 1985 HOME AND GUIDELINES FOR ATTIC AND CRAWL SPACE DUCT SEALING

    Energy Technology Data Exchange (ETDEWEB)

    Boudreaux, Philip R [ORNL; Christian, Jeffrey E [ORNL; Jackson, Roderick K [ORNL

    2012-01-01

    The U.S. Department of Energy (DOE) is fully committed to research for developing the information and capabilities necessary to provide cost-effective residential retrofits yielding 50% energy savings within the next several years. Heating, ventilation, and air conditioning (HVAC) is the biggest energy end use in the residential sector, and a significant amount of energy can be wasted through leaky ductwork in unconditioned spaces such as attics and crawl spaces. A detailed duct sealing case study is presented for one house along with nine brief descriptions of other duct retrofits completed in the mixed-humid climate. Costs and estimated energy savings are reported for most of the ten houses. Costs for the retrofits ranged from $0.92/ft2 to $1.80/ft2 of living space and estimated yearly energy cost savings due to the duct retrofits range from 1.8% to 18.5%. Lessons learned and duct sealing guidelines based on these ten houses, as well as close work with the HVAC industry in the mixed-humid climate of East Tennessee, northern Georgia, and south-central Kentucky are presented. It is hoped that the lessons learned and guidelines will influence local HVAC contractors, energy auditors, and homeowners when diagnosing or repairing HVAC duct leakage and will be useful for steering DOE s future research in this area.

  5. Condensation in jet engine intake ducts during stationary operation

    Energy Technology Data Exchange (ETDEWEB)

    Young, J.B. [Univ. of Cambridge (United Kingdom). Whittle Lab.

    1995-04-01

    The paper describes on analysis of the condensation of moist air in very long intake ducts of jet engines during stationary operation. Problems arising from such condensation include fan over speed and increased stagnation pressure loss in the intake duct. The analysis demonstrates that, for moderate values of relative humidity, homogeneous condensation will occur in an outer annulus adjacent to the intake cowling if the local flow Mach number attains values of about 1.0. In the central region of the intake duct, where design Mach numbers of 0.8 may be attained, homogeneous condensation is unlikely to occur except, possibly, when the relative humidity is close to 100 percent and the ambient temperature very high. However, if the intake duct is very long, significant heterogeneous condensation on foreign particles present in the atmosphere is possible. The concentration of foreign nuclei required for this type of condensation is comparable to the likely levels of contamination at many industrial test sites. The effects of condensation on engine test results are twofold. First, condensation is a thermodynamically irreversible process and results in an increase of entropy and hence loss of total pressure in the intake duct. Uncorrected measurements using Pitot probes may not record this loss correctly. Second, the mass and energy transfer between the phases during the condensation process has a tendency to accelerate the flow approaching the engine, an effect that may be counteracted by a reduction in mass flow rate in order to maintain the static pressure constant. These conclusions are in agreement with experimental results obtained on-site during the testing of a jet engine fitted with a very long intake duct.

  6. The acoustics of aircraft engine-duct systems

    Science.gov (United States)

    Nayfeh, A. H.; Kaiser, J. E.; Telionis, D. P.

    1973-01-01

    Noise generated in aircraft engines is usually suppressed by acoustically treating the engine ducts. The optimization of this treatment requires an understanding of the transmission and attenuation of the acoustic waves. A critical review is presented of the state of the art regarding methods of determining the transmission and attenuation parameters and the effect on these parameters of (1) acoustic properties of liners, (2) the mean velocity, including uniform and shear profiles and nonparallel flow, (3) axial and transverse temperature gradients, (4) slowly and abruptly varying cross sections, and (5) finite-amplitude waves and nonlinear duct liners.

  7. Nonlinear acoustic propagation in two-dimensional ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    The method of multiple scales is used to obtain a second-order uniformly valid expansion for the nonlinear acoustic wave propagation in a two-dimensional duct whose walls are treated with a nonlinear acoustic material. The wave propagation in the duct is characterized by the unsteady nonlinear Euler equations. The results show that nonlinear effects tend to flatten and broaden the absorption versus frequency curve, in qualitative agreement with the experimental observations. Moreover, the effect of the gas nonlinearity increases with increasing sound frequency, whereas the effect of the material nonlinearity decreases with increasing sound frequency.

  8. Acoustic propagation in ducts with varying cross sections

    Science.gov (United States)

    Nayfeh, A. H.; Telionis, D. P.

    1973-01-01

    The method of multiple scales is used to derive the equations that describe the spatial and temporal variation of the amplitudes and phases of a wave packet propagating in slowly varying hard-walled or lined ducts. The analysis is carried out for rectangular as well as circular ducts. These equations are statements of the conservation of energy. For large admittance or high-frequency modes, an approximate expression is obtained for the attenuation. This expression shows that all possible acoustic modes are attenuating. The results also show that decreasing the cross sectional area can lead to elimination of some of the acoustic modes.

  9. Ursodeoxycholic acid treatment of vanishing bile duct syndromes

    Institute of Scientific and Technical Information of China (English)

    Thomas Pusl; Ulrich Beuers

    2006-01-01

    Vanishing bile duct syndromes (VBDS) are characterized by progressive loss of small intrahepatic ducts caused by a variety of different diseases leading to chronic cholestasis, cirrhosis, and premature death from liver failure. The majority of adult patients with VBDS suffer from primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA), a hydrophilic dihydroxy bile acid, is the only drug currently approved for the treatment of patients with PBC, and anticholestatic effects have been reported for several other cholestatic syndromes. Several potential mechanisms of action of UDCA have been proposed including stimulation of hepatobiliary secretion, inhibition of apoptosis and protection of cholangiocytes against toxic effects of hydrophobic bile acids.

  10. A numerical investigation of primary surface rounded cross wavy ducts

    Science.gov (United States)

    Utriainen, E.; Sundén, B.

    A three-dimensional numerical study was conducted to assess the hydraulic and heat transfer performance of primary surface type heat exchanger surfaces, called cross wavy (CW) ducts aimed for recuperators. The governing equations, i.e., the mass conservation equation, Navier-Stokes equations and the energy equation, are solved numerically by a finite volume method for boundary fitted coordinates. Periodic boundary conditions are imposed in the main flow direction. In this particular case laminar convective flow and heat transfer prevail. Details of the recuperator ducts and the numerical method as well as relevant results are presented.

  11. A measuring stand for a ducted fan aircraft propulsion unit

    Directory of Open Access Journals (Sweden)

    Hlaváček David

    2014-03-01

    Full Text Available The UL-39 ultra-light aircraft which is being developed by the Department of Aerospace Engineering, Faculty of Mechanical Engineering, Czech Technical University in Prague, is equipped with an unconventional ducted fan propulsion unit. The unit consists of an axial fan driven by a piston engine and placed inside a duct ended with a nozzle. This article describes the arrangement of a modernised measuring stand for this highly specific propulsion unit which will be able to measure the fan pressure ratio and velocity field in front of and behind the fan and its characteristic curve.

  12. Radiation from a lined duct in uniform flow

    DEFF Research Database (Denmark)

    Juhl, Peter Møller

    1999-01-01

    This paper presents a boundary element formulation for modelling the sound field inside and outside a duct in uniform flow. The model is the first step towards models for predicting the noise radiated from turbo fan engines. For this purpose the frequency range is very large (up to ka=40), and non......-axisymmetric excitation is important (spinning modes). In addition the model allows the duct to be partially or fully treated with an axisymmetric locally reacting liner. Results determined with the model are compared with results from the literature and results calculated with an analytic model....

  13. Simultaneous Papillary Carcinoma in Thyroglossal Duct Cyst and Thyroid

    Directory of Open Access Journals (Sweden)

    Gustavo Cancela e Penna

    2017-01-01

    Full Text Available Thyroglossal duct cyst (TDC is a cystic expansion of a remnant of the thyroglossal duct tract. Carcinomas in the TDC are extremely rare and are usually an incidental finding after the Sistrunk procedure. In this report, an unusual case of a 36-year-old woman with concurrent papillary thyroid carcinoma arising in the TDC and on the thyroid gland is presented, followed by a discussion of the controversies surrounding the possible origins of a papillary carcinoma in the TDC, as well as the current management options.

  14. Advanced Strategy Guideline: Air Distribution Basics and Duct Design

    Energy Technology Data Exchange (ETDEWEB)

    Burdick, A.

    2011-12-01

    This report discusses considerations for designing an air distribution system for an energy efficient house that requires less air volume to condition the space. Considering the HVAC system early in the design process will allow adequate space for equipment and ductwork and can result in cost savings. Principles discussed that will maximize occupant comfort include delivery of the proper amount of conditioned air for appropriate temperature mixing and uniformity without drafts, minimization of system noise, the impacts of pressure loss, efficient return air duct design, and supply air outlet placement, as well as duct layout, materials, and sizing.

  15. 103Pd radioactive stent inhibits biliary duct restenosis and reduces smooth muscle actin expression during duct healing in dogs

    Institute of Scientific and Technical Information of China (English)

    Gui-Jin He; Qin-Yi Gao; Shu-He Xu; Hong Gao; Tao Jiang; Xian-Wei Dai; Kai Ma

    2006-01-01

    BACKGROUND: This study was designed to assess the expression of smooth muscle actin (SMA) in the healing process after implanting a 103Pd radioactive stent in the biliary duct, and to discuss the function and signiifcance of this stent in preventing biliary stricture formation. METHODS:A model of biliary injury in dogs was made and then a 103Pd radioactive stent was positioned in the biliary duct. The expression and distribution of SMA were assessed in the anastomotic tissue 30 days after implantation of the stent. RESULTS:SMA expression was less in the 103Pd stent group than in the ordinary stent group. The 103Pd stent inhibited scar contracture and anastomotic stenosis. CONCLUSION:The 103Pd stent can reduce the expression of SMA in the healing process and inhibit scar contracture and anastomotic stenosis in the dog biliary duct.

  16. Effect of flow on the acoustic resonances of an open-ended duct

    Science.gov (United States)

    Ingard, U.; Singhal, V. K.

    1975-01-01

    The effect of flow on the acoustic resonances of an open-ended, hard-walled duct is analyzed. The flow produces acoustic losses both in the interior of the duct and at the ends. Unless the duct is very long, typically 100 times the diameter, the losses at the ends dominate. At flow Mach numbers in excess of 0.4 the losses are so large that axial duct resonances are almost completely suppressed. The plane-wave Green's function for the duct with flow is expressed in terms of the (experimentally determined) pressure reflection coefficients at the ends of the duct, and the flow dependence of the complex eigenfrequencies of the duct is obtained. Some observations concerning the noise produced by the flow in the duct are also reported.

  17. Congenital double bile duct presenting as recurrent cholangitis in a child

    Directory of Open Access Journals (Sweden)

    K.D. Chakravarty

    2015-12-01

    Full Text Available Double common bile duct (DCBD is a rare congenital anomaly. Most of these bile duct anomalies are associated with bile duct stones, anomalous pancreaticobiliary junction (APBJ, pancreatitis and bile duct or gastric cancers. Early detection and treatment is important to avoid long term complications. Surgical resection of the anomalous bile duct and reconstruction of the biliary enteric anastomosis is the treatment of choice. We report a rare case of DCBD anomaly in a girl, who presented with recurrent cholangitis. She had type Va DCBD anomaly. She underwent successful resection of the bile duct and reconstruction of the biliary enteric anastomosis. Preoperative imaging and diagnosis of the congenital biliary anomaly is very important to avoid intraoperative bile duct injury. Review of the literature shows very few cases of type Va DCBD, presenting with either bile duct stones or APBJ.

  18. ASSESSMENT OF FUNGAL (PENICILLIUM CHRYSOGENUM) GROWTH ON THREE HVAC DUCT MATERIALS

    Science.gov (United States)

    The article discusses laboratory experiments to evaluate the susceptibility of three ventilation duct materials (fibrous glass ductboard, galvanized steel, and insulated flexible duct) to fungal (P. chrysogenum) growth. [NOTE: Many building investigators have documented fungal bi...

  19. Measure Guideline: Summary of Interior Ducts in New Construction, Including an Efficient, Affordable Method to Install Fur-Down Interior Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Beal, D.; McIlvaine , J.; Fonorow, K.; Martin, E.

    2011-11-01

    This document illustrates guidelines for the efficient installation of interior duct systems in new housing, including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces. This document illustrates guidelines for the efficient installation of interior duct systems in new housing. Interior ducts result from bringing the duct work inside a home's thermal and air barrier. Architects, designers, builders, and new home buyers should thoroughly investigate any opportunity for energy savings that is as easy to implement during construction, such as the opportunity to construct interior duct work. In addition to enhanced energy efficiency, interior ductwork results in other important advantages, such as improved indoor air quality, increased system durability and increased homeowner comfort. While the advantages of well-designed and constructed interior duct systems are recognized, the implementation of this approach has not gained a significant market acceptance. This guideline describes a variety of methods to create interior ducts including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces. As communication of the intent of an interior duct system, and collaboration on its construction are paramount to success, this guideline details the critical design, planning, construction, inspection, and verification steps that must be taken. Involved in this process are individuals from the design team; sales/marketing team; and mechanical, insulation, plumbing, electrical, framing, drywall and solar contractors.

  20. Intraductal aspiration LPT liquid - based thin - layer cytology by fiberoptic ductoscopy for patients with nipple discharge.%乳管内镜辅助液基细胞学测试对乳头溢液的诊断

    Institute of Scientific and Technical Information of China (English)

    董明; 钟兰英; 杜伟钊; 王开昕; 陈妮娜; 钟笑萍

    2011-01-01

    目的 探讨乳管内镜(FDS)检查中冲洗液液基细胞学(LPT)检查辅助诊断乳头溢液病因的价值.方法 对2006年4月至2010年6月间200例乳头溢液患者进行FDS和冲洗液LPT检查,118例接受手术治疗,同时进行冲洗液普通涂片检查,比较各种检查方法与病理检查结果进行对照研究.结果 FDS检查符合率为74.6%(88/118),冲洗液涂片为39.8%(47/118),LPT为56.8%(67/118);FDS诊断恶性病变的符合率分别为6/11,LPT为8/11;LPT和FDS联合,恶性病变诊断符合率为10/11.结论 FDS检查联合冲洗液LPT检查对乳头溢液诊断准确性高,减少末梢导管病变的漏诊,尤其可以提高恶性病变的检出率.%Objective To evaluate the value of intraductal aspiration LPT by fiberoptic ductoscopy ( FDS ) in the diagosis of nipple discharge. Methods FDS, intraductal aspiration LPT by FDS were used to diagnose and examine 200 patients with confused nipple discharge during April 2006 to December 2006, 118 patients were treated operatively. The results of diagnosis and biopsy pathology were studied. Results The diagnose accordance rates of FDS, intraductal aspiration LPT, intraductal aspiration conventional film preparation were 74.6% , 56.8% , and 39.8% , respectively. The malignant diagnose accordance rates of FDS, intraductal aspiration LPT, FDS + LPT were 6/11, 8/11 and 10/11,respectively. Conclusion FDS with intraductal aspiration LPT is a good method to diagnose nipple discharge. It is especially helpful in diferentiating malgnant from benign discharge.

  1. Chiral methyl-branched pheromones.

    Science.gov (United States)

    Ando, Tetsu; Yamakawa, Rei

    2015-07-01

    Insect pheromones are some of the most interesting natural products because they are utilized for interspecific communication between various insects, such as beetles, moths, ants, and cockroaches. A large number of compounds of many kinds have been identified as pheromone components, reflecting the diversity of insect species. While this review deals only with chiral methyl-branched pheromones, the chemical structures of more than one hundred non-terpene compounds have been determined by applying excellent analytical techniques. Furthermore, their stereoselective syntheses have been achieved by employing trustworthy chiral sources and ingenious enantioselective reactions. The information has been reviewed here not only to make them available for new research but also to understand the characteristic chemical structures of the chiral pheromones. Since biosynthetic studies are still limited, it might be meaningful to examine whether the structures, particularly the positions and configurations of the branched methyl groups, are correlated with the taxonomy of the pheromone producers and also with the function of the pheromones in communication systems.

  2. Chitin in the silk gland ducts of the spider Nephila edulis and the silkworm Bombyx mori.

    Directory of Open Access Journals (Sweden)

    Gwilym J G Davies

    Full Text Available Here we report the detection and localisation of chitin in the cuticle of the spinning ducts of both the spider Nephila edulis and the silkworm Bombyx mori. Our observations demonstrate that the duct walls of both animals contain chitin notwithstanding totally independent evolutionary pathways of the systems. We conclude that chitin may well be an essential component for the construction of spinning ducts; we further conclude that in both species chitin may indicate the evolutionary origin of the spinning ducts.

  3. Chitin in the silk gland ducts of the spider Nephila edulis and the silkworm Bombyx mori.

    Science.gov (United States)

    Davies, Gwilym J G; Knight, David P; Vollrath, Fritz

    2013-01-01

    Here we report the detection and localisation of chitin in the cuticle of the spinning ducts of both the spider Nephila edulis and the silkworm Bombyx mori. Our observations demonstrate that the duct walls of both animals contain chitin notwithstanding totally independent evolutionary pathways of the systems. We conclude that chitin may well be an essential component for the construction of spinning ducts; we further conclude that in both species chitin may indicate the evolutionary origin of the spinning ducts.

  4. Sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe in rats

    Institute of Scientific and Technical Information of China (English)

    Anuj Shrestha; Huan Feng; Wen Li and Qiang Han; Yong Zhou; Hui Mao; Fu-Yu Li; Wen-Jie Ma; Nan-Sheng Cheng; Ri-Hua Xu; Yong-Qiong Zhang; Ting Jiang

    2014-01-01

    BACKGROUND: The high recurrence rate of hepatolithiasis and the high operative risk of right posterior, caudate or multiple  lobe  hepatectomy  are  the  unsettled  problems  in hepatobiliary surgery. The present study was to investigate the efifcacy of chemical hepatectomy performed via applying sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe. METHODS: The bile duct and portal vein branches of the median hepatic lobe of rats were treated with: 1) bile duct embolization  followed  by  portal  vein  ligation  (BDE+PVL) and 2) portal vein ligation followed by bile duct embolization (PVL+BDE). The efifcacy of chemical hepatectomy in BDE+PVL and PVL+BDE groups was compared with that of sole BDE by histology and Western blotting analysis of collagen I expression. RESULTS: After six weeks of the chemical hepatectomy, rats in the BDE group showed hepatocyte damages, ifbrosis and "self-cut" only in the periphery of the embolized lobe. In contrast, rats in the PVL+BDE and BDE+PVL groups exhibited complete necrosis  of  hepatocytes  and  replacement  with  proliferative ductules and collagen ifbers, leading to complete ifbrosis and "self-cut" phenomenon in the whole targeted lobe. Collagen I expression in the PVL+BDE group was slightly higher than that in the BDE+PVL group; however, no statistically signiifcant difference was noted. CONCLUSION: The sequential embolization of the bile duct and portal vein branches to the targeted hepatic lobe may be a feasible and effective approach to acheive the ideal effect of chemical hepatectomy in a short period of time.

  5. Experimental study on the particles deposition in the sampling duct

    Energy Technology Data Exchange (ETDEWEB)

    Vendel, J.; Charuau, J. [Institut de Protection et de Surete Nucleaire, Yvette (France)

    1995-02-01

    A high standard of protection against the harmful effects of radioactive aerosol dissemination requires a measurement, as representative as possible, of their concentration. This measurement depends on the techniques used for aerosol sampling and transfer to the detector, as well as on the location of the latter with respect to the potential sources. The aeraulic design of the apparatus is also an important factor. Once collected the aerosol particles often have to travel through a variably shaped duct to the measurement apparatus. This transport is responsible for losses due to the particles deposition on the walls, leading to a distortion on the concentration measurements and a change in the particle size distribution. To estimate and minimize measurement errors it is important to determine the optimal transport conditions when designing a duct; its diameter and material, the radius of curvature of the bends and the flow conditions must be defined in particular. This paper presents an experimental study in order to determine, for each deposition mechanism, the retained fraction, or the deposition velocity for different flow regimes. This study has pointed out that it exists a favourable flow regime for the particle transport through the sampling ducts (2 500 < Re < 5 000). It has been established, for any particle diameters, equations to predict the aerosol penetration in smooth-walled cylindrical metal ducts.

  6. Reynolds-stress model prediction of 3-D duct flows

    CERN Document Server

    Gerolymos, G A

    2014-01-01

    The paper examines the impact of different modelling choices in second-moment closures by assessing model performance in predicting 3-D duct flows. The test-cases (developing flow in a square duct [Gessner F.B., Emery A.F.: {\\em ASME J. Fluids Eng.} {\\bf 103} (1981) 445--455], circular-to-rectangular transition-duct [Davis D.O., Gessner F.B.: {\\em AIAA J.} {\\bf 30} (1992) 367--375], and \\tsn{S}-duct with large separation [Wellborn S.R., Reichert B.A., Okiishi T.H.: {\\em J. Prop. Power} {\\bf 10} (1994) 668--675]) include progressively more complex strains. Comparison of experimental data with selected 7-equation models (6 Reynolds-stress-transport and 1 scale-determining equations), which differ in the closure of the velocity/pressure-gradient tensor $\\Pi_{ij}$, suggests that rapid redistribution controls separation and secondary-flow prediction, whereas, inclusion of pressure-diffusion modelling improves reattachment and relaxation behaviour.

  7. Design curves for circular and annular duct silencers

    Science.gov (United States)

    Watson, Willie R.; Ramakrishnan, R.

    1989-01-01

    Conventional models of sound propagation between porous walls (Scott, 1946) are adapted in order to calculate design curves for the lined circular and annular-duct silencers used in HVAC systems. The derivation of the governing equations is outlined, and results for two typical cases are presented graphically. Good agreement with published experimental data is demonstrated.

  8. Benign Pancreatic Duct Strictures: Medical and Endoscopic Therapy

    Directory of Open Access Journals (Sweden)

    JE Geenen

    2000-01-01

    Full Text Available Pancreatic duct strictures usually reflect underlying pancreatic disease and are likely caused by one or more of the following: acute or chronic pancreatitis, benign or malignant pancreatic neoplasm, pseudocyst and trauma. The characteristics of pancreatic strictures are identified, and medical and endoscopic therapy options are reviewed.

  9. Two phase flow combustion modelling of a ducted rocket

    NARCIS (Netherlands)

    Stowe, R.A.; Dubois, C.; Harris, P.G.; Mayer, A.E.H.J.; Champlain, A. de; Ringuette, S.

    2001-01-01

    Under a co-operative program, the Defence Research Establishment Valcartier and Université Laval in Canada and the TNO Prins Maurits Laboratory in the Netherlands have studied the use of a ducted rocket for missile propulsion. Hot-flow direct-connect combustion experiments using both simulated and s

  10. Predicting Turbulent Convective Heat Transfer in Fully Developed Duct Flows

    Science.gov (United States)

    Rokni, Masoud; Gatski, Thomas B.

    2001-01-01

    The performance of an explicit algebraic stress model (EASM) is assessed in predicting the turbulent flow and forced heat transfer in both straight and wavy ducts, with rectangular, trapezoidal and triangular cross-sections, under fully developed conditions. A comparison of secondary flow patterns. including velocity vectors and velocity and temperature contours, are shown in order to study the effect of waviness on flow dynamics, and comparisons between the hydraulic parameters. Fanning friction factor and Nusselt number, are also presented. In all cases. isothermal conditions are imposed on the duct walls, and the turbulent heat fluxes are modeled using gradient-diffusion type models. The formulation is valid for Reynolds numbers up to 10(exp 5) and this minimizes the need for wall functions that have been used with mixed success in previous studies of complex duct flows. In addition, the present formulation imposes minimal demand on the number of grid points without any convergence or stability problems. Criteria in terms of heat transfer and friction factor needed to choose the optimal wavy duct cross-section for industrial applications among the ones considered are discussed.

  11. Thyroglossal Duct Papillary Thyroid Carcinoma and Synchronous Lingual Thyroid Atypia

    Directory of Open Access Journals (Sweden)

    Timothy Yoo

    2016-01-01

    Full Text Available Thyroglossal duct and lingual thyroid ectopic lesions are exceedingly rare synchronous findings. Papillary thyroid carcinoma of these ectopic thyroid sites is well understood but still a rare finding. This case points to some management nuances in regard to ectopic thyroid screening with imaging and also shows the effectiveness of minimally invasive transoral robotic surgery for lingual thyroid.

  12. Optimizing the Treatment of Acute Duct-Destructive Pancreatitis

    Science.gov (United States)

    Zhakiev, Bazylbek S.; Karsakbayev, Uteugali G.; Kelimberdiev, Mersaid S.; ?uhamedgalieva, Bodagoz M.; K?nonenko, Aleksander F.

    2016-01-01

    The search for new methods for treating duct-destructive pancreatitis is a relevant problem. Endogenous intoxication and oxidative stress that accompany acute pancreatitis often progress even after surgery, which forces one to search for additional possibilities of preventing these severe consequences. This research studied the effect of small…

  13. Breast Duct Endoscopy for the Diagnosis and Treatment of Nipple Discharge: Report of 632 Cases%纤维乳腺导管内镜辅助诊治乳头溢液632例报告

    Institute of Scientific and Technical Information of China (English)

    张起; 蒋宏传; 李杰

    2012-01-01

    Objective To discuss the clinical value of fiber ductoscopy for diagnosing Tis stage breast cancer. Methods Since May 2001 to May 2010, we conducted fiber ductoscopy on totally 632 cases of nipple discharge (702 examinations) , and performed fiber ductoscopy-assisted surgery on 310 of the patients who had protuberant lesions. Results Among the cases, 475 patients were diagnosed with protruded lesions, including 388 cases of intraductal papilloma (61. 4%), 79 cases of intraductal papillomatosis (12. 5% ) , and 8 cases of ductal Tis carcinoma ( 1. 3% ) ; the other 157 cases showed non-protuberant lesions, including 82 cases of duct ectasia ( 13. 0% ) , 73 cases of chronic duct inflammation (11. 6% ) , and 2 cases of ductal Tis carcinoma (0.3% ). In the patients who had protruded lesions, 310 underwent breast duct endoscopy-assisted positioning for surgery. The fiber ductoscopy showed a positive predictive value of 83. 3% ( 10/12) for ductal Tis carcinoma in our hospital. Conclusion Breast fiber ductoscopy is a supplement to the diagnosis of Tis breast cancer with nipple discharge, and thus is a valuable method for diagnosing early-stage breast cancer.%目的 探讨纤维乳腺导管内镜对Tis期乳腺癌的临床诊断价值.方法 2001年5月~ 2010年5月,对632例乳头溢液进行乳腺导管内镜检查702次,并对其中310例隆起性病变行乳腺导管内镜辅助定位手术.结果 475例诊断为隆起性病变,包括乳管内乳头状瘤388例(61.4%),乳管内乳头状瘤病79例(12.5%),导管内癌8例(1.3%);157例为非隆起性病变,包括导管扩张症82例(13.0%),慢性乳管炎73例(11.6%)和导管内癌2例(0.3%).310例行乳腺导管内镜辅助定位手术,内镜诊断对导管内癌的阳性预测值为83.3%(10/12).结论 纤维乳腺导管内镜检查弥补了伴有乳头溢液的Tis期乳腺癌诊断的空白,对乳腺癌的早期诊断有积极的意义.

  14. Current perspective in the treatment of bile duct injuries

    Directory of Open Access Journals (Sweden)

    Juan Jos and eacute; Granados-Romero

    2016-03-01

    Full Text Available The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient and acute;s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient and acute;s quality of life, and represent less risk of complications in short/long term. [Int J Res Med Sci 2016; 4(3.000: 677-684

  15. Papillary carcinoma in a thyroglossal duct: case report

    Directory of Open Access Journals (Sweden)

    Antonio Santos Martins

    1999-11-01

    Full Text Available CONTEXT: Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1%. OBJECTIVE: To report a case of papillary carcinoma in thyroglossal duct cysts. DESIGN: Case report. CASE REPORT: The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease.

  16. Modal Analysis in Lined Wedge-Shaped Ducts

    Science.gov (United States)

    Mechel, F. P.

    1998-10-01

    It has been suggested to describe the sound field in a wedge-shaped duct in a cylindrical co-ordinate system in which the boundaries of the wedge lie in a co-ordinate surface. This suggestion was developed in a companion paper [1]. The wave equation can be separated only if the boundaries are ideally reflecting (rigid or soft). Two solutions were proposed in reference [1] for absorbing boundaries. In the first solution the sound field is composed of “ideal modes” (modes in a wedge with ideally reflecting boundaries); the boundary condition at the absorbing boundary then leads to a system of equations for the mode amplitudes. The problem with this method lies in the fact that there is no radial orthogonality of the ideal modes so that the precision of the field synthesis by ideal modes is doubtful. In the second method in reference [1] one defines “fictitious modes” which satisfy the boundary conditions at the flanks exactly and which are based on hypergeometric functions as radial functions, but which produce a “rest” in the wave equation. It was described how this rest can be minimized; this procedure leads to slow numerical integrations. In the present paper, the wedge is subdivided into duct sections with parallel walls (the boundary is stepped); the fields in the sections are composed of duct modes (modes in a straight lined duct); the mode amplitudes are determined from the boundary conditions at the section limits. The advantages of the present method are (analytically) the duct modes are orthogonal across the sections, so the mode amplitudes can be determined with the usual precision of a modal analysis, and (numerically) no numerical integrations are needed.

  17. Isolated segmental, sectoral and right hepatic bile duct injuries

    Institute of Scientific and Technical Information of China (English)

    Radoje B Colovic

    2009-01-01

    The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery;3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated;4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes;the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis;all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-Y repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-Y repair. Two others also underwent a Roux-en-Y repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-Y anastomosis should be considered.

  18. Stabilization of Branching Queueing Networks

    CERN Document Server

    Brázdil, Tomáš

    2011-01-01

    Queueing networks are gaining attraction for the performance analysis of parallel computer systems. A Jackson network is a set of interconnected servers, where the completion of a job at server i may result in the creation of a new job for server j. We propose to extend Jackson networks by "branching" and by "control" features. Both extensions are new and substantially expand the modelling power of Jackson networks. On the other hand, the extensions raise computational questions, particularly concerning the stability of the networks, i.e, the ergodicity of the underlying Markov chain. We show for our extended model that it is decidable in polynomial time if there exists a controller that achieves stability. Moreover, if such a controller exists, one can efficiently compute a static randomized controller which stabilizes the network in a very strong sense; in particular, all moments of the queue sizes are finite.

  19. Branching process models of cancer

    CERN Document Server

    Durrett, Richard

    2015-01-01

    This volume develops results on continuous time branching processes and applies them to study rate of tumor growth, extending classic work on the Luria-Delbruck distribution. As a consequence, the authors calculate the probability that mutations that confer resistance to treatment are present at detection and quantify the extent of tumor heterogeneity. As applications, the authors evaluate ovarian cancer screening strategies and give rigorous proofs for results of Heano and Michor concerning tumor metastasis. These notes should be accessible to students who are familiar with Poisson processes and continuous time. Richard Durrett is mathematics professor at Duke University, USA. He is the author of 8 books, over 200 journal articles, and has supervised more than 40 Ph.D. students. Most of his current research concerns the applications of probability to biology: ecology, genetics, and most recently cancer.

  20. Branching diffusions in random environment

    CERN Document Server

    Böinghoff, Christian

    2011-01-01

    We consider the diffusion approximation of branching processes in random environment (BPREs). This diffusion approximation is similar to and mathematically more tractable than BPREs. We obtain the exact asymptotic behavior of the survival probability. As in the case of BPREs, there is a phase transition in the subcritical regime due to different survival opportunities. In addition, we characterize the process conditioned to never go extinct and establish a backbone construction. In the strongly subcritical regime, mean offspring numbers are increased but still subcritical in the process conditioned to never go extinct. Here survival is solely due to an immortal individual, whose offspring are the ancestors of additional families. In the weakly subcritical regime, the mean offspring number is supercritical in the process conditioned to never go extinct. Thus this process survives with positive probability even if there was no immortal individual.