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Sample records for branch duct intraductal

  1. Enucleation: A treatment alternative for branch duct intraductal papillary mucinous neoplasms.

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    Kaiser, Joerg; Fritz, Stefan; Klauss, Miriam; Bergmann, Frank; Hinz, Ulf; Strobel, Oliver; Schneider, Lutz; Büchler, Markus W; Hackert, Thilo

    2017-03-01

    Small, asymptomatic, branch-duct intraductal papillary mucinous neoplasms of the pancreas are often kept under surveillance despite their malignant potential. The management of branch-duct intraductal papillary mucinous neoplasm is controversial with regard to indications and extent of any operative intervention. The present study aimed to evaluate enucleation as an alternative operative approach for branch-duct intraductal papillary mucinous neoplasms to exclude and prevent malignancy. For branch-duct intraductal papillary mucinous neoplasms of neoplasm on the basis of these features between January 2004 and September 2014 were analyzed. Among these, patients with successful enucleation were compared with those who were scheduled for enucleation but converted intraoperatively to pancreatic resection (intention-to-treat analysis). End points were hospital morbidity and mortality as well as histopathology and functional outcome at a mean follow-up of 32 months. In the study, 115 patients with presumed branch-duct intraductal papillary mucinous neoplasm and the intention to perform pancreatic enucleation were included; 87 enucleations were performed in 74 patients. In 41 patients, enucleation was converted to a pancreatic resection (procedure-specific success rate 64%); indications for conversion included location or size (46%), presence of multicystic lesions (39%), or involvement of the main pancreatic duct (15%). Of the 74 patients with enucleation, 64 branch-duct intraductal papillary mucinous neoplasms revealed low- (85%), 11% moderate dysplasia-, and 4% high-grade dysplasia on histology. Among converted resections, 6 intraductal papillary mucinous neoplasms revealed high-grade dysplasia or invasive carcinoma (15%). Intention-to-treat analysis with patients converted to pancreatic resection showed that enucleations resulted in less blood loss (100 vs 400 mL) and a shorter operation time (146 vs 255 minutes; P neoplasm-specific recurrence rates (3% vs 6

  2. 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.)

  3. Liver transplant patients have a similar risk of progression as sporadic patients with branch duct intraductal papillary mucinous neoplasms

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    Lennon, Anne Marie; Victor, David; Zaheer, Atif; Ostovaneh, Mohammad Reza; Jeh, Jessica; Law, Joanna K.; Rezaee, Neda; Molin, Marco Dal; Ahn, Young Joon; Wu, Wenchuan; Khashab, Mouen A.; Girotra, Mohit; Ahuja, Nita; Makary, Martin A.; Weiss, Matthew J.; Hirose, Kenzo; Goggins, Michael; Hruban, Ralph H.; Cameron, Andrew; Wolfgang, Christopher L.; Singh, Vikesh K.; Gurakar, Ahmet

    2015-01-01

    Background Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential, and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch duct-IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant patients are at increased risk of extra-hepatic malignancy. However there are few data regarding the risk of progression of BD-IPMNs in liver transplant recipients. The aim of this study was to determine if liver transplant recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Methods Consecutive patients who underwent a liver transplant with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3cm). Results Twenty three liver transplant patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24 months in liver transplant and control groups respectively. Four (17.4%) liver transplant patients and 45 (16.4%) controls developed high-risk features (p=0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with liver transplantation. Conclusion There was no statistically significant difference in the risk of developing high-risk features between the liver transplant and control groups. PMID:25155689

  4. 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

    2016-11-21

    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. 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. 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 (appearance (P > 0.01). 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.

  5. Malignant transformation of branch duct-type intraductal papillary mucinous neoplasms of the pancreas based on contrast-enhanced endoscopic ultrasonography morphological changes: focus on malignant transformation of intraductal papillary mucinous neoplasm itself.

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    Ohno, Eizaburo; Itoh, Akihiro; Kawashima, Hiroki; Ishikawa, Takuya; Matsubara, Hiroshi; Itoh, Yuya; Nakamura, Yosuke; Hiramatsu, Takeshi; Nakamura, Masanao; Miyahara, Ryoji; Ohmiya, Naoki; Ishigami, Masatoshi; Katano, Yoshiaki; Goto, Hidemi; Hirooka, Yoshiki

    2012-08-01

    The natural history of branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas remains unclear. We conducted a retrospective long-term follow-up study for malignant transformation (MT) of BD-IPMNs focusing on morphological changes. The subjects consisted of 142 patients who underwent contrast-enhanced endoscopic ultrasonography for initial diagnosis from January 2001 with more than 12 months of follow-up. The MT rate, including the co-occurrence of invasive ductal cancer, was evaluated by univariate and multivariate analysis. In addition, on the basis of morphological changes in patients who underwent surgery, the predictive factors for malignant IPMNs were evaluated. Median follow-up term was 42.5 months (range, 12-105 months). Thirty patients who exhibited morphological changes underwent surgery. Malignant transformation occurred in 9 patients (6.3%), and 5-year MT rate was 10.7%. The co-occurrence of invasive ductal cancer was seen in 5 patients. Multivariate analysis showed that the existence of mural nodules at initial diagnosis and involvement of main pancreatic duct were significant predictors of MT of BD-IPMN. Malignant transformation of BD-IPMN is not rare. The observation of morphological changes of main pancreatic duct and nodules, mainly on contrast-enhanced endoscopic ultrasonography, is practical and useful for predicting MT of BD-IPMN itself.

  6. Intraductal papillary neoplasm of the bile duct: A biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas?

    National Research Council Canada - National Science Library

    Rocha, Flavio G; Lee, Hwajeong; Katabi, Nora; DeMatteo, Ronald P; Fong, Yuman; D'Angelica, Michael I; Allen, Peter J; Klimstra, David S; Jarnagin, William R

    2012-01-01

    Intraductal papillary neoplasm of the bile duct (IPNB) is a variant of bile duct carcinoma characterized by intraductal growth and better outcome compared with the more common nodular‐sclerosing type...

  7. Radiological spectrum of intraductal papillary tumors of the bile ducts

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    Lim, Jae Hoon; Yi, Chin A; Lim, Hyo Keun; Lee, Won Jae; Lee, Soon Jin; Kim, Seung Hoon [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2002-01-01

    Papillary tumor of the bile duct is characterized by the presence of an intraductal tumor with a papillary surface comprising innumerable frondlike infoldings of proliferated columnar epithelial cells surrounding slender fibrovascular stalks. There may be multiple tumors along the bile ducts (papillomatosis or papillary carcinomatosis), which are dilated due to obstruction by a tumor per se, by sloughed tumor debris, or by excessive mucin. Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production. A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall. Sloughed tumor debris and mucin plugs should be differentiated from bile duct stones. Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.

  8. Intraductal papillary neoplasm originating from an anomalous bile duct.

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    Maki, Harufumi; Aoki, Taku; Ishizawa, Takeaki; Tanaka, Mariko; Sakatani, Takashi; Beck, Yoshifumi; Hasegawa, Kiyoshi; Sakamoto, Yoshihiro; Kokudo, Norihiro

    2017-04-01

    An 82-year-old woman who had been suffering from repeated obstructive jaundice for 7 years was referred to our hospital. Although endoscopic aspiration of the mucin in the common bile duct had been temporally effective, origin of the mucin production had not been detectable. The patient thus had been forced to be on long-term follow-up without curative resection. Endoscopic retrograde cholangioscopy on admission revealed massive mucin in the common bile duct. In addition, an anomalous bile duct located proximal to the gallbladder was identified. Since the lumen of the anomalous duct was irregular and the rest of biliary tree was completely free of suspicious lesions, the anomalous duct was judged to be the primary site. Surgical resection of the segment 4 and 5 of the liver combined with the extrahepatic biliary tract was performed. Pathological diagnosis was compatible to intraductal papillary neoplasm with high-grade intraepithelial dysplasia of the anomalous bile duct. The patient has been free from the disease for 6.5 years after resection. This is the first case of intraductal papillary neoplasm derived from an anomalous bile duct, which was resected after long-term conservative treatment. The present case suggested the slow growing character of natural history of the neoplasm.

  9. Intraductal papillary mucinous neoplasm.

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    Shi, Chanjuan; Hruban, Ralph H

    2012-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is a grossly visible (≥1 cm), mucin-producing neoplasm that arises in the main pancreatic duct and/or its branches. Patients with intraductal papillary mucinous neoplasm can present with symptoms caused by obstruction of the pancreatic duct system, or they can be asymptomatic. There are 3 clinical subtypes of intraductal papillary mucinous neoplasm: main duct, branch duct, and mixed. Five histologic types of intraductal papillary mucinous neoplasm are recognized: gastric foveolar type, intestinal type, pancreatobiliary type, intraductal oncocytic papillary neoplasm, and intraductal tubulopapillary neoplasm. Noninvasive intraductal papillary mucinous neoplasms are classified into 3 grades based on the degree of cytoarchitectural atypia: low-, intermediate-, and high-grade dysplasia. The most important prognosticator, however, is the presence or absence of an associated invasive carcinoma. Some main duct-intraductal papillary mucinous neoplasms progress into invasive carcinoma, mainly tubular adenocarcinoma (conventional pancreatic ductal adenocarcinoma) and colloid carcinoma. Branch duct-intraductal papillary mucinous neoplasms have a low risk for malignant transformation. Preoperative prediction of the malignant potential of an intraductal papillary mucinous neoplasm is of growing importance because pancreatic surgery has its complications, and many small intraductal papillary mucinous neoplasms, especially branch duct-intraductal papillary mucinous neoplasms, have an extremely low risk of progressing to an invasive cancer. Although most clinical decision making relies on imaging, a better understanding of the molecular genetics of intraductal papillary mucinous neoplasm could help identify molecular markers of high-risk lesions. When surgery is performed, intraoperative frozen section assessment of the pancreatic resection margin can guide the extent of resection. Intraductal papillary mucinous neoplasms are often

  10. Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways.

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    Schlitter, Anna Melissa; Born, Diana; Bettstetter, Marcus; Specht, Katja; Kim-Fuchs, Corina; Riener, Marc-Oliver; Jeliazkova, Petia; Sipos, Bence; Siveke, Jens T; Terris, Benoit; Zen, Yoh; Schuster, Tibor; Höfler, Heinz; Perren, Aurel; Klöppel, Günter; Esposito, Irene

    2014-01-01

    Intraductal papillary neoplasms of the bile duct are still poorly characterized regarding (1) their molecular alterations during the development to invasive carcinomas, (2) their subtype stratification and (3) their biological behavior. We performed a multicenter study that analyzed these issues in a large European cohort. Intraductal papillary neoplasms of the bile duct from 45 patients were graded and subtyped using mucin markers and CDX2. In addition, tumors were analyzed for common oncogenic pathways, and the findings were correlated with subtype and grade. Data were compared with those from 22 extra- and intrahepatic cholangiocarcinomas. Intraductal papillary neoplasms showed a development from preinvasive low- to high-grade intraepithelial neoplasia to invasive carcinoma. Molecular and immunohistochemical analysis revealed mutated KRAS, overexpression of TP53 and loss of p16 in low-grade intraepithelial neoplasia, whereas loss of SMAD4 was found in late phases of tumor development. Alterations of HER2, EGFR, β-catenin and GNAS were rare events. Among the subtypes, pancreato-biliary (36%) and intestinal (29%) were the most common, followed by gastric (18%) and oncocytic (13%) subtypes. Patients with intraductal papillary neoplasm of the bile duct showed a slightly better overall survival than patients with cholangiocarcinoma (hazard ratio (cholangiocarcinoma versus intraductal papillary neoplasm of the bile duct): 1.40; 95% confidence interval: 0.46-4.30; P=0.552). The development of biliary intraductal papillary neoplasms of the bile duct follows an adenoma-carcinoma sequence that correlates with the stepwise activation of common oncogenic pathways. Further large trials are needed to investigate and verify the finding of a better prognosis of intraductal papillary neoplasms compared with conventional cholangiocarcinoma.

  11. A Case of Intraductal Papillary Neoplasm of the Bile Duct with Stromal Invasion

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    Atsushi Nanashima

    2008-09-01

    Full Text Available Intraductal papillary neoplasm of the bile duct (IPNB represents biliary papillary tumors mainly growing and is considered to be of relatively low-grade malignancy. Here we report a case of IPNB in whom the poorly differentiated component deeply infiltrated the bile duct wall. A 77-year-old male had an invasive carcinoma of the bile duct 3 cm in size. He underwent right hemihepatectomy with combined resection of the extrahepatic bile duct. Papillary growing tumor was observed in the common bile duct and the right posterior Glisson’s pedicle was invaded. Histologic finding showed papillary adenocarcinoma in the surface layer superficially extending to the epithelium of the surrounding bile duct. In the subserosal layer, the tumor represented poorly differentiated adenocarcinoma. The tumor was diagnosed as invasive bile duct carcinoma arising from IPNB.

  12. Research Advances in Clinical and Imaging Characteristics of Intraductal Papillary Mucinous Neoplasm of the Bile Duct.

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    He, Meng-Na; Zhang, Jing; Zhang, Qing; Lv, Ke; Jiang, Yu-Xin

    2017-06-20

    Understanding on the intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) has dramatically improved in the past three decades. A new disease named intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) reported in recent years shares several similar clinical features with IPMN-P. The clinical manifestations and imaging characteristics of IPMN-B have been gradually recognized. This review summarizes some of the typical cases reported since 2000 and find that clinical manifestations of IPMN-B include epigastric discomfort,biliary colic,jaundice,intermittent fever,sometimes without any symptoms; imaging triads for IPMN-B are mucobilia,dilated bile duct,and bile duct mural nodule.

  13. Gd-EOB-DTPA-enhanced magnetic resonance imaging for bile duct intraductal papillary mucinous neoplasms

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    Ying, Shi-Hong; Teng, Xiao-Dong; Wang, Zhao-Ming; Wang, Qi-Dong; Zhao, Yi-Lei; Chen, Feng; Xiao, Wen-Bo

    2015-01-01

    AIM: To investigate gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) of intraductal papillary mucinous neoplasms of the bile duct (IPMN-B). METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented. RESULTS: Conventional imaging showed diffuse dilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. Gd-EOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomography-CT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology. CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases. PMID:26167082

  14. Clinicopathological characterization of so-called “cholangiocarcinoma with intraductal papillary growth” with respect to “intraductal papillary neoplasm of bile duct (IPNB)”

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    Nakanuma, Yasuni; Sato, Yasunori; Ojima, Hidenori; Kanai, Yae; Aishima, Shinichi; Yamamoto, Masakazu; Ariizumi, Shun-ichi; Furukawa, Toru; Hayashi, Hiroki; Unno, Michiaki; Ohta, Tetsuo

    2014-01-01

    Cholangiocarcinoma (CC) of the biliary tract occasionally presents a predominant intraductal papillary growth in the bile ducts, called as biliary tract carcinoma (BTC) of papillary growth (PG) and intrahepatic CC (ICC) of intraductal growth (IG) type. Recently, intraductal papillary neoplasm of bile duct (IPNB) has been proposed as a pre-invasive biliary neoplasm. This study was performed to characterize pathologically BTC of PG type and ICC of IG type with respect to IPNB. It was found that 126 of such 154 CCs (81.8%) fulfilled the criteria of IPNB, while the remaining 28 cases showed different histologies, such as tubular adenocarcinoma and carcinosarcoma. These IPNBs occurred in old aged patients with a male predominance, and the left lobe was rather frequently affected in the liver. A majority of these cases were high grade IPNB (43 cases) and invasive IPNB (77 cases), while low grade IPNB was rare (6 cases). Pancreatobiliary type was predominant (48 cases) followed by gastric (30 cases), intestinal (29 cases) and oncocytic (19 cases) types. Mucus hypersecretion was found in 45 cases, and this was frequent in IPNB at the intrahepatic large bile duct and hilar bile ducts but rare at the extrahepatic bile ducts. Interestingly, 36 cases of high grade and invasive IPNBs contained foci of moderately differentiated adenocacinoma within the intraductal papillary tumor. In conclusion, a majority of ICC of IG type and BTC of PG type could be regarded as a IPNB lineage, and clinically detectable IPNBs were already a malignant papillary lesion. PMID:25031730

  15. Caroli's disease misdiagnosed as intraductal papillary neoplasm of the bile duct.

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    Gu, Dae Hoe; Park, Min Seon; Jung, Chang Ho; Yoo, Yang Jae; Cho, Jae Young; Lee, Yun Ho; Seo, Yeon Seok; Yim, Hyung Joon; Um, Soon Ho; Ryu, Ho Sang

    2015-06-01

    Caroli's disease is a rare autosomal-recessive disorder caused by malformation of the ductal plate during embryonic development. Although it is present at birth, Caroli's disease is typically not diagnosed until between the second and fourth decades of life, as it was in the present patient. Here we report a rare case of Caroli's disease limited to one liver segment, which was initially misdiagnosed as an intraductal papillary neoplasm of the bile duct. The asymptomatic patient was treated with liver segmentectomy.

  16. Intraductal tubulopapillary neoplasm of the bile duct: A case report and review of the published work.

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    Nakagawa, Takashi; Arisaka, Yoshifumi; Ajiki, Tetsuo; Fujikura, Kohei; Masuda, Atsuhiro; Takenaka, Mamoru; Shiomi, Hideyuki; Okabe, Yoshihiro; Fukumoto, Takumi; Ku, Yonson; Azuma, Takeshi; Zen, Yoh

    2016-06-01

    Recent studies have suggested that a peculiar tumor mimicking intraductal tubulopapillary neoplasms (ITPN) of the pancreas can develop in the bile duct. Here, we present a similar case and review the published work on the newly proposed biliary neoplasm. A 68-year-old woman was referred to us for further evaluation of a liver mass. On imaging, the tumor was 40 mm in size and intraductal in location, and was enhanced slightly on the contrast-enhanced computed tomography. No mucin overproduction was found. She underwent right hepatectomy for suspected intraductal papillary neoplasm of the bile duct. The tumor histologically consisted of the biliary-type epithelium arranged in a tubular architecture within the dilated bile duct. Tumor cells had features of high-grade dysplasia but no stroma invasion. No expressions of MUC2 and MUC5AC were noted. On molecular studies, KRAS and GNAS appeared to be wild-type genotypes. These features were in keeping with ITPN. In the published work review, "biliary ITPN" described in four manuscripts were characterized by predominantly intrahepatic/hilar in location, histological tubular architecture, negative expressions of MUC2 and MUC5AC, and uncommon alterations of KRAS, GNAS and BRAF. Although invasive malignancy was present in 71%, the outcome was favorable with the 5-year survival expected to be approximately 90%. Biliary ITPN are supposedly uncommon, but a greater awareness of this condition may give more chance to diagnose the underrecognized neoplasm. © 2015 The Japan Society of Hepatology.

  17. 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.

  18. Caroli's disease misdiagnosed as intraductal papillary neoplasm of the bile duct

    Directory of Open Access Journals (Sweden)

    Dae Hoe Gu

    2015-06-01

    Full Text Available Caroli's disease is a rare autosomal-recessive disorder caused by malformation of the ductal plate during embryonic development. Although it is present at birth, Caroli's disease is typically not diagnosed until between the second and fourth decades of life, as it was in the present patient. Here we report a rare case of Caroli's disease limited to one liver segment, which was initially misdiagnosed as an intraductal papillary neoplasm of the bile duct. The asymptomatic patient was treated with liver segmentectomy.

  19. Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound.

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    Liu, L N; Xu, H X; Zheng, S G; Sun, L P; Guo, L H; Zhang, Y F; Xu, J M; Liu, C; Xu, X H

    2015-12-01

    To investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS). The imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS. Bile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5 ± 1.1 (range, 1.2 - 4.2 cm) and 5.6 ± 2.0 cm (range, 3.3 - 9.8 cm) (P = 0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (n = 8), bile duct dilation without intraductal mass (n = 3), and cystic-solid mixed type (n = 5). On CEUS, solid components of 13 lesions appeared hyper- (n = 12) or iso-enhancement (n = 1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0 %) and 5(31.3 %) of 16 IPNBs respectively (P = 0.04). For CECT, correct diagnosis was also achieved in 12 (75.0 %) of 16 lesions (P = 1.00, in comparison with CEUS). IPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US. Intraductal mass length > 3.0 cm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Colon cancer metastasis mimicking intraductal papillary neoplasm of the extra-hepatic bile duct.

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    Yamao, Takanobu; Hayashi, Hiromitsu; Higashi, Takaaki; Takeyama, Hideyuki; Kaida, Takayoshi; Nitta, Hidetoshi; Hashimoto, Daisuke; Chikamoto, Akira; Beppu, Toru; Baba, Hideo

    2015-01-01

    An accurate diagnosis of the primary cancer in cases with metastatic lesions is quite important because misdiagnosis may lead to the selection of incorrect adjuvant therapy and worse long-term outcomes after surgery. The metastatic sites associated with the dissemination of colon cancer are well known and normally predictable, which includes the lymphatic, haematogenous, or peritoneal regions, while other locations are quite rare. In this report, we present a case of colon cancer with an unusual metastatic pattern mimicking an intraductal papillary neoplasm of the bile duct (IPNB) present in the extra-hepatic bile duct with a cytokeratin (CK)-7-negative and CK-20-positive profile (intestinal type). In the case of this patient who had a history of colon cancer, immunohistochemical staining for the CKs was useful for distinguishing between primary IPNB and colon cancer metastases. We suspect that the metastatic pattern of this case of colon cancer that mimicked IPNB at the extra-hepatic bile duct developed incidentally via the bile stream. This is a rare case of colon cancer metastasis mimicking IPNB at the extra-hepatic bile duct. Our findings also suggest that there may be an incidental 4th metastatic route via the bile stream. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Intraductal papillary neoplasm of the bile duct accompanying biliary mixed adenoneuroendocrine carcinoma

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    Onishi, Ichiro; Kitagawa, Hirohisa; Harada, Kenichi; Maruzen, Syogo; Sakai, Seisyo; Makino, Isamu; Hayashi, Hironori; Nakagawara, Hisatoshi; Tajima, Hidehiro; Takamura, Hiroyuki; Tani, Takashi; Kayahara, Masato; Ikeda, Hiroko; Ohta, Tetsuo; Nakanuma, Yasuni

    2013-01-01

    We present the first case of an intraductal papillary neoplasm of the bile duct (IPNB) accompanying a mixed adenoneuroendocrine carcinoma (MANEC). A 74-year-old woman presented with fever of unknown cause. Laboratory data revealed jaundice and liver injury. Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct, which exhibited early enhancement and papillary growth. Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater, characterized by its protruding and dilated orifice. Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct, but no invasive region was suggested by diagnostic imaging. Therefore, the initial diagnosis was IPNB. After endoscopic nasobiliary drainage, a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia, indicating pancreaticobiliary-type IPNB. In addition, solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident. Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component, diagnosing it as a neuroendocrine tumor (NET). Furthermore, the MIB-1 proliferation index of NET was higher than that of IPNB, and microinvasion of the NET component was found, indicating neuroendocrine carcinoma (NET G3). This unique case of MANEC, comprising IPNB and NET, provides insight into the pathogenesis of biliary NET. PMID:23716999

  2. 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.

  3. 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.)

  4. Clinicopathological features of intraductal papillary neoplasms of the bile duct: a comparison with intraductal papillary mucinous neoplasm of the pancreas with reference to subtypes.

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    Fukumura, Yuki; Nakanuma, Yasuni; Kakuda, Yuko; Takase, Masaru; Yao, Takashi

    2017-07-01

    Intraductal papillary epithelial neoplasms of the pancreatobiliary system (intraductal papillary neoplasm of the bile duct (IPNB) and intraductal papillary mucinous neoplasm (IPMN)) seem to share many clinicopathological features; however, IPNB has not been fully characterized. In order to understand the clinicopathological/immunohistochemical features of IPNB better, we compared 52 cases of IPNB with 42 cases of IPMNs with mural nodules. The IPNB cases were divided into two groups according to their histological similarity and according to five key histological findings. All IPNB and IPMN cases mainly affected middle-aged to elderly people, predominantly men. Mucin hypersecretion was less frequent in IPNB compared to IPMN. Group 2 IPNB more frequently had a higher histopathological grade and more extensive stromal invasion than IPMN. Group 1 IPNB and IPMN were further classified into four subtypes (gastric, intestinal, pancreatobiliary, and oncocytic). Although each subtype of IPNB and IPMN showed similar histology, the immunohistochemical results were different. The gastric type of IPNB was less frequently positive for CDX2, and intestinal IPNB was more frequently positive for MUC1 and less frequently positive for MUC2, MUC5AC, and CDX2 compared to each subtype of IPMN, respectively. In conclusion, IPNB and IPMN have some clinicopathological features in common, but mucin hypersecretion was less frequent both in IPNBs than in IPMN. Group 2 IPNB differed from IPMN in several parameters of tumor aggressiveness. Additional clinicopathological and molecular studies should be performed with respect to the subtypes of IPNB and IPMN.

  5. Intraductal papillary neoplasm of the bile ducts: A case report and literature review.

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    Tan, Yaohong; Milikowski, Clara; Toribio, Yanelba; Singer, Adam; Rojas, Claudia P; Garcia-Buitrago, Monica T

    2015-11-21

    Intraductal papillary neoplasm of the bile duct (IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries, it is very rare and the etiology is unknown. In this article, we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-year-old female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB, gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of PubMed database, we collected 354 IPNB patients reported in 22 articles. In these patients, 52.8% were from Japan and 27.7% were from western countries including the United States (11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically, 57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically, pancreato-biliary subtype accounted for 41.8%, intestinal 28.0%, gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies, diagnosis of IPNB is still challenging, especially in western countries due to its rarity. Defined clinico-pathologic features are in demand for the accurate diagnosis and proper treatment.

  6. Intraductal papillary neoplasm of the bile ducts: A case report and literature review

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    Tan, Yaohong; Milikowski, Clara; Toribio, Yanelba; Singer, Adam; Rojas, Claudia P; Garcia-Buitrago, Monica T

    2015-01-01

    Intraductal papillary neoplasm of the bile duct (IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries, it is very rare and the etiology is unknown. In this article, we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-year-old female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB, gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of PubMed database, we collected 354 IPNB patients reported in 22 articles. In these patients, 52.8% were from Japan and 27.7% were from western countries including the United States (11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically, 57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically, pancreato-biliary subtype accounted for 41.8%, intestinal 28.0%, gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies, diagnosis of IPNB is still challenging, especially in western countries due to its rarity. Defined clinico-pathologic features are in demand for the accurate diagnosis and proper treatment. PMID:26604656

  7. 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.

  8. Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct.

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    Luvira, Vor; Pugkhem, Ake; Bhudhisawasdi, Vajarabhongsa; Pairojkul, Chawalit; Sathitkarnmanee, Egapong; Luvira, Varisara; Kamsa-Ard, Supot

    2017-02-01

    Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. Studies about the surgical outcomes for IPNB are few; therefore, we investigated the survival of patients who underwent curative surgical resection of IPNB. We retrospectively reviewed the medical and pathological records of 148 IPNB patients who underwent curative-intent hepatic resection between January 2005 and December 2011, to examine the prognosis of IPNB. All demographic and operative parameters were analyzed the effect on survival of patients. The median survival of IPNB patients was 1326 days with a respective 1, 3, and 5 year overall survival of 83.6% (95%CI: 76.5-88.7), 64.4% (95%CI: 56.0-71.6), and 47% (95%CI: 38.4-55.7). The level of invasiveness of IPNB predicted survival very well. For malignant IPNB, univariate analysis showed that serum CA19-9 level, lymph node metastasis, and completeness of resection were significant prognostic factors. Lymph node metastasis and completeness of resection were found in multivariate analysis to be significantly related to survival of the patients. The level of invasiveness and lymph node status were found to be associated with patient survival, as was adequacy of surgery. We recommend R0 resection be attempted for patients with IPNB. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  9. Intraductal papillary neoplasm of the bile duct, gastric type, arising in the intrapancreatic common bile duct could progress to colloid carcinoma: report of a case.

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    Tajima, Shogo; Ohata, Akihiko; Koda, Kenji; Maruyama, Yasuhiko

    2015-01-01

    Intraductal papillary neoplasm of the bile duct (IPNB) exists in a pathway of multistep-carcinogenesis toward cholangiocarcinoma. Four subtypes are observed in IPNB, pancreatobiliary type, intestinal type, gastric type, and oncocytic type, similarly to the corresponding disease in the pancreas, intraductal papillary mucinous neoplasm (IPMN). IPNB can present with or without macroscopically visible mucin secretion. IPNB usually progresses to tubular adenocarcinoma. However, there are a limited number of well-described cases of gastric-type IPNB progressing not to tubular adenocarcinoma but to colloid carcinoma. Herein, we present a case of an 82-year-old female patient with gastric-type IPNB in the intrapancreatic common bile duct without macroscopically visible mucin secretion, which progressed to colloid carcinoma. As IPNB, especially without visible mucin secretion, is considered to be a heterogeneous group of diseases, such an unexpected association could occur.

  10. Gallbladder papillary neoplasms share pathological features with intraductal papillary neoplasm of the bile duct.

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    Wan, Xueshuai; Shi, Jie; Wang, Anqiang; Xie, Yuan; Yang, Xiaobo; Zhu, Chengpei; Zhang, Haohai; Wu, Liangcai; Wang, Shanshan; Huang, Hanchun; Lin, Jianzhen; Zheng, Yongchang; Liang, Zhiyong; Sang, Xinting; Zhao, Haitao

    2017-05-09

    Intraductal papillary neoplasm of the bile duct (IPNB) has been widely recognized. However, the knowledge of intracystic papillary neoplasm of the gallbladder (IPNG) including papillary adenoma and adenocarcinoma is not well defined. In this study, we compared the clinicopathological and immunohistochemical features between 32 IPNG cases and 32 IPNB cases. IPNG-1 (low-high grade dysplasia) exhibited an earlier onset age, smaller tumor size and lower level of CK20 expression compared to IPNG-2 (invasive carcinoma). Histologically, pancreaticobiliary and intestinal subtype accounted for nearly half of IPNG or IPNB (44.4% and 48.1% vs. 44.0% and 44.0%), respectively. Immunohistochemically, 88.9% of IPNG and 92.0% of IPNB cases were positive for MUC1, and 96.3% and 92.0% for CK7, respectively. CDX2 and MUC2 were more highly expressed in the intestinal subtype than in other subtypes. CK20 expression increased in parallel with tumor progression. In addition, 53.1% of IPNG cases and 68.6% of IPNB cases exhibited invasive carcinoma, and showed significant survival advantages to conventional gallbladder adenocarcinoma and cholangiocarcinoma, respectively. In conclusion, papillary adenoma and adenocarcinoma of the gallbladder can be recognized as different pathological stages of IPNG, and they share pathological features with IPNB.

  11. Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms.

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    Sawai, Y; Yamao, K; Bhatia, V; Chiba, T; Mizuno, N; Sawaki, A; Takahashi, K; Tajika, M; Shimizu, Y; Yatabe, Y; Yanagisawa, A

    2010-12-01

    Side-branch intraductal papillary mucinous neoplasms (SB-IPMNs), and associated synchronous and metachronous pancreatic cancers are increasingly detected as imaging modalities become more sensitive. We investigated the natural history of SB-IPMN, and the incidence and characteristics of pancreatic cancers among patients undergoing long-term follow-up. We reviewed the clinical, imaging, and pathological features in 103 patients, diagnosed at the Aichi Cancer Center between September 1988 and September 2006 as having SB-IPMN, and conservatively followed up for ≥ 2 years (median 59 months) based on an endoscopic ultrasonography (EUS) database. 74 (71.8 %) patients had nonprogressive lesions. Overall, six patients (5.8 %) developed pancreatic cancers during follow-up, with intraductal papillary mucinous (IPM) carcinoma in four, and ductal carcinoma of pancreas that was not IPMN in two patients. Of the six pancreatic cancers, five were diagnosed at a resectable stage. The 5-year and 10-year actuarial rates of development of pancreatic cancer were 2.4 % and 20.0 %, respectively. Although, at the last follow-up, cyst size, main pancreatic duct (MPD) diameter, mural nodule size, and frequency of metachronous and/or synchronous cancers of other organs were significantly higher in patients who developed IPM carcinoma, resected SB-IPMNs without mural nodules and dilated MPDs had no IPM carcinomas. The frequency of pancreatic cancers is high on long-term follow-up of SB-IPMN. Although conservative management is appropriate for selected patients, regular and long-term imaging, especially by EUS is essential, even if SB-IPMN remains unchanged for 2 years. Presence of mural nodule and dilated MPD seem to be more appropriate indicators for resection than cyst size alone for SB-IPMNs. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Loss of Trefoil Factor 2 From Pancreatic Duct Glands Promotes Formation of Intraductal Papillary Mucinous Neoplasms in Mice.

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    Yamaguchi, Junpei; Mino-Kenudson, Mari; Liss, Andrew S; Chowdhury, Sanjib; Wang, Timothy C; Fernández-Del Castillo, Carlos; Lillemoe, Keith D; Warshaw, Andrew L; Thayer, Sarah P

    2016-12-01

    Little is known about the origin of pancreatic intraductal papillary mucinous neoplasms (IPMN). Pancreatic duct glands (PDGs) are gland-like outpouches budding off the main pancreatic ducts that function as a progenitor niche for the ductal epithelium; they express gastric mucins and have characteristics of side-branch IPMNs. We investigated whether PDGs are a precursor compartment for IPMNs and the role of Trefoil factor family 2 (TFF2)-a protein expressed by PDGs and the gastric mucosa that are involved in epithelial repair and tumor suppression. We obtained pancreatectomy specimens from 20 patients with chronic pancreatitis, 13 with low-grade side-branch IPMNs, and 15 patients with PDAC; histologically normal pancreata were used as controls (n = 18). Samples were analyzed by immunohistochemistry to detect TFF1 and TFF2 and cell proliferation. We performed mitochondrial DNA mutational mapping studies to determine the cell lineage and fate of PDG cells. Pdx1-Cre;LSL-KRASG12D (KC) mice were bred with TFF2-knockout mice to generate KC/Tff2-/- and KC/Tff2+/- mice. Pancreata were collected and histologically analyzed for formation of IPMN, pancreatic intraepithelial neoplasias, and PDAC, in addition to proliferation and protein expression. Human pancreatic ductal epithelial cells and PDAC cell lines were transfected with vectors to overexpress or knock down TFF2 or SMAD4. Histologic analysis of human samples revealed gastric-type IPMN to comprise 2 molecularly distinct layers: a basal crypt segment that expressed TFF2 and overlying papillary projections. Proliferation occurred predominantly in the PDG-containing basal segments. Mitochondrial mutation mapping revealed a 97% match between the profiles of proliferating PDG cells and their overlying nonproliferative IPMN cells. In contrast to KC mice, 2-month-old KC/Tff2+/- and KC/Tff2-/- mice developed prominent papillary structures in the duct epithelium with cystic metaplasia of the PDG, which resembled human IPMN

  13. Clinicopathologic characteristics of patients with resected multifocal intraductal papillary mucinous neoplasm of the pancreas.

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    Fritz, Stefan; Schirren, Moritz; Klauss, Miriam; Bergmann, Frank; Hackert, Thilo; Hartwig, Werner; Strobel, Oliver; Grenacher, Lars; Büchler, Markus W; Werner, Jens

    2012-09-01

    Intraductal papillary mucinous neoplasms of the pancreas are defined as mucin-producing neoplasms arising in the main pancreatic duct (main duct type), its major branches (branch duct type), or in both (mixed type). Intraductal papillary mucinous neoplasms of the pancreas can occur as a single collection of cysts or as multifocal lesions. While subtypes of intraductal papillary mucinous neoplasms of the pancreas are well described in literature, little is known about the importance of multifocal intraductal papillary mucinous neoplasms of the pancreas. This study evaluated the clinicopathologic characteristics of patients with surgically resected, multifocal intraductal papillary mucinous neoplasm of the pancreas. Clinicopathologic features and preoperative imaging of patients resected for multifocal intraductal papillary mucinous neoplasm of the pancreas defined as intraductal papillary mucinous neoplasm of the pancreas occurring in more than just 1 area, from January 2004 to July 2010 at the Department of Surgery, University of Heidelberg were analyzed. Preoperative parameters, including number of cysts, cyst size, presence of nodules, and epidemiologic data, were assessed and compared to patients with unifocal intraductal papillary mucinous neoplasms of the pancreas. Among 287 patients with resected intraductal papillary mucinous neoplasms of the pancreas, 51 patients (17.8%) with multifocal cystic pancreatic lesions were identified by preoperative imaging. The median age of patients with multifocal intraductal papillary mucinous neoplasms of the pancreas was ≥ 68 years (P = .002) compared to patients with unifocal intraductal papillary mucinous neoplasm of the pancreas (median age, 64 years). Thirty-one multifocal intraductal papillary mucinous neoplasms of the pancreas were of mixed type (60.8%), 15 of branch duct type (29.4%), and 5 of main duct type (9.8%). Histologically, 10 multifocal intraductal papillary mucinous neoplasms of the pancreas had low

  14. Simple resection of the lesion bile duct branch for treatment of regional hepatic bile duct stones.

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    Enliang, Li; Rongshou, Wu; Shidai, Shi; Jingling, Zhang; Qian, Feng; Wenjun, Liao; Linquan, Wu

    2017-07-01

    To evaluate the effectiveness and safety of simple resections of bile duct branch lesions for the treatment of regional hepatic bile duct stones.A retrospective analysis of the clinical data from patients in our hospital from November 2008 to November 2015, who only underwent a simple resection of the lesion bile duct branch. The patients' clinical characteristics, surgical features, postoperative complications, stone clear rate, residual stone rate, and recurrence stone rate were analyzed.This study of 32 patients included 13 males and 19 females with intrahepatic bile duct stones confined to the right hepatic bile duct branch. The intraoperative blood loss, operation time, and postoperative hospital stay were 478.0 ± 86.5, 210.7 ± 6.6, and 10.8 ± 3.5, respectively. Postoperative complications occurred in 6 patients (18.8%), all of whom recovered with conservative management. There were no deaths during hospitalization. The intraoperative stone clearance rate was 95.8%. Three patients had a recurrence of stones at a mean of 22 months of follow-up (range, 4-36 months).Simple resection of bile duct branch lesions is safe and feasible for patients who have regional hepatic bile duct stones limited to the right hepatic bile duct branches.

  15. Helicobacter pylori is undetectable in intraductal papillary mucinous neoplasm.

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    Baysal, Birol; İnce, Ali Tüzün; Gültepe, Bilge; Gücin, Zuhal; Malya, Fatma Ümit; Tozlu, Mukaddes; Şentürk, Hakan; Bağcı, Pelin; Çelikel, Çiğdem Ataizi; Aker, Fügen; Özkara, Selvinaz; Paşaoğlu, Esra; Dursun, Nevra; Özgüven, Banu Yılmaz; Tunçel, Deniz

    2016-01-01

    About half of the world population is infected with Helicobacter pylori (H. pylori), a bacterium associated with gastric cancer and considered to be a risk factor for pancreatic ductal adenocarcinoma. Whether the bacterium is associated with intraductal papillary mucinous neoplasm, believed to be a precursor of pancreatic ductal adenocarcinoma, is unknown. The aim of this study was to investigate the presence of H. pylori DNA in tissue sections of intraductal papillary mucinous neoplasm. The presence of H. pylori DNA was tested in a retrospective controlled study of formalin-fixed, paraffin-embedded pancreatic tissues from 24 patients who underwent surgery for intraductal papillary mucinous neoplasm. Histologically normal tissues surrounding neoplasms were used as control. H. pylori DNA was evaluated after deparaffinization, DNA extraction, and purification, and results were evaluated statistically. Samples were collected from 13 males and 11 females with mean age 59 years (range 44-77), and consisted of 19 cases of main-duct and three cases of branched-duct intraductal papillary mucinous neoplasm. Two patients were diagnosed with pancreatic cancer and main-duct intraductal papillary mucinous neoplasm. H. pylori DNA was not detected either in intraductal papillary mucinous neoplasm tissue, or in surrounding normal tissue. Although H. pylori has been implicated in pancreatic ductal adenocarcinoma, it may not play a key role in the development of intraductal papillary mucinous neoplasm. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  16. CT findings of intraductal papillary neoplasm of the bile duct: Assessment with multiphase contrast-enhanced examination using multi-detector CT

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    Ogawa, H., E-mail: ogawa.hiroshi@h.mbox.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Itoh, S. [Department of Radiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya (Japan); Nagasaka, T. [Department of Medical Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Suzuki, K. [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Ota, T. [Department of Radiology, Aichi Medical University Hospital, Nagakute Aichi (Japan); Naganawa, S. [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2012-03-15

    Aim: To evaluate multi-detector computed tomography (MDCT) findings of intraductal papillary neoplasm of the bile duct (IPNB), a neoplasm that is considered to be the biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. Materials and methods: Two radiologists retrospectively evaluated multiphase contrast-enhanced CT images with 0.5 or 1 mm collimation in 37 consecutive patients with resected IPNB diagnosed by a single pathologist. The CT findings were correlated with the pathological findings concerning invasion of the surrounding organs and vessels. Results: All patients showed bile duct dilatation. An intraductal mass was detected in 36 patients and the following findings were observed: extensive infiltration along the bile duct more than 20 mm (n = 32), compared with normal hepatic parenchyma, isodense or hyperdense during the late arterial phase (n = 31), not hyperdense during the portal-venous and delayed phases (n = 36), and intense enhancement rim at the base of the mass during the portal-venous or delayed phase (n = 27). Parenchymal invasion of the surrounding organs was seen in eight of 16 tumours showing irregular or bulging margins. Vascular invasion was false positive in four of eight tumours. Conclusions: IPNB exhibits relatively characteristic findings with multiphase contrast-enhanced examination using MDCT. A tendency to overestimate invasion of the surrounding organs and vessels was seen.

  17. Long-term observation and treatment of a widespread intraductal papillary neoplasm of the bile duct extending from the intrapancreatic bile duct to the bilateral intrahepatic bile duct: A case report.

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    Hokuto, Daisuke; Nomi, Takeo; Yasuda, Satoshi; Yoshikawa, Takahiro; Ishioka, Kohei; Yamada, Takatsugu; Akahori, Takahiro; Nakagawa, Kenji; Nagai, Minako; Nakamura, Kota; Obara, Shinsaku; Kanehiro, Hiromichi; Sho, Masayuki

    2017-01-01

    Few studies have reported the long-term outcomes of surgical resected intraductal papillary neoplasm of the bile duct (IPNB). Here, we describe the long-term observation and treatment of a case of widespread IPNB. A 57-year-old male was referred to our hospital due to jaundice and dilation of the intrahepatic bile duct. Computed tomography showed dilation and irregularities of the right intrahepatic and extrahepatic bile ducts together with a 3cm nodule in the common hepatic duct. Peroral cholangioscopy revealed mucinous discharge from the ampulla of Vater, which resulted in a diagnosis of IPNB. A biopsy of the nodule and the bile duct revealed papillary adenoma in all of them. Right hepatectomy, caudate lobectomy, extrahepatic bile duct resection, and left hepaticojejunostomy were performed. The nodule was histologically diagnosed as papillary carcinoma in situ, and R0 resection was performed. However, mucus production from the papillary adenoma in the B3 and B4 was observed. We carefully managed the patient's biliary tract by inserting a biliary drainage tube into the segment 2, and he has survived for more than 7 years since the initial treatment. Mucus might be produced after the surgical resection of IPNB even if s surgical margin was benign. Five-year survival rate of benign IPNB was reported from 85% to 100%. That might be caused by difference of the postoperative management of the biliary tract. Careful management of the biliary tract should be performed after surgical resection of IPNB. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. 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.)

  19. Cystic lesion of pancreas - Intraductal papillary mucinous neoplasm

    Directory of Open Access Journals (Sweden)

    Rajiv Baijal

    2013-01-01

    Full Text Available Intraductal papillary mucinous neoplasm (IPMN of the pancreas is an intraductal mucin-producing epithelial neoplasm that arises from the main and/or branched pancreatic duct. It usually presents as cystic lesion of pancreas. There are well known differential diagnosis of cystic pancreatic lesion. Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use of abdominal imaging. The diagnosis and treatment of intraductal papillary mucinous tumors (IPMN of the pancreas has evolved over the past decade. IPMN represents a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. Definitive management is surgical resection for appropriate candidates, as benign lesions harbor malignant potential. IPMN has a prognosis, which is different from adenocarcinoma of the pancreas. We report a case of a 58-year-old male with intraductal papillary neoplasm involving main duct and side branches presenting to us with clinical symptoms of chronic pancreatitis with obstructive jaundice and cholangitis treated surgically.

  20. Risk Factors for Progression or Malignancy in Main-Duct and Mixed-Type Intraductal Papillary Mucinous Neoplasm of the Pancreas.

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    Jang, Dong Kee; Ryu, Ji Kon; Chung, Kwang Hyun; Lee, Ban Seok; Park, Joo Kyung; Lee, Sang Hyub; Kim, Yong-Tae

    2016-08-01

    The 2012 international guidelines state that surgery should be considered for all surgically fit patients with pancreatic main-duct (MD)/mixed intraductal papillary mucinous neoplasms (IPMNs). This study evaluated the follow-up results of MD/mixed IPMNs and risk factors for progression or malignancy. Patients with MD/mixed IPMNs were retrospectively enrolled and divided into surgical and nonsurgical groups. These 2 groups were compared and further categorized as progression/malignancy or not. In the nonsurgical group, disease progression was defined as radiologic tumor growth or adjacent organ invasion. Data from 101 patients (73 males; mean [SD] age, 66.3 [9.1] years), including 27 and 74 in the nonsurgical and surgical groups, respectively, were analyzed. Mural nodules were more frequently detected in the surgical group (7.4% vs 31.1%, P = 0.018), whereas more multifocal cysts were observed in the nonsurgical group (40.7% vs 20.3%, P = 0.037). Forty-one patients (40.6%) showed progression or malignancy. Multivariate analysis showed that main pancreatic duct of 10 mm or greater (odds ratio, 4.368; P = 0.024) and pre-existing diabetes (odds ratio, 3.077; P = 0.046) were independent risk factors for progression or malignancy. A watchful waiting strategy could be feasible for some patients with MD/mixed IPMNs, particularly those with a main pancreatic duct of less than 10 mm and without diabetes.

  1. Evaluation of Intraductal Ultrasonography, Endoscopic Brush Cytology and K-ras, P53 Gene Mutation in the Early Diagnosis of Malignant Bile Duct Stricture.

    Science.gov (United States)

    Huang, Ping; Zhang, Hao; Zhang, Xiao-Feng; Zhang, Xiao; Lyu, Wen; Fan, Zhen

    2015-07-20

    In qualitative diagnosis of bile duct stenosis, single diagnostic measure is difficult to make a correct diagnosis, to combine several diagnostic techniques may be helpful to make an accurate diagnosis. The aim of this study was to evaluate the value of intraductal ultrasonography (IDUS), endoscopic brush cytology and K-ras, P53 gene mutation in the early diagnosis of malignant biliary stricture. From February 2012 to February 2013, 84 patients with suspected malignant biliary stricture were performed IDUS firstly, then endoscopic brush cytology and finally K-ras, P53 gene mutation detection, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of all above ways were evaluated and compared. Of 84 patients, 52 cases were ultimately diagnosed malignant biliary stenosis; of which, 9 cases had no recurrence or metastasis to other organs after radical operation during the follow-up period. IDUS combined with brush cytology and K-ras + P53 gene mutation detection had obvious advantage in the sensitivity, accuracy and negative predictive value than any other joint detection and single detection (the advantage was more significant compared with IDUS + brush cytology or any single detection P ras and IDUS + brush cytology or IDUS (P ras (P > 0.05). IDUS combined with brush cytology and K-ras, P53 gene mutation detection is better than the separate detection and contribute to the early diagnosis of malignant biliary stricture. Its more widespread use is recommended.

  2. Synchronous pancreatic solid pseudopapillary neoplasm and intraductal papillary mucinous neoplasm.

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    Hirabayashi, Kenichi; Zamboni, Giuseppe; Ito, Hiroyuki; Ogawa, Masami; Kawaguchi, Yoshiaki; Yamashita, Tomohiro; Nakagohri, Toshio; Nakamura, Naoya

    2013-06-07

    Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.

  3. Study of Relationship Between the Blood Supply of the Extrahepatic Bile Duct and Duct Supply Branches from Gastroduodenal Artery on Imaging and Anatomy

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    Jie Dai

    2015-01-01

    Full Text Available Background: Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation. Methods: The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct. Results: The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% (49/600. Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery (61.22%, 30/49, the proper hepatic artery (14.29%, 7/49, or both the gastroduodenal artery and the proper hepatic artery (24.49%, 12/49. In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct. Conclusions: There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications.

  4. Study of Relationship Between the Blood Supply of the Extrahepatic Bile Duct and Duct Supply Branches from Gastroduodenal Artery on Imaging and Anatomy

    Science.gov (United States)

    Dai, Jie; Wu, Xiao-Feng; Yang, Chun; Li, Hong-Jun; Chen, Ya-Liang; Liu, Guo-Zhen; Song, Yi-Zhi; Wu, Huan-Huan; Ding, Jin-Li; Li, Ning

    2015-01-01

    Background: Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation. Methods: The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct. Results: The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% (49/600). Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery (61.22%, 30/49), the proper hepatic artery (14.29%, 7/49), or both the gastroduodenal artery and the proper hepatic artery (24.49%, 12/49). In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct. Conclusions: There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications. PMID:25635427

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

    Science.gov (United States)

    Xiao, Shu-Yuan

    2012-01-01

    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. PMID:24278753

  6. Ultrasound appearance of chronic mammary duct ectasia

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    Duchesne, N. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)]. E-mail: nathalie_duchesne_22@yahoo.ca; Skolnik, S. [Univ. of Toronto, Dept. of Family Medicine, Toronto, Ontario (Canada); Bilmer, S. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)

    2005-12-15

    Mammary duct ectasia (MDE), also called periductal mastitis, mammary dysplasia, or plasma cell mastitis, is a benign condition of the mammary gland first described by Haagensen in 1951. The etiology of MDE is unknown and its pathogenesis still controversial; the periductal inflammation could be either the cause or the result of dilated damaged ducts. The process is usually bilateral and asymptomatic, with only a small percentage of patients presenting with symptoms that may include long course of tumour formation, usually subareolar breast lumps, nipple discharge, nipple retraction, mastalgia, and mammary abscess or fistulas. Mammographic presentation of MDE is well known; its features include periductal calcification, benign intraductal calcification, and retroareolar duct dilatation. The periductal calcification results from dystrophic calcification and forms calcified rings or very dense, oval, elongated calcifications, each with a central lucency representing the dilated duct. Intraductal calcifications of duct ectasia represent inspissated intraductal material and are typically of uniform high density, often needle-like, and occasionally branching. Occasionally, there are no mammographic findings, and the diagnosis must rely on sonographic features. Appearance of MDE on ultrasonography (US) depends on the stage of the disease and the contents of the dilated ducts. The acute presentation has been demonstrated in the literature more often than has its chronic counterpart. In the former, duct content can vary from anechoic to isoechoic with surrounding fatty tissue. In chronic MDE, episodes of inflammation are longer. This tends to result in secretions that have a more solid, cheesy texture, partly due to cholesterol crystals, foam cells, and inflammatory cells. For both types of MDE, the appearance can mimic high-grade ductal carcinoma in situ (DCIS) on US. In this essay, 2 chronic MDE cases are presented and their US appearance discussed. Our goal is to explore

  7. 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.

  8. Multifocal intraductal papillary mucinous neoplasm of the pancreas from mild dysplasia to invasive carcinoma A case report.

    Science.gov (United States)

    Mirarchi, Mariateresa; De Raffele, Emilio; Santini, Donatella; Calculli, Lucia; Cuicchi, Dajana; Lecce, Ferdinando; Cola, Bruno

    2016-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is defined as an intraductal mucin-producing neoplasm of the pancreatic ducts. IPMNs may be multifocal, have malignant potential and exhibit a broad histological spectrum ranging from adenoma to invasive carcinoma. The "hyperplasia-dysplasia-carcinoma sequence" in the evolution of IPMNs is considered very similar to the "adenoma-carcinoma sequence" of colorectal tumours. Patients with multifocal IPMN are potential candidates to total pancreatectomy, which still carries significant perioperative risks, especially in the elderly. In selected cases a reasonable alternative to total pancreatectomy is represented by the resection of the dominant tumour leaving deliberately in place the smaller, low-risk tumours. In this context, intraoperative ultrasonography (IOUS) can be useful to define the extent of IPMNs and to plan the surgical strategy. We report the case of a 84-year-old female with multiple IPMNs showing different stages of neoplastic progression up to invasive carcinoma. The patient underwent IOUS-guided distal splenopancreatectomy, while the small multiple branchduct type IPMNs of the head of the pancreas were considered at very low risk of neoplastic progression and were deliberately left in place. The patient is alive without recurrence 96 months after surgery and without evidence of progression of the branch-duct type IPMNs of the head of the pancreas. IOUS-guided pancreatectomy should be considered in selected elderly patients affected by multifocal IPMN evolved to invasive carcinoma without evidence of distant metastases. Intraductal papillary mucinous neoplasm, Intraoperative ultrasonography, Pancreatectomy.

  9. One of the multifocal intraductal papillary mucinous neoplasms with the clinical characteristics of mucinous cystic neoplasm.

    Science.gov (United States)

    Hata, Tatsuo; Sakata, Naoaki; Motoi, Fuyuhiko; Unno, Michiaki

    2013-02-18

    A 74-year-old woman with multiple cystic lesions in the pancreas was first examined at a previous hospital. Many of the lesions in the head and body were diagnosed as a branch duct intraductal papillary mucinous neoplasms (IPMN), but one lesion in the tail was a simple cyst. She had no surgical treatment because there were no signs of malignancy in any of the lesions. After 3 years, solid components appeared only in the tail lesion. Because of its preoperative diagnosis as a mucinous cystic neoplasm (MCN), distal pancreatectomy was performed. Histopathological findings revealed that the cystic tumour in the tail was IPMN with minimally invasive carcinoma and the other lesion in the body was IPMN with low-grade dysplasia. They were IPMNs bridged by a non-dilated main pancreatic duct. There may be some cases in which it is difficult to diagnose between IPMN and MCN.

  10. A case of MUC5AC-positive intraductal neoplasm of the pancreas classified as an intraductal tubulopapillary neoplasm?

    Science.gov (United States)

    Muraki, Takashi; Uehara, Takeshi; Sano, Kenji; Oota, Hiroyoshi; Yoshizawa, Akihiko; Asaka, Shiho; Tateishi, Ayako; Otsuki, Toshiaki; Shingu, Kunihiko; Matoba, Hisanori; Kobayashi, Shota; Ichimata, Shojiro; Watanabe, Takayuki; Itou, Tetsuya; Tanaka, Eiji

    2015-12-01

    This report describes a unique case of intraductal tubulopapillary neoplasm (ITPN) of the pancreas in order to clarify its oncogenesis and more precisely classify pancreatic intraductal neoplasms. A 74-year-old man visited our institution for follow-up of acute pancreatitis. Imaging examinations revealed a hypovascular intraductal mass in the head of the pancreas with progressive dilation of the pancreatic duct, atrophy of the pancreatic parenchyma, and a non-mucinous appearance. A pancreatoduodenectomy was performed to identify this pancreatic intraductal neoplasm. Macroscopically, the tumor was a solid nodular mass with no visibly secreted mucin obstructing the dilated ducts. Histologically, it had a homogeneous appearance with nodules of back-to-back tubular glands and occasional papillary elements, and there were no apparent transitions to areas with less marked cytoarchitectural atypia. Although the intraductal neoplastic growth corresponded to an ITPN, immunohistochemical staining revealed partial positivity for MUC5AC, for which ITPNs are characteristically negative. Somatic mutations in KRAS, GNAS, BRAF, and PIK3CA were not detected. A loss of MUC5AC expression and mutations in KRAS and GNAS are key elements in the diagnosis of ITPN. Thus, it was difficult to distinguish the present case as a pancreatobiliary-type (PB-type) intraductal papillary mucinous neoplasm (IPMN) or a phenotypic variant of ITPN. As it is possible that some cases of PB-type IPMN and ITPN overlap, the precise classification of these rare lesions may require re-evaluation. Copyright © 2015 Elsevier GmbH. All rights reserved.

  11. Endoscopic ultrasound in the diagnosis of pancreatic intraductal papillary mucinous neoplasms

    Science.gov (United States)

    Efthymiou, Alkiviadis; Podas, Thrasyvoulos; Zacharakis, Emmanouil

    2014-01-01

    Pancreatic cystic lesions are increasingly recognised due to the widespread use of different imaging modalities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a common, but also heterogeneous group of cystic tumors with a significant malignant potential. These neoplasms must be differentiated from other cystic tumors and properly classified into their different types, main-duct IPMNs vs branch-duct IPMNs. These types have a different malignant potential and therefore, different treatment strategies need to be implemented. Endoscopic ultrasound (EUS) offers the highest resolution of the pancreas and can aid in the differential diagnosis, classification and differentiation between benign and malignant tumors. The addition of EUS fine-needle aspiration can supply further information by obtaining fluid for cytology, measurement of tumor markers and perhaps DNA analysis. Novel techniques, such as the use of contrast and sophisticated equipment, like intraductal probes can provide information regarding malignant features and extent of these neoplasms. Thus, EUS is a valuable tool in the diagnosis and appropriate management of these tumors. PMID:24976716

  12. Smoking is not associated with severe dysplasia or invasive carcinoma in resected intraductal papillary mucinous neoplasms.

    Science.gov (United States)

    Rezaee, Neda; Khalifian, Saami; Cameron, John L; Pawlik, Timothy M; Hruban, Ralph H; Fishman, Elliot K; Makary, Martin A; Lennon, Anne Marie; Wolfgang, Christopher L; Weiss, Matthew J

    2015-04-01

    Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are precursor lesions that progress to invasive cancer through progressively worsening dysplasia. Although smoking is an established risk factor for pancreatic adenocarcinoma, potential associations with IPMN grade of dysplasia remain unclear. Pancreatic resections for IPMN from 1995 to 2013 were retrospectively reviewed. A total of 446 patients in which the smoking status was documented were identified. Smoking history was positive in 47% of patients. Of smokers, 50% had branch-duct, 14% had main-duct, and 36% had mixed-type IPMN. Patients with main-duct IPMN were more commonly smokers (65%), compared to smoking history in 46% with mixed and 44% with branch-duct IPMN (p = 0.03). High-grade dysplasia occurred in 25% of smokers and 21% of nonsmokers (p = 0.32), and invasive carcinoma in 25% of smokers and 25% nonsmokers (p = 0.95). On multivariate analysis, duct size was independently associated with high-grade dysplasia (OR = 3.17, 95% CI = 1.79-5.64, p smoking history (OR = 1.10, 95% CI = 0.64-1.88, p = 0.73), were independent predictors of invasive carcinoma. Median overall survival was 70 months for smokers and 88 months for nonsmokers (p = 0.68). Positive smoking history correlated with duct type classification but does not appear to be a risk factor for harboring high-grade dysplasia or invasive carcinoma in IPMNs.

  13. The relationship of the parotid duct to the buccal and zygomatic branches of the facial nerve; an anatomical study with parameters of clinical interest.

    Science.gov (United States)

    Erbil, K M; Uz, A; Hayran, M; Mas, N; Senan, S; Tuncel, M

    2007-05-01

    There have been studies concerning the protection of the facial nerve during plastic surgery intended for the parotid gland. The close relationship between the parotid duct and the buccal and zygomatic branches of the facial nerve is studied here. The dissections were performed on 10 fixed cadavers at the Anatomy Dissection Laboratory of Ankara University in 2004. The reference points used for surgery of this region were taken into consideration as the landmarks for morphometric measurements. In 7 of the cases the zygomatic branch was double and in 3 it was single. In 4 of the 7 cases with a double zygomatic branch both superior and inferior branches crossed the parotid duct. In the remaining 3 cases the superior branches of the zygomatic nerve coursed through the zygomatic major and minor muscles. In 9 of all the cases the zygomatic branch of the facial nerve crossed the duct anteriorly and in one it did so posteriorly (case 10). The buccal branch was single in 4 of the cases and double in 6. Among these one of the most precise measurements was the distance between the lateral canthus and the intersection point of the zygomatic branch and the duct with a coefficient of variation of 9.9%. With the use of this reliable measurement the intersection point of the zygomatic branch and the duct may be estimated to be within 5.16+/-1.01 centimetres of the lateral canthus. Facial nerve paralysis is the most important complication of superficial face surgery and the anatomy of this region must thus be taken into detailed consideration by surgeons.

  14. [Intraductal pancreatic adenomatosis. Apropos of a new case].

    Science.gov (United States)

    Brassier, D; Boudon, P; Godefroy, Y; Slama, J L; Choudat, L; Malbec, D

    1996-01-01

    A 49-year-old diabetic patient with abdominal pain was found upon ultrasonography and computed tomography to have a cystic mass in the head of the pancreas with dilation of the main pancreatic duct. The head of the pancreas and duodenum were removed surgically. Examination of the operative specimen showed chronic pancreatitis, dilation of the main pancreatic duct, and impacted mucus in the secondary ducts with villous proliferation of the ductal epithelium, establishing the diagnosis of intraductal adenomatosis. There was no evidence of malignancy. The resection margin was involved, and consequently the remainder of the pancreas was removed six months after the initial surgical procedure. A review of the literature showed that intraductal adenomatosis tends to spread and carries a high risk of malignant transformation. Surgery is required because of the risk of pancreatic duct obstruction and pancreatic cancer. Intraductal adenomatosis of the pancreas shares many characteristics with other adenomatous proliferations of the gastrointestinal tract (colorectal villous adenoma, bile duct adenomatosis), including presence of villous structures with increased mucus production, a tendency to spread massively, and a high risk of malignant transformation.

  15. Imaging Features for the Prediction of Extensive Intraductal Components in Invasive Cancer in Addition to the Histopathologic Grades

    Energy Technology Data Exchange (ETDEWEB)

    Han, Hye Yoen; Kim, Keum Won; Park, Yong Sung; Cho, Yong Jun; Hwang, Cheol Mog; Kim, Hyun Jin; Sul, Hae Jung; Yoon, Dae Sung [Konyang University, College of Medicine, Nonsan (Korea, Republic of); Kim, Gyu Soon [Eulji University, College of Medicine, Daejeon (Korea, Republic of)

    2009-12-15

    To evaluate the usefulness of US and mammography in detecting extensive intraductal component (EIC) in invasive cancer and correlating the results with the histopathologic grade. We retrospectively reviewed the mammographic and sonographic features of 125 invasive breast cancers, classified as 'invasive cancer with EIC' (n=57) and 'invasive cancer without EIC' (n=68). The mammographic features are classified as microcalcifications only, microcalcifications beyond the soft tissue density, soft tissue density without microcalcification, and sonographic features classified according to ten sonographic suspicious features for malignancy by Stavros. We calculated sensitivities, specificities, positive predictive value, negative predictive value, and accuracy to correlate them with histologic grade. Microcalcifications on mammography, calcification, duct extension, and a branching pattern on sonography were found to be statistically significant predictors of EIC. Also, a thick echogenic halo, angular margin, microlobuation, taller than wide feature on sonography, and soft tissue shadow without microcalcification on mammography showed a decreased risk of EIC. In addition, the presence of a branching pattern is an indicator of high histologic grade (p<0.05). Microcalcification on mammography, calcification, duct extension, and branching pattern on sonography are an indicator of the presence of EIC in invasive cancer. In addition, when a branching pattern is present, the tumor tends to have a high histologic grade.

  16. Uptodate in the assessment and management of intraductal papillary mucinous neoplasms of the pancreas.

    Science.gov (United States)

    Pagliari, D; Saviano, A; Serricchio, M L; Dal Lago, A A; Brizi, M G; Lanza, F; Manfredi, R; Gasbarrini, A; Attili, F

    2017-06-01

    Intraductal Papillary Mucinous Neoplasms (IPMNs) are the most common cystic tumors of the pancreas and are considered premalignant lesions. IPMNs are characterized by the papillary growth of the ductal epithelium with rich mucin production, which is responsible for cystic segmental or diffuse dilatation of the main pancreatic duct (MPD) and/or its branches. According to the different involvement of pancreatic duct system, IPMNs are divided into main duct type (MD-IPMN), branch duct type (BD-IPMN), and mixed type (MT-IPMN). IPMNs may be incidentally discovered in asymptomatic patients, particularly in those with BD-IPMNs, when imaging studies are performed for unrelated indications. The increase in their frequency may reflect the combined effects of new diagnostic techniques, the improvement of radiologic exams and progress in the recognition of the pathology. MD-IPMNs present a higher risk of malignant progression than BD-IPMNs; as a consequence, all the guidelines strictly suggest the need of surgery for MD- and MT- IPMNs with MPD > 10 mm, while the management of BD-IPMNs is still controversial and depends on several cysts and patients features. The choice between non-operative and surgical management depends on the distinction between benign and invasive IPMN forms, assessment of malignancy risk, patient's wellness and its preferences. This manuscript revises the different guidelines for the management of IPMNs that have been published in different world countries: the international (Sendai 2006 and Fukuoka 2012), the 2013 European, the 2014 Italian, and finally the 2015 American guidelines. In summary, this review will integrate the recent insights in the combination of diagnostic techniques, such as Magnetic Resonance Imaging (MRI) and endoscopic ultrasound (EUS), pathology classification, and management of IPMNs.

  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. Intraductal papillary mucinous neoplasms of the pancreas with concurrent pancreatic and periampullary neoplasms.

    Science.gov (United States)

    Sahora, K; Crippa, S; Zamboni, G; Ferrone, C; Warshaw, A L; Lillemoe, K; Mino-Kenudson, M; Falconi, M; Fernandez-del Castillo, C

    2016-02-01

    Intraductal papillary mucinous neoplasms (IPMN) have been reported to be associated with concurrent, distinct pancreatic ductal adenocarcinoma (con-PDAC) in about 8% (range, 4-10%) of resected branch duct (BD) lesions. In addition, other pancreatic and ampullary tumors are occasionally diagnosed with IPMN in patients undergoing pancreatic surgery. The objective of this study is to describe the prevalence, clinicopathologic characteristics and prognosis of IPMN with concurrent pancreatic and ampullary neoplasms, especially con-PDAC. The combined databases of pancreatic resections from the Massachusetts General Hospital and the Negrar Hospital, Italy, were analyzed for patients who had been diagnosed with IPMN and concurrent pancreatic or ampullary neoplasms. 2762 patients underwent pancreatic surgery from January 2000 to December 2012. Sixteen percent (n = 441) had pathologically confirmed IPMN and 11% of these (n = 50) had a different distinct synchronous pancreatic neoplasm. The majority of these, 62%, were con-PDAC, followed by neuroendocrine neoplasms (10%) and ampullary carcinoma (10%). Less frequently, mucinous (6%) as well as serous cystic neoplasms (6%), adenosquamous carcinoma (4%) and distal bile duct cancer (2%) were diagnosed. Among all patients with synchronous neoplasms, 66% harbored BD-IPMN, 28% combined IPMN and 6% main duct IPMN. Abdominal pain and/or jaundice were the leading symptoms in half of patients. IPMN, mainly BD-IPMN, are associated with con-PDAC in about 7% of patients and account for 62% of all concurrent pancreatic/ampullary neoplasms. Other synchronous neoplasms may be found sporadically with IPMN without a suspected association. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Ex vivo feasibility study of endoscopic intraductal laser ablation of the breast.

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    de Boorder, Tjeerd; Waaijer, Laurien; van Diest, Paul J; Witkamp, Arjen J

    2017-10-09

    To determine the feasibility and safety of breast endoscopic thulium laser ablation for treatment of intraductal neoplasia. Ductoscopy is a minimally invasive endoscopic approach of the milk ducts of the breast via the nipple. Besides diagnosis in women with pathologic nipple discharge (PND), it allows non-invasive removal of intraductal lesions with a stalk like papillomas. Removal, however, is often incomplete and flat lesions cannot be targeted. We therefore developed laser ductoscopy. Dosimetry of laser ductoscopy was assessed in thirteen mastectomy specimens, applying power settings of 1-5 W with 100-1000 ms pulsed exposure to a 375-μm outer diameter thulium fiber laser. Subsequently histology was obtained from the breast tissue that was treated with the Thulium laser. Endoscopic view was maintained during ductoscopic laser ablation at 1-3 W. Increasing power to 4-5 W caused impaired vision due to shrinkage of the main duct around the ductoscope tip. Histology revealed localized ablation of the duct wall. We show for the first time that laser ductoscopy is technically feasible. The Thulium laser enables a superficial intraductal ablation and is a useful tool for intraductal interventions. An in vivo prospective study is needed to further demonstrate its potential. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Features of the Diagnosis of Intraductal Breast Diseases in Adolescent Girls Through the Example of Clinical Cases. The Algorithm of Examination And Treatment of Pathologies in Adolescence

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    M. L. Travina

    2016-01-01

    Full Text Available Intraductal breast diseases are characterized by a high risk of transformation in breast cancer. Difficulties of diagnosing intraductal lesions are associated with the only symptom — the appearance of pathologic discharge from the breast nipple. In adolescent girls, taking into account the immaturity of the nipple and it flatness, there are difficulties with removing it correctly. On physical examination, as well as with the high density of the surrounding tissue and areola, the control over the presence of pathologic discharge from the mammary ducts is difficult. The intraductal pathology requires ultrasound examination, mammography, and only after a full examination — ductographic research. The article presents its own clinical observations of the intraductal pathology in adolescent girls aged 14 and 15 years. The algorithms of examination and patient surveillance with intraductal pathology are described.

  1. Microdochectomy assisted by ultrasound-guided indigo carmine staining of intraductal lesions: a case report.

    Science.gov (United States)

    Jeong, Bo Young; Kim, Dae Bong; Kwak, Beom Seok

    2014-06-01

    Spontaneous bloody nipple discharge from a single duct is a significant clinical problem. When performing preoperative marking of the discharging duct, it is sometimes difficult to identify the duct owing to intermittent discharge. Precise preoperative marking of the discharging duct and intraductal lesions is very important to avoid unnecessary wide excision of breast tissue or failure to remove the cause of nipple discharge. We herein present a case of preoperative ultrasound-guided indigo carmine staining in a patient with no discharge on the day of surgery. When a dilated duct is visualized on ultrasound, the targeted duct can be localized using indigo carmine staining, and it is possible to perform a precise minimal volume microdochectomy.

  2. 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.)

  3. Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review.

    Science.gov (United States)

    Watanabe, Yusuke; Nishihara, Kazuyoshi; Niina, Yusuke; Abe, Yuji; Amaike, Takao; Kibe, Shin; Mizuuchi, Yusuke; Kakihara, Daisuke; Ono, Minoru; Tamiya, Sadafumi; Toyoshima, Satoshi; Nakano, Toru; Mitsuyama, Shoshu

    2016-09-01

    The aim of this study was to investigate the validity of the management strategy for intraductal papillary mucinous neoplasms (IPMNs) advocated by the international consensus guidelines 2012 (ICG2012). The medical records of 49 patients who underwent pancreatectomy for IPMN were retrospectively reviewed. According to preoperative imaging, 10 patients (20 %) had main-duct IPMNs, 20 (41 %) had mixed IPMNs, and 19 (39 %) had branch-duct IPMNs, with malignancy frequencies of 80, 15, and 37 %, respectively. Twenty-seven patients had high-risk stigmata and 21 had worrisome features, with malignancy frequencies of 59 and 10 %, respectively. The sensitivity, specificity, and positive and negative predictive values of high-risk stigmata for malignancy were 88, 65, 59, and 91 %, respectively. Lesions were malignant in 88 % of patients with an enhanced solid component, which was significantly correlated with the prevalence of malignancy (P < 0.01). However, of the 10 patients who underwent pancreatectomy solely due to a main pancreatic dilation of ≥10 mm, 9 (90 %) had benign IPMNs. Many mixed IPMNs defined according to ICG2012 are benign. Although the management strategy advocated by ICG2012 has been improved relative to the Sendai criteria, the different high-risk stigmata carry unequal weights. Consequently, ICG2012 remains suboptimal for predicting malignant IPMN.

  4. Metachronous intracystic and intraductal papillary neoplasms of the biliary tree.

    Science.gov (United States)

    Sato, Hirohide; Sato, Yasunori; Harada, Kenichi; Sasaki, Motoko; Hirano, Katsuyasu; Nakanuma, Yasuni

    2013-09-28

    A 77-year-old woman complained of epigastralgia, and a tumor (5 cm in diameter) of the gallbladder neck was detected by image analysis. Following cholecystectomy, the tumor was pathologically diagnosed as intraductal papillary neoplasm (IPN), gastric type, with associated invasive carcinoma. About 10 mo later, intraluminal multiple masses (3 foci, up to 1.8 cm) were noted in the extrahepatic bile duct, and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion, and they were synchronous multiple lesions. This case showed a papillary tumor of the gallbladder of gastric phenotype, and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.

  5. [Evaluation of intraductal papillary mucinous neoplasms of the pancreas on MDCT and MRI].

    Science.gov (United States)

    Wang, Dali; Zhou, Jian; Zheng, Shuangli; Xia, Jianyu; Hu, Hongjie

    2014-09-01

    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. 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. 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 combined

  6. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy.

    Science.gov (United States)

    Lévy, Philippe; Jouannaud, Vincent; O'Toole, Dermot; Couvelard, Anne; Vullierme, Marie Pierre; Palazzo, Laurent; Aubert, Alain; Ponsot, Philippe; Sauvanet, Alain; Maire, Frédérique; Hentic, Olivia; Hammel, Pascal; Ruszniewski, Philippe

    2006-04-01

    Natural history of intraductal papillary mucinous tumors of the pancreas (IPMTs) is unknown. Cross-sectional studies suggest that exclusive branch duct (BD) involvement is associated with a lower risk of carcinoma than main pancreatic duct (MPD) involvement. The aim of our study was to calculate longitudinal risk of malignant transformation of IPMT since the first sign. All the patients with a diagnosis of highly probable or histologically proven IPMT were included. Actuarial risks of occurrence of at least low-grade dysplasia (>or=LGD), high-grade dysplasia (>or=HGD), or invasive carcinoma (IC) were calculated by Kaplan-Meier method from the first sign attributable to IPMT. The risks according to sex, acute pancreatitis, tumor size, and involvement of MPD were compared by log-rank test. One hundred six patients were included with a proven (n = 76) or probable (n = 30) IPMT. The tumor was confined to BD in 53 cases. Median duration since the onset of the first sign to the end of follow-up was 21 months (range, 0-241). Ten-year actuarial risk that IPMT grade was >or=LGD, >or=HGD, or IC was 67%, 49%, and 29%, respectively. The only morphologic risk factor of malignant transformation was involvement of MPD, with a 5-year actuarial risk of >or=HGD of 63% in the MPD group compared with 15% in the BD group (P < .001). Longitudinal risk of at least HGD or IC is time-dependent. Patients with BD IPMT present a much lower risk, justifying a nonoperative surveillance.

  7. 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

  8. Cytomorphology of intraductal oncocytic papillary neoplasm of the liver.

    Science.gov (United States)

    Jurczyk, Matthew F; Zhu, Bing; Villa, Celina; DeFrias, Denise; Lin, Xiaoqi

    2014-10-01

    We describe the first cytology case report of an intraductal oncocytic papillary neoplasm (IOPN) of the liver. A 51-year-old male presented with recurrent cholangitis. Magnetic resonance imaging and endoscopic retrograde cholangiopancreatogram revealed a 1.1 × 0.9 cm polypoid lesion within the left intrahepatic bile duct. Fine-needle aspiration and needle core biopsy (NCB) revealed nests, 3-dimensional or papillary clusters of columnar or cuboidal cells with loss of polarity. The nuclei were uniform with even chromatin, and cytoplasm was granular or vacuolated. No mitosis or necrosis was seen. The cytologic and histologic diagnosis was "consistent with Intraductal Oncocytic Papillary Neoplasm (IOPN), intermediate grade (borderline)." The patient then underwent a left lateral liver segmentectomy. Microscopic examination showed histology similar to the NCB with no stromal invasion identified. Hepatic IOPN poses a diagnostic challenge due to its broad differential diagnoses. Both malignant and non-malignant IOPNs may present with similar clinical symptoms, pathology, histology, cytomorphology, and immunohistochemistry. Hepatic IOPN should be excised as it is a precursor lesion of adenocarcinoma. © 2013 Wiley Periodicals, Inc.

  9. Pancreatic intraductal tubulopapillary neoplasm is genetically distinct from intraductal papillary mucinous neoplasm and ductal adenocarcinoma.

    Science.gov (United States)

    Basturk, Olca; Berger, Michael F; Yamaguchi, Hiroshi; Adsay, Volkan; Askan, Gokce; Bhanot, Umesh K; Zehir, Ahmet; Carneiro, Fatima; Hong, Seung-Mo; Zamboni, Giuseppe; Dikoglu, Esra; Jobanputra, Vaidehi; Wrzeszczynski, Kazimierz O; Balci, Serdar; Allen, Peter; Ikari, Naoki; Takeuchi, Shoko; Akagawa, Hiroyuki; Kanno, Atsushi; Shimosegawa, Tooru; Morikawa, Takanori; Motoi, Fuyuhiko; Unno, Michiaki; Higuchi, Ryota; Yamamoto, Masakazu; Shimizu, Kyoko; Furukawa, Toru; Klimstra, David S

    2017-12-01

    Intraductal tubulopapillary neoplasm is a relatively recently described member of the pancreatic intraductal neoplasm family. The more common member of this family, intraductal papillary mucinous neoplasm, often carries genetic alterations typical of pancreatic infiltrating ductal adenocarcinoma (KRAS, TP53, and CDKN2A) but additionally has mutations in GNAS and RNF43 genes. However, the genetic characteristics of intraductal tubulopapillary neoplasm have not been well characterized. Twenty-two intraductal tubulopapillary neoplasms were analyzed by either targeted next-generation sequencing, which enabled the identification of sequence mutations, copy number alterations, and selected structural rearrangements involving all targeted (≥300) genes, or whole-exome sequencing. Three of these intraductal tubulopapillary neoplasms were also subjected to whole-genome sequencing. All intraductal tubulopapillary neoplasms revealed the characteristic histologic (cellular intraductal nodules of back-to-back tubular glands lined by predominantly cuboidal cells with atypical nuclei and no obvious intracellular mucin) and immunohistochemical (immunolabeled with MUC1 and MUC6 but were negative for MUC2 and MUC5AC) features. By genomic analyses, there was loss of CDKN2A in 5/20 (25%) of these cases. However, the majority of the previously reported intraductal papillary mucinous neoplasm-related alterations were absent. Moreover, in contrast to most ductal neoplasms of the pancreas, MAP-kinase pathway was not involved. In fact, 2/22 (9%) of intraductal tubulopapillary neoplasms did not reveal any mutations in the tested genes. However, certain chromatin remodeling genes (MLL1, MLL2, MLL3, BAP1, PBRM1, EED, and ATRX) were found to be mutated in 7/22 (32%) of intraductal tubulopapillary neoplasms and 27% harbored phosphatidylinositol 3-kinase (PI3K) pathway (PIK3CA, PIK3CB, INPP4A, and PTEN) mutations. In addition, 4/18 (18%) of intraductal tubulopapillary neoplasms had FGFR2

  10. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers.

    Science.gov (United States)

    Shimizu, Yasuhiro; Yamaue, Hiroki; Maguchi, Hiroyuki; Yamao, Kenji; Hirono, Seiko; Osanai, Manabu; Hijioka, Susumu; Hosoda, Waki; Nakamura, Yasushi; Shinohara, Toshiya; Yanagisawa, Akio

    2013-07-01

    The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis. Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]). The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.

  11. 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. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Diagnosis of a Nonpalpable Intraductal Papilloma without Radiological Abnormality by Nipple Discharge Smear Examination: A Case Report

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    Anshul Singh

    2014-01-01

    Full Text Available Nipple discharge is the third most common breast complaint after breast pain and breast mass, most commonly associated with endocrine alterations and/or medications, pregnancy, lactation, post lactation, fibrocystic disease, intraductal papilloma, duct ectasia, nipple adenoma, infection, chronic mastitis, subareolar abscess, and least frequently, breast carcinoma. Cytological examination of nipple discharge (ND is a noninvasive method of diagnosing the underlying breast pathology. We report a 46 year old female, who presented with pain and blood-mixed ND from the right breast with an impalpable mass. Cytological examination of the discharge was done and diagnosis of papillary neoplasm with degeneration, metaplasia, and atypia was given, which was further confirmed on histology and positive IHC for HMWCK and p63. Final diagnosis was intraductal papilloma of the lactiferous duct with squamous metaplasia and infarction. Differentiating benign papilloma from a carcinoma is challenging to the cytopathologist and requires clinicopathological correlation and a good knowledge of cytology.

  13. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience

    National Research Council Canada - National Science Library

    Sohn, Taylor A; Yeo, Charles J; Cameron, John L; Hruban, Ralph H; Fukushima, Noriyoshi; Campbell, Kurtis A; Lillemoe, Keith D

    2004-01-01

    To update the authors' experience with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. IPMNs are intraductal mucin-producing cystic neoplasms of the pancreas with clear malignant potential...

  14. Intraductal Cooling via a Nasobiliary Tube During Radiofrequency Ablation of Central Liver Tumors Reduces Biliary Injuries.

    Science.gov (United States)

    Felker, Ely R; Lee-Felker, Stephanie A; Ajwichai, Khobkhoon; Tan, Nelly; Lu, David S; Durazo, Francisco A; Raman, Steven S

    2015-06-01

    The objective of our study was to determine the safety and efficacy of intraductal perfusion of chilled 5% dextrose in water (D5W) via an endoscopic nasobiliary tube (NBT) for the prevention of thermal bile duct injury in patients undergoing percutaneous radiofrequency ablation (RFA) of central liver tumors. We performed a retrospective study comparing outcomes of 32 consecutive patients who underwent percutaneous RFA of central liver tumors without intraductal perfusion of chilled D5W (control cohort) and 14 consecutive patients who underwent temporary intraductal perfusion of chilled D5W at 2 mL/s via endoscopic NBT placement before RFA (endoscopic NBT cohort). The primary and secondary outcomes were the rate of biliary complications and local tumor progression, respectively. All patients tolerated the procedures well. There was a significantly lower rate of biliary complications in the endoscopic NBT cohort (0/14 patients, 0%) than in the control cohort (10/32 patients, 31%) (p NBT cohort (12/14 patients, 86%) compared with the control cohort (20/32 patients, 62%) (p = 0.05). There was no difference in the rate of local tumor progression between the endoscopic NBT cohort (4/19 tumors, 21%) and the control cohort (9/39 tumors, 23%) (p = 1.0). Perfusion of chilled water through an endoscopic NBT helps prevent thermal biliary injury during RFA of central liver tumors without increasing rates of local tumor progression.

  15. Intraductal Tubulopapillary Neoplasm: A New Entity in the Spectrum of Pancreatic Intraductal Neoplasms.

    Science.gov (United States)

    Maghrebi, Houcine; Makni, Amin; Rhaeim, Rami; Zehani, Alia; Bensafta, Zoubeir

    2017-09-01

    Intraductal Tubulopapillary Neoplasms (ITPN) is a rare and new entity defined as an intraductal, grossly visible, tubule-forming epithelial neoplasm with high- grade dysplasia and ductal differentiation without overt production of mucin. Its clinical presentation can be varied, which makes the diagnosis quite challenging. In this report, we present a case of pancreatic ITPN and review the published work to learn clinicopathological, radiological features and treatment strategies of this recently proposed pancreatic neoplasm.

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

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    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.

  17. 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.

  18. Biliopancreatic fistula and abscess formation in the bursa omentalis associated with intraductal papillary mucinous cancer of the pancreas.

    Science.gov (United States)

    Nagano, Hideki; Koneri, Kenji; Honda, Kei; Murakami, Makoto; Hirono, Yasuo; Maeda, Hiroyuki; Goi, Takanori; Iida, Atsushi; Katayama, Kanji; Yamaguchi, Akio

    2009-10-01

    We describe an unusual case of biliopancreatic fistula, free perforation, and subsequent abscess formation within the lesser peritoneal sac associated with intraductal papillary mucinous carcinoma (IPMC). A 71-year-old man presented with general fatigue and loss of appetite that had persisted for 1 month. Abdominal computed tomography (CT) revealed findings consistent with an intraductal papillary mucinous neoplasm (IPMN) of the pancreas, accompanied by abscess formation in the bursa omentalis. Gastrointestinal fiberscopy revealed a swollen papilla of Vater expanded by sticky mucus, and a communication between the pancreatic duct and bile duct was demonstrated by the injection of indigo carmine solution into the pancreatic duct. Percutaneous transhepatic abscess drainage (PTAD) was performed on the day of admission. After this procedure, the patient was managed for 1 month and supported nutritionally with glycemic control for diabetes mellitus. After admission, the patient had an episode of obstructive jaundice that was treated by retrograde biliary drainage. Pancreaticoduodenectomy with lymph node dissection was then performed. Pathological examination revealed IPMN with patchy, scattered carcinoma of the pancreatic head and uncinate process with the formation of a biliopancreatic fistula. Bile duct epithelium in the area of the biliopancreatic fistula demonstrated atypical papillary epithelium suggestive of tumor invasion.

  19. Pancreatic lithiasis and intraductal papillary-mucinous neoplasm with special reference to the pathogenesis of lithiasis.

    Science.gov (United States)

    Kimura, Wataru

    2010-11-01

    In pancreatic lithiasis in elderly autopsy cases, the stones are small and the pancreatic duct is changed very slightly when viewed by simple X-ray film, pancreatic ductography and gross appearance. Histologically, a slight fibrous increase is seen very locally, but findings consistent with chronic pancreatitis are not found throughout the whole pancreas. However, marked, diffuse and irregular dilatation of the pancreatic duct is frequently found in operative cases with chronic pancreatitis and pancreatic stones. These findings show that the changes seen with aging and with chronic pancreatitis can be distinguished based on the findings of pancreatic ductography. Mucin production in epithelia in intraductal papillary-mucinous neoplasm (IPMN) may not be strongly associated with the pathogenesis of pancreatic lithiasis. Pancreatic lithiasis may be related to squamous cell metaplasia. IPMN and dilatation of the pancreatic duct are closely associated with mucin production. An increase in intraductal pressure of the pancreatic duct may be somewhat related to the mechanism of stone formation. The incidental co-existence of pancreatic epithelia with pancreatic lithiasis in patients with chronic pancreatitis and the development of IPMN may also be possible. IPMN and pancreatic lithiasis may be related through the mechanism(s) of their pathogenesis, their synergism and the pathogenesis of stone formation. The relation between mucinous metaplasia and stone formation is slight and, therefore, there may be only a weak correlation between IPMN and pancreatic stones. This may explain why there are few reports of the co-existence of IPMN and pancreatic stones (Kimura in Kan Tan Sui 58:485-492, 2009).

  20. Salivary duct carcinoma.

    Science.gov (United States)

    D'heygere, Emmanuel; Meulemans, Jeroen; Vander Poorten, Vincent

    2018-01-25

    The review puts new information on geno- and phenotype of salivary duct carcinoma (SDC) in the perspective of the updated 2017 WHO classification. The proportion of SDC is increasing. This may be because of a true rise in incidence, but certainly to better diagnostic tests and changed WHO definitions. In this light, a substantial proportion of carcinoma expleomorphic adenoma is now attributed to the category of SDC. 'Low-grade SDC' and 'SDC in-situ' of the former WHO classification, are now named low-grade and high-grade intraductal carcinoma (IDC), respectively. Recent series quantify biologic aggressiveness: perineural growth, vascular invasion, and extracapsular extension in lymph node metastasis are each observed in two out of three patients with SDC. Most patients die within 3 years, but once 5-year disease-free survival is reached, further disease activity is exceptional. The typical molecular biological profile with high human epidermal growth factor receptor 2 and androgen receptor expression is increasingly successfully exploited in clinical trials for advanced SDC. The aggressive SDC is increasingly diagnosed. Despite intensive combined surgery and radiation therapy, many patients recur, for whom new bullets, targeting the molecular biological mechanisms, are the subject of ongoing clinical trials.

  1. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Senescence in intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Miyasaka, Yoshihiro; Nagai, Eishi; Ohuchida, Kenoki; Fujita, Hayato; Nakata, Kohei; Hayashi, Akifumi; Mizumoto, Kazuhiro; Tsuneyoshi, Masazumi; Tanaka, Masao

    2011-12-01

    Intraductal papillary mucinous neoplasm of the pancreas is attracting attention as a precursor lesion of the invasive ductal adenocarcinoma, whereas it has been reported that some intraductal papillary mucinous neoplasms do not display progression to malignancy and remain almost unchanged in size and morphology. Recent studies have reported that oncogene-induced senescence has been observed in neoplasms, especially in premalignant lesions, and that it can play an important role in preventing malignant progression. To clarify the presence of senescence in intraductal papillary mucinous neoplasms, we analyzed the expression of several markers of senescence. The intraductal papillary mucinous neoplasms evaluated in this study were classified into 4 groups according to the degree of dysplasia. Senescence-associated β-galactosidase activity and senescence-associated heterochromatin foci formation were investigated in 33 cases of intraductal papillary mucinous neoplasms and 6 normal controls. Immunohistochemical analysis of p16(INK4a) and p15(INK4b) was performed in 158 cases of intraductal papillary mucinous neoplasms and 10 normal controls. In the normal controls, neither senescence-associated β-galactosidase activity nor senescence-associated heterochromatin foci formation was observed. Most of the normal epithelia were negative for either p16(INK4a) or p15(INK4b). For all 4 markers, the percentages of positive cases reached a peak in intraductal papillary mucinous neoplasm with low-grade dysplasia and showed significant decreasing trends in the transition from intraductal papillary mucinous neoplasm with low-grade dysplasia to intraductal papillary mucinous neoplasm with an associated invasive carcinoma. Our results indicate that senescence is induced in the early stage of intraductal papillary mucinous neoplasm and gradually attenuated according to the progression. It is suggested that senescence plays a role in preventing malignant progression of intraductal

  3. Thread sign in biliary intraductal papillary mucinous neoplasm: a novel specific finding for MRI.

    Science.gov (United States)

    Hong, Gil-Sun; Byun, Jae Ho; Kim, Jin Hee; Kim, Hyoung Jung; Lee, Seung Soo; Hong, Seung-Mo; Lee, Moon-Gyu

    2016-09-01

    To evaluate thread sign of biliary intraductal papillary mucinous neoplasm (B-IPMN) on magnetic resonance imaging (MRI). Thread sign was defined as intraductal linear or curvilinear hypointense striations. Two radiologists independently evaluated the presence and location of thread sign on MR cholangiography (thin-slice, thick-slab and 3D MRC) and axial MR images (T2 TSE, T2 HASTE and DWI) in patients with B-IPMN (n = 38) and in matched control groups with benign (n = 36) or malignant (n = 35) biliary diseases. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of thread sign for diagnosing B-IPMN were evaluated. Thread sign was observed only in patients with B-IPMN on MRC (44.7-52.6 % [17/38-20/38], P < 0.001) and axial MR images (31.6 % [12/38], P < 0.001), except in one patient with recurrent pyogenic cholangitis on MRC (2.8 %, 1/36). The sensitivity, specificity, accuracy, PPV and NPV of thread sign for diagnosing B-IPMN on MRC were 0.53, 0.99, 0.83, 0.95 and 0.80, respectively (reader 1) and 0.45, 1.0, 0.81, 1.0 and 0.77, respectively (reader 2). Thread sign was detected mainly at the extrahepatic bile duct (52.6 %, 20/38). B-IPMN can manifest thread sign, a novel specific MR finding, mainly at the extrahepatic bile duct on MRI, especially on MRC. • Some B-IPMNs manifest thread sign within the bile ducts on MRI. • Thread sign is a highly specific finding for B-IPMN on MRI. • MRC is superior to axial T2WI and DWI for detecting thread sign.

  4. Pathological spectrum of bile duct lesions from chronic bile duct injury to invasive cholangiocarcinoma corresponding to bile duct imaging findings of occupational cholangiocarcinoma.

    Science.gov (United States)

    Kinoshita, Masahiko; Kubo, Shoji; Nakanuma, Yasuni; Sato, Yasunori; Takemura, Shigekazu; Tanaka, Shogo; Hamano, Genya; Ito, Tokuji; Terajima, Hiroaki; Yamada, Terumasa; Nakamori, Shoji; Arimoto, Akira; Fujikawa, Masahiro; Sugawara, Yasuhiko; Yamamoto, Takatsugu; Abue, Makoto; Nakagawa, Kei; Unno, Michiaki; Mizuguchi, Toru; Takenaka, Kenji; Shirabe, Ken; Shibata, Toshihiko

    2016-02-01

    We aimed to identify the pathological characteristics of occupational cholangiocarcinoma. We examined the location and distribution of the carcinomas: atypical epithelium including biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the bile duct (IPNB); and chronic bile duct injuries in operative or autopsy liver specimens from 16 patients. We examined the detailed pathological findings and diagnostic imaging of three patients. Immunohistochemical analysis using primary antibodies against γH2AX and S100P was performed. BilIN and chronic bile duct injury were observed in 16 patients, and IPNB or invasive IPNB was observed in 11 patients. BilIN, IPNB, and/or chronic bile duct injury were observed in almost all the large bile ducts. Regional dilatation of the bile ducts without tumor-induced obstruction revealed such pathological changes. Highly positive results for the γH2AX and S100P markers were noted in invasive carcinoma, BilIN, and IPNB, whereas positive results for γH2AX and negative results for S100P were noted in non-neoplastic biliary epithelium. The carcinogenic process of occupational cholangiocarcinoma comprised chronic bile duct injury and DNA damage in almost all the large bile ducts, along with induction of precancerous lesions and development of invasive carcinoma. Such pathological findings reflected radiological changes on diagnostic imaging. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  5. 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.

  6. The anatomy of fluid-yielding ducts in breast cancer.

    Science.gov (United States)

    Twelves, Dominique; Nerurkar, Ashutosh; Osin, Peter; Ward, Ann; Isacke, Clare M; Gui, Gerald P H

    2012-04-01

    The concept of an intraductal approach to evaluate the breast microenvironment assumes direct access to the cancer-containing duct. Central duct access to the cancer-affected lobe is essential if cytology or cell markers are to be useful indicators of pre-malignant change. Access to the cancer-bearing lobe would be less important if field change effects of malignant change were predominantly supra-lobar. The aim of this study was to determine how often duct lavage fluid drains the breast cancer-affected segment. 58 patients undergoing mastectomy for breast cancer were recruited among which 47 had at least one fluid-yielding duct. Following duct lavage, fluid-yielding ducts were perfused ex vivo with Polyurethane Elastomer (PU4ii) resin. Specimens were sliced sagittally, and the extent of resin perfusion and anatomical relationship to the cancer-affected segment was recorded. Computed tomography (CT) scanning was performed on selected mastectomies before cut-up for a feasibility study of 3D duct reconstruction. The median number of fluid-yielding ducts cannulated per cancer-affected breast was 2 (range 1-4). 35/47 (74%) mastectomy specimens were successfully cannulated for resin perfusion. 29/35 (83%) showed tracing of the cancer-affected duct system, 6/35 resin perfusions traced duct systems unaffected by cancer and 12/35 perfusions extravasated. The proportion of sagittal breast slices perfused by resin was 13-68% (median 43%). Volume rendering CT showed it is feasible to produce a simulated image of the perfused ducts. Duct access to the cancer-containing segment is feasible in the majority of patients. Fluid-yielding ducts proportionately drain a significant volume of the breast. Large symptomatic cancers may cause obstruction with distal collapse. Further quantitative study of breast perfusion CT scans may be helpful for estimating the volume fraction of breast tissue perfused by fluid-yielding ducts. The intraductal approach is a valid concept for biomarker

  7. Proposed classification of the feline "complex" mammary tumors as ductal and intraductal papillary mammary tumors.

    Science.gov (United States)

    Zappulli, V; Caliari, D; Rasotto, R; Ferro, S; Castagnaro, M; Goldschmidt, M

    2013-11-01

    When compared with the canine species, feline mammary tumors (FMTs) are much less heterogeneous, with a predominance of simple malignant neoplasm. Benign FMTs are rare, and it is unclear if complex and mixed tumors exist in the feline. In this study, we selected for immunohistochemical analyses 12 FMTs that had unusual histologic features. A group of 8 (2 benign and 6 malignant) FMTs showed a biphasic epithelial/myoepithelial population and a very regular cord-like distribution in a "Chinese lettering" pattern, within ectatic ducts. A second group (2 benign and 2 malignant) had an intraductal epithelial papillary growth pattern with a basally located monolayer of myoepithelial cells and a supporting fibrovascular stroma. The myoepithelial component always produced a standard immunohistochemical signature. All malignancies were grade I, and the subjects were all alive at 1 year postdiagnosis. On the basis of their morphology, we propose that they be classified as feline ductal adenoma/carcinoma and feline intraductal papillary adenoma/carcinoma, respectively. They overlap with their canine counterparts and lack the typical myoepithelial differentiation patterns seen in canine complex neoplasms, and therefore, the term complex should be avoided in felines. This study will add new information on FMT classification and be useful for prognostic studies.

  8. 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.

  9. Intraductal ultrasonographic anatomy of biliary varices in patients with portal hypertension.

    Science.gov (United States)

    Takagi, Tadayuki; Irisawa, Atsushi; Shibukawa, Goro; Hikichi, Takuto; Obara, Katsutoshi; Ohira, Hiromasa

    2015-01-01

    The term, portal biliopathy, denotes various biliary abnormalities, such as stenosis and/or dilatation of the bile duct, in patients with portal hypertension. These vascular abnormalities sometimes bring on an obstructive jaundice, but they are not clear which vessels participated in obstructive jaundice. The aim of present study was clear the bile ductal changes in patients with portal hypertension in hopes of establishing a therapeutic strategy for obstructive jaundice caused by biliary varices. Three hundred and thirty-seven patients who underwent intraductal ultrasound (IDUS) during endoscopic retrograde cholangiography for biliary abnormalities were enrolled. Portal biliopathy was analyzed using IDUS. Biliary varices were identified in 11 (2.7%) patients. IDUS revealed biliary varices as multiple, hypoechoic features surrounding the bile duct wall. These varices could be categorized into one of two groups according to their location in the sectional image of bile duct: epicholedochal and paracholedochal. Epicholedochal varices were identified in all patients, but paracholedochal varices were observed only in patients with extrahepatic portal obstruction. IDUS was useful to characterize the anatomy of portal biliopathy in detail.

  10. Intraductal Sonography in Patients With Portal Cavernoma Cholangiopathy.

    Science.gov (United States)

    Bhatia, Vikram; Shasthry, Saggere Muralikrishna; Mukund, Amar

    2016-03-01

    Intraductal sonography generates high-resolution images of the entire length of the biliary tree and peribiliary tissues, including 3-dimensional dual- and muti-plane reconstructions to depict complex anatomy. Portal cavernoma cholangiopathy (previously called portal biliopathy) can have multiple etiologies of obstructive cholestasis in the same patient, which can be difficult to define even with advanced imaging techniques.We describe 2 difficult cases of portal cavernoma cholangiopathy in which intraductal sonography helped in clinical management decisions. We think that intraductal sonography should be part of the standard management algorithm for patients with portal cavernoma cholangiopathy and describe the intraductal sonographic correlates of the cholangiographic changes in this condition. © 2016 by the American Institute of Ultrasound in Medicine.

  11. Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma

    OpenAIRE

    Khalefa Ali Alghofaily; Musab Hamoud Almushayqih; Muhannad Faleh Alanazi; Abdullah Abdulrahman Bin Salamah; Halldor Benediktsson

    2017-01-01

    Introduction. Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. Case Presentation. A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed ...

  12. Total parenchymal pancreatectomy preserving the duodenum, choledochus and spleen for widespread intraductal papillary mucinous neoplasm: report of a case.

    Science.gov (United States)

    Ichimura, Tatsunosuke; Kondo, Satoshi; Okamura, Keisuke; Tanaka, Eiichi; Hirano, Satoshi

    2010-01-01

    For patients with benign or low malignant diseases of the pancreas, several organ-preserving surgical techniques of pancreatectomy have been presented for localized lesions. In cases of widespread or multifocal neoplasms of the pancreas, however, it is difficult to treat with this limited pancreatectomy because of a possible risk of residual dysplastic foci. We herein report a patient with widespread intraductal papillary mucinous neoplasm treated successfully with total parenchymal pancreatectomy. A 73-year-old man was diagnosed as main duct intraductal papillary mucinous neoplasm. A papillary tumor was located in the body of the pancreas, and intraepithelial spreading reached almost the end of the pancreas tail and nearly over the midpoint of the pancreas head. We performed total parenchymal pancreatectomy, an initial surgical procedure in which almost all parenchyma of the pancreas was resected but the duodenum, the common bile duct and the spleen were preserved and no reconstruction was needed. The postoperative course was uneventful and his blood glucose level had been controlled carefully with insulin formulation. No recurrence was observed during over the 30-month follow-up period. For susceptible patients, total parenchymal pancreatectomy may provide clinical benefits of significant radicality and less invasiveness than classical total pancreatectomy.

  13. Diagnosis of intraductal spread of breast cancer by high-resolution MR imaging. Correlation between MR imaging and pathohistological findings

    Energy Technology Data Exchange (ETDEWEB)

    Date, Shuji [Hiroshima City Hospital (Japan)

    1998-04-01

    The main purpose of this study was to investigate pathohistological factors that affect the MR findings of intraductal spread (IDS) of breast cancer. The subjects of the present study were 42 breast cancer patients who were examined by MR imaging. Fat-suppressed high-resolution T1-weighted spin-echo images (350/13/1 (TR/TE/excitations), 16-cm FOV, 5-mm section thickness, and 512 x 256 matrix) were obtained one minute after the intravenous administration of Gd-DTPA. In this protocol, contrast determination time was 1 min 48 sec. Of the 42 cases, IDS was found to be located more than 1 cm from the primary focus in 22 cases (52%). Rates of sensitivity, specificity and accuracy of MR imaging for the detection of IDS were 82%, 80%, and 81%, respectively. The probable cause of misdiagnosis was parenchymal enhancement due to severe fibrocystic disease and normal menstrual cycle. In 21 of 42 cases, the MR findings were precisely correlated with the pathohistologic findings of almost the same cross-section. The MR findings of IDS varied greatly with observation of linear, band-like, branch-like, plate-like and minute ring enhancements. These findings closely reflected the size, aggregation pattern, and distribution of intraductal lesions. In particular, minute ring enhancement was only observed in 4 comedo-type lesions. This pattern of enhancement is considered to reflect elevated intraductal cellular density with necrosis in the central region. (author)

  14. A comparative study of intraductal papillary neoplasia of the biliary tract and pancreas

    NARCIS (Netherlands)

    Kloek, Jaap J.; van der Gaag, Niels A.; Erdogan, Deha; Rauws, Erik A. J.; Busch, Olivier R. C.; Gouma, Dirk J.; ten Kate, Fiebo J. W.; van Gulik, Thomas M.

    2011-01-01

    Intraductal papillary mucinous neoplasm of the pancreas is a rare but well-established entity in contrast to intraductal papillary mucinous neoplasm of the biliary tract. The aim of this study was to compare the clinicopathologic features of intraductal papillary mucinous neoplasms of the biliary

  15. Bile Duct Exploration

    Science.gov (United States)

    ... Departments Home / Health Library / Articles / Bile Duct Exploration Bile Duct Exploration The CBD is a tube connecting the ... liver and gallbladder to the intestine. When is bile duct exploration performed? If something is blocking the bile ...

  16. Bile Duct Cancer (Cholangiocarcinoma)

    Science.gov (United States)

    ... Home > Types of Cancer > Bile Duct Cancer (Cholangiocarcinoma) Bile Duct Cancer (Cholangiocarcinoma) This is Cancer.Net’s Guide to Bile Duct Cancer (Cholangiocarcinoma). Use the menu below to choose ...

  17. MUC2 expression and prevalence of high-grade dysplasia and invasive carcinoma in mixed-type intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Masuda, Atsuhiro; Arisaka, Yoshifumi; Hara, Shigeo; Matsumoto, Ippei; Takenaka, Mamoru; Sakai, Arata; Shiomi, Hideyuki; Matsuki, Nobuyuki; Sugimoto, Maki; Fujita, Tsuyoshi; Hayakumo, Takanobu; Ku, Yonson; Ogino, Shuji; Azuma, Takeshi; Kutsumi, Hiromu

    2013-01-01

    Morphological types and mucin protein expressions classify intraductal papillary mucinous neoplasms (IPMNs). Main duct (MD)-IPMN mostly consists of intestinal type (I-type), which expresses MUC2. Branch duct (BD)-IPMN mostly consists of gastric type (G-type), which does not express MUC2. However, the definition of mixed-type IPMN has yet to be clarified and it contains various histological types. The aim of this study was to investigate the relationship between MUC2 expression and the presence of high-grade dysplasia (HGD) and invasive carcinoma, especially in mixed-type IPMN. This retrospective study included 101 consecutive patients with surgically resected IPMNs between April 2001 and October 2012. All patients were morphologically classified into four distinct types (I-type, G-type, PB-type: pancreatobilliary, O-type: oncocytic) and immunohistochemical reactivity of various anti-mucin antibodies were investigated. According to the classification of the 2012 international guidelines, the numbers (and histomorphological types: I/G/PB/O) of MD, mixed-type, and BD-IPMNs were 16 (12/4/0/0), 45 (16/28/1/0), and 40 (0/38/1/1). Prevalence of MUC2 expression in MD, mixed-type, and BD-IPMNs were 75% (12/16), 36% (16/45), and 0% (0/40). In mixed-type IPMN, the prevalence of HGD and/or invasive carcinoma in MUC2-positive IPMN was significantly higher than that of MUC2-negative IPMN (HGD + invasive carcinoma: 88% vs. 38%, p = 0.0017; invasive carcinoma: 50% vs. 21%, p = 0.042). Multivariate analysis showed that MUC2 expression is an independent predictive factor of HGD and invasive carcinoma in mixed IPMN (odds ratio 14.6, 95% CI 2.5-87.4, p = 0.003). In mixed-type IPMN, MUC2 expression clearly identified HGD and invasive carcinoma and may provide most appropriate surgical indication. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  18. 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...

  19. Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma

    Directory of Open Access Journals (Sweden)

    Khalefa Ali Alghofaily

    2017-01-01

    Full Text Available Introduction. Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. Case Presentation. A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed multiple recurrent lesions at the same site. Conclusion. Primary osteogenic sarcomas of the breast are very rare. Although the main treatment is resection the optimal management remains uncertain and prognosis is poor.

  20. [Risk evaluation for malignant transformation breast intraductal papilloma].

    Science.gov (United States)

    Dimov, A

    2008-01-01

    To evaluate the risk evaluation for malignant transformation breast intraductal papiloma. 277 women with pathologic nipple discharge were evaluated and operated on during 1994-2005. Nipple discharge was unilateral in 217 patients and bilateral in 60. The main diagnostic methods were clinical examination, ductography, discharge cytology. Cytologycal test was of greatest evidence. All 277 women were with small multiple papillomes. We found carcinoma in only 3 cases--1 intraductal and 2 invasive ductal carcinomas. According to our results 1.1% of our patient were with malignant potential.

  1. 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.

  2. Pancreatic Mucinous Cystic Neoplasm Communicating with Main Pancreatic Duct: An Unrecognized Presentation of Pancreatic Mucinous Neoplasm?

    Science.gov (United States)

    Zhou, Weixun; Saam, Trustin; Zhou, Yihua; Trevino, Jose; Liu, Xiuli; Cao, Dengfeng; Lai, Jinping

    2017-12-01

    Mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) are two well recognized entities of precursor cystic lesions of pancreatic duct adenocarcinoma. The characteristic features of MCNs are the lined mucinous epithelium with underlying ovarian-type stroma, but without communication with the ducts, while that for IPMNs are the communication with the ducts but without the underlying ovarian-type stroma. Here we report a case of MCN communicating with the main pancreatic duct in a 68-year-old woman. The initial radiographic diagnosis was pancreatic IPMN with main pancreatic involvement and this was also confirmed during gross examination. Histologically, the pancreatic cystic neoplasm was lined with mucinous epithelium with underlying ovarian-type of stroma. Immunohistochemical stains confirmed that the stroma cells were positive for ER, PR, alpha-inhibin and focally positive for CD10. The final pathologic diagnosis was pancreatic mucinous cystic neoplasm communicating with the main pancreatic duct. To the best of our knowledge, this is the second pathology confirmed case of MCN communicating with the main pancreatic duct. A careful gross examination and bivalvation of the main duct communicating with the cystic neoplasm helps render the correct diagnosis. If more cases are reported in the future, the MCN communicating with duct could become a new entity of pancreatic mucinous neoplasm. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  3. A novel duct-lobular segmentectomy for breast tumors with nipple discharge using near-infrared indocyanine green fluorescence imaging

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Ohno

    2013-10-01

    Full Text Available A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that measured 17 mm in diameter with a dilated mammary duct. Contrast-enhanced magnetic resonance imaging showed an early-enhanced cystic tumor and a dilated mammary duct. We performed a duct-lobular segmentectomy using near-infrared indocyanine green (ICG-fluorescence imaging. Under general anesthesia, a silicone tube was inserted into an orifice of a fluid-discharging mammary duct, and 1 mL dye-fluorescence liquid containing ICG and indigo carmine was injected into the mammary duct. A periareolar incision was made, and the fluorescence image of the demarcated mammary duct segment was obtained. The mammary duct segment was dissected, along with the demarcation line. The cystic lesion and dilated mammary duct were fully resected, and the pathological diagnosis was intraductal papilloma of the breast. We report that near-infrared ICG fluorescence could be applied for imaging of the mammary duct segment, and the fluorescence image allowed for easier duct-lobular segmentectomy for nipple discharge.

  4. Intraductal Oncocytic Papillary Neoplasm of the Pancreas: Report of a Case Requiring Completion Pancreatectomy

    OpenAIRE

    Wohlauer, Max V.; Csaba Gajdos; Martine McManus; Norio Fukami

    2013-01-01

    Context Cystic tumors of the pancreas have been diagnosed with increasing frequency. Intraductal oncocytic papillary neoplasm is a rare type of cystic pancreatic tumor. Intraductal oncocytic papillary neoplasm is considered a distinct entity with the potential of developing into invasive carcinoma and it should be differentiated from other cystic tumors of the pancreas, including mucinous cystic neoplasm and other forms of intraductal papillary mucinous neoplasm (IPMN). Histologically, the fo...

  5. Intraductal Ultrasonography as a Local Assessment Before Magnetic Compression Anastomosis for Obstructed Choledochojejunostomy.

    Science.gov (United States)

    Kawabata, Hideaki; Hitomi, Misuzu; Inoue, Naonori; Kawakatsu, Yukino; Okazaki, Yuji; Miyata, Masatoshi

    2017-08-01

    Magnetic compression anastomosis (MCA) has been developed as a non-surgical alternative treatment for biliary obstruction without serious complications. A 70-year-old woman who had undergone pancreaticoduodenectomy with modified Child reconstruction for pancreatic head cancer suffered from obstructed choledochojejunostomy with no recurrent findings 4 months after the operation. Cholangiography using the percutaneous transhepatic cholangiographic drainage (PTCD) and fluoroscopy revealed complete obstruction of the upper common bile duct, and the length of the obstruction was 7 mm. Intraductal ultrasonography (IDUS) showed fibrous heterogenous hyperechoic appearance without fluid collection, vessels or foreign bodies at the site of the obstruction. We performed choledochojejunostomy using the MCA technique. One magnet was inserted into the obstruction of the hepatic side through the PTCD fistula. Another was delivered endoscopically to the obstruction of the jejunal side. The two magnets were immediately attracted towards each other transmurally, and reanastomosis was confirmed 7 days after starting the compression. The magnets were easily retrieved endoscopically. A 16-Fr indwelling drainage tube was placed in the jejunum through the PTCD. The internal tube is still in place 6 months after reanastomosis, and no MCA-related complications have been observed. In conclusion, MCA is a safe, effective, low-invasive treatment for biliary obstruction, and IDUS is useful for the pretreatment assessment of feasibility and safety.

  6. Bile Duct Cancer

    Science.gov (United States)

    ... your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. ... the liver get rid of toxins and wastes. Bile duct cancer is rare. It can happen in the ...

  7. Bile Duct Diseases

    Science.gov (United States)

    ... your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. ... toxins and wastes. Different diseases can block the bile ducts and cause a problem with the flow of ...

  8. 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.

  9. The coexistence of atypical intraductal hyperplasias with breast carcinoma.

    Science.gov (United States)

    Bogdan, F; Gîrniţă, L; Florescu, M; Simionescu, C; Crăiţoiu, S; Comănescu, V

    1998-01-01

    We present a study made during 4 years (1992-1996), which pursued the underlining of the atypical intraductal hiperplasias (A.I.D.H.) lesions, met isolated or in the association with mamar carcinoma. Our study included a 188 number of the breast tumors, among: in the 23 cases we established the existence of the modification by the A.I.D.H, type at the fibrocystics disease associated or not with the other benign diseases of the breast (fibroadenosis, intraductal papiloma) and in the 63 cases there were the modification by the AIDH associated with in situ or invasiv carcinoma. Epithelial hyperplasia is frequently associated with the fibrocystic changes, being included in the category of fibrocystic or proliferating modifications. The synonymous terms used for the epithelial hyperplasia are the hiperplazia ductala, or the epitelioza, or the papilomatosis The last two are suggested by the proliferation possibility (papillary or linear) of the epithelial or the mio-epithelial cells. Regardless of the microscopic aspect of the lesion, that should be acknowledged and treated as it is, due to the increased risk of the development of a carcinoma later on, and also due to the ratio of association between the modification and the mammary carcinoma. The risk of occurrence of subsequent carcinoma is augmented in the presence of the epithelial atipii and also increases in the presence of a mammary carcinoma at the relatives of the first rank (1.3). In this context, the importance of the differential diagnosis between the simple intraductal hyperplasia and the atypical one, the difficulty of differentiation from intraductal carcinoma in some cases, and finally the association with an increased risk of subsequent occurrence of carcinoma, constitute into sufficient arguments to consider this topic separately.

  10. Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations

    Science.gov (United States)

    Tamada, Kiichi; Ushio, Jun; Sugano, Kentaro

    2011-01-01

    The accurate diagnosis of extrahepatic bile duct carcinoma is difficult, even now. When ultrasonography (US) shows dilatation of the bile duct, magnetic resonance cholangiopancreatography followed by endoscopic US (EUS) is the next step. When US or EUS shows localized bile duct wall thickening, endoscopic retrograde cholangiopancreatography should be conducted with intraductal US (IDUS) and forceps biopsy. Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity. In patients with papillary type bile duct carcinoma, three biopsies are sufficient. In patients with nodular or infiltrating-type bile duct carcinoma, multiple biopsies are warranted, and IDUS can compensate for the limitations of biopsies. In preoperative staging, the combination of dynamic multi-detector low computed tomography (MDCT) and IDUS is useful for evaluating vascular invasion and cancer depth infiltration. However, assessment of lymph nodes metastases is difficult. In resectable cases, assessment of longitudinal cancer spread is important. The combination of IDUS and MDCT is useful for revealing submucosal cancer extension, which is common in hilar cholangiocarcinoma. To estimate the mucosal extension, which is common in extrahepatic bile duct carcinoma, the combination of IDUS and cholangioscopy is required. The utility of current peroral cholangioscopy is limited by the maneuverability of the “baby scope”. A new baby scope (10 Fr), called “SpyGlass” has potential, if the image quality can be improved. Since extrahepatic bile duct carcinoma is common in the Far East, many researchers in Japan and Korea contributed these studies, especially, in the evaluation of longitudinal cancer extension. PMID:21611097

  11. 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

  12. Neurogenin3 Activation Is Not Sufficient to Direct Duct-to-Beta Cell Transdifferentiation in the Adult Pancreas*

    Science.gov (United States)

    Xiao, Xiangwei; Guo, Ping; Shiota, Chiyo; Prasadan, Krishna; El-Gohary, Yousef; Wiersch, John; Gaffar, Iljana; Gittes, George K.

    2013-01-01

    It remains controversial whether adult pancreatic ducts harbor facultative beta cell progenitors. Because neurogenin3 (Ngn3) is a key determinant of pancreatic endocrine cell neogenesis during embryogenesis, many studies have also relied upon Ngn3 expression as evidence of beta cell neogenesis in adults. Recently, however, Ngn3 as a marker of adult beta cell neogenesis has been called into question by reports of Ngn3 expression in fully-developed beta cells. Nevertheless, direct evidence as to whether Ngn3 activation in adult pancreatic duct cells may lead to duct-to-beta cell transdifferentiation is lacking. Here we studied two models of Ngn3 activation in adult pancreatic duct cells (low-dose alloxan treatment and pancreatic duct ligation) and lineage-traced Ngn3-activated duct cells by labeling them through intraductal infusion with a cell-tagging dye, CFDA-SE No dye-labeled beta cells were found during the follow-up in either model, suggesting that activation of Ngn3 in duct cells is not sufficient to direct their transdifferentiation into beta cells. Therefore, Ngn3 activation in duct cells is not a signature for adult beta cell neogenesis. PMID:23867457

  13. Neurogenin3 activation is not sufficient to direct duct-to-beta cell transdifferentiation in the adult pancreas.

    Science.gov (United States)

    Xiao, Xiangwei; Guo, Ping; Shiota, Chiyo; Prasadan, Krishna; El-Gohary, Yousef; Wiersch, John; Gaffar, Iljana; Gittes, George K

    2013-08-30

    It remains controversial whether adult pancreatic ducts harbor facultative beta cell progenitors. Because neurogenin3 (Ngn3) is a key determinant of pancreatic endocrine cell neogenesis during embryogenesis, many studies have also relied upon Ngn3 expression as evidence of beta cell neogenesis in adults. Recently, however, Ngn3 as a marker of adult beta cell neogenesis has been called into question by reports of Ngn3 expression in fully-developed beta cells. Nevertheless, direct evidence as to whether Ngn3 activation in adult pancreatic duct cells may lead to duct-to-beta cell transdifferentiation is lacking. Here we studied two models of Ngn3 activation in adult pancreatic duct cells (low-dose alloxan treatment and pancreatic duct ligation) and lineage-traced Ngn3-activated duct cells by labeling them through intraductal infusion with a cell-tagging dye, CFDA-SE No dye-labeled beta cells were found during the follow-up in either model, suggesting that activation of Ngn3 in duct cells is not sufficient to direct their transdifferentiation into beta cells. Therefore, Ngn3 activation in duct cells is not a signature for adult beta cell neogenesis.

  14. The oncocytic subtype is genetically distinct from other pancreatic intraductal papillary mucinous neoplasm subtypes.

    Science.gov (United States)

    Basturk, Olca; Tan, Marcus; Bhanot, Umesh; Allen, Peter; Adsay, Volkan; Scott, Sasinya N; Shah, Ronak; Berger, Michael F; Askan, Gokce; Dikoglu, Esra; Jobanputra, Vaidehi; Wrzeszczynski, Kazimierz O; Sigel, Carlie; Iacobuzio-Donahue, Christine; Klimstra, David S

    2016-09-01

    In 2010, the World Health Organization reclassified the entity originally described as intraductal oncocytic papillary neoplasm as the 'oncocytic subtype' of intraductal papillary mucinous neoplasm. Although several key molecular alterations of other intraductal papillary mucinous neoplasm subtypes have been discovered, including common mutations in KRAS, GNAS, and RNF3, those of oncocytic subtype have not been well characterized. We analyzed 11 pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms. Nine pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms uniformly exhibited typical entity-defining morphology of arborizing papillae lined by layers of cells with oncocytic cytoplasm, prominent, nucleoli, and intraepithelial lumina. The remaining two were atypical. One lacked the arborizing papilla and had flat oncocytic epithelium only; the other one had focal oncocytic epithelium in a background of predominantly intestinal subtype intraductal papillary mucinous neoplasm. Different components of this case were analyzed separately. Formalin-fixed, paraffin-embedded specimens of all cases were microdissected and subjected to high-depth-targeted next-generation sequencing for a panel of 300 key cancer-associated genes in a platform that enabled the identification of sequence mutations, copy number alterations, and select structural rearrangements involving all targeted genes. Fresh frozen specimens of two cases were also subjected to whole-genome sequencing. For the nine typical pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms, the number of mutations per case, identified by next-generation sequencing, ranged from 1 to 10 (median=4). None of these cases had KRAS or GNAS mutations and only one had both RNF43 and PIK3R1 mutations. ARHGAP26, ASXL1, EPHA8, and ERBB4 genes were somatically altered in more than one of these typical 'oncocytic subtype' of intraductal papillary mucinous neoplasms but not in

  15. Quantitative nucleic features are effective for discrimination of intraductal proliferative lesions of the breast

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    Masatoshi Yamada

    2016-01-01

    Full Text Available Background: Intraductal proliferative lesions (IDPLs of the breast are recognized as a risk factor for subsequent invasive carcinoma development. Although opportunities for IDPL diagnosis have increased, these lesions are difficult to diagnose correctly, especially atypical ductal hyperplasia (ADH and low-grade ductal carcinoma in situ (LG-DCIS. In order to define the difference between these lesions, many molecular pathological approaches have been performed. However, still we do not have a molecular marker and objective histological index about IDPLs of the breast. Methods: We generated full digital pathology archives from 175 female IDPL patients, including usual ductal hyperplasia (UDH, ADH, LG-DCIS, intermediate-grade (IM-DCIS, and high-grade (HG-DCIS. After total 2,035,807 nucleic segmentations were extracted, we evaluated nuclear features using step-wise linear discriminant analysis (LDA and a support vector machine. Results: High diagnostic accuracy (81.8–99.3% was achieved between pathologists' diagnoses and two-group LDA predictions from nucleic features for IDPL discrimination. Grouping of nuclear features as size and shape-related or intranuclear texture-related revealed that the latter group was more important when distinguishing between normal duct, UDH, ADH, and LG-DCIS. However, these two groups were equally important when discriminating between LG-DCIS and HG-DCIS. The Mahalanobis distances between each group showed that the smallest distance values occurred between LG-DCIS and IM-DCIS and between ADH and Normal. On the other hand, the distance value between ADH and LG-DCIS was larger than this distance. Conclusions: In this study, we have presented a practical and useful digital pathological method that incorporates nuclear morphological and textural features for IDPL prediction. We expect that this novel algorithm is used for the automated diagnosis assisting system for breast cancer.

  16. Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

    Science.gov (United States)

    Paini, Marina; Crippa, Stefano; Partelli, Stefano; Scopelliti, Filippo; Tamburrino, Domenico; Baldoni, Andrea; Falconi, Massimo

    2014-01-01

    Since the first description of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in the eighties, their identification has dramatically increased in the last decades, hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases. However, the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions. The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed. We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms, identifying some genes, molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy. The knowledge of molecular biology of IPMNs has impressively developed over the last few years. A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified, in pancreatic juice or in blood or in the samples from the pancreatic resections, but further researches are required to use these informations for clinical intent, in order to better define the natural history of these diseases and to improve their management. PMID:25110429

  17. Distinct Pathways of Pathogenesis of Intraductal Oncocytic Papillary Neoplasms and Intraductal Papillary Mucinous Neoplasms of the Pancreas

    Science.gov (United States)

    Basturk, Olca; Chung, Sun M.; Hruban, Ralph H.; Adsay, N. Volkan; Askan, Gokce; Iacobuzio-Donahue, Christine; Balci, Serdar; Zee, Sui Y.; Memis, Bahar; Shia, Jinru; Klimstra, David S.

    2016-01-01

    Intraductal oncocytic papillary neoplasm(IOPN) of the pancreas is classified as a variant of intraductal papillary mucinous neoplasm(IPMN) in the WHO guidelines. However, the neoplastic cells of IOPNs are unique, with distinctive architecture/oncocytic cytoplasm. Although molecular/immunohistochemical features of other IPMN variants have been extensively studied, those of IOPNs have not been well characterized. Expression profile of antibodies associated with genetic alterations previously described for ductal adenocarcinomas(DAs) and IPMNs(SMAD4/β-catenin/p53/mesothelin/claudin-4) as well as with antibodies to mucins and differentiation markers(MUC1/MUC2/MUC5AC/MUC6/CDX2/HepPar-1) was investigated in 24 IOPNs and 22 IPMNs to assess the similarities/differences between these tumors. Expression of mesothelin and claudin-4 were dissimilar between these tumor types: a higher proportion of IOPNs labeled with mesothelin[21/24(87.5%) of IOPNs, 6/22(27%) of IPMNs, pneoplasms. PMID:27591765

  18. Azygos ladder and looped thoracic duct – a case report

    Directory of Open Access Journals (Sweden)

    Kumar N

    2011-04-01

    Full Text Available Knowledge of variations in the posterior mediastinum close to the vertebral column is important for cardiothoracic surgeons, radiologists and orthopedic surgeons. We report variations of azygos veins and thoracic duct. The azygos system of veins showed a ladder pattern. The hemiazygos and accessory hemiazygos veins communicated with the azygos vein through six transverse channels across the vertebral column. The accessory hemiazygos and hemiazygos veins joined to form a common channel which opened into the azygos vein. The thoracic duct gave two branches in the posterior mediastinum and these branches joined to form a loop.

  19. Progressive lymphangiectasis and recurrent chylothorax in a dog after thoracic duct ligation.

    Science.gov (United States)

    Kerpsack, S J; Smeak, D D; Birchard, S J

    1995-10-15

    A 2-year-old Bernese Mountain Dog was examined to determine the cause of bilateral pleural effusion. Torsion was diagnosed, and a lobectomy of a lung lobe was performed. Chylothorax developed 12 days after lung lobectomy. Mesenteric lymphangiography revealed lymphangiectasis Lymphangiography immediately after surgical thoracic duct was completely obstructed, but chylothorax persisted after thoracic duct ligation. Lymphangiography was repeated 50 days after ligation of the thoracic duct and revealed multiple patent thoracic duct branches and progressive lymphangiectasis. A second attempt to ligate the thoracic duct caused the effusion to become serosanguineous. A pleuroperitoneal shunt with a manually operated pump chamber was used to remove the pleural effusion. Chylothorax was again detected 50 weeks after placement of shunt. Mesenteric lymphangiography revealed multiple patent thoracic duct branches and a lymphatic plexus that extended across the thoracic cavity.

  20. Intraductal papillary mucinous neoplasm of the pancreas: cytologic features predict histologic grade

    National Research Council Canada - National Science Library

    Michaels, Paul J; Brachtel, Elena F; Bounds, Brenna C; Brugge, William R; Pitman, Martha Bishop

    2006-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized cystic neoplasm of the pancreas, histologically classified by the degree of epithelial atypia and by the presence or absence of invasion of the cyst wall...

  1. Bile duct obstruction

    Science.gov (United States)

    ... to the biliary system Liver and bile duct worms (flukes) The risk factors include: History of gallstones, ... In: Walker BR, Colledge NR, Ralston SH, Perman ID, eds. Davidson's Principles and Practice of Medicine. 22nd ...

  2. Mammary Duct Ectasia

    Science.gov (United States)

    ... lumps Mammary duct ectasia Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  3. Latest advances in diagnosis and treatment of occult common bile duct stones

    Directory of Open Access Journals (Sweden)

    WANG Chao

    2017-07-01

    Full Text Available Occult common bile duct stones have no clinical symptoms and if it is not diagnosed or treated in time, it can cause unexplained abdominal pain after cholecystectomy or serious complications such as biliary pancreatitis and acute cholangitis, which may threaten patients′ lives. Proper diagnosis and treatment modalities can reduce postoperative complications, save medical resources, and reduce medical disputes. This article introduces the latest advances in the diagnosis and treatment of occult common bile duct stones, including the features and diagnostic efficacy of imaging examinations (abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography (MRCP, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP, intraoperative cholangiography, intraoperative laparoscopic ultrasonography, intraductal ultrasonography, and intraoperative choledochoscopy, as well as the effect of treatment modalities (endoscopic sphincterotomy (EST, laparoscopic common bile duct exploration (LCBDE, open common bile duct exploration, endoscopic papillary balloon dilatation, electrohydaulic lithotripsy, extracorporeal shockwave lithotripsy, litholysis, and laser lithotripsy. It is pointed out that the diagnosis and treatment of occult common bile duct stones should be treated differently according to risk stratification. Endoscopic ultrasonography or MRCP should be performed for patients with moderate risks or above, and their results are critical to the choice of surgical procedure. For treatment modality, LCBDE or ERCP/EST should be selected according to patients′ actual conditions.

  4. Peroral pancreatoscopy using the SpyGlass system for the assessment of intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Nagayoshi, Yosuke; Aso, Teppei; Ohtsuka, Takao; Kono, Hiroshi; Ideno, Noboru; Igarashi, Hisato; Takahata, Shunichi; Oda, Yoshinao; Ito, Tetsuhide; Tanaka, Masao

    2014-06-01

    Peroral pancreatoscopy (POPS) using a mother-baby endoscope system is often useful for assessment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with main pancreatic duct (MPD) involvement, but is not widely used for several reasons. The aim of this study was to evaluate the usefulness of the SpyGlass Direct Visualization System for assessment of IPMN. Seventeen patients diagnosed with possible IPMN with MPD dilation underwent peroral pancreatoscopy using the SpyGlass system at our institution. The quality of visualization and the sensitivities of cytological and pathological investigations for diagnosing malignant lesions were evaluated. Peroral pancreatoscopy was performed using the SpyScope in 12 patients and an endoscopic retrograde cholangiopancreatography (ERCP) catheter in five patients. Sufficient visualization was achieved in 92% of cases using the SpyScope and 40% of cases using the ERCP catheter. Biopsy under direct visualization was successful in seven patients. Biopsy specimens showed adenocarcinoma in one patient, benign neoplastic epithelium in five patients, and regenerative changes in one patient; and had 25% sensitivity and 100% specificity for detecting malignancy. SpyGlass pancreatoscopy with irrigation cytology had 100% sensitivity and 100% specificity for detecting malignancy. SpyGlass pancreatoscopy was useful for determining the operative excision line in three patients. There were no severe procedure-related adverse events. Peroral pancreatoscopy using the SpyGlass system seems to be feasible and useful for assessment of IPMN with a dilated MPD. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  5. Surgical management for bile duct injury.

    Science.gov (United States)

    Feng, Xiaobin; Dong, Jiahong

    2017-09-12

    The management of bile duct injury (BDI) remains a considerable challenge in hepatobiliary surgery. BDI is mainly iatrogenic, and mostly occurs in cholecystectomy. Laparoscopic cholecystectomy (LC) has been performed widely, however, the incidence of BDI associated with LC increases 2-3 times compared to that in open cholecystectomy (OC). BDI also occurs in robotic cholecystectomy. In China, the evidence-based Practice Guideline for Diagnosis and Treatment of BDI was published by the Biliary Surgery Group of Surgery Branch of Chinese Medical Association, with the purpose of reducing the incidence of BDI as well as promoting its optimal diagnosis and treatment. Surgery remains the mainstay of treatment for BDI and traumatic bile duct stricture. The definitive repair involves a series of procedures including exposing the proximal and distal bile duct, anastomotic bile duct tissue preparation, minimally invasive tissue anastomoses, and so on. Successful management is a surgical challenge requiring great specialized experience and precise surgical skill. The application of precision biliary surgery is recommended for promoting standardized management of BDI.

  6. 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.

  7. Patent arterial duct

    Directory of Open Access Journals (Sweden)

    Martin Robin P

    2009-07-01

    Full Text Available Abstract Patent arterial duct (PAD is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in 2000 full term infants. A higher prevalence is found in preterm infants, especially those with low birth weight. The female to male ratio is 2:1. Most patients are asymptomatic when the duct is small. With a moderate-to-large duct, a characteristic continuous heart murmur (loudest in the left upper chest or infraclavicular area is typical. The precordium may be hyperactive and peripheral pulses are bounding with a wide pulse pressure. Tachycardia, exertional dyspnoea, laboured breathing, fatigue or poor growth are common. Large shunts may lead to failure to thrive, recurrent infection of the upper respiratory tract and congestive heart failure. In the majority of cases of PAD there is no identifiable cause. Persistence of the duct is associated with chromosomal aberrations, asphyxia at birth, birth at high altitude and congenital rubella. Occasional cases are associated with specific genetic defects (trisomy 21 and 18, and the Rubinstein-Taybi and CHARGE syndromes. Familial occurrence of PAD is uncommon and the usual mechanism of inheritance is considered to be polygenic with a recurrence risk of 3%. Rare families with isolated PAD have been described in which the mode of inheritance appears to be dominant or recessive. Familial incidence of PAD has also been linked to Char syndrome, familial thoracic aortic aneurysm/dissection associated with patent arterial duct, and familial patent arterial duct and bicuspid aortic valve associated with hand abnormalities. Diagnosis is based on clinical examination and confirmed with transthoracic echocardiography. Assessment of ductal blood flow can be made using colour flow mapping and pulsed wave Doppler. Antenatal diagnosis is not possible, as PAD is a normal structure during antenatal life. Conditions with signs and symptoms of

  8. [Clinicopathologic features of drug-induced vanishing bile duct syndrome].

    Science.gov (United States)

    Ye, L H; Wang, C K; Zhang, H C; Liu, Z Q; Zheng, H W

    2017-04-20

    Vanishing bile duct syndrome (VBDS) manifests as progressive destruction and disappearance of the intrahepatic bile duct caused by various factors and cholestasis. VBDS associated with drug-induced liver injury (D-VBDS) is an important etiology of VBDS, and immune disorder or immune imbalance may be the main pathogenesis. According to its clinical symptoms, serological markers, and course of the disease, D-VBDS is classified into major form and minor form, and its clinical features are based on various pathomorphological findings. Its prognosis is associated various factors including regeneration of bile duct cells, number of bile duct injuries, level and range of bile duct injury, bile duct proliferation, and compensatory shunt of bile duct branches. This disease has various clinical outcomes; most patients have good prognosis after drug withdrawal, and some patients may experience cholestatic cirrhosis, liver failure, and even death. Due to the clinical manifestation and biochemical changes are similar to the primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), it need to identify by clinical physician.

  9. Mammary analog secretory carcinoma, low-grade salivary duct carcinoma, and mimickers: a comparative study.

    Science.gov (United States)

    Stevens, Todd M; Kovalovsky, Andra O; Velosa, Claudia; Shi, Qiuying; Dai, Qian; Owen, Randall P; Bell, Walter C; Wei, Shi; Althof, Pamela A; Sanmann, Jennifer N; Sweeny, Larissa; Carroll, William R; Siegal, Gene P; Bullock, Martin J; Brandwein-Gensler, Margaret

    2015-08-01

    Mammary analog secretory carcinoma (MASC) is a recently recognized low-grade salivary carcinoma characterized by a specific ETV6 rearrangement. We describe 14 new MASCs and examine their immunophenotypic and genetic profiles in the context of look-alikes, namely, low-and high-grade salivary duct carcinoma and acinic cell carcinoma. ETV6 rearrangement, and robust expression of mammaglobin and S100, were demonstrated in 11/11, 14/14, and 12/14 MASCs, respectively. All low-grade salivary duct carcinomas coexpressed S100/mammaglobin (6/6); none harbored ETV6 rearrangements (0/5). Given that S100/mammaglobin coexpression and absence of zymogen granules are features of both MASC and low-grade salivary duct carcinoma, these two are best distinguished histologically. The former is predominantly an extraductal neoplasm with bubbly pink cytoplasm, whereas the latter is a distinct intraductal micropapillary and cribriform process. Querying ETV6 gene status may be necessary for difficult cases. No acinic cell carcinoma expressed mammaglobin (0/13) or harbored an ETV6 rearrangement (0/7); only 1/13 acinic cell carcinomas weakly expressed S100. DOG1 expression was limited or absent among all tumor types, except acinic cell carcinoma which expressed DOG1 diffusely in a canalicular pattern. Therefore, histology and immunohistochemistry (mammaglobin, S100, DOG1) suffices in distinguishing acinic cell carcinoma from both MASC and low-grade salivary duct carcinoma. HER2 (ERBB2) amplification was detected in only 1/10 acinic cell carcinomas, but none of the MASCs or low-grade salivary duct carcinomas tested. High-grade salivary duct carcinomas frequently expressed mammaglobin (11/18) and harbored HER2 amplifications (13/15); none harbored ETV6 rearrangements (0/12). High-grade salivary duct carcinomas can easily be distinguished from these other entities by histology and HER2 amplification.

  10. 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

  11. Turbofan Duct Propagation Model

    Science.gov (United States)

    Lan, Justin H.; Posey, Joe W. (Technical Monitor)

    2001-01-01

    The CDUCT code utilizes a parabolic approximation to the convected Helmholtz equation in order to efficiently model acoustic propagation in acoustically treated, complex shaped ducts. The parabolic approximation solves one-way wave propagation with a marching method which neglects backwards reflected waves. The derivation of the parabolic approximation is presented. Several code validation cases are given. An acoustic lining design process for an example aft fan duct is discussed. It is noted that the method can efficiently model realistic three-dimension effects, acoustic lining, and flow within the computational capabilities of a typical computer workstation.

  12. Nasopalatine Duct Cyst

    Directory of Open Access Journals (Sweden)

    Pratik Dedhia

    2013-01-01

    Full Text Available The nasopalatine cyst is the most common epithelial and nonodontogenic cyst of the maxilla. The cyst originates from epithelial remnants from the nasopalatine duct. The cells may be activated spontaneously during life or are eventually stimulated by the irritating action of various agents (infection, etc.. It is different from a radicular cyst. The definite diagnosis should be based on clinical, radiological, and histopathological findings. The treatment is enucleation of the cystic tissue, and only in rare cases a marsupialisation needs to be performed. A case of a nasopalatine duct cyst in a 35-year-old male is reviewed. The typical radiologic and histological findings are presented.

  13. Bile Duct Exploration

    Science.gov (United States)

    ... 223.2273 Request an Appointment Contact Us Share Facebook Twitter Linkedin Email Bile Duct Exploration Menu Print Full Article Overview Test Details Results and Follow-Up Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We ...

  14. 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)

    2014-08-01

    The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques for duct leakage 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. The three duct leak measurement methods assessed in this report are the two duct pressurization methods that are commonly used by many practitioners and the DeltaQ technique. These are methods B, C and A, respectively of the ASTM E1554 standard. Although it would be useful to evaluate other duct leak test methods, this study focused on those test methods that are commonly used and are required in various test standards, such as BPI (2010), RESNET (2014), ASHRAE 62.2 (2013), California Title 24 (CEC 2012), DOE Weatherization and many other energy efficiency programs.

  15. Connecting device for air ducts

    Energy Technology Data Exchange (ETDEWEB)

    Kippenberger, G.

    1979-11-29

    The connecting device for air ducts described consists of matched coupling elements of great tensile strength in the form of eyes and cords, which are fitted on the front of the air duct sections. There is a sleeve apron on one side which projects into the other section of air duct.

  16. 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.

  17. Total rupture of hydatid cyst of liver in to common bile duct: a case report.

    Science.gov (United States)

    Robleh, Hassan; Yassine, Fahmi; Driss, Khaiz; Khalid, Elhattabi; Fatima-Zahra, Bensardi; Saad, Berrada; Rachid, Lefriyekh; Abdalaziz, Fadil; Najib, Zerouali Ouariti

    2014-01-01

    Rupture of hydatid liver cyst into biliary tree is frequent complications that involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts,but rarely rupture into common bile duct. The rupture of hydatid cyst is serious life threating event. The authors are reporting a case of total rupture of hydatid cyst of liver into common bile duct. A 50-year-old male patient who presented with acute cholangitis was diagnosed as a case of totally rupture of hydatid cyst on Abdominal CT Scan. Rupture of hydatid cyst of liver into common bile duct and the gallbladder was confirmed on surgery. Treated by cholecystectomy and T-tube drainage of Common bile duct.

  18. Rare bile duct anomaly: B3 duct draining to gallbladder

    Directory of Open Access Journals (Sweden)

    Seung Eun Lee

    2016-01-01

    Full Text Available A 10-year-old girl presented with recurrent right upper abdominal pain and dyspepsia. Magnetic resonance cholangiopancreatography revealed a dilated common channel of intrahepatic bile duct of segment 3 (B3 and segment 4 (B4 drained into the gallbladder directly. The patient underwent laparoscopic cholecystectomy and Roux-en Y hepaticojejunostomy (B3-jejunostomy. Among the anatomical variability of the biliary system, the cholecystohepatic ducts are controversial in existence and incidence. We report a very rare variant of a cholecystohepatic duct in which the B3 duct drained into gallbladder directly and to the best of our knowledge this is the first report.

  19. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study

    NARCIS (Netherlands)

    Furukawa, Toru; Klöppel, Günter; Volkan Adsay, N.; Albores-Saavedra, Jorge; Fukushima, Noriyoshi; Horii, Akira; Hruban, Ralph H.; Kato, Yo; Klimstra, David S.; Longnecker, Daniel S.; Lüttges, Jutta; Offerhaus, G. Johan A.; Shimizu, Michio; Sunamura, Makoto; Suriawinata, Arief; Takaori, Kyoichi; Yonezawa, Suguru

    2005-01-01

    Now that more than two decades have passed since the first reports of intraductal papillary-mucinous neoplasms (IPMNs), it has become clear that IPMN consists of a spectrum of neoplasms with both morphological and immunohistochemical variations. At a meeting of international experts on pancreatic

  20. Pancreatic Serous Cystadenoma with Compression of the Main Pancreatic Duct: An Unusual Entity

    Directory of Open Access Journals (Sweden)

    Stéphanie Truant

    2011-01-01

    Full Text Available Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. CT and MRI showed a 10 cm-polycystic tumor with upstream dilatation of the main pancreatic duct (MPD, suggestive of intraductal papillary mucinous tumor (IPMT. Ultrasonographic aspect and EUS-guided fine-needle aspiration gave arguments for serous cystadenoma. ERCP showed a communication between cysts and the dilated MPD, compatible with IPMT. The patient underwent left pancreatectomy with splenectomy. Pathological examination concluded in a serous cystadenoma, with only a ductal obstruction causing proximal dilatation.

  1. Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis

    Directory of Open Access Journals (Sweden)

    Liliane S. Deeb

    2008-01-01

    Full Text Available Background/Aim: Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence of pancreatic abscess or infected necrosis. Case Report: A 46-year-old Asian-Indian man with chronic tropical pancreatitis who was admitted with recurrent epigastric pain that rapidly evolved into septic shock. A CT scan of abdomen revealed a dilated pancreatic duct with a large calculus. Broad-spectrum antibiotics, vasopressors and activated recombinant protein C were initiated. Emergency ERCP showed the papilla of Vater spontaneously expelling pus. Probing and stenting was instantly performed until pus drainage ceased. Repeat CT scan confirmed the absence of pancreatic necrosis or fluid collection, and decreasing ductal dilatation. Dramatic clinical improvement was observed within 36 hours after intervention. Blood cultures grew Klebsiella ornithinolytica. The patient completed his antibiotic course and was discharged. Conclusion: ASPD without pancreatic abscess or infected necrosis is an exceptional clinical entity that should be included in the differential diagnosis of pancreatic sepsis. A chronically diseased pancreas and diabetes may have predisposed to the uncommon pathogen. The presence of intraductal pancreatic stones obstructing outflow played a major role in promoting bacterial growth, suppuration and septicemia. Immediate drainage of the pancreatic duct with endoscopic intervention is critical and mandatory.

  2. Branched polymers on branched polymers

    OpenAIRE

    Durhuus, Bergfinnur; Jonsson, Thordur

    1996-01-01

    We study an ensemble of branched polymers which are embedded on other branched polymers. This is a toy model which allows us to study explicitly the reaction of a statistical system on an underlying geometrical structure, a problem of interest in the study of the interaction of matter and quantized gravity. We find a phase transition at which the embedded polymers begin to cover the basis polymers. At the phase transition point the susceptibility exponent $\\gamma$ takes the value 3/4 and the ...

  3. 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....

  4. 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.

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

    Science.gov (United States)

    Djukić, Milan; Ilisić, Tamara; Stefanović, Igor; Gradinac, Marija; Vulićević, Irena; Parezanović, Vojislav; Jovanović, Ida

    2013-01-01

    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. 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. Stenting of DA can be an effective alternative to primary surgical correction in selected patients with duct-dependent CHD.

  6. Characterization of Insulin-Immunoreactive Cells and Endocrine Cells Within the Duct System of the Adult Human Pancreas.

    Science.gov (United States)

    Li, Rong; Zhang, Xiaoxi; Yu, Lan; Zou, Xia; Zhao, Hailu

    2016-01-01

    The adult pancreatic duct system accommodates endocrine cells that have the potential to produce insulin. Here we report the characterization and distribution of insulin-immunoreactive cells and endocrine cells within the ductal units of adult human pancreas. Sequential pancreas sections from 12 nondiabetic adults were stained with biomarkers of ductal epithelial cells (cytokeratin 19), acinar cells (amylase), endocrine cells (chromogranin A; neuron-specific enolase), islet hormones (insulin, glucagon, somatostatin, pancreatic polypeptide), cell proliferation (Ki-67), and neogenesis (CD29). The number of islet hormone-immunoreactive cells increased from large ducts to the terminal branches. The insulin-producing cells outnumbered endocrine cells reactive for glucagon, somatostatin, or pancreatic polypeptide. The proportions of insulin-immunoreactive count compared with local islets (100% as a baseline) were 1.5% for the main ducts, 7.2% for interlobular ducts, 24.8% for intralobular ducts, 67.9% for intercalated ducts, and 348.9% for centroacinar cells. Both Ki-67- and CD29-labeled cells were predominantly localized in the terminal branches around the islets. The terminal branches also showed cells coexpressing islet hormones and cytokeratin 19. The adult human pancreatic ducts showed islet hormone-producing cells. The insulin-reactive cells predominantly localized in terminal branches where they may retain potential capability for β-cell neogenesis.

  7. Silver zeolite antimicrobial activity in aluminium heating, ventilation and air conditioning system ducts.

    Science.gov (United States)

    Rizzetto, R; Mansi, A; Panatto, D; Rizzitelli, E; Tinteri, C; Sasso, T; Gasparini, R; Crovari, P

    2008-03-01

    Air pollution in confined environments is a serious health problem, in that most people spend long periods indoors (in homes, offices, classrooms etc.). Some people (children, the elderly, heart disease patients, asthmatic or allergic subjects) are at greater risk because of their conditions of frailty. The growing use of air-conditioning systems in many public and private buildings aggravates this health risk, especially when these systems are not correctly installed or regularly serviced. The aim of our study was to verify the capacity of Ag+ ions to stop the growth of bacteria and moulds inside the ducts of Heating, Ventilation and Air Conditioning system ducts (HVAC) systems when these ducts were lined with active Ag+ ions zeolite-coated panels. A Y-shaped HVAC model with two branches was used; one branch was made of traditional galvanized iron, as was the whole system, while the other was lined with active Ag+ zeolite-coated polyurethane panels. During the test, samples of dust present inside both ducts were collected and seeded in liquid and solid media to detect bacteria and moulds. The presence of bacteria was also sought in the air emerging from the outlets of both ducts. Tests made on samples of particulate collected from the two different ducts revealed a lower total bacterial load in the samples collected from the Ag+ zeolite-coated duct than in the samples from the traditional Zn galvanized duct. In addition, the values of bacterial load found in the air emerging from the Ag+ ions zeolite-lined duct were 5 times lower than those found in the air from the traditional galvanized iron duct. The utilization of Ag+ zeolite-coated panels in air-conditioning systems could improve the quality of the emerging air in comparison with traditional installations in galvanized iron. This innovation could prove particularly advantageous in the event of accidents during the installation of air-conditioning systems or of contaminated aerosols coming from outside.

  8. Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance.

    Science.gov (United States)

    De Filippo, M; Calabrese, M; Quinto, S; Rastelli, A; Bertellini, A; Martora, R; Sverzellati, N; Corradi, D; Vitale, M; Crialesi, G; Sarli, L; Roncoroni, L; Garlaschi, G; Zompatori, M

    2008-09-01

    The objective of this paper is to document the magnetic resonance cholangiopancreatography (MRCP) findings and the epidemiology of congenital anomalies and variations of the bile and pancreatic ducts and to discuss their clinical significance. Three-hundred and fifty patients of both sexes (150 females, 200 males, age range 0-76 years, average age 38 years) underwent MRCP for clinically suspected lithiasic, neoplastic or inflammatory disease of the bile and pancreatic ducts. Patients were imaged with a 1.5-T superconductive magnet (Magnetom Vision, Siemens, Erlangen, Germany), a four-channel phased-array body coil, breath-hold technique, with multislice T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), MIP reconstructions, and a single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) with different slice thicknesses. Studies in oncological patients were completed with fat saturation 3D T1 gradient-echo sequences during the intravenous injection of gadolinium diethylene triamine pentaacetate acid (DTPA) (0.2 ml/kg). MRCP demonstrated recurrent and therefore normal bile and pancreatic ducts in 57% of patients. In the remaining 42.3%, it documented anatomical variants (41%) and congenital anomalies (1.3%). Variants of the intrahepatic bile duct were seen in 21% of cases: crossover anomaly (6.7%), anterior branch of the right hepatic duct draining the IV and VII segments that flow together with the left bile duct (3.1%) and anterior and posterior branches of the right hepatic duct that flow together with the common hepatic duct (3.3%). Variants of the extrahepatic bile ducts were present in 8.8% of patients: low insertion of the cystic duct into the common hepatic duct (4.5%), emptying of the cystic duct into the right hepatic duct (2.7%) and a second-order large branch draining into the cystic duct (1.6%). MRCP identified a double gall bladder in 3% of patients and anatomical variants of the

  9. Intraductal oncocytic papillary neoplasm of the pancreas: a case of a second neoplasm in a pancreas cancer survivor.

    Science.gov (United States)

    Garg, Mrinal S; Schuerle, Theresa; Liu, Yulin; Thakkar, Shyam J

    2015-01-31

    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. 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. 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.

  10. Digital next-generation sequencing identifies low-abundance mutations in pancreatic juice samples collected from the duodenum of patients with pancreatic cancer and intraductal papillary mucinous neoplasms.

    Science.gov (United States)

    Yu, Jun; Sadakari, Yoshihiko; Shindo, Koji; Suenaga, Masaya; Brant, Aaron; Almario, Jose Alejandro Navarro; Borges, Michael; Barkley, Thomas; Fesharakizadeh, Shahriar; Ford, Madeline; Hruban, Ralph H; Shin, Eun Ji; Lennon, Anne Marie; Canto, Marcia Irene; Goggins, Michael

    2017-09-01

    Secretin-stimulated pancreatic juice contains DNA shed from cells lining the pancreatic ducts. Genetic analysis of this fluid may form a test to detect pancreatic ductal neoplasia. We employed digital next-generation sequencing ('digital NGS') to detect low-abundance mutations in secretin-stimulated juice samples collected from the duodenum of subjects enrolled in Cancer of the Pancreas Screening studies at Johns Hopkins Hospital. For each juice sample, digital NGS necessitated 96 NGS reactions sequencing nine genes. The study population included 115 subjects (53 discovery, 62 validation) (1) with pancreatic ductal adenocarcinoma (PDAC), (2) intraductal papillary mucinous neoplasm (IPMN), (3) controls with non-suspicious pancreata. Cases with PDAC and IPMN were more likely to have mutant DNA detected in pancreatic juice than controls (both pcancer despite close surveillance had SMAD4/TP53 mutations from their cancer detected in juice samples collected over 1 year prior to their pancreatic cancer diagnosis when no suspicious pancreatic lesions were detected by imaging. The detection in pancreatic juice of mutations important for the progression of low-grade dysplasia to high-grade dysplasia and invasive pancreatic cancer may improve the management of patients undergoing pancreatic screening and surveillance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Optimization of the mechanical performance of a two-duct semicircular duct sytem. Part 1. Dynamics and duct dimensions

    NARCIS (Netherlands)

    Muller, M.; Verhagen, J.H.G.

    2002-01-01

    The classical representation of the semicircular duct system consists of three separate duct circuits. The ducts are, however, in reality, hydrodynamically interconnected. Muller & Verhagen (1988a,b) derived equations for the mechanical behaviour of an interconnected system with three ducts

  12. ROV inspection inside ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, R.E.; Street, P.F.; Cole, G.V. [AEA Technology, Harwell (United Kingdom)

    1996-12-31

    An instrumentation package for carrying out visual inspections and radiation monitoring within radioactive duct-work has been developed. This paper describes the first application of the package in the main ventilation duct of the Dounreay fuel cycle area. The package was deployed via a commerical ROV within a duct consisting of two parallel runs, over 300 metres long, between 0.9 and 1.7 metres high and 1.1 metres wide. An integrated, computer-controlled station was used for data collection, recording in digital form and on video tape. (Author).

  13. Protein tyrosine kinase 7 is essential for tubular morphogenesis of the Wolffian duct.

    Science.gov (United States)

    Xu, Bingfang; Washington, Angela M; Domeniconi, Raquel Fantin; Ferreira Souza, Ana Cláudia; Lu, Xiaowei; Sutherland, Ann; Hinton, Barry T

    2016-04-15

    The Wolffian duct, the proximal end of the mesonephric duct, undergoes non-branching morphogenesis to achieve an optimal length and size for sperm maturation. It is important to examine the mechanisms by which the developing mouse Wolffian duct elongates and coils for without proper morphogenesis, male infertility will result. Here we show that highly proliferative epithelial cells divide in a random orientation relative to the elongation axis in the developing Wolffian duct. Convergent extension (CE)-like of cell rearrangements is required for elongating the duct while maintaining a relatively unchanged duct diameter. The Wolffian duct epithelium is planar polarized, which is characterized by oriented cell elongation, oriented cell rearrangements, and polarized activity of regulatory light chain of myosin II. Conditional deletion of protein tyrosine kinase 7 (PTK7), a regulator of planar cell polarity (PCP), from mesoderm results in loss of the PCP characteristics in the Wolffian duct epithelium. Although loss of Ptk7 does not alter cell proliferation or division orientation, it affects CE and leads to the duct with significantly shortened length, increased diameter, and reduced coiling, which eventually results in loss of sperm motility, a key component of sperm maturation. In vitro experiments utilizing inhibitors of myosin II results in reduced elongation and coiling, similar to the phenotype of Ptk7 knockout. This data suggest that PTK7 signaling through myosin II regulates PCP, which in turn ensures CE-like of cell rearrangements to drive elongation and coiling of the Wolffian duct. Therefore, PTK7 is essential for Wolffian duct morphogenesis and male fertility. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Bile Duct Diseases - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bile Duct Diseases URL of this page: https://medlineplus.gov/languages/bileductdiseases.html Other topics A-Z Expand Section ...

  15. Cystic tumor of the liver without ovarian-like stroma or bile duct communication: two case reports and a review of the literature.

    Science.gov (United States)

    Kishida, Norihiro; Shinoda, Masahiro; Masugi, Yohei; Itano, Osamu; Fujii-Nishimura, Yoko; Ueno, Akihisa; Kitago, Minoru; Hibi, Taizo; Abe, Yuta; Yagi, Hiroshi; Tanimoto, Akihiro; Tanabe, Minoru; Sakamaoto, Michiie; Kitagawa, Yuko

    2014-07-21

    We report two cases of cystic neoplasm of the liver with mucinous epithelium in which both ovarian-like stroma and bile duct communication were absent. The first case was a 41-year-old woman. She underwent right trisegmentectomy due to a multilocular cystic lesion, 15 cm in diameter, with papillary nodular components in the medial segment and right lobe. Histologically, arborizing papillae were seen in the papillary lesion. The constituent neoplastic cells had sufficient cytoarchitectural atypia to be classified as high-grade dysplasia. The second case was a 60-year-old woman. She underwent left lobectomy due to a unilocular cystic lesion, 17 cm in diameter, in the left lobe. Histologically, the cyst wall was lined by low columnar epithelia with slight cellular atypia. In both cases, neither ovarian-like stroma nor bile duct communications were found throughout the resected specimen. According to the most recent World Health Organization (WHO) classification in 2010, cystic tumors of the liver with mucinous epithelium are classified as mucinous cystic neoplasms when ovarian-like stromata are found, and as intraductal papillary neoplasm of bile duct when bile duct communication exists. Therefore, we diagnosed the cystic tumors as 'biliary cystadenoma' according to the past WHO classification scheme from 2000. We believe that the combined absence of both ovarian-like stroma and bile duct communication is possible in mucinous cystic tumors of the liver. Herein, we have described the clinicopathologic features of the two cases and reviewed past cases in the literature.

  16. Therapeutic effect of intraductal irrigation of the salivary gland: A technical report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chena [Dept. of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul (Korea, Republic of); Kim, Jo Eun; Huh, Kyoung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2017-06-15

    Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.

  17. Pure intraductal carcinoma of the parotid gland: Cytologic findings on FNA sample. Report of one case.

    Science.gov (United States)

    Barizzi, Jessica; Merlo, Elisabetta; Schönegg, Rene; Pelloni, Raffaele; Mazzuchelli, Luca; Fulciniti, Franco

    2017-11-01

    One case of intraductal carcinoma of the parotid gland in a 67-year-old male patient is here introduced. The patient, who had a one-year history of a parotid mass, had undergone ultrasound and MRI examination that disclosed a 13x4x3 mm well delimited nodular mass of the accessory lobe of his left parotid gland. Ultrasound-guided Fine Needle Aspiration (FNA) had been performed by the clinician. The obtained smears showed widespread cellular necrosis in which cellular clusters with moderate and focally severe atypias displayed papillary and cribriform architecture and were admixed with sheets of epithelial cells with less striking nuclear atypias, squamous, or apocrine metaplasia. Histopathological examination disclosed a pure intraductal carcinoma of the parotid gland with classical morphology, which was radically excised. The differential cytological diagnosis of pure intraductal carcinoma of salivary glands may be difficult and comprises mucoepidermoid carcinoma as well as "in situ" carcinomas developping in the context of sclerosing polycystic adenosis, mammary analogue secretory carcinoma (MASC) of the salivary glands and cystic variants of salivary adenocarcinoma NOS (formerly called cystadenocarcinomas). © 2017 Wiley Periodicals, Inc.

  18. Therapeutic effect of intraductal irrigation of the salivary gland: A technical report.

    Science.gov (United States)

    Lee, Chena; Kim, Jo-Eun; Huh, Kyoung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Lee, Sam-Sun; Choi, Soon-Chul

    2017-06-01

    Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.

  19. Postoperative Biliary Leak Treated with Chemical Bile Duct Ablation Using Absolute Ethanol: A Report of Two Cases.

    Science.gov (United States)

    Sasaki, Maho; Hori, Tomohide; Furuyama, Hiroaki; Machimoto, Takafumi; Hata, Toshiyuki; Kadokawa, Yoshio; Ito, Tatsuo; Kato, Shigeru; Yasukawa, Daiki; Aisu, Yuki; Kimura, Yusuke; Takamatsu, Yuichi; Kitano, Taku; Yoshimura, Tsunehiro

    2017-08-08

    BACKGROUND Postoperative bile duct leak following hepatobiliary and pancreatic surgery can be intractable, and the postoperative course can be prolonged. However, if the site of the leak is in the distal bile duct in the main biliary tract, the therapeutic options may be limited. Injection of absolute ethanol into the bile duct requires correct identification of the bile duct, and balloon occlusion is useful to avoid damage to the surrounding tissues, even in cases with non-communicating biliary fistula and bile leak. CASE REPORT Two cases of non-communicating biliary fistula and bile leak are presented; one case following pancreaticoduodenectomy (Whipple's procedure), and one case following laparoscopic cholecystectomy. Both cases were successfully managed by chemical bile duct ablation with absolute ethanol. In the first case, the biliary leak occurred from a fistula of the right posterior biliary tract following pancreaticoduodenectomy. Cannulation of the leaking bile duct and balloon occlusion were achieved via a percutaneous route, and seven ablation sessions using absolute ethanol were required. In the second case, perforation of the bile duct branch draining hepatic segment V occurred following laparoscopic cholecystectomy. Cannulation of the bile duct and balloon occlusion were achieved via a transhepatic route, and seven ablation sessions using absolute ethanol were required. CONCLUSIONS Chemical ablation of the bile duct using absolute ethanol is an effective treatment for biliary leak following hepatobiliary and pancreatic surgery, even in cases with non-communicating biliary fistula. Identification of the bile duct leak is required before ethanol injection to avoid damage to the surrounding tissues.

  20. 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.

  1. SLC2A1/GLUT1 expression in mural nodules of intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Oda, Yasunori; Aishima, Shinichi; Shindo, Koji; Fujino, Minoru; Mizuuchi, Yusuke; Hattori, Masami; Miyazaki, Tetsuyuki; Tanaka, Masao; Oda, Yoshinao

    2017-07-01

    In intraductal papillary mucinous neoplasms (IPMNs), the presence of a mural nodule showing a papillary or nodular proliferation of tumor cells in the dilated pancreatic duct is an indication for resection of IPMN. Solute carrier family 2, facilitated glucose transporter member 1, known as glucose transporter type 1 (SLC2A1/GLUT1) mediates cellular glucose uptake in many carcinomas and is correlated with increased 18F-fluorodeoxyglucose (18F-FDG) uptake. We examined SLC2A1/GLUT1 expression in the mural nodules of 180 IPMN specimens to distinguish malignant/benign tumors. A mural nodule was detected in 80 (44.4%) of the IPMNs, and was detected in 18.6% (13/70) of the IPMN-low (dysplasia) specimens, 36.1% (13/36) of the IPMN-int, 93.3% (28/30) of the IPMN-high, and 59.1% (26/44) of the IPMN-inv (with an associated invasive carcinoma) specimens. The sensitivity for detecting mural nodules was 81.7% by endoscopic ultrasonography, 70% by contrast-enhanced computed tomography and 54% by endoscopic retrograde cholangiopancreatography. SLC2A1/GLUT1 expression in the mural nodules was recognized in the basal and basolateral cytomembrane of tumor cells and was expressed in 15.4% (2/13) of the IPMN-low, 15.4% (2/13) of the IPMN-int, 71.4% (20/28) of the IPMN-high and 84.6% (22/26) of the IPMN-inv groups. The SLC2A1/GLUT1 expression was significantly higher in the IPMN-high and IPMN-inv mural nodules than in those of the IPMN-low and IPMN-int groups. Our findings suggest that SLC2A1/GLUT1 is expressed late in the adenoma-carcinoma sequence during carcinogenesis in IPMN, and SLC2A1/GLUT1 act as therapeutic target for malignant IPMN. Copyright © 2017. Published by Elsevier Inc.

  2. Intraductal Carcinoma of the Prostate on Diagnostic Needle Biopsy Predicts Prostate Cancer Mortality: A Population-Based Study.

    Science.gov (United States)

    Saeter, Thorstein; Vlatkovic, Ljiljana; Waaler, Gudmund; Servoll, Einar; Nesland, Jahn M; Axcrona, Karol; Axcrona, Ulrika

    2017-06-01

    Intraductal carcinoma of the prostate (IDC-P) is a distinct histopathologic feature associated with high-grade, advanced prostate cancer. Although studies have shown that IDC-P is a predictor of progression following surgical or radiation treatment for prostate cancer, there are sparse data regarding IDC-P on diagnostic needle biopsy as a prognosticator of prostate cancer mortality. This was a population-based study of all prostate cancer patients diagnosed using needle biopsy and without evidence of systemic disease between 1991 and 1999 within a defined geographic region of Norway. Patients were identified by cross-referencing the Norwegian Cancer Registry. Of 318 eligible patients, 283 had biopsy specimens available for central pathology review. Clinical data were obtained from medical charts. We examined whether IDC-P on diagnostic needle biopsy was associated with adverse clinicopathological features and prostate cancer mortality. Patients with IDC-P on diagnostic needle biopsy had a more advanced stage and a higher Gleason score compared to patients without IDC-P. IDC-P was also associated with an intensively reactive stroma. The 10-year prostate cancer-specific survival was 69% for patients with IDC-P on diagnostic needle biopsy and 89% for patients without IDC-P (Log rank P-value prostate cancer mortality after adjustments for clinical prognostic factors and treatment. After adjustment for the newly implemented Grade Group system of prostate cancer, IDC-P showed a strong tendency toward statistical significance. However, IDC-P did not remain a statistically significant predictor in the multivariable analysis. IDC-P on diagnostic needle biopsy is an indicator of prostate cancer with a high risk of mortality. Accordingly, a diagnosis of IDC-P on needle biopsy should be reported and considered a feature of high-risk prostate cancer. Moreover, the association between IDC-P and reactive stroma provides evidence in support of the idea that stromal factors

  3. Origin, pattern, and mechanism of bile duct proliferation following biliary obstruction in the rat.

    Science.gov (United States)

    Slott, P A; Liu, M H; Tavoloni, N

    1990-08-01

    Proliferation of bile duct-like structures is a hepatic cellular reaction observed in most forms of human liver disease and in a variety of experimental conditions associated with liver injury. Yet the origin, means of initiation, and significance of this hyperplasia are unknown. To clarify these issues we induced bile duct proliferation in rats by ligating the common bile duct and studied (a) hepatic incorporation of [3H]thymidine by histoautoradiography, (b) hepatic morphometry, (c) biliary tree volume using [3H]taurocholate as a marker of biliary transit time, (d) immunohistochemical expression of cytokeratin no. 19, (e) the effect of indomethacin, and (f) the role of increased biliary pressure, in the absence of physiological and biochemical evidence of cholestasis, on [3H]thymidine incorporation by the bile-duct cells. The results have demonstrated that (a) the proliferating bile duct-like cells are products of the extant biliary epithelium and retain its characteristics; (b) bile duct cells divide irrespective of the size of the duct in which they are located and form a system with a lumen continuous with the preexisting one; (c) bile duct proliferation results mainly in elongation, not in circumferential enlargement or sprouting of side branches; (d) portal macrophage infiltration does not play a role in the hyperplastic reaction, and (e) increased biliary pressure is the initiating factor in bile duct cell division. Our results provide evidence that under the present conditions, ductular metaplasia of hepatocytes does not occur and there is no functioning stem cell for biliary epithelial growth segregated in any particular duct size or within the portal connective tissue.

  4. Retrieval of Surgical Clip from Common Bile Duct by Endoscopic Retrograde Cholangiopancreatography: A Rare Complication of Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Shahid Rasool

    2017-04-01

    Full Text Available Laparoscopic cholecystectomy has become the standard procedure for the surgical management of symptomatic cholelithiasis. Laparoscopic cholecystectomy is generally considered a safe procedure although a few complications such as major bleeding, wound infection, bile leakage, biliary and bowel injury are well known. We are reporting a case of a thirty-seven year old male who presented with abdominal pain, three weeks after laparoscopic cholecystectomy. Abdominal ultrasound revealed a filling defect in common bile duct with deranged liver function tests. With an impression of choledocholithiasis, his endoscopic retrograde cholangiopancreatography (ERCP was done which revealed a surgical clip impacted in the ampulla. The surgical clip was retrieved successfully by ERCP. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy. Appropriate management requires timely identification and retrieval during ERCP.

  5. Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    ZHANG Kai

    2015-05-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy in the treatment of malignant obstructive jaundice. MethodsThis study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014. Nine of them (test group underwent percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement. The other 11 similar cases (control group underwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography. Operative complications and remission of jaundice were observed, and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups. ResultsAll patients were followed completely by outpatient or telephone. The stent patency rate at 3 months after operation was 9/9 in the test group and 8/11 in the control group (χ2=2.888, P=0.218, and the stent patency rates at 6 months were 7/8 and 3/11, respectively (χ2=6.739, P=0.02. During follow-up, one case in the test group died of gastrointestinal bleeding at 113 d after operation; one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. ConclusionPercutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction, and the preliminary efficacy in prolonging the patency of self-expanding metallic stent is satisfactory. However, this therapy needs to be further verified via large-sample randomized controlled studies.

  6. Performance Study of a Ducted Fan System

    Science.gov (United States)

    Abrego, Anita I.; 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 with the objective of determining the performance characteristics of a ducted fan. The model was an annular duct with a 38-in diameter, 10-in chord, and a 5-bladed fixed-pitch fan. Model variations included duct angle of attack, exit vane flap length, flap deflection angle, and duct chord length. Duct performance data were obtained for axial and forward flight test conditions. Axial flow test data showed figure of merit decreases with increasing advance ratio. Forward flight data showed an increasing propulsive force with decreasing duct angle of attack. Exit vane flap deflection angle and flap chord length were shown to be an effective way of providing side force. Extending the duct chord did not effect the duct performance.

  7. Affections of the salivary ducts in buffaloes

    Directory of Open Access Journals (Sweden)

    N.A. Misk

    2014-06-01

    Full Text Available The aim of the present study was to determine different affections of the salivary ducts in buffaloes with special reference to diagnosis and treatment. The study was carried out on 39 buffaloes suffering from different affections of the salivary ducts. The recorded affections of the salivary ducts in buffaloes include; ectasia of the parotid duct (21 cases, parotid duct fistula (15 cases and sialocele (3 cases. Each case was subjected to full study including case history, clinical examination, diagnosis, and treatment whenever possible. Exploratory puncture and radiography were used for confirmation of diagnosis. Intraoral marsupialization was performed for treatment of parotid duct ectasia. Salivary fistula was corrected by one of two successful techniques; the first by reconstruction of the parotid duct and the second by ligation of the parotid duct just caudal to the fistula opening. Sialoceles were corrected by removal of the mandibular salivary gland of the affected side.

  8. Intraductal papilloma in a reconstructed breast: mammographic and sonographic appearance with pathologic correlation.

    Science.gov (United States)

    Mesurolle, Benoît; Kethani, Karim; El-Khoury, Mona; Meterissian, Sarkis

    2006-10-01

    The usual abnormal mammographic and sonographic findings encountered after reconstruction with autologous myocutaneous flaps for breast carcinoma, include fat necrosis, calcifications, lymphedema, and locally recurrent carcinoma. This case report describes a case of an intraductal papilloma occurring in a reconstructed breast in a 48-year-old woman who underwent a left-sided mastectomy for recurrent ductal carcinoma in situ followed by immediate reconstruction with a supercharged transverse rectus abdominal muscle flap. The role of imaging in the detection and management of occult or clinically palpable abnormalities in reconstructed breasts is discussed.

  9. Duct injection technology prototype development

    Energy Technology Data Exchange (ETDEWEB)

    Harper, S.L. (Babcock and Wilcox Co., Alliance, OH (United States). Research and Development Div.)

    1991-08-01

    This report describes a test program conducted to determine the corrosion rate of materials in the dry scrubber or duct injection systems. Four materials were evaluated: 1010 carbon steel, Corten, 317SS and Hastelloy C-276. The results show that acidic conditions result in higher corrosion rates than alkaline conditions for all the materials. The carbon steel, Corten and stainless steel show moderate to heavy pitting attack in the acidic environment. For the alkaline conditions, the corrosion rates of carbon steel and Corten were higher than the stainless steel or Hastelloy C-276. Also, the corrosion rate of abraded specimens were four time those of unabraded specimens in the flue gas. It is probable that areas of wall-wetting and plugging in the duct injection process will exhibit high rates of corrosion for the carbon steel, Corten, and stainless steel materials. General corrosion and pitting corrosion will predominate. Additionally, abraded duct areas will corrode at a significantly higher rate than unabraded duct materials. 6 refs., 11 figs., 7 tabs.

  10. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... cholesterol) and by-products of drugs from the body. The biliary tract consists of small tubes (ducts) that carry bile from the liver to the gallbladder and then to the small intestine. The gallbladder is a small, pear-shaped sac located beneath the liver. It stores bile. ...

  11. Immunohistochemical expression of sex steroid hormone receptors, cell cycle regulators and angiogenesis factors in intraductal papillary mucinous neoplasms: an explorative study.

    Science.gov (United States)

    Georgiadou, Despoina; Sergentanis, Theodoros N; Sakellariou, Stratigoula; Filippakis, George M; Zagouri, Flora; Psaltopoulou, Theodora; Lazaris, Andreas C; Patsouris, Efstratios; Gounaris, Antonia; Zografos, George C

    2015-02-01

    The objectives of our explorative study were to (i) evaluate the immunohistochemical expression of sex steroid hormone receptors (estrogen receptor a [ERα], estrogen receptor β [ERβ], progesterone receptor [PR] and androgen receptor [AR]), angiogenesis factors (vascular endothelial growth factor [VEGF] and inhibitor of differentiation/DNA synthesis 1 [Id-1]) and cell-cycle regulators (cyclin D1, p16 and p27) in intraductal papillary mucinous neoplasms (IPMNs) in comparison to normal adjacent pancreatic tissues and (ii) assess their correlation with the grade and histological sub-type of those lesions. Paraffin-embedded specimens from 12 consecutive patients with IPMNs were immunostained for the studied markers and staining quantification was assessed by an image analysis system. AR H-score and cyclin D1 H-score were significantly higher in the IPMN lesions (0.86±0.33 vs. 0.57±0.12 in the normal tissue, p=0.010 and 0.47±0.23 vs. 0.21±0.20 in the normal tissue, p=0.019, respectively). No significant differences were noted regarding the expression of ERα, ERβ, PR, p16, p27, VEGF, Id-1 or MVD. Moreover, no significant associations were found between the expression of studied markers and grade or histological subtype. Our study showed higher expression of AR and cyclin D1 in IPMNs compared to normal pancreatic ducts without any association between AR and cyclin D1 expression and IPMNs' grade or subtype. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Usefulness of positron emission tomography (PET)/contrast-enhanced computed tomography (CE-CT) in discriminating between malignant and benign intraductal papillary mucinous neoplasms (IPMNs).

    Science.gov (United States)

    Ohta, Koji; Tanada, Minoru; Sugawara, Yoshifumi; Teramoto, Norihiro; Iguchi, Haruo

    2017-10-03

    We evaluated the usefulness of positron emission tomography (PET)/contrast-enhanced computed tomography (CE-CT) in discriminating between malignant and benign intraductal papillary mucinous neoplasms (IPMNs). PET/CE-CT imaging was conducted on 29 IPMN lesions, which subsequently underwent surgery. Preoperative findings on PET/CE-CT imaging were compared with the histological findings of the resected specimens to determine the diagnostic accuracy of PET/CE-CT imaging for evaluation of the differential diagnosis between benign and malignant IPMNs. The final diagnoses of the 29 IPMN lesions were 9 benign and 20 malignant. Overall, 18 of the 20 malignant cases were positive for FDG uptake, while 7 of 9 benign cases were negative. The sensitivity, specificity, and diagnostic accuracy for benign/malignant differentiation using FDG uptake as a marker were 90.0%, 77.8%, and 86.2%, respectively. When guideline-based high-risk findings were used as markers, sensitivity, specificity, and diagnostic accuracy for mural nodules were 50.0%, 66.7%, and 55.2%, while they were 40.0%, 56%, and 48.3% for main duct dilatation, respectively. FDG uptake on PET is a useful new marker for malignancy in benign/malignant differentiation. Because PET/CE-CT imaging is a noninvasive imaging modality that can evaluate FDG uptake in addition to the conventional high-risk findings, we believe it should be the first-line method for determining therapeutic approaches to IPMN. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  13. Application of Neural Networks to the Classification of Pancreatic Intraductal Proliferative Lesions

    Directory of Open Access Journals (Sweden)

    Krzysztof Okoń

    2001-01-01

    Full Text Available The aim of the study was to test applycability of neural networks to classification of pancreatic intraductal proliferative lesions basing on nuclear features, especially chromatin texture. Material for the study was obtained from patients operated on for pancreatic cancer, chronic pancreatitis and other tumours requiring pancreatic resection. Intraductal lesions were classified as low and high grade as previously described. The image analysis system consisted of a microscope, CCD camera combined with a PC and AnalySIS v. 2.11 software. The following texture characteristics were measured: variance of grey levels, features extracted from the grey levels correlation matrix and mean values, variance and standard deviation of the energy obtained from Laws matrices. Furthermore we used moments derived invariants and basic geometric data such as surface area, the minimum and maximum diameter and shape factor. The sets of data were randomly divided into training and testing groups. The training of the network using the back‐propagation algorithm, and the final classification of data was carried out with a neural network simulator SNNS v. 4.1. We studied the efficacy of networks containing from one to three hidden layers. Using the best network, containing three hidden layers, the rate of correct classification of nuclei was 73%, and the rate of misdiagnosis was 3%; in 24% the network response was ambiguous. The present findings may serve as a starting point in search for methods facilitating early diagnosis of ductal pancreatic carcinoma.

  14. Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy.

    Science.gov (United States)

    Li, Xin; Weaver, Olena; Desouki, Mohamed Mokhtar; Dabbs, David; Shyum, Susan; Carter, Gloria; Zhao, Chengquan

    2012-12-01

    The follow-up excision (FUE) results were analyzed from 370 cases diagnosed as intraductal papilloma on breast core needle biopsy (CNB) with no history of malignancy or other risk factors. Of these cases, 98.6% were rendered a Breast Imaging Reporting and Data System score of 4 on mammography before the CNB. Fifty-one cases (13.8%) were found to have microcalcifications on microscopic examination of CNB. A total of 7 (1.9%) of 370 cases were upgraded to invasive carcinoma, ductal carcinoma in situ, or pleomorphic lobular carcinoma in situ on FUE. Six of 51 (11.8%) cases with microcalcifications found on imaging and CNB were upgraded to ductal carcinoma in situ or invasive carcinoma, whereas only 1 (0.3%) of 319 cases without microcalcifications was upgraded to pleomorphic lobular carcinoma in situ (P = .003). Results of a multivariate analysis adjusted for age confirmed that microcalcifications was a risk factor for upgrading to cancer, independent of age. Our results indicate that surgical excision is required for intraductal papilloma diagnosed on CNB if microcalcifications are present. However, excision may not be required for those who have no microcalcifications on CNB and no other known risk factors.

  15. A Unifying Theory of Branching Morphogenesis.

    Science.gov (United States)

    Hannezo, Edouard; Scheele, Colinda L G J; Moad, Mohammad; Drogo, Nicholas; Heer, Rakesh; Sampogna, Rosemary V; van Rheenen, Jacco; Simons, Benjamin D

    2017-09-21

    The morphogenesis of branched organs remains a subject of abiding interest. Although much is known about the underlying signaling pathways, it remains unclear how macroscopic features of branched organs, including their size, network topology, and spatial patterning, are encoded. Here, we show that, in mouse mammary gland, kidney, and human prostate, these features can be explained quantitatively within a single unifying framework of branching and annihilating random walks. Based on quantitative analyses of large-scale organ reconstructions and proliferation kinetics measurements, we propose that morphogenesis follows from the proliferative activity of equipotent tips that stochastically branch and randomly explore their environment but compete neutrally for space, becoming proliferatively inactive when in proximity with neighboring ducts. These results show that complex branched epithelial structures develop as a self-organized process, reliant upon a strikingly simple but generic rule, without recourse to a rigid and deterministic sequence of genetically programmed events. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  16. Long-term surveillance is necessary after operative resection for intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Hirono, Seiko; Kawai, Manabu; Okada, Ken-Ichi; Miyazawa, Motoki; Shimizu, Atsushi; Kitahata, Yuji; Ueno, Masaki; Yanagisawa, Akio; Yamaue, Hiroki

    2016-08-01

    There is not enough evidence to establish an appropriate surveillance strategy after operative resection for intraductal papillary mucinous neoplasm. This study included 257 consecutive intraductal papillary mucinous neoplasm patients who underwent operative resection between July 1999 and March 2014. The frequencies, patterns, time-to-event, and risk factors for postoperative recurrence in intraductal papillary mucinous neoplasm were analyzed. Fifty-six intraductal papillary mucinous neoplasm patients (21.8%) had recurrence after the operation, including those with remnant pancreatic recurrence (n = 14) and extrapancreatic recurrence (n = 42). Remnant pancreatic recurrence had no influence on the overall survival, whereas patients with extrapancreatic recurrence had significantly worse overall survival (P neoplasm patients with extrapancreatic recurrence was shorter than that for patients with remnant pancreatic recurrence (median overall survival: 21.8 versus 110.6 months; P 5 years after the operation. All extrapancreatic recurrences occurred within 5 years. We found that the positive pancreatic transection margin was the only independent risk factor for remnant pancreatic recurrence (P neoplasm (P neoplasm patients should be subject to continual surveillance every 6 months for >5 years after operation to evaluate the remnant pancreatic recurrence; furthermore, the data indicate that strict 5-year surveillance, including every 3 months for 1 year after the operation and every 6 months thereafter, is necessary for intraductal papillary mucinous neoplasm patients at risk for extrapancreatic recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    1999-10-01

    noted below. (3) Stimulation of nipple duct fluid with oxytocin , a material used in stimulating breast feeding. One of the investigators tried a nasal ...DAMD17-96-C-6117 1/31/97 Phase IA: Anatomy of nipple duct orifices Part one. Anatomy of nipple duct orifices in lactating women data analysis of nipple... lactating women Data analysis of nipple data (completed year 1) note the original work was done under DOD Grant DAMD1 7-94-J-4281 and the analysis

  18. Development of Intraductal Techniques for Breast Cancer Prevention, Diagnosis, and Treatment

    Science.gov (United States)

    1997-10-01

    stimulating breast feeding. One of the investigators tried a nasal spray of oxytocin and noted no increase in breast ductal fluid. None of these were...withdraw saline) or acellular return. In our anatomical studies we found that the median number of lactating duct orifices identified per breast was 5...observations that are clinically relevant. "* The median number of lactating breast duct orifices per nipple is 5 with a range from 1-12. They form a

  19. Quadcopter thrust optimization with ducted-propeller

    Directory of Open Access Journals (Sweden)

    Kuantama Endrowednes

    2017-01-01

    Full Text Available In relation to quadcopter body frame model, propeller can be categorized into propeller with ducted and without ducted. This study present differences between those two using CFD (Computational Fluid Dynamics method. Both categories utilize two blade-propeller with diameter of 406 (mm. Propeller rotation generates acceleration per time unit on the volume of air. Based on the behavior of generated air velocity, ducted propeller can be modeled into three versions. The generated thrust and performance on each model were calculated to determine the best model. The use of ducted propeller increases the total weight of quadcopter and also total thrust. The influence of this modeling were analyzed in detail with variation of angular velocity propeller from 1000 (rpm to 9000 (rpm. Besides the distance between propeller tip and ducted barrier, the size of ducted is also an important part in thrust optimization and total weight minimization of quadcopter.

  20. Specific transduction and labeling of pancreatic ducts by targeted recombinant viral infusion into mouse pancreatic ducts.

    Science.gov (United States)

    Guo, Ping; Xiao, Xiangwei; El-Gohary, Yousef; Criscimanna, Angela; Prasadan, Krishna; Rymer, Christopher; Shiota, Chiyo; Wiersch, John; Gaffar, Iliana; Esni, Farzad; Gittes, George K

    2013-11-01

    Specific labeling of pancreatic ducts has proven to be quite difficult. Such labeling has been highly sought after because of the power it would confer to studies of pancreatic ductal carcinogenesis, as well as studies of the source of new insulin-producing β-cells. Cre-loxp recombination could, in theory, lineage-tag pancreatic ducts, but results have been conflicting, mainly due to low labeling efficiencies. Here, we achieved a high pancreatic duct labeling efficiency using a recombinant adeno-associated virus (rAAV) with a duct-specific sox9 promoter infused into the mouse common biliary/pancreatic duct. We saw rapid, diffuse duct-specific labeling, with 50 and 89% labeling in the pancreatic tail and head region, respectively. This highly specific labeling of ducts should greatly enhance our ability to study the role of pancreatic ducts in numerous aspects of pancreatic growth, development and function.

  1. Molecular Mechanisms of Bile Duct Development

    OpenAIRE

    Zong, Yiwei; Stanger, Ben Z.

    2010-01-01

    The mammalian biliary system, consisting of the intrahepatic and extrahepatic bile ducts, is responsible for transporting bile from the liver to the intestine. Bile duct dysfunction, as is seen in some congenital biliary diseases such as Alagille syndrome and biliary atresia, can lead to the accumulation of bile in the liver, preventing the excretion of detoxification products and ultimately leading to liver damage. Bile duct formation requires coordinated cell-cell interactions, resulting in...

  2. 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.

  3. The evaluation of extensive intraductal component (EIC) in breast carcinoma using MR mammography

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Yasuhiro; Mineta, Masayuki; Yamada, Tomonori [Asahikawa Medical Univ. (Japan)] [and others

    1997-10-01

    Twenty-one patients with breast cancer underwent MR mammography (MRM) for evaluation of extensive intraductal component (EIC). Linear or small nodular structures continuing to main tumor, irregular margin, and early stain on dynamic scan were considered to be suggestive of EIC. The sensitivity, specificity and accuracy of detecting EIC were 88.9%, 91.7% and 90.5%, respectively. Misleading structures or pathological conditions to distinguish from EIC on MRM were interstitial connective tissue, interstitial spreading of the cancer, mastitis, and vessels. Although MRM appears to be very useful in evaluating EIC of the breast cancer, it is necessary for the radiologist to understand that there are several misleading signal intensities or abnormal enhancement to discriminate from EIC. (author)

  4. Neuro-Oncology Branch

    Science.gov (United States)

    ... BTTC are experts in their respective fields. Neuro-Oncology Clinical Fellowship This is a joint program with ... can increase survival rates. Learn more... The Neuro-Oncology Branch welcomes Dr. Mark Gilbert as new Branch ...

  5. Branched polynomial covering maps

    DEFF Research Database (Denmark)

    Hansen, Vagn Lundsgaard

    1999-01-01

    A Weierstrass polynomial with multiple roots in certain points leads to a branched covering map. With this as the guiding example, we formally define and study the notion of a branched polynomial covering map. We shall prove that many finite covering maps are polynomial outside a discrete branch...... set. Particular studies are made of branched polynomial covering maps arising from Riemann surfaces and from knots in the 3-sphere....

  6. Branched polynomial covering maps

    DEFF Research Database (Denmark)

    Hansen, Vagn Lundsgaard

    2002-01-01

    A Weierstrass polynomial with multiple roots in certain points leads to a branched covering map. With this as the guiding example, we formally define and study the notion of a branched polynomial covering map. We shall prove that many finite covering maps are polynomial outside a discrete branch...... set. Particular studies are made of branched polynomial covering maps arising from Riemann surfaces and from knots in the 3-sphere. (C) 2001 Elsevier Science B.V. All rights reserved....

  7. Cytopathologic diagnosis of oncocytic type intraductal papillary mucinous neoplasm: Criteria and clinical implications of accurate diagnosis.

    Science.gov (United States)

    Reid, Michelle D; Stallworth, Christina R; Lewis, Melinda M; Akkas, Gizem; Memis, Bahar; Basturk, Olca; Adsay, Volkan

    2016-02-01

    Cytologic findings of pancreatic oncocytic-type intraductal papillary mucinous neoplasms (IPMNs)/intraductal oncocytic papillary neoplasms (IOPNs) are largely unknown. Five IOPNs encountered by the authors were analyzed. Four IOPNs were located in the pancreatic head, and 1 was located in the pancreatic body/tail in 2 men and 3 women ages 56 to 84 years (mean age, 66 years). Radiologic diagnoses included pancreatic ductal adenocarcinoma (PDAC) in 2 patients, invasive cancer associated with IPMN in 1 patient, IPMN versus mucinous cystic neoplasm in 1 patient, and cystic mass in 1 patient. Cytologic findings included: hypercellular smears (4 of 5 cases) containing well formed clusters of oncocytic cells (5 of 5 cases) with prominent, slightly eccentric nucleoli (4 of 5 cases), predominantly arranged in sheets/papillary units (5 of 5 cases), with punched-out intercytoplasmic spaces (4 of 5 cases), and with occasional 3-dimensional groups and focal necrosis (3 of 5 cases). The intracytoplasmic mucin and thick extracellular mucin typical of other IPMNs were observed only in 2 cases and were very limited. The mean size on resection was 4.5 cm. Invasion was observed in 3 cases (0.1, 0.3, and 2.0 cm) of tubular-type IPMN. Initial cytologic evaluation was performed by the authors in 4 of 5 cases, which were diagnosed as IOPN (n = 3) and IPMN versus cystic PDAC (n = 1). One case was initially misdiagnosed as PDAC and, on resection, proved to be noninvasive IOPN. Cytologic features of IOPNs are classical, similar to their histologic counterparts, and differ significantly from other IPMN subtypes. Because of their highly complex appearance, they are often radiologically misdiagnosed as PDAC; thus, failure to recognize their characteristic features on fine-needle aspiration may lead to inappropriate treatment. Patients with IOPN have an incomparably better prognosis than patients with ordinary PDAC, even when their neoplasms are invasive. © 2015 American Cancer Society.

  8. Minimum Leakage/Low Cost Duct Connections

    Energy Technology Data Exchange (ETDEWEB)

    John Proctor

    2003-08-01

    Leaky and disconnected joints in HVAC air distribution systems are extremely widespread. The average efficiency of duct systems in homes in the US is approximately 55% with approximately 60% of the loss due to duct leakage. Beyond the energy and emissions penalties caused by these leaks, leaky systems have detrimental comfort, health, and safety effects. The health and safety effects include the delivery of combustion products into the homes due to leakage induced depressurization. Current duct installation practice does not attempt to address the problem. This project developed a prototype Professionally Engineered Duct System that will virtually eliminate air leakage and that can be applied in new and replacement installations at the same labor cost as current designs. It uses snap-together duct fittings that will not come apart, can be applied to all types of duct systems, and cannot be separated without exceptional force. its use would require minimal changes to current installation practice. The research team developed the prototype through a multi-step process beginning with a functional analysis of duct connections. This was followed by identifying duct sealing and attachment methods offering potential to meet design objectives, evaluating the designs in terms of function and economic feasibility, and building and testing the most promising design option. Two versions of this design were developed through a test, revise, retest process. One application was to a rigid sheet metal duct, the other was to a helix core flex duct. The process produced a sheet metal application with 1/20th the leakage of a standard connection and a flex duct application with 1/10th the leakage of a standard connection. A patent search has found that the design will not infringe on existing patents and is patentable.

  9. Three-dimensional reconstructions of intrahepatic bile duct tubulogenesis in human liver

    DEFF Research Database (Denmark)

    Vestentoft, Peter S; Jelnes, Peter; Hopkinson, Branden M

    2011-01-01

    BACKGROUND: During liver development, intrahepatic bile ducts are thought to arise by a unique asymmetric mode of cholangiocyte tubulogenesis characterized by a series of remodeling stages. Moreover, in liver diseases, cells lining the Canals of Hering can proliferate and generate new hepatic...... tissue. The aim of this study was to develop protocols for three-dimensional visualization of protein expression, hepatic portal structures and human hepatic cholangiocyte tubulogenesis. RESULTS: Protocols were developed to digitally visualize portal vessel branching and protein expression of hepatic...... in normal liver and in the extensive ductular reactions originating from intrahepatic bile ducts and branching into the parenchyma of the acetaminophen intoxicated liver. In the developing human liver, three-dimensional reconstructions using multiple marker proteins confirmed that the human intrahepatic...

  10. 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.

  11. 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.

  12. Ducted wind turbine optimization : A numerical approach

    NARCIS (Netherlands)

    Dighe, V.V.; De Oliveira Andrade, G.L.; van Bussel, G.J.W.

    2017-01-01

    The practice of ducting wind turbines has shown a beneficial effect on the overall performance, when compared to an open turbine of the same rotor diameter1. However, an optimization study specifically for ducted wind turbines (DWT’s) is missing or incomplete. This work focuses on a numerical

  13. Thoracic duct lymphography by subcutaneous contrast agent ...

    African Journals Online (AJOL)

    A 4-year-old male Japanese Shiba Inu presented with recurrent chylothorax. The thoracic duct was successfully imaged using computed tomography after the injection of an iodine contrast agent into the subcutaneous tissue surrounding the anus. The thoracic duct was successfully ligated and pericardectomy performed via ...

  14. 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.

  15. 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.

  16. Salivary Duct Cyst: Histo-pathologic Correlation

    Directory of Open Access Journals (Sweden)

    Divya Vinayachandran

    2013-01-01

    Full Text Available Non-neoplastic cysts of the salivary glands are uncommon and represent 2-5% of all salivary gland lesions. They are mainly mucoceles or salivary duct cysts. Unlike a mucocele, which is surrounded by granulation tissue, the salivary duct cyst is lined by epithelium. Salivary duct cysts are more common in the oral minor salivary glands and rarely occur in the major salivary glands, show a marked predilection for the superficial lobe of the parotid, and represent 10% of all salivary gland cysts. Neoplastic differentiation of the lining of the salivary duct cyst has been reported. We report a case of a salivary duct cyst of the left parotid gland, with a review of radiographic and histopathologic features.

  17. Diffuse bile duct tumors: guidelines for management.

    Science.gov (United States)

    Saunders, K; Longmire, W; Tompkins, R; Chavez, M; Cates, J; Roslyn, J

    1991-12-01

    The majority of patients with bile duct cancer have small focal adenocarcinomas localized to the upper, middle, or lower third of the bile duct. In contrast, a small subgroup of patients have been identified with bile duct tumors that are diffuse, involving multiple segments of the extrahepatic biliary tract. Among 186 patients with documented bile duct cancer treated at the UCLA Medical Center between 1954 and 1988, 13 patients (7%) had diffuse lesions. Patients with diffuse tumors had markedly poorer survival rates than did those with focal lesions. As diffuse tumors are not amenable to resection, surgical management consists primarily of establishing suitable biliary drainage. All patients with bile duct cancer should undergo careful intraoperative evaluation to exclude a diffuse lesion before tumor resection.

  18. Advantages of laparoscopic common bile duct exploration in common bile duct stones.

    Science.gov (United States)

    Li, Ke-Yue; Shi, Cheng-Xian; Tang, Ke-Li; Huang, Jian-Zhao; Zhang, De-Lin

    2017-07-31

    To compare the efficacy, safety, and surgical outcomes of laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, and open common bile duct exploration for treatment of common bile duct stones. In total, 210 patients were prospectively randomized into 3 groups: laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, and open common bile duct exploration. The primary outcome measures were the common bile duct stone clearance rate and the complication rate. The secondary outcome measures were mortality, total costs, and length of hospital stay. The success rates in the laparoscopic common bile duct exploration group (97.14%, 68 out of 70) and open common bile duct exploration group (98.57%, 69/70) were significantly higher than that in the endoscopic retrograde cholangiopancreatography group (85.71%, 60/70, both p  0.05). Laparoscopic common bile duct exploration provides an alternative therapeutic approach that was safer and more reliable, allowed for earlier recovery, and provided more cost-effective treatment of common bile duct stones.

  19. GNAS(R201H) and Kras(G12D) cooperate to promote murine pancreatic tumorigenesis recapitulating human intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Taki, K; Ohmuraya, M; Tanji, E; Komatsu, H; Hashimoto, D; Semba, K; Araki, K; Kawaguchi, Y; Baba, H; Furukawa, T

    2016-05-05

    Intraductal papillary mucinous neoplasm (IPMN), the most common pancreatic cystic neoplasm, is known to progress to invasive ductal adenocarcinoma. IPMNs commonly harbor activating somatic mutations in GNAS and KRAS, primarily GNAS(R201H) and KRAS(G12D). GNAS encodes the stimulatory G-protein α subunit (Gsα) that mediates a stimulatory signal to adenylyl cyclase to produce cyclic adenosine monophosphate (cAMP), subsequently activating cAMP-dependent protein kinase A. The GNAS(R201H) mutation results in constitutive activation of Gsα. To study the potential role of GNAS in pancreatic tumorigenesis in vivo, we generated lines of transgenic mice in which the transgene consisted of Lox-STOP-Lox (LSL)-GNAS(R201H) under the control of the CAG promoter (Tg(CAG-LSL-GNAS)). These mice were crossed with pancreatic transcription factor 1a (Ptf1a)-Cre mice (Ptf1a(Cre/+)), generating Tg(CAG-LSL-GNAS);Ptf1a(Cre/+) mice. This mouse line showed elevated cAMP levels, small dilated tubular complex formation, loss of acinar cells and fibrosis in the pancreas; however, no macroscopic tumorigenesis was apparent by 2 months of age. We then crossed Tg(CAG-LSL-GNAS);Ptf1a(Cre/+) mice with LSL-Kras(G12D) mice, generating Tg(CAG-LSL-GNAS);LSL-Kras(G12D);Ptf1a(Cre/+) mice. We used these mice to investigate a possible cooperative effect of GNAS(R201H) and Kras(G12D) in pancreatic tumorigenesis. Within 5 weeks, Tg(CAG-LSL-GNAS);LSL-Kras(G12D);Ptf1a(Cre/+) mice developed a cystic tumor consisting of marked dilated ducts lined with papillary dysplastic epithelia in the pancreas, which closely mimicked the human IPMN. Our data strongly suggest that activating mutations in GNAS and Kras cooperatively promote murine pancreatic tumorigenesis, which recapitulates IPMN. Our mouse model may serve as a unique in vivo platform to find biomarkers and effective drugs for diseases associated with GNAS mutations.

  20. Evaluation of Intraductal Ultrasonography, Endoscopic Brush Cytology and K-ras, P53 Gene Mutation in the Early Diagnosis of Malignant Bile Duct Stricture

    Directory of Open Access Journals (Sweden)

    Ping Huang

    2015-01-01

    Conclusions: IDUS combined with brush cytology and K-ras, P53 gene mutation detection is better than the separate detection and contribute to the early diagnosis of malignant biliary stricture. Its more widespread use is recommended.

  1. Symptomatic pancreatic duct stones in the disconnected bile duct: A case series.

    Science.gov (United States)

    Ende, Alexander R; Irani, Shayan; Kozarek, Richard A

    Pancreaticobiliary maljunction (PBM) refers to the union of the pancreatic and biliary ducts outside of the duodenal wall. Patients are at increased risk of bile duct and gallbladder cancer, likely secondary to pancreatic juice refluxing into the biliary tree, and it is recommended that they undergo biliary diversion. This is a case series of all patients in our institution with PBM and bilioenteric anastomosis who presented with symptomatic pancreatic duct stones in a disconnected bile duct. IRB approval was obtained prior to the initiation of the study. We describe eight cases of this finding. All patients underwent ERCP, with stones successfully removed from the disconnected bile duct in seven patients and from the pancreatic duct in one patient. This novel finding has not been described in the medical literature, and may become more prevalent as more patients with PBM undergo bilioenteric anastomosis. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  2. Coherent branching feature bisimulation

    Directory of Open Access Journals (Sweden)

    Tessa Belder

    2015-04-01

    Full Text Available Progress in the behavioral analysis of software product lines at the family level benefits from further development of the underlying semantical theory. Here, we propose a behavioral equivalence for feature transition systems (FTS generalizing branching bisimulation for labeled transition systems (LTS. We prove that branching feature bisimulation for an FTS of a family of products coincides with branching bisimulation for the LTS projection of each the individual products. For a restricted notion of coherent branching feature bisimulation we furthermore present a minimization algorithm and show its correctness. Although the minimization problem for coherent branching feature bisimulation is shown to be intractable, application of the algorithm in the setting of a small case study results in a significant speed-up of model checking of behavioral properties.

  3. Intraductal papillary mucinous neoplasm of the pancreas, one manifestation of a more systemic disease?

    Science.gov (United States)

    Roch, Alexandra M; Rosati, Carlo Maria; Cioffi, Jessica L; Ceppa, Eugene P; DeWitt, John M; Al-Haddad, Mohammad A; House, Michael G; Zyromski, Nicholas J; Nakeeb, Attila; Schmidt, C Max

    2016-03-01

    Several studies have demonstrated a high prevalence of extrapancreatic malignancies, and an association with autoimmune pancreatitis in patients with intraductal papillary mucinous neoplasm (IPMN). We hypothesized that IPMNs were associated with an increase rate of systemic diseases. From 1996 to 2013, a retrospective analysis of a prospectively collected database was performed and supplemented with electronic medical charts review. Two hundred twenty extrapancreatic malignancies were found in 185 patients (22%) compared with expected 5% in the general population. Colorectal, lung, and renal cell carcinoma had significant observed/expected ratios (P < .0001). One hundred ten synchronous autoimmune diseases were found in 96 patients (11%). Systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease showed statistically significant observed/expected ratios (P < .0001, .01, and <.0001, respectively). There was no impact of immunosuppressive treatment on the IPMN subtype and malignancy rate. IPMN are associated with surprisingly high rates of autoimmune diseases suggesting that IPMN might be 1 manifestation of a more systemic disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 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.

  5. Traumatic resin ducts as indicators of bark beetle outbreaks

    Science.gov (United States)

    R. Justin DeRose; Matthew F. Bekker; James N. Long

    2017-01-01

    The formation of traumatic resin ducts (TRDs) represents an important induced defense in woody plants that enhances oleoresin production and flow in response to environmental perturbations. In some genera (Pinus), resin ducts are copious and conspicuous; however, in others (Picea), resin ducts are relatively rare. The occurrence and strength of resin ducts, in...

  6. Sun ducts: new design and applications

    Energy Technology Data Exchange (ETDEWEB)

    Coch, H.; Isalgue, A. [School of Architecture, Barcelona (Spain)

    2000-07-01

    Developed in Barcelona since 1968, sun ducts are an architectural technique which takes advantage of direct sunlight, enabling it to reach interior zones of buildings which would normally be dark and gloomy. In addition to its main function of illuminating interiors with a special quality, unlike other natural lighting devices, sun ducts also offer other associated functional possibilities making their use highly advantageous in many cases of dense modern architecture. In recent years, using the experience gained since 1968, we have been attempting to produce standardised sun duct designs; new models have been researched and developed which once standardised, have begun to be used in buildings. The good results in the applications carried out and the ample possibilities for future uses of the ducts in architectural and urban design solutions in compact urban fabrics together make the development of applications of this technique very interesting. (author)

  7. Thoracic duct injury from blunt trauma.

    Science.gov (United States)

    Pai, G P; Bhatti, N A; Ellison, R G; Rubin, J W; Moore, H V

    1984-05-01

    We have reported a case of traumatic chylothorax occurring as a rare complication of fracture dislocation of the dorsal spine. When conservative management by drainage, low-fat diet, and parenteral alimentation proved unsuccessful, thoracic duct ligation effected a cure.

  8. Mode propagation and attenuation in lined ducts

    CERN Document Server

    BI, Wenping

    2014-01-01

    Optimal impedance for each mode is an important concept in an infinitely long duct lined with uniform absorption material. However it is not valid for finite length linings. This is because that the modes in lined ducts are not power-orthogonal; the total sound power is not equal to the sum of the sound power of each mode; cross-power terms may play important roles. In this paper, we study sound propagation and attenuation in an infinite rigid duct lined with a finite length of lining impedance. The lining impedance may be axial segments and circumferentially non-uniform. We propose two new physical quantities Kp and S to describe the self-overlap of the left eigenfunction and right eigenfunction of one mode and the normalized overlap between modes, respectively. The two new physical quantities describe totally the mode behaviors in lined ducts.

  9. 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

  10. 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

  11. Calcium influx pathways in rat pancreatic ducts

    DEFF Research Database (Denmark)

    Hug, M J; Pahl, C; Novak, I

    1996-01-01

    by CCH by 55%. In resting ducts, an increase in extracellular pH, pHe, by means of HEPES and HCO3-/CO2 buffers, increased [Ca2+]i; a decrease in pHe had the opposite effect. In stimulated ducts the pH-evoked effects on Ca2+ influx were more pronounced and depended on the agonist used. At pHe 6.5 both ATP...

  12. Factors affecting common bile duct diameter.

    Science.gov (United States)

    Daradkeh, Salam; Tarawneh, Emad; Al-Hadidy, Azmy

    2005-01-01

    The purpose of the study was to see the effect of age, sex, body mass index, previous cholecystectomy, hepatomegaly and fasting status on the common bile duct diameter. A series of 463 patients, 283 females and 180 males, with no hepatobiliary or pancreatic pathology were included in this study, the mean age was 45 +/- 16 years. Their age, sex, weight, height, fasting status and previous cholecystectomy was assessed and recorded by a physician prior to ultrasound examination. All patients were examined by real-time ultrasound to see if there was any pathology in the hepatobiliary and pancreatic area. Those with history of common bile duct exploration, endoscopic sphincterotomy or with previous history of cholecystectomy of less than 6 months and patients with common bile duct pathology were excluded from the study. The midportion of the common bile duct was taken as a fixed measurement for all patients and the size of the liver was also recorded. Analysis of variance as part of SPSS statistical package was used where common bile duct was considered a dependent variable, while sex, fasting status, hepatomegaly and previous cholecystectomy were considered to be independent variables, age and sex were considered as co-variants. The factors found to be significantly affecting the diameter of the common bile duct (P<0.05) were age, previous cholecystectomy and body mass index. If the CBD dilatation can not be explained by age, previous cholecystectomy and BMI, a pathology causing obstruction should be ruled out.

  13. 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.

  14. Drug-induced bile duct injury.

    Science.gov (United States)

    Visentin, Michele; Lenggenhager, Daniela; Gai, Zhibo; Kullak-Ublick, Gerd A

    2017-09-04

    Drug-induced liver injury includes a spectrum of pathologies, some related to the mode of injury, some to the cell type primarily damaged. Among these, drug-induced bile duct injury is characterized by the destruction of the biliary epithelium following exposure to a drug. Most of the drugs associated with bile duct injury cause immune-mediated lesions to the epithelium of interlobular ducts. These share common histopathological features with primary biliary cholangitis, such as inflammation and necrosis at the expense of cholangiocytes and, if the insult persists, bile duct loss and biliary cirrhosis. Some drugs selectively target larger ducts. Such injury is often dose-dependent and thought to be the result of intrinsic drug toxicity. The histological changes resemble those seen in primary sclerosing cholangitis. This overview focuses on the clinical and pathological features of bile duct injury associated with drug treatment and on the immunological and biochemical effects that drugs exert on the biliary epithelium. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn

    2017-01-01

    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  16. Materials Test Branch

    Science.gov (United States)

    Gordon, Gail

    2012-01-01

    The Materials Test Branch resides at Marshall Space Flight Center's Materials and Processing laboratory and has a long history of supporting NASA programs from Mercury to the recently retired Space Shuttle. The Materials Test Branch supports its customers by supplying materials testing expertise in a wide range of applications. The Materials Test Branch is divided into three Teams, The Chemistry Team, The Tribology Team and the Mechanical Test Team. Our mission and goal is to provide world-class engineering excellence in materials testing with a special emphasis on customer service.

  17. PATHOLOGIC EVALUATION AND REPORTING OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS (IPMNs) OF THE PANCREAS AND OTHER TUMORAL INTRAEPITHELIAL NEOPLASMS OF PANCREATOBILIARY TRACT: RECOMMENDATIONS OF VERONA CONSENSUS MEETING

    Science.gov (United States)

    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; Krasinskas, Alyssa; Klöppel, Günter; Ohike, Nobuyuki; Tajiri, Takuma; Jang, Kee-Taek; Roa, Juan Carlos; Allen, Peter; Castillo, Carlos Fernández-del; Jang, Jin-Young; Klimstra, David S.; Hruban, Ralph H.

    2015-01-01

    Background There are no established guidelines for pathologic diagnosis/reporting of IPMNs. Design An international multidisciplinary group brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results 1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. 2) Invasive component is to be documented in a full synoptic report including its size, type, grade, stage. 3) The term “minimally invasive” should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤0.5, >0.5–≤1, >1 cm), is to be documented. 4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. 5) A category of “indeterminate/(suspicious) for invasion” is acceptable for rare cases. 6) The term “malignant” IPMN should be avoided. 7) The highest grade of dysplasia in the non-invasive component is to be documented separately. 8) Lesion size is to be correlated with imaging findings in cysts with rupture. 9) The main duct diameter, and if possible, its involvement is to be documented; however, it is not required to provide main vs branch duct classification in the resected tumor. 10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. 11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. 12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, intra-biliary/cholecystic). Conclusion These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms. PMID:25775066

  18. Bundle Branch Block

    Science.gov (United States)

    ... 2015. Bundle branch block Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  19. 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...

  20. Immunohistochemical expression of Sonic hedgehog in intraductal papillary mucinous tumor of the pancreas.

    Science.gov (United States)

    Jang, Kee-Taek; Lee, Kyu Taek; Lee, Jong Gyun; Choi, Seoung Ho; Heo, Jin Seok; Choi, Dong Wook; Ahn, Geunghwan

    2007-09-01

    Aberrant expression of Sonic hedgehog (Shh) has been reported in many human cancers including ductal carcinoma of the pancreas. The intraductal papillary mucinous tumor (IPMT) has been considered as one of the precursor lesions of invasive ductal carcinoma of the pancreas. Shh expression in pancreatic IPMT has not been reported. We investigated an immunohistochemical (IHC) expression of Shh in 55 cases of pancreatic IPMT. We analyzed the IHC expression of Shh in the following histologic grades of tumor: adenoma (AD), moderate dysplasia (MD), noninvasive carcinoma (NIC), and invasive carcinoma (IC), and with the following histologic subtype classification: intestinal, pancreatobiliary, null, and unclassifiable type. IHC Shh expression was noted in 6 (46.2%) of 13 AD, 5 (35.7%) of 14 MD, 12 (80%) of 15 NIC, and 11 (84.6%) of 13 IC. Shh expression was significantly increased in malignant IPMT (NIC+IC) compared with nonmalignant IPMT (AD+MD) (82.1% vs. 40.7%, P=0.0005). IHC Shh expression was found in 11 (68.8%) of 16 intestinal types, 13 (92.8%) of 14 pancreatobiliary types, 8 (38.1%) of 21 null types, and 2 (50%) of 4 unclassifiable types. Intestinal and pancreatobiliary subtypes showed a high expression of Shh compared with the null and unclassifiable type of IPMT. All 3 cases of node metastasis showed IHC Shh expression in tumor cells of metastatic lymph nodes. Therefore, Shh expression may have a critical role in the late stage of carcinogenesis of IPMT, and may impact metastatic progression to the lymph nodes in malignant IPMT.

  1. Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy.

    Science.gov (United States)

    Koch, Michael; Schapher, Mirco; Mantsopoulos, Konstantinos; von Scotti, Felix; Goncalves, Miguel; Iro, Heinrich

    2017-12-15

    To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL). Retrospective study in a tertiary referral center. Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis. Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free. These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  2. 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.

  3. [Analysis of clinical prognosis and the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization in patients with hepatocellular carcinoma].

    Science.gov (United States)

    Xu, H Y; Yu, X P; Feng, R; Hu, H J; Xiao, W W

    2017-05-23

    Objective: To evaluate the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization, and to analyze the clinical prognosis of hepatocellular carcinoma patients. Methods: From January18, 2012 to December18, 2014, 21 patients underwent TACE for HCC were retrospectively reviewed, including patients' clinical and pathological data. The clinical outcome and relevant factors for bile duct injury were analyzed. Results: A total of 21 patients were identified with bile duct injury at our single institution. All patients received 48 TACE treatments, including proper hepatic artery (14), left hepatic artery (3), the right hepatic artery (10), left and right hepatic artery (9) and tumor artery branches (12). Thirty-five bile duct injury occurred in 21 patients: 7 cases was close to the tumor, 2 distant to the tumor, 7 at right liver, 2 left liver, 11 both lobes of liver and 6 hepatic hilar. After medical conservative treatment and biliary tract inside and outside drainage, liver function of 10 cases were improved. In four patients with hepatic bile duct stricture and biloma, the effect of drainage was not obvious, which subsequently caused biliary complications such as infection, gallbladder and common bile duct stones. Three patients with liver cirrhosis at decompensation stage developed complications, and one of them died of hepatic encephalopathy. Four patients experienced tumor recurrence during the follow-up period. Conclusions: The location of bile duct injury after transcatheter arterial chemoembolization is quite consistent with the level of hepatic arterial embolization. There may be some blood vessels mainly involved in blood supply of biliary duct. Complete embolism of these vessels may lead to bile duct injuries. Biliary drainage is ineffective in patients with hilar bile duct stricture, and can lead to complications of biliary tract later on.

  4. Numerical simulation of flow past circular duct

    Directory of Open Access Journals (Sweden)

    Ze-gao Yin

    2010-06-01

    Full Text Available The Renormalization Group (RNG k—ɛ 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.

  5. 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.

  6. Numerical simulation of flow past circular duct

    Directory of Open Access Journals (Sweden)

    Ze-gao YIN

    2010-06-01

    Full Text Available On the basis of Fluent software, Renormalization Group (RNGk-ε turbulent model and Volume of Fluid (VOF method are employed to simulate the flow past circular duct to obtain and analyze the hydraulic parameters. According to various upper and bottom gap-ratios, the force on duct is calculated. Firstly, when bottom gap-ratio is 0, drag force coefficient, lift force coefficient and composite force reach the maximum respectively and azimuth reaches the minimum. Secondly, with the increase of bottom gap-ratio from 0 to 1, drag force coefficient and composite force decrease sharply, lift force coefficient decreases a little, but azimuth increases dramatically. Thirdly, with the continuous increase of bottom gap-ratio from 1, drag force coefficient, lift force coefficient, composite force and azimuth vary little. So, bottom gap-ratio is the key factor influencing the force on circular duct. When bottom gap-ratio is less than 1, upper gap-ratio has the remarkable influence on the circular duct force. When bottom gap-ratio is greater than 1, the varation of upper gap-ratio has a little influence on the circular duct force.

  7. Analytical review of diagnosis and treatment strategies for dominant bile duct strictures in patients with primary sclerosing cholangitis

    Science.gov (United States)

    Aljiffry, Murad; Renfrew, Paul D; Walsh, Mark J; Laryea, Marie; Molinari, Michele

    2011-01-01

    Background The diagnosis and treatment of indeterminate dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the literature on the subject is scarce. Objectives This review aims to appraise and synthesize the evidence published in the English-language medical literature on this topic. Methods Scientific papers published from 1950 until week 4 of July 2010 were extracted from MEDLINE, Ovid Medline In-Process, the Cochrane Database of Systematic Reviews, the Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, EMBASE, PubMed and the National Library of Medicine Gateway. Results Strategies for the optimal management of DS in PSC patients are supported only by level II and III evidence. Intraductal endoscopic ultrasound appears to be the most sensitive (64%) and specific (95%) diagnostic test for the evaluation of DS in PSC. Endoscopic and percutaneous dilatations achieve 1- and 3-year palliation in 80% and 60% of patients, respectively. Although dilatation and stenting are the most common palliative interventions in DS, no randomized trials on the optimal duration of treatment have been conducted. Conclusions In benign DS, endoscopic dilatation with short-term stenting seems to be effective and safe and does not increase the risks for malignant transformation or complications after liver transplantation. Surgical bile duct resection and/or bilioenteric bypass are indicated only in patients with preserved liver function. PMID:21241424

  8. Endoscopic biliary stenting for irretrievable common bile duct stones: Indications, advantages, disadvantages, and follow-up results.

    Science.gov (United States)

    Yang, Jun; Peng, Jia-yuan; Chen, Wei

    2012-08-01

    The advantages of endoscopic retrograde cholangiopancreatography (ERCP) over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct (CBD) stones cannot be removed with a basket or balloon. Methods for managing "irretrievable stones" include surgery; mechanical, intraductal shock wave, and extracorporeal shock wave lithotripsy; chemical dissolution; and biliary stenting. Endoscopic biliary stent insertion, which is frequently used in specific situations, has both advantages and disadvantages. To maximize the advantages and minimize the complications of biliary endoprosthesis, it is important to recognize its proper indications and to apply the technique in proper situations. We reviewed all publications cited in Pubmed and published through July 2011 on biliary endoprosthesis in patients with irretrievable CBD stones. We analyzed the indications, advantages, disadvantages, and long-term follow-up results of this technique. Despite the occurrence of related complications, such as cholangitis, endoscopic placement of an endoprosthesis may reduce stone size, allowing later clearance of unextractable stones. Permanent biliary stenting may be a definitive treatment in selected elderly patients who are poor candidates for surgery. Endoscopic biliary stenting remains a simple and safe method for patients with stones difficult to manage by conventional endoscopic methods and those patients unfit for surgery or at high surgical risks. Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  9. Synthesis of branched polysaccharides with tunable degree of branching

    NARCIS (Netherlands)

    Ciric, Jelena; Loos, Katja

    2013-01-01

    An in vitro enzyme-catalyzed tandem reaction using the enzymes phosphorylase b from rabbit muscle and Deinococcus geothermalis glycogen branching enzyme (Dg GBE) to obtain branched polyglucans with tunable degree of branching (2% divided by 13%) is presented. The tunable degree of branching is

  10. [Clinical analysis of 22 cases with parotid gland duct injury].

    Science.gov (United States)

    Jiang, Yong-lian; Yang, Pei-lei; Liu, Guo-yuan

    2011-08-01

    To discuss the early diagnosis and treatment of injury to the parotid duct. Segmental epidural catheter was used to repair the injured parotid duct, if the broken ends of the parotid duct can't be anastomized end to end, facial vein transplantation and fascia parotideomasseterica flap were used for reconstruction. In 22 cases, one case was lost to follow-up, nineteen cases had successful reconstruction of the parotid duct with good parotid secretions. Two cases had atrophy of the parotid gland. Early diagnosis is critical for treatment of injury of parotid duct. The efficacy of segmental epidural catheter is excellent for repair of parotid duct defect.

  11. Breast Intraductal Papillomas without Atypia in Radiologic-Pathologic Concordant Core Needle Biopsies: Predictors of Upgrade to Carcinoma at Excision

    Science.gov (United States)

    Pareja, Fresia; Corben, Adriana; Brennan, Sandra; Murray, Melissa P.; Bowser, Zenica; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth; Brogi, Edi

    2016-01-01

    Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. PMID:27315013

  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. 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.

  14. 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...... increased all-cause and cardiovascular mortality in both genders with age-adjusted hazard ratios (HR) of 1.31 [95% confidence interval (CI), 1.11-1.54] and 1.87 (95% CI, 1.48-2.36) in the gender pooled analysis with little attenuation after multiple adjustment. Right bundle branch block was associated...

  15. Patients with a resected pancreatic mucinous cystic neoplasm have a better prognosis than patients with an intraductal papillary mucinous neoplasm : A large single institution series

    NARCIS (Netherlands)

    Griffin, James F; Page, Andrew J; Samaha, Georges J; Christopher, Adrienne; Bhaijee, Feriyl; Pezhouh, Maryam K; Peters, Niek A.; Hruban, Ralph H.; He, Jin; Makary, Martin A; Lennon, Anne Marie; Cameron, John L; Wolfgang, Christopher L; Weiss, Matthew J

    2017-01-01

    BACKGROUND/OBJECTIVES: Mucinous cystic neoplasms (MCNs) are rare pancreas tumors distinguished from intraductal papillary mucinous neoplasms (IPMNs) by the presence of ovarian-type stroma. Historical outcomes for MCNs vary due to previously ambiguous diagnostic criteria resulting in confusion with

  16. Salivary duct carcinoma of the palate

    Directory of Open Access Journals (Sweden)

    Ponniah I

    2005-01-01

    Full Text Available Salivary duct carcinoma is a rare high-grade neoplasm that more frequently affects the parotid gland. Though neoplasms of this type are infrequent in minor salivary glands, they are less aggressive and may lead to early diagnosis before distant metastases could occur. Salivary duct carcinoma is also the most frequent epithelial component of carcinosarcoma. The present article reports a case of SDC of the palate in a 26-year-old male and discusses SDC as a malignant epithelial component in carcinosarcoma.

  17. Collecting duct carcinoma associated with oncocytoma

    Directory of Open Access Journals (Sweden)

    George M. Yousef

    2005-10-01

    Full Text Available Collecting duct carcinoma (CDC is a rare, highly aggressive malignant neoplasm that arises from the collecting duct epithelium of the kidney. CDC was reported to coexist with renal cell and transitional cell carcinomas. We report a rare case of CDC associated with oncocytoma, confirmed by the characteristic histological appearance and immunohistochemistry. We also review the epidemiological, histological and immunohistochemical criteria for diagnosis, in addition to the genetic and cytogenetic aberrations reported in the literature. Identification and reporting CDC is important for the establishment of treatment strategies and monitoring prognosis.

  18. Acoustic power balance in lined ducts

    Science.gov (United States)

    Eversman, W.

    1979-01-01

    It is shown that the two common definitions of acoustic energy density and intensity in uniform unlined ducts carrying uniform flow are compatible to the extent that both energy densities can be used in an appropriate variational principle to derive the convected wave equation. When the duct walls are lined both energy densities must be modified to account for the wall energy density. This results in a new energy conservation equation which utilizes a modified definition of axial power and accounts for wall dissipation. Computations in specific cases demonstrate the validity of the modified acoustic energy relation.

  19. Low-cost orbiting grinder for cutting ducts

    Science.gov (United States)

    Lang, E. J.

    1970-01-01

    Low-cost, portable machine cuts ducts made from heat-treated alloys. An abrasive wheel, powered by a high-speed air motor mounted on an expandible plug against the inner wall of the duct, gives precise cutting.

  20. The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN).

    Science.gov (United States)

    McMillan, Matthew T; Lewis, Russell S; Drebin, Jeffrey A; Teitelbaum, Ursina R; Lee, Major K; Roses, Robert E; Fraker, Douglas L; Vollmer, Charles M

    2016-02-15

    The literature investigating pancreatic invasive intraductal papillary mucinous neoplasm (IPMN) has largely come from small institutional studies, preventing adequately powered comparisons of adjuvant therapy versus surgery alone (SA) within specific patient subgroups. Patients with resected, stage I through IV, invasive IPMN and conventional pancreatic ductal adenocarcinoma (PDAC) were identified in the National Cancer Data Base (1998-2010). Cox modeling of patients with invasive IPMN was used to compare overall survival (OS) between patients who received adjuvant therapy and those who underwent SA. A second model was used to compare OS between patients with invasive IPMN and those with PDAC. For the 1220 patients with invasive IPMN, the median OS was 28.9 months; the 1-year and 5-year actuarial survival rates were 76% and 17%, respectively; and 47% received adjuvant therapy. Cox modeling associated SA with worse OS (hazard ratio, 1.36; 95% confidence interval, 1.17-1.58; P = .00005) as well as American Joint Committee on Cancer (AJCC) TNM stage III/IV disease, positive lymph node status, positive margins, and poor tumor differentiation (all P ≤ .05). In addition, Cox modeling stratified by the following characteristics demonstrated improved OS with adjuvant therapy: AJCC TNM stage II or III/IV, positive lymph node status, positive margins, and poorly differentiated tumors. There was no survival advantage from adjuvant therapy for patients who had AJCC TNM stage I or lymph node-negative disease. Patients who had invasive IPMN had improved risk-adjusted OS compared with those who had PDAC (hazard ratio, 0.73; 95% confidence interval, 0.68-0.78; P < .00001). Invasive IPMN appears to be more indolent than conventional PDAC. Adjuvant therapy is associated with improved OS compared with SA in patients with invasive IPMN, especially for those with higher stage disease, positive lymph nodes, positive margins, or poorly differentiated tumors. Conversely

  1. Mammographic findings predicting an extensive intraductal component in early stage invasive breast cancer : analysis on microcalcification

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ah; Kim, Mi Hye; Lee, Mi Kyung; Oh, Ki Keun [College of Medicine, Yonsei University, Seoul (Korea, Republic of); Kim, Eun Kyung [Pundang CHA General Hospital, College of Medicine, Pochon CHA University, Seoul (Korea, Republic of)

    2000-05-01

    To analyze the mammographic findings of extensive intraductal component (EIC)-positive early invasive breast carcinoma and to determine the mammographic features which predict an EIC positivity in an invasive carcinoma. The mammographic and pathologic findings in 71 patients aged 34-79 (mean 50) years in whom stage I or II invasive breast carcinoma had been diagnosed were retrospectively analysed. The mammographic findings were assigned to one of three groups: mass, mass with microcalcification, or microcalcification only. The shape and distribution of a calcification were classified according to the BI-RADS lexicon, and its extent was classified as either more or less than 3 cm. To detect the presence or absence of EIC and the type of ductal carcinoma in situ (DCIS), the findings were re-examined by means of slide mappings. Twenty-eight of 71 patients (39%) showed ECI positivity. The mammographic findings of EIC-positive invasive cancer (n=3D28) were mass with microcalcification (n=3D14), microcalcification only (n=3D7) and mass only (n=3D7). The mammographic finding which predicted EIC positivity was mass with microcalcification (PPV:0.67, NPV:0.33, p=3D0.02). A mammographic of mass only (n=3D39) showed a significantly high negative predictive value for EIC positivity. (PPV 0.18, NPV 0.82, P less than 0.01). A comparison of cases with or without calcification showed that those with microcalcifications (n=3D32) showed a significantly high PPV of 0.66 (NPV:0.34, p less than 0.01) while those without calcification (n=3D39) showed a significantly high NPV of 0.82 (PPV:0.18, p less than 0.01). There were no significant differences in positive predictive values for EIC between the shape, distribution and extent of calcifications. Whenever microcalcification with or without mass is seen on mammographs obtained during early breast cancer, we can predict EIC-positivity, regardless of shape or distribution according to the BI-RADS lexicon. (author)

  2. Percutaneous Intraductal Radiofrequency Ablation for Extrahepatic Distal Cholangiocarcinoma: A Method for Prolonging Stent Patency and Achieving Better Functional Status and Quality of Life

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Tian-tian, E-mail: matthewwu1979@hotmail.com; Li, Wei-min, E-mail: weimin-li-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Li, Hu-cheng, E-mail: hucheng-li-surgery@126.com [The 307th Hospital of PLA, General Surgery Department (China); Ao, Guo-kun, E-mail: guokun-ao-radiology@126.com [The 309th Hospital of PLA, Radiology Department (China); Zheng, Fang, E-mail: fang-zheng-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Lin, Hu, E-mail: hu-lin-radiology@126.com [The 309th Hospital of PLA, Radiology Department (China)

    2017-02-15

    PurposeThe clinical efficacy of intraductal radiofrequency ablation (RFA) with Habib™ EndoHPB catheter, a newly developed intervention for malignant extrahepatic biliary obstruction, remains uncertain. The aim of this study was to investigate the clinical efficacy of intraductal RFA.MethodsData from 71 patients with extrahepatic distal cholangiocarcinoma were retrospectively analyzed. The study patients were divided into RFA and control groups. The RFA group had undergone percutaneous transhepatic intraductal RFA with a Habib™ EndoHPB catheter, followed by placement of covered or uncovered biliary self-expandable metallic stents (SEMs) whereas the control group had undergone percutaneous transhepatic covered or uncovered SEMs placement. Procedure-related complications, stent patency, patient survival, and postoperative serum bilirubin concentrations were compared between the two groups. The Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire was administered to evaluate functional status, improvement in clinical manifestations, and quality of life.ResultsThe RFA group had a longer median stent patency than the control group (p = 0.001 for uncovered SEMs placement). Higher functional well-being, hepatobiliary-specific cancer subscale, Trial Outcome Index, and total FACT-Hep scores were observed during post-procedure follow-up in the RFA group. However, median survival did not differ significantly between the two groups (p > 0.05).ConclusionsProlongation of stent patency and better functional status and quality of life, which are all important clinical endpoints, were observed in patients treated with intraductal RFA. Prospective randomized controlled clinical trials are necessary to further investigate the clinical efficacy and long-term benefits of intraductal RFA.

  3. HVAC; Heating, Ventilation, Air Conditioning - Aerosol Duct Sealant

    Science.gov (United States)

    2016-09-01

    Expeditionary Warfare Center. This technology internally seals leaks in air distribution ducts by injecting a fog of aerosolized sealant particles...Duct Sealant The Aeroseal™ duct sealant technology was demonstrated in four buildings at four different Navy facilities around the country...climatic conditions and different air distribution systems types. Data on thermal energy and fan power was collected before and after the duct sealant

  4. Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

    OpenAIRE

    Watanabe, Takayuki; Maruyama, Masahiro; Ito, Tetsuya; Maruyama, Masafumi; Muraki, Takashi; Hamano, Hideaki; Arakura, Norikazu; Hasebe, Osamu; Kawa, Shigeyuki

    2014-01-01

    Objectives We attempted to clarify the mechanism underlying lower bile duct stricture in autoimmune pancreatitis. Methods Imaging and histologic finding of the bile duct were assessed for 73 patients with autoimmune pancreatitis to clarify whether IgG4-related biliary inflammation or pancreatic head swelling is associated with lower bile duct stricture. Results Lower bile duct stricture was found in 59 (81%) patients. Pancreatic head swelling was significantly more frequent among patients wit...

  5. State-set branching

    DEFF Research Database (Denmark)

    Jensen, Rune Møller; Veloso, Manuela M.; Bryant, Randal E.

    2008-01-01

    In this article, we present a framework called state-set branching that combines symbolic search based on reduced ordered Binary Decision Diagrams (BDDs) with best-first search, such as A* and greedy best-first search. The framework relies on an extension of these algorithms from expanding a sing...

  6. 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

  7. Detonation duct gas generator demonstration program

    Science.gov (United States)

    Wortman, Andrew; Brinlee, Gayl A.; Othmer, Peter; Whelan, Michael A.

    1991-01-01

    The feasibility of the generation of detonation waves moving periodically across high speed channel flow is experimentally demonstrated. Such waves are essential to the concept of compressing requirements and increasing the engine pressure compressor with the objective of reducing conventional compressor requirements and increasing the engine thermodynamic efficiency through isochoric energy addition. By generating transient transverse waves, rather than standing waves, shock wave losses are reduced by an order of magnitude. The ultimate objective is to use such detonation ducts downstream of a low pressure gas turbine compressor to produce a high overall pressure ratio thermodynamic cycle. A 4 foot long, 1 inch x 12 inch cross-section, detonation duct was operated in a blow-down mode using compressed air reservoirs. Liquid or vapor propane was injected through injectors or solenoid valves located in the plenum or the duct itself. Detonation waves were generated when the mixture was ignited by a row of spark plugs in the duct wall. Problems with fuel injection and mixing limited the air speeds to about Mach 0.5, frequencies to below 10 Hz, and measured pressure ratios of about 5 to 6. The feasibility of the gas dynamic compression was demonstrated and the critical problem areas were identified.

  8. Metastatic leiomyosarcoma of the intrapancreatic bile duct.

    Science.gov (United States)

    Perysinakis, Iraklis; Katopodi, Aggeliki; Avlonitis, Spyridon; Georgiadou, Despoina; Choreftaki, Theodosia; Christopoulos, George; Margaris, Ilias

    2013-01-01

    We report the case of a patient with a history of surgically treated pulmonary leiomyosarcoma, presenting with recurrent acute cholangitis and metastatic leiomyosarcoma of the common bile duct. Preoperative examinations had revealed a high grade malignant neoplasm and bilateral lung metastases. The patient underwent pylorus-preserving pancreaticoduodenectomy and survived for 5.5 years after the first diagnosis.

  9. Whistler instability in a magnetospheric duct

    Energy Technology Data Exchange (ETDEWEB)

    Talukdar, I.; Tripathi, V.K. (Indian Inst. of Tech., New Delhi (India). Dept. of Physics); Jain, V.K. (Jawaharlal Nehru Univ., New Delhi (India). School of Environmental Sciences)

    1989-04-01

    A whistler wave propagating through a preformed magnetospheric duct is susceptible to growth/amplification by an electron beam. The interaction is non-local and could be of Cerenkov or slow-cyclotron type. First-order perturbation theory is employed to obtain the growth rate for flat and Gaussian beam densities. (author).

  10. Transhorizon Radiowave Propagation due to Evaporation Ducting ...

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 11; Issue 1. Transhorizon Radiowave Propagation due to Evaporation Ducting - The Effect of Tropospheric Weather Conditions on VHF and UHF Radio Paths Over the Sea. Salil David Gunashekar D R Siddle E M Warrington. General Article Volume 11 ...

  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,…

  12. Persistent Mullerian Duct Syndrome with Transverse Testicular ...

    African Journals Online (AJOL)

    inguinal side. The opposite scrotum is empty. PMDS with. TTE is rare. We report a case of PMDS with TTE discovered during surgery for a right inguinal hernia in a 25-year-old male. Key words: Mullerian inhibiting factor, persistent. Mullerian duct syndrome, transverse testicular ectopia. Address for correspondence: Dr. P.

  13. 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.

  14. Congenital nasolacrimal duct obstruction: irrigation or probing?

    Science.gov (United States)

    Kim, Y S; Moon, S C; Yoo, K W

    2000-12-01

    The authors investigated the efficacy of antibiotic irrigation as the therapeutic option in congenital nasolacrimal duct obstruction. We retrospectively reviewed the medical record of 76 patients' eyes in whom congenital nasolacrimal duct obstruction had been diagnosed. In 50 of these patients, the colonizing microorganism was identified and, irrigation through canaliculi was performed using antibiotics of suitable sensitivity. Nasolacrimal system probing was performed on 26 patients as the control group. Treatment was regarded successful when over a 4 week period epiphora or mucous discharge disappeared and when saline passed without resistance on irrigation. 96.0% of patients in the irrigation group and 84.6% of patients in probing group were treated successfully. There was no statistical difference in the success rate between the two groups (P = 0.173). The recovery period based on culture results was 3.22 +/- 0.37 months in the group in which microorganisms were isolated and 2.39 +/- 0.35 months in the group in which no organisms were isolated. There were no statistically significant differences in the success rates between the group in which there was growth and the group in which there was no growth (P = 0.1308). Thus a similar result was obtained using nasolacrimal probing and canaliculus antibiotic irrigation in congenital nasolacrimal duct obstruction. Antibiotic irrigation is a safe and simple therapeutic option in congenital nasolacrimal duct obstruction.

  15. Ducted wind turbines : A potential energy shaper

    NARCIS (Netherlands)

    Dighe, V.V.

    2016-01-01

    In order to harvest wind resources more efficiently and to the greatest extent possible, unconventional wind turbine designs have been proposed, but never gained any acceptance in the marketplace. A team of researchers from TU Delft plans to revisit the concept of ducted wind turbines, which have

  16. Surgical management of Stenson's duct injury using epidural ...

    African Journals Online (AJOL)

    Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal ... These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early ...

  17. Persistent Mullerian Duct Syndrome (PMDS With Large Intraabdominal Seminoma

    Directory of Open Access Journals (Sweden)

    Della Harigovind

    2017-07-01

    Full Text Available Persistent Mullerian Duct Syndrome, a form of male pseudohermaphroditism is characterized by the presence of the Mullerian duct derivatives in an otherwise phenotypically as well as genotypically normal male. We report a case of large intra abdominal seminoma in a male patient with cryptorchidism, along with persistence of Mullerian duct derivatives (uterus.

  18. Affections of the salivary ducts in buffaloes | Misk | Open Veterinary ...

    African Journals Online (AJOL)

    Exploratory puncture and radiography were used for confirmation of diagnosis. Intraoral marsupialization was performed for treatment of parotid duct ectasia. Salivary fistula was corrected by one of two successful techniques; the first by reconstruction of the parotid duct and the second by ligation of the parotid duct just ...

  19. Laser-Guided Repair of Complex Bile Duct Strictures

    NARCIS (Netherlands)

    van Gulik, Thomas; Beek, Johan; de Reuver, Philip; Aronson, Daniel; van Delden, Otto; Busch, Olivier; Gouma, Dirk

    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

  20. Termination pattern of the main and accessory pancreatic ducts ...

    African Journals Online (AJOL)

    The pancreas has the main and occasionally a patent accessory pancreatic ducts that carry secretions to the duodenum. Anatomical studies on these ducts are limited. The present study observed the anatomy of the two ducts in eighty six Tanzanians' autopsy subjects to find out if the pattern is similar to those reported from ...

  1. 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

  2. Experimental evaluation of gas filled plenum (GFP) insulation for ducts

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.; Guillot, Cyril

    2003-01-26

    Forced-air heating and cooling system ducts are often located outside conditioned space in US houses. For these systems to perform efficiently it is important that these ducts be well insulated. Common practice is to use a glass fiber wrap around the ducts--either field applied or more commonly, integrated into a flexible duct. Most duct insulation has an R-value of 4.2, with R6 and R8 ducts also occasionally used. With glass fiber insulation being about R4 per inch (RSI 0.28/cm), this adds 2 to 4 inches (50 to 100 mm) to the duct diameter. Some building codes are now requiring these higher insulation levels, for example, the EPA requires the use of R6 ducts (for Energy Star ducts), and International Energy Conservation Code (BOCA 2003) requires R8 ducts. The difficulty with adding insulation to ducts is the increase in diameter of the ducts that makes them expensive to transport because they take up a large volume and are difficult to install in the confined spaces available for ducts in houses. The objective of this study was to evaluate Gas Filled Plenum (GFP) technology as an alternative duct insulation. GFP ducts have the potential to provide greater insulation levels than existing ducts (for a given thickness of insulation or size of duct) and provide cost savings in transportation. These transportation cost savings are based on the idea of shipping the GFP ducts empty and inflating them on-site. To evaluate this technology for ducts we constructed a prototype duct and determined both its flow and heat transfer resistance in LBNL's duct testing laboratories. The GFP technology works by encapsulating a gas (usually air--but other noble gases such as Argon or Krypton can provide significant increases in thermal resistance with increased cost) in a metalized film jacket. A honeycomb structure is used to keep individual gas pockets small to minimize convection heat transfer. A metallic finish (usually aluminum) minimizes radiation heat transfer between the

  3. Late Probing for Congenital Nasolacrimal Duct Obstruction

    Directory of Open Access Journals (Sweden)

    Mohammad Abrishami

    2009-04-01

    Full Text Available

    PURPOSE: To report the results of late nasolacrimal duct probing in patients with congenital nasolacrimal duct obstruction (NLDO. METHODS: This retrospective study was performed on a consecutive series of patients with congenital NLDO who underwent late (after 15 months of age nasolacrimal duct probing for the first time. RESULTS: Over a period of five years, 158 patients including 75 (47.4% male and 83 (52.6% female subjects with mean age of 3±4.2 years (range, 15 months to 37 years underwent initial probing for NLDO. Nasolacrimal duct probing was performed unilaterally in 78% and bilaterally in 22% of the patients. Success rate was 75% overall, 72% in unilateral cases and 83% in bilateral instances. Success rate was not correlated with age at intervention. CONCLUSIONS: Nasolacrimal duct probing seems to be reasonably successful for treatment of congenital NLDO in patients older than 15 months who are seen for the first time. Silicone intubation or dacryocystorhinostomy should be reserved for refractory cases.

  4. Experimental evaluation of gas filled plenum (GFP) insulation for ducts

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.; Guillot, Cyril

    2003-01-26

    Forced-air heating and cooling system ducts are often located outside conditioned space in US houses. For these systems to perform efficiently it is important that these ducts be well insulated. Common practice is to use a glass fiber wrap around the ducts--either field applied or more commonly, integrated into a flexible duct. Most duct insulation has an R-value of 4.2, with R6 and R8 ducts also occasionally used. With glass fiber insulation being about R4 per inch (RSI 0.28/cm), this adds 2 to 4 inches (50 to 100 mm) to the duct diameter. Some building codes are now requiring these higher insulation levels, for example, the EPA requires the use of R6 ducts, and International Energy Conservation Code (BOCA 2003) requires R8 ducts. The difficulty with adding insulation to ducts is the increase in diameter of the ducts that makes them expensive to transport because they take up a large volume and are difficult to install in the confined spaces available for ducts in houses. The objective of this study was to evaluate Gas Filled Plenum (GFP) technology as an alternative duct insulation. GFP ducts have the potential to provide greater insulation levels than existing ducts (for a given thickness of insulation or size of duct) and provide cost savings in transportation. These transportation cost savings are based on the idea of shipping the GFP ducts empty and inflating them on-site. To evaluate this technology for ducts we constructed a prototype duct and determined both its flow and heat transfer resistance in LBNL's duct testing laboratories. The GFP technology works by encapsulating a gas (usually air--but other noble gases such as Argon or Krypton can provide significant increases in thermal resistance with increased cost) in a metalized film jacket. A honeycomb structure is used to keep individual gas pockets small to minimize convection heat transfer. A metallic finish (usually aluminum) minimizes radiation heat transfer between the surfaces.

  5. 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.

  6. 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.

  7. Intraductal papillary mucinous neoplasm in a neonate with congenital hyperinsulinism and a de novo germline SKIL gene mutation.

    Science.gov (United States)

    Jiao, Yuchen; Lumpkins, Kimberly; Terhune, Julia; Hruban, Ralph H; Klein, Alison; Kinzler, Kenneth W; Papadopoulos, Nickolas; Vogelstein, Bert; Strauch, Eric

    2015-01-01

    A 3 day old infant with persistent severe hypoglycemia was found to have a cystic pancreatic tumor. Cessation of glucose infusion led to severe hypoglycemia. Pancreaticoduodenectomy was performed and revealed an intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia. Sequencing of the IPMN revealed a KRAS gene mutation not present in surrounding normal tissues. Deep sequencing of the patient's blood for KRAS mutations showed no evidence of mosaicism. Whole exome sequencing of the blood of the patient and both parents revealed a de novo germline SKIL mutation in the child that was not present in either parent. This suggests a possible role for SKIL in the pathogenesis of pancreatic tumors. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  8. Middle-preserving pancreatectomy for multifocal intraductal papillary mucinous neoplasms of the pancreas: report of a case.

    Science.gov (United States)

    Nishi, Masaaki; Kawasaki, Hideki; Fujii, Masahiko; Nagahashi, Miya; Obatake, Masayoshi; Shirai, Makoto; Yamamoto, Koji; Harada, Masamitsu

    2014-06-01

    Multifocal or continuous pancreatic lesion is identified frequently but finding an appropriate surgical approach is quite challenging. Total pancreatectomy is a useful procedure. However, postoperative endocrine and exocrine disturbance is inevitable. Recently, the safety and feasibility of parenchyma preserving pancreatectomy, including middle-preserving pancreatectomy (MPP), have been reported. MPP is a combined procedure of pancreaticoduodenectomy and distal pancreatectomy, while preserving the body of the pancreas, for cases of multifocal pancreatic lesions. So far, there have only been a few reports that have described MPP. We report a case of MPP for multifocal intraductal papillary mucinous neoplasms of the pancreas, describe the surgical procedure, and discuss the feasibility of MPP as parenchyma-preserving pancreatectomy with reference to the literature.

  9. Coupled parametric design of flow control and duct shape

    Science.gov (United States)

    Florea, Razvan (Inventor); Bertuccioli, Luca (Inventor)

    2009-01-01

    A method for designing gas turbine engine components using a coupled parametric analysis of part geometry and flow control is disclosed. Included are the steps of parametrically defining the geometry of the duct wall shape, parametrically defining one or more flow control actuators in the duct wall, measuring a plurality of performance parameters or metrics (e.g., flow characteristics) of the duct and comparing the results of the measurement with desired or target parameters, and selecting the optimal duct geometry and flow control for at least a portion of the duct, the selection process including evaluating the plurality of performance metrics in a pareto analysis. The use of this method in the design of inter-turbine transition ducts, serpentine ducts, inlets, diffusers, and similar components provides a design which reduces pressure losses and flow profile distortions.

  10. 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.

  11. Usefulness of breast MRI for diagnosing an extensive intraductal component of breast cancer: comparison with mammography and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hee; Kang, Doo Kyung; Jung, Yong Sik; Yim, Hyun Ee [Ajou University College of Medicine, Suwon (Korea, Republic of)

    2006-06-15

    An extensive intraductal component of breast cancer is a principal risk factor for local recurrence, and this is difficult to diagnose with performing only mammography. We investigated the usefulness of breast MRI for evaluating an extensive intraductal component of breast cancer, and we compared this modality with mammography and ultrasonography (US). From March 2003 to July 2004, 90 patients underwent breast MRI among all the patients who were suffering with breast cancer and for whom and EIC was ultimately revealed to be present or not. A total 83 patients with stage I and II breast cancer were finally included in this study. EIC positivity was defined according to the imaging data as follows: 1) microcalcifications beyond the tumor shadow or malignant microcalcifications without a tumor mass on mammography, 2) tubular hypoechoic structures adjacent to the tumor or architectural distortion with calcifications beyond the tumor on US, and 3) linear or ductal enhancement, segmental or regional clumped enhancement, and spotty nodular or reticular enhancement adjacent to the tumor on MRI. EIC was present in 41 patients and this finding was negative in 42 patients. The results were then compared those results from mammography and US. The sensitivities of detecting EIC by mammography, US and MRI were 48.6%, 67.5% and 80.5%, respectively, and the corresponding specificities were 92.3%, 73.2% and 69.0%, respectively. In the cases that were suspected to be EIC positive on more than two imaging modality, the positive predictive value (PPV) was 78.1%. In cases that were suspected of being EIC positive on just one imaging modality, the negative predictive value (NPV) was 75.0%. Breast MRI provides good information about an EIC of breast cancer and it is a more sensitive study than mammography and US, yet the specificity for the detection of EIC is highest on mammography. A combined evaluation by mammography, US and MRI is the most accurate way to diagnose an EIC of breast

  12. 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

    2017-04-01

    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. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. 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.

  14. Renal collecting duct carcinoma in a dog.

    Science.gov (United States)

    Kobayashi, N; Suzuki, K; Shibuya, H; Sato, T; Aoki, I; Nagashima, Y

    2008-07-01

    An 8-year-old, male, mongrel dog developed severe cough and anorexia and died within 3 months. Autopsy revealed an invasive grayish-white mass in the right kidney and multiple nodules in the lungs, thoracic wall, and spleen. Histologically, the renal mass and the other nodules were mainly composed of papillotubular structures lined by oval-to-polygonal pleomorphic cells. The cells were reactive with DBA, PNA, and UEA-1 lectins and positive for vimentin but negative for CD10 and high molecular weight cytokeratin. Because of its histological, histochemical, and immunohistochemical similarities with human collecting duct carcinoma (CDC), a diagnosis of renal collecting duct carcinoma with pulmonary, thoracic, and splenic metastases was established. To our knowledge, this is the first case report of CDC in animals.

  15. Active noise reduction systems in ducts

    Science.gov (United States)

    Tichy, J.; Poole, L. A.; Warnaka, G. E.

    1984-12-01

    Fundamentals of the theory of the sound propagation in ducts with perfectly reflecting walls, relevant to noise reduction systems, is summarized. A brief historical review of the active sound cancellation techniques is given. Systems based on time invariant parameters are analyzed and their inherited drawbacks outlined. A new generation of systems using controllers based on modified adaptive LMS algorithm is described. The measurements in an experimental duct show that the random noise can be reduced by 25-30 dB, while the noise with line spectra can be decreased by up to 40 dB. Good success is also reported with impulse signals which have random time intervals between the pulses.

  16. 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 PRRUB-/- 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 PRRUB-/-, 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 PRRUB-/-/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. Copyright © 2017 the American Physiological Society.

  17. Primary tuberculosis of cystic duct lymph node.

    Science.gov (United States)

    Ghazanfar, Aamir; Asghar, Afifa; Khan, Naqeeb Ullah; Hassan, Iram

    2017-06-16

    Tuberculosis (TC) is very common and significant cause of morbidity and mortality worldwide. Isolated cystic duct lymph node TC cases without involvement of gallbladder are exceedingly rare. It is difficult to diagnose preoperatively because of lack of characteristic signs and symptoms of TC. We report a man aged 45 years who presented with right upper abdominal pain since 1week. It was associated with nausea and postprandial fullness. There was no evidence of jaundice and lymphadenopathy. Abdominal examination showed moderate right upper quadrant tenderness with positive Murphy's sign and splenomegaly but no signs of peritonism. Abdomen ultrasound revealed sludge in gallbladder, dilated pancreatic duct, coarse exotexture of liver, splenomegaly and no lymphadenopathy. He underwent laparoscopic cholecystectomy; histological report showed chronic caseating granulomatous lymphadenitis with Langhans type of giant cells in lymph node near cystic duct with chronic cholecystitis of gallbladder. Standard antituberculosis therapy was given for 12 months. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Thermal Energy Conversion Branch

    Science.gov (United States)

    Bielozer, Matthew C.; Schreiber, Jeffrey, G.; Wilson, Scott D.

    2004-01-01

    The Thermal Energy Conversion Branch (5490) leads the way in designing, conducting, and implementing research for the newest thermal systems used in space applications at the NASA Glenn Research Center. Specifically some of the most advanced technologies developed in this branch can be broken down into four main areas: Dynamic Power Systems, Primary Solar Concentrators, Secondary Solar Concentrators, and Thermal Management. Work was performed in the Dynamic Power Systems area, specifically the Stirling Engine subdivision. Today, the main focus of the 5490 branch is free-piston Stirling cycle converters, Brayton cycle nuclear reactors, and heat rejection systems for long duration mission spacecraft. All space exploring devices need electricity to operate. In most space applications, heat energy from radioisotopes is converted to electrical power. The Radioisotope Thermoelectric Generator (RTG) already supplies electricity for missions such as the Cassini Spacecraft. The focus of today's Stirling research at GRC is aimed at creating an engine that can replace the RTG. The primary appeal of the Stirling engine is its high system efficiency. Because it is so efficient, the Stirling engine will significantly reduce the plutonium fuel mission requirements compared to the RTG. Stirling is also being considered for missions such as the lunar/Mars bases and rovers. This project has focused largely on Stirling Engines of all types, particularly the fluidyne liquid piston engine. The fluidyne was developed by Colin D. West. This engine uses the same concepts found in any type of Stirling engine, with the exception of missing mechanical components. All the working components are fluid. One goal was to develop and demonstrate a working Stirling Fluidyne Engine at the 2nd Annual International Energy Conversion Engineering Conference in Providence, Rhode Island.

  19. The branch librarians' handbook

    CERN Document Server

    Rivers, Vickie

    2004-01-01

    ""Recommended""--Booklist; ""an excellent addition...highly recommended""--Public Libraries; ""clear...very sound advice...strongly recommend""--Catholic Library World; ""excellent resource...organized...well written""--Against the Grain; ""interesting...thoroughly practical...a very good book...well organized...clearly written""--ARBA. This handbook covers a wide variety of issues that the branch librarian must deal with every day. Chapters are devoted to mission statements (the Dallas Public Library and Dayton Metro Library mission statements are highlighted as examples), library systems,

  20. Flight Dynamics Analysis Branch

    Science.gov (United States)

    Stengle, Tom; Flores-Amaya, Felipe

    2000-01-01

    This report summarizes the major activities and accomplishments carried out by the Flight Dynamics Analysis Branch (FDAB), Code 572, in support of flight projects and technology development initiatives in fiscal year 2000. The report is intended to serve as a summary of the type of support carried out by the FDAB, as well as a concise reference of key accomplishments and mission experience derived from the various mission support roles. The primary focus of the FDAB is to provide expertise in the disciplines of flight dynamics, spacecraft trajectory, attitude analysis, and attitude determination and control. The FDAB currently provides support for missions and technology development projects involving NASA, government, university, and private industry.

  1. 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.

  2. Unilateral Duplication Of Parotid Duct. A Rare Anatomical Variation

    Directory of Open Access Journals (Sweden)

    Humberto Ferreira Arquez

    2017-11-01

    Full Text Available Background: The paired parotid glands are the largest of the major salivary glands and produces mainly serous secretions. The secretion of this gland reaches the oral cavity through single parotid duct (Stensen’s duct. The parotid duct begins at the anterior border of the gland, crosses the masseter muscle, and then pierces the buccinator muscle to reach the mucosa lining the mouth at the level of the cheek. The purpose of this study is determine the morphologic features of the parotid duct and describe an anatomical variation until now unreported. Methods and Findings: A total of 17 cadavers were used for this study in the Morphology Laboratory at the University of Pamplona. In a cadaver were findings: The main parotid duct originated two conducts: Left superior parotid duct and Left inferior parotid duct, is observed the criss-cross of the ducts, and then perforated the buccinator muscle and entered the oral cavity at a double parotid papilla containing a double opening, separated from each other in 0,98 mm. In the remaining  33 parotid regions (97.06% the parotid duct is conformed to the classical descriptions given in anatomical textbooks. Conclusions: The parotid duct anatomy is important for duct endoscopy, lithotripsy, sialography and trans-ductal facial nerve stimulation in the early stage of facial palsy in some cases. The anatomical variations also has clinical importance for parotid gland surgery and facial cosmetic surgery. To keep in mind the parotid duct variation will reduce iatrogenic injury risks and improve diagnosis of parotid duct injury.

  3. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  4. Granular Cell Tumour of the Bile Duct in Association with Intrahepatic Bile Duct Adenomas

    Directory of Open Access Journals (Sweden)

    F Schweiger

    1994-01-01

    Full Text Available Granular cell tumour of the extrahepatic biliary tract is a rare benign lesion likely of neurogenic origin. Review of the previously reported cases indicates that almost all patients are female, and the majority is Black. Symptoms usually are those of biliary obstruction or cholecystitis. Surgical resection of the tumour is curative. Intrahepatic bile duct adenoma is another rare benign biliary neoplasm that does not manifest clinically but can be confused with metastatic carcinoma, cholangiocarcinoma or other focal liver lesions at laparotomy or autopsy. The authors report the case of an asymptomatic Caucasian woman with biochemical evidence of liver disease who had a granular cell tumour of the bile duct as well as several intrahepatic bile duct adenomas.

  5. Juvenile fibroadenoma with features of phyllodes tumor showing intraductal growth and prominent epithelial hyperplasia in an 11-year-old girl

    Directory of Open Access Journals (Sweden)

    Jun Miyauchi, MD

    2016-06-01

    Full Text Available Breast tumors in children are uncommon, with the majority of them being adult-type fibroadenoma (FA. We report a case of juvenile FA (JFA with features of a benign phyllodes tumor (PT in an 11-year-old girl, showing very unusual intraductal/intracystic growth. The tumor was located at the outer peripheral portion of the right breast apart from the nipple. Histologically, the tumor showed extensive leaf-like papillary structures with a broad fibrous stroma, protruding into multiple contiguous cystic spaces lined by flat ductal epithelium, and closely resembled PT but the stroma of the tumor was only slightly cellular, showing no nuclear atypia and very few mitotic figures. In contrast, epithelial cells covering the fronds exhibited marked hyperplasia, forming a thick multilayered epithelium. The histology of the tumor with intracystic papillary structures and epithelial hyperplasia showed some similarities with intraductal papilloma (IDP. The mechanism of such unusual intraductal growth of fibroepithelial tumors, including FA/JFA and PT, and their possible common histogenesis with IDP are discussed.

  6. Endoscopic treatment for complex biliary and pancreatic duct injuries

    Directory of Open Access Journals (Sweden)

    Simon Bouchard

    2014-01-01

    Full Text Available Severe injuries of biliary or pancreatic ducts are associated with significant morbidity and mortality. Severe bile duct injuries such as major biliary leaks, complete transection, or complete occlusion of bile ducts can be grouped under the term complex bile duct injuries (CBDI. In the spectrum of pancreatic duct injuries, disconnected pancreatic duct syndrome (DPDS represents the most severe form and most often occurs after a severe episode of acute pancreatitis. Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. However, in the past few years, some studies have reported the successful management of CBDI or DPDS using endoscopic procedures alone or in combination with a percutaneous approach. In this review, we detail the endoscopic or combined endoscopic/percutaneous treatment possibilities for CBDI and DPDS.

  7. Flow regime analysis of non-Newtonian duct flows

    Science.gov (United States)

    Speetjens, Michel; Rudman, Murray; Metcalfe, Guy

    2006-01-01

    Reoriented duct flows of generalized Newtonian fluids are an idealization of non-Newtonian fluid flow in industrial in-line mixers. Based on scaling analysis and computation we find that non-Newtonian duct flows have several limit behaviors, in the sense that such flows can become (nearly) independent of one or more of the rheological and dynamical control parameters, simplifying the general flow and mixing problem. These limit flows give several levels of modeling complexity to the full problem of non-Newtonian duct flow. We describe the sets of simplified flow models and their corresponding regions of validity. This flow-model decomposition captures the essential rheological and dynamical characteristics of the reoriented duct flows and enables a more efficient and systematic study and design of flow and mixing of non-Newtonian fluids in ducts. Key aspects of the flow-model decomposition are demonstrated via a specific, but representative, duct flow.

  8. Pancreatic duct cells as a source of VEGF in mice.

    Science.gov (United States)

    Xiao, Xiangwei; Prasadan, Krishna; Guo, Ping; El-Gohary, Yousef; Fischbach, Shane; Wiersch, John; Gaffar, Iljana; Shiota, Chiyo; Gittes, George K

    2014-05-01

    Vascular endothelial growth factor (VEGF) is essential for proper pancreatic development, islet vascularisation and insulin secretion. In the adult pancreas, VEGF is thought to be predominantly secreted by beta cells. Although human duct cells have previously been shown to secrete VEGF at angiogenic levels in culture, an analysis of the kinetics of VEGF synthesis and secretion, as well as elucidation of an in vivo role for this ductal VEGF in affecting islet function and physiology, has been lacking. We analysed purified duct cells independently prepared by flow cytometry, surgical isolation or laser-capture microdissection. We infected duct cells in vivo with Vegf (also known as Vegfa) short hairpin RNA (shRNA) in an intrapancreatic ductal infusion system and examined the effect of VEGF knockdown in duct cells in vitro and in vivo. Pancreatic duct cells express high levels of Vegf mRNA. Compared with beta cells, duct cells had a much higher ratio of secreted to intracellular VEGF. As a bioassay, formation of tubular structures by human umbilical vein endothelial cells was essentially undetectable when cultured alone and was substantially increased when co-cultured with pancreatic duct cells but significantly reduced when co-cultured with duct cells pretreated with Vegf shRNA. Compared with islets transplanted alone, improved vascularisation and function was detected in the islets co-transplanted with duct cells but not in islets co-transplanted with duct cells pretreated with Vegf shRNA. Human islet preparations for transplantation typically contain some contaminating duct cells and our findings suggest that the presence of duct cells in the islet preparation may improve transplantation outcomes.

  9. The importance of cognitive map placement in bile duct injuries.

    Science.gov (United States)

    Sutherland, Francis; Dixon, Elijah

    2017-12-01

    Bile duct injuries often occur because of surgeon spatial disorientation. The psychological concept of cognitive map misplacement is a useful explanation of how this disorientation and injury occurs. Surgeons may find that using a "bile duct time out" is a helpful way to orient. Based on the mnemonic B-SAFE, they can use 5 subhepatic landmarks (B, bile duct; S, sulcus of Rouviere; A, hepatic artery; F, umbilical fissure; E, enteric/duodenum) to correctly place their cognitive map.

  10. Squamous Cell Carcinoma of the Distal Common Bile Duct

    OpenAIRE

    Jain A; Juneja M; Naik S; Sharma S; Kapoor S; Sewkani A; Varshney S

    2005-01-01

    CONTEXT: Squamous cell carcinoma of the biliary tree is rare. Although few cases of squamous cell carcinoma of the intrahepatic bile-duct and gallbladder have been reported, until today, only four cases of squamous cell carcinoma of the extrahepatic bile duct have been reported in the literature. CASE REPORT: We present a case of squamous cell carcinoma of the distal common bile duct presenting with obstructive jaundice in a 60-year-old male which was successfully managed by a Whipple's pancr...

  11. Active noise control in a duct to cancel broadband noise

    Science.gov (United States)

    Chen, Kuan-Chun; Chang, Cheng-Yuan; Kuo, Sen M.

    2017-09-01

    The paper presents cancelling duct noises by using the active noise control (ANC) techniques. We use the single channel feed forward algorithm with feedback neutralization to realize ANC. Several kinds of ducts noises including tonal noises, sweep tonal signals, and white noise had investigated. Experimental results show that the proposed ANC system can cancel these noises in a PVC duct very well. The noise reduction of white noise can be up to 20 dB.

  12. 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 $G = SL(l$.

  13. Risk factors for central bile duct injury complicating partial liver resection

    NARCIS (Netherlands)

    Boonstra, E. A.; de Boer, M. T.; Sieders, E.; Peeters, P. M. J. G.; de Jong, K. P.; Slooff, M. J. H.; Porte, R. J.

    Background: Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct,

  14. CLINICAL AND MORPHOLOGICAL DIAGNOSTIC INTRAHEPATIC BILE DUCTS PAUCITY

    Directory of Open Access Journals (Sweden)

    O. E. Iryshkin

    2013-01-01

    Full Text Available Aim. To study the clinica-morphological features of syndromatic and nonsyndromatic paucity of intrahepatic bile ducts in pediatric liver transplant recipients. Methods and results. The clinical records were analyzed and histological studies of native livers of 20 children, who had suffered from paucity of intrahepatic bile ducts and to whom liver transplantation were made, were completed. The obtained data indicate higher levels of AST in patients with nonsyndromatic paucity of intrahepaticbile ducts (p = 0,023. Ductopenia was the more frequent indication of syndromatic form of paucity of intrahepatic bile ducts (p = 0,01, while ductular proliferations, which form «ductular structure», were discovered more often in nonsyndromatic paucity of intrahepaticbile ducts (p = 0,03. The extent of inflammatory-destructive changes was more expressed in nonsyndromatic pauci- ty of intrahepatic bile ducts (p = 0,01. Fibrosis or cirrhosis was formed more often in nonsyndromatic paucity of intrahepatic bile ducts (p = 0,008. Conclusion. Our results indicate more severe clinical and morphological manifestations in nonsyndromatic paucity of intrahepatic bile ducts. These findings may suggest about heavier liver condition in patient with nonsyndromatic form of paucity of intrahepatic bile ducts

  15. 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)

  16. 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.)

  17. 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.

  18. Flexible metallic 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

    2014-04-22

    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 flexible metallic seal contacting the interface member to provide a seal between the interface member and the turbine section.

  19. Convolution 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

    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.

  20. Durability of branches in branched and fenestrated endografts.

    Science.gov (United States)

    Mastracci, Tara M; Greenberg, Roy K; Eagleton, Matthew J; Hernandez, Adrian V

    2013-04-01

    Branched and fenestrated repair has been shown to be effective for treatment of complex aortic aneurysms. However, the long-term durability of branches is not well reported. Prospective data collected for all patients enrolled in a physician-sponsored investigational device exemption trial for branched and fenestrated endografts were analyzed. Retrospective review of imaging studies and electronic records was used to supplement the dataset. Incidences of branch stent secondary intervention, stent fracture, migration, branch-related rupture, and death were calculated. A time-to-event analysis was performed for secondary intervention for any branch. Univariable and multivariable analyses were performed to identify related variables. Branch instability, a composite outcome of any branch event, was reported as a function of exponential decay to capture the loss of freedom from complications over time. Between the years 2001 and 2010, 650 patients underwent endovascular aortic repair with branched or fenestrated devices. Over 9 years of follow-up (mean [standard deviation], 3 [2.3] years), secondary procedures were performed for 0.6% of celiac, 4% of superior mesenteric artery (SMA), 6% of right renal artery, and 5% of left renal artery stents. Mean time to reintervention was 237 (354) days. The 30-day, 1-year, and 5-year freedom from branch intervention was 98% (95% confidence interval [CI], 96%-99%), 94% (95% CI, 92%-96%), and 84% (95% CI, 78%-90%), respectively. Death from branch stent complications occurred in three patients, two related to SMA thrombosis and one due to an unstented SMA scallop. Multivariable analysis revealed no factors as independent predictors of need for branch reintervention. Branches, after branched or fenestrated aortic repair, appear to be durable and are rarely the cause of patient death. The absence of long-term data on branch patency in open repair precludes comparison, yet the lower morbidity and mortality risk coupled with longer

  1. Salivary duct carcinoma of accessory parotid

    OpenAIRE

    Al-Hashim, Mohammed A.; Al-Jazan, Nasser A.

    2017-01-01

    Accessory parotid gland (APG) is seen in around 21%?56% of individuals. Tumors of accessory parotid are uncommon with an incidence rate of 1%?8% of all parotid tumors. Ductal carcinoma of APG is rare, so no reported incidence was seen in the literature. However, salivary gland ductal carcinoma is reported to be 1% of all salivary gland neoplasms. We report here a case of salivary duct carcinoma of APG. Clinical presentation, investigation, and management are discussed. A 69-year-old female pr...

  2. 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.

  3. The control of branching morphogenesis

    Science.gov (United States)

    Iber, Dagmar; Menshykau, Denis

    2013-01-01

    Many organs of higher organisms are heavily branched structures and arise by an apparently similar process of branching morphogenesis. Yet the regulatory components and local interactions that have been identified differ greatly in these organs. It is an open question whether the regulatory processes work according to a common principle and how far physical and geometrical constraints determine the branching process. Here, we review the known regulatory factors and physical constraints in lung, kidney, pancreas, prostate, mammary gland and salivary gland branching morphogenesis, and describe the models that have been formulated to analyse their impacts. PMID:24004663

  4. 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.

  5. Multistep carcinogenesis of perihilar cholangiocarcinoma arising in the intrahepatic large bile ducts.

    Science.gov (United States)

    Nakanuma, Yasuni; Sasaki, Motoko; Sato, Yasunori; Ren, Xiangshan; Ikeda, Hiroko; Harada, Kenichi

    2009-10-31

    Flat-type "biliary intraepithelial neoplasia (BilIN)" and papillary-type "intraductal papillary neoplasm of the bile duct (IPN-B)" are proposed as precursors of invasive, perihilar intrahepatic cholangiocarcinoma (ICC). Three carcinogenetic pathways are proposed: BilIN progressing to tubular adenocarcinoma, and IPN-B progressing to tubular adenocarcinoma or to colloid carcinoma. Carcinogenesis via BilIN was characterized by mucin core protein 2-/cytokeratin 20-(MUC2-/CK20-) with MUC1 expression, while carcinogenesis via IPN-B leading to tubular adenocarcinoma was associated with MUC1 expression or that to colloid carcinoma with MUC1-negativity. In both the BilIN and IPNB series, the expression of p21, p53, and cyclin D1 was upregulated with histological progression. Interestingly, p53 expression was upregulated at the invasive stage of BilIN, but was low in noninvasive BilIN, while p53 expression was upregulated in IPN-B1 and reached a plateau in IPN-B2 and invasive ICC. Expression of p16(INK4a), which was frequent in BilIN1, was decreased in BilIN-2/3 and invasive carcinoma. EZH2 expression showed a stepwise increase from BilIN to invasive carcinoma. Membranous expression of β-catenin and E-cadherin was more markedly decreased in ICC with BilIN than in ICC with IPNB. Interestingly, disruption of the membranous distribution of β-catenin and E-cadherin seems to result in the invasion and metastasis of carcinoma cells of BilIN and IPN-B expressing MMP-7 and MT1-MMP. Increased expression of cyclin D1 and c-myc was more frequent in the IPNB lineage than BilIN lineage, possibly related to the Wnt signaling pathway associated with the nuclear accumulation of β-catenin. In conclusion, BilIN and IPN-B progress to invasive ICC through characteristic multistep processes.

  6. Oblique bile duct predisposes to the recurrence of bile duct stones.

    Science.gov (United States)

    Strnad, Pavel; von Figura, Guido; Gruss, Regina; Jareis, Katja-Marlen; Stiehl, Adolf; Kulaksiz, Hasan

    2013-01-01

    Bile stones represent a highly prevalent condition and abnormalities of the biliary tree predispose to stone recurrence due to development of biliary stasis. In our study, we assessed the importance of an altered bile duct course for stone formation. 1,307 patients with choledocholithiasis in the absence of any associated hepatobiliary disease who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2002 and 2009 were analysed. The angle enclosed between the horizontal portion of the common bile duct (CBD) and the horizontal plane was measured (angle α). Oblique common bile duct (OCBD) was defined as a CBD with angle α < 45°. 103 patients (7.9%) were found to harbour OCBD and these were compared to 104 randomly selected control subjects. Compared to controls, OCBD patients were (i) significantly older (72 ± 13 vs. 67 ± 13, p<0.00001); (ii) more frequently underwent a cholecystectomy (p = 0.02) and biliary surgery (p = 0.003) prior to the diagnosis and (iii) more often developed chronic pancreatitis (p = 0.04) as well as biliary fistulae (p = 0.03). Prior to and after ERCP, OCBD subjects displayed significantly elevated cholestatic parameters and angle α negatively correlated with common bile duct diameter (r = -0.29, p = 0.003). OCBD subjects more often required multiple back-to-back ERCP sessions to remove bile stones (p = 0.005) as well as more ERCPs later on due to recurrent stone formation (p<0.05). OCBD defines a novel variant of the biliary tree, which is associated with chronic cholestasis, hampers an efficient stone removal and predisposes to recurrence of bile duct stones.

  7. Oblique bile duct predisposes to the recurrence of bile duct stones.

    Directory of Open Access Journals (Sweden)

    Pavel Strnad

    Full Text Available BACKGROUND AND STUDY AIMS: Bile stones represent a highly prevalent condition and abnormalities of the biliary tree predispose to stone recurrence due to development of biliary stasis. In our study, we assessed the importance of an altered bile duct course for stone formation. PATIENTS AND METHODS: 1,307 patients with choledocholithiasis in the absence of any associated hepatobiliary disease who underwent endoscopic retrograde cholangiopancreatography (ERCP between 2002 and 2009 were analysed. The angle enclosed between the horizontal portion of the common bile duct (CBD and the horizontal plane was measured (angle α. Oblique common bile duct (OCBD was defined as a CBD with angle α < 45°. RESULTS: 103 patients (7.9% were found to harbour OCBD and these were compared to 104 randomly selected control subjects. Compared to controls, OCBD patients were (i significantly older (72 ± 13 vs. 67 ± 13, p<0.00001; (ii more frequently underwent a cholecystectomy (p = 0.02 and biliary surgery (p = 0.003 prior to the diagnosis and (iii more often developed chronic pancreatitis (p = 0.04 as well as biliary fistulae (p = 0.03. Prior to and after ERCP, OCBD subjects displayed significantly elevated cholestatic parameters and angle α negatively correlated with common bile duct diameter (r = -0.29, p = 0.003. OCBD subjects more often required multiple back-to-back ERCP sessions to remove bile stones (p = 0.005 as well as more ERCPs later on due to recurrent stone formation (p<0.05. CONCLUSION: OCBD defines a novel variant of the biliary tree, which is associated with chronic cholestasis, hampers an efficient stone removal and predisposes to recurrence of bile duct stones.

  8. Classification and management of bile duct injuries.

    Science.gov (United States)

    Mercado, Miguel Angel; Domínguez, Ismael

    2011-04-27

    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), GII- 2000-2004 (139 cases) and GIII- 2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment IV and V resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period. The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.

  9. 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...

  10. Legislative Branch: FY2014 Appropriations

    Science.gov (United States)

    2013-11-25

    Authorizations Since 1999, by Matthew E. Glassman . Legislative Branch: FY2014 Appropriations Congressional Research Service 10 The FY2012 level of...Congresses, by Matthew E. Glassman . Legislative Branch: FY2014 Appropriations Congressional Research Service 11 Members’ Representational...vehicles; communications equipment; security equipment and its installation; dignitary protection; intelligence analysis; hazardous material response

  11. Surgical management of Stenson's duct injury using epidural catheter

    African Journals Online (AJOL)

    2012-07-05

    Jul 5, 2012 ... ... drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy.

  12. 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.

  13. 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...

  14. Bidirectional infrasonic ducts associated with sudden stratospheric warming events

    NARCIS (Netherlands)

    Assink, J.D.; Waxler, R.; Smets, P.S.M.; Evers, L.G.

    2014-01-01

    In January 2011, the state of the polar vortex in the midlatitudes changed significantly due to a minor sudden stratospheric warming event. As a result, a bidirectional duct for infrasound propagation developed in the middle atmosphere that persisted for 2 weeks. The ducts were due to two zonal wind

  15. 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...

  16. Morphological study of pancreatic duct in red jungle fowl | Kadhim ...

    African Journals Online (AJOL)

    Neither goblet cells nor ductal glands were found in the pancreatic ducts. Secretion of both neutral and sulfated materials by the epithelial lining the pancreatic ducts, suggesting that they are acting not only to facilitate the transport of the pancreatic juice, but also as a protective barrier to protect the gland from autodigestion.

  17. Associated patent urachus and patent omphalo– mesenteric duct in ...

    African Journals Online (AJOL)

    The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare. A computer-assisted (PubMed and Google Scholar) search of the pediatric literature to identify all cases of patent urachus and a patent omphalo–mesenteric duct association was performed. We found only eleven cases of the ...

  18. Long duct nacelle aerodynamic development for DC-10 derivatives

    Science.gov (United States)

    Patel, S. P.; Donelson, J. E.

    1980-01-01

    The results are presented of a wind tunnel test utilizing a 4.7-percent-scale semispan model of the DC-10 in the Calspan 8-foot transonic wind tunnel. The effect of a revised long-duct nacelle shape on the channel velocities, the incremental drag relative to the baseline long-duct nacelle, and channel velocities for the baseline long-duct nacelle were determined and compared with data obtained at Ames. The baseline and the revised long-duct nacelles are representative of a CF6-50 mixed-flow configuration and were evaluated on a model of a proposed DC-10 stretched-fuselage configuration. The results showed that the revised long-duct nacelle has an appreciable effect on the inboard channel velocities, resulting in an increased channel Mach number. However, the pressure recovery on the nacelle afterbody was about the same for both nacelles. The lift curves for both long-duct nacelle configurations were the same. The channel pressures measured at Calspan were in good agreement with those measured at Ames for the baseline long-duct nacelle. The incremental drag for the revised nacelle was measured as two to four counts (three counts is approximately equal to one percent of the airplane drag) higher than that of the baseline long-duct nacelle.

  19. 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.

  20. Morphological study of pancreatic duct in red jungle fowl

    African Journals Online (AJOL)

    Jane

    2010-10-18

    Oct 18, 2010 ... Morphological and histochemical study of the pancreas and pancreatic ducts of ten adult red jungle fowl (Gallus gallus spadiceus) were carried out by means of light microscopy. The bulk of the pancreas consists of a dorsal, ventral, third and small splenic lobe. Three pancreatic ducts were recognized as.

  1. ATP release, generation and hydrolysis in exocrine pancreatic duct cells

    DEFF Research Database (Denmark)

    Kowal, Justyna Magdalena; Yegutkin, G.G.; Novak, Ivana

    2015-01-01

    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, ou...

  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 buff...

  3. Differentiation of pancreatic serous cystadenoma from endocrine tumor and intraductal papillary mucinous neoplasm based on washout pattern on multiphase CT.

    Science.gov (United States)

    Sahara, Shinya; Kawai, Nobuyuki; Sato, Morio; Ikoma, Akira; Minamiguchi, Hiroki; Nakai, Motoki; Sanda, Hiroki; Nakata, Kouhei; Takeuchi, Taizou; Tanaka, Takami; Shirai, Shintaro; Sonomura, Tetsuo

    2012-01-01

    To evaluate the washout (WO) pattern of serous cystadenomas (SCAs) compared with endocrine tumors (ETs) and intraductal papillary mucinous neoplasm (IPMN). Patients with serous cystadenoma (n = 12), ET (n = 29), and IPMN (n = 35) underwent 4-phase computed tomography CT. Tumors were categorized as hyperdense or hypodense. Computed tomographic values measured were unenhanced attenuation (AU), pancreatic attenuation (A12, 12 seconds), portal attenuation (A35), and equilibrium (A158). Computed tomographic parameters calculated were wash-in (WI) = A12 - AU; WO = A12 - A35; and washout ratio (WOR) = WO/WI × 100/22. Hyperdense SCAs had significantly higher WOR than did hyperdense ETs (P = 0.001). Among the 3 hypodense tumors, SCAs had the significantly highest WOR (P < 0.05/3). Relative to the pancreas, the WOR of SCAs were equivalent, whereas the WOR of ETs and IPMNs were significantly lower. Hyperdense SCAs had significantly higher WOR than did hyperdense ETs, and hypodense SCAs had the significantly highest WOR among the three.

  4. Significance of aggressive surgery for an invasive carcinoma derived from an intraductal papillary mucinous neoplasm diagnosed preoperatively as borderline resectable.

    Science.gov (United States)

    Aimoto, Takayuki; Mizutani, Satoshi; Kawano, Youichi; Suzuki, Hideyuki; Uchida, Eiji

    2013-01-01

    We investigated the clinicopathological features of borderline resectable invasive carcinomas (BRICs) derived from intraductal papillary mucinous neoplasms (IPMNs) and examined the significance of the aggressive "surgery first" approach compared with the treatment of conventional borderline resectable pancreatic ductal adenocarcinomas (BRPDAs). We retrospectively studied 7 patients with BRICs derived from IPMNs and 14 patients with conventional BRPDAs. Several factors were reviewed: initial symptoms, preoperative imaging, serum level of CA19-9, perioperative factors, pathological findings, adjuvant chemotherapy, and outcome. All BRICs derived from IPMN were huge tumors (more than 3 cm in diameter) suspected to involve BRICs derived from IPMNs were larger than those of conventional BRPDAs (pBRICs derived from IPMN less frequently metastasized to lymph nodes (pBRICs derived from IPMNs (100%) than for conventional BRPDAs (19%, pBRICs derived from an intestinal or gastric IPMN are less aggressive than conventional BRPDAs and have a more favorable prognosis. In addition, aggressive "surgery first" approach may contribute to this better prognosis.

  5. Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm.

    Science.gov (United States)

    Kamata, Ken; Takenaka, Mamoru; Nakai, Atsushi; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Matsuda, Tomohiro; Yamao, Kentaro; Imai, Hajime; Chiba, Yasutaka; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Chikugo, Takaaki; Matsumoto, Ippei; Takeyama, Yoshifumi; Kudo, Masatoshi

    2017-01-01

    Risk factors for pancreatic ductal adenocarcinoma (PDAC) include diabetes mellitus, chronic pancreatitis, obesity, a family history of pancreatic cancer, and a history of smoking or alcohol consumption. The aim of this study was to evaluate the association between risk factors for PDAC and malignant intraductal papillary mucinous neoplasm (IPMN). The study included 134 consecutive patients with IPMN who underwent surgical resection at Kindai University Hospital between April 2009 and March 2015. Data on the presence or absence of mural nodules (MNs) and risk factors for PDAC were evaluated. Multivariable logistic regression analysis was performed with malignant IPMN as the outcome variable and MNs and risk factors for PDAC as explanatory variables. The odds ratio of malignant IPMN to MNs was 3.88 (95% confidence interval [CI] 1.53-9.84; p = 0.004), whereas that of malignant IPMN to smoking history was 1.66 (95% CI 0.74-3.71; p = 0.22). When the presence of MNs was considered as a predictive factor for malignancy, the sensitivity and specificity were 88.5 and 32.1%, respectively, whereas when the presence of both smoking history and MNs was considered, the specificity improved to 73.2%, with a decrease in sensitivity to 42.3%. The presence of both a smoking history and MNs was a valuable predictive factor for malignant IPMN with high specificity. A smoking history should be considered before surgical resection in addition to the presence of MNs. © 2017 S. Karger AG, Basel.

  6. Risk for mortality from causes other than pancreatic cancer in patients with intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Kawakubo, Kazumichi; Tada, Minoru; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Takahara, Naminatsu; Miyabayashi, Koji; Yamamoto, Keisuke; Mizuno, Suguru; Mohri, Dai; Kogure, Hirofumi; Sasaki, Takashi; Yamamoto, Natsuyo; Tateishi, Ryosuke; Hirano, Kenji; Ijichi, Hideaki; Tateishi, Keisuke; Koike, Kazuhiko

    2013-05-01

    The long-term prognosis in patients with intraductal papillary mucinous neoplasm (IPMN) has not been determined. The aim of this study was to elucidate the risk for nonpancreatic cancer-specific mortality in patients with IPMN. Seven hundred ninety-three patients with IPMN who were followed up more than 1 year were included in this study. Fine and Gray competing risk regression was used to assess the risk for mortality unrelated to pancreatic cancer. A comorbidity score at diagnosis was assigned using the Adult Comorbidity Evaluation 27. After a median follow-up of 50 months, a high comorbidity score and age at diagnosis were significantly associated with a risk for mortality unrelated to pancreatic cancer. Adjusted hazards ratio and 95% confidence interval of each comorbidity burden were as follows: none, 1; mild, 2.68 (0.76-9.45; P = 0.124); moderate, 10.9 (3.19-37.1; P pancreatic cancer-specific mortality. Comorbidity and age at diagnosis was significantly related to mortality unrelated to pancreatic cancer in patients with IPMN. For patients at high risk for nonpancreatic cancer mortality, a follow-up management may be more reasonable than surgery.

  7. 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

  8. Topological mixing study of non-Newtonian duct flows

    Science.gov (United States)

    Speetjens, Michel; Metcalfe, Guy; Rudman, Murray

    2006-10-01

    Tracer advection of non-Newtonian fluids in reoriented duct flows is investigated in terms of coherent structures in the web of tracer paths that determine transport properties geometrically. Reoriented duct flows are an idealization of in-line mixers, encompassing many micro and industrial continuous mixers. The topology of the tracer dynamics of reoriented duct flows is Hamiltonian. As the stretching per reorientation increases from zero, we show that the qualitative route from the integrable state to global chaos and good mixing does not depend on fluid rheology. This is due to a universal symmetry of reoriented duct flows, which we derive, controlling the topology of the tracer web. Symmetry determines where in parameter space global chaos first occurs, while increasing non-Newtonian effects delays the quantitative value of onset. Theory is demonstrated computationally for a representative duct flow, the rotated arc mixing flow.

  9. 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.)

  10. A Plug-and-Play Duct System Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beach, Robert [IBACOS, Inc., Pittsburgh, PA (United States); Dickson, Bruce [IBACOS, Inc., Pittsburgh, PA (United States); Grisolia, Anthony [IBACOS, Inc., Pittsburgh, PA (United States); Poerschke, Andrew [IBACOS, Inc., Pittsburgh, PA (United States); Rapport, Ari [IBACOS, Inc., Pittsburgh, PA (United States)

    2017-07-10

    This report describes an air distribution system composed of a series of uniformly-sized ducts that terminate in rooms throughout the home and return to a central manifold, similar in fashion to a “home-run” cross-linked polyethylene plumbing system. With a well-designed manifold, each duct receives an equal static pressure potential for airflow from the air handling unit, and the number of needed ducts for each room are simply attached to fittings located on the manifold; in this sense, the system is plug-and-play (PnP). As indicated, all ducts in the PnP system are identical in size and small enough to fit in the ceiling and wall cavities of a house (i.e., less than 3.5-in. outer diameter). These ducts are also more appropriately sized for the lower airflow requirements of modern, energy-efficient homes; therefore, the velocity of the air moving through the duct is between that of conventional duct systems (approximately 700 ft/min) and high-velocity systems (more than 1,500 ft/min) on the market today. The PnP duct system uses semi-rigid plastic pipes, which have a smooth inner wall and are straightforward to install correctly, resulting in a system that has minimal air leakage. However, plastic ducts are currently not accepted by code for use in residential buildings; therefore, the project team considered other duct materials for the system that are currently accepted by code, such as small-diameter, wirehelix, flexible ductwork.

  11. A Plug-and-Play Duct System Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beach, R. [IBACOS, Inc., Pittsburgh, PA (United States); Dickson, B. [IBACOS, Inc., Pittsburgh, PA (United States); Grisolia, A. [IBACOS, Inc., Pittsburgh, PA (United States); Poerschke, A. [IBACOS, Inc., Pittsburgh, PA (United States); Rapport, A. [IBACOS, Inc., Pittsburgh, PA (United States)

    2017-07-01

    This report describes an air distribution system composed of a series of uniformly-sized ducts that terminate in rooms throughout the home and return to a central manifold, similar in fashion to a “home-run” cross-linked polyethylene plumbing system. With a well-designed manifold, each duct receives an equal static pressure potential for airflow from the air handling unit, and the number of needed ducts for each room are simply attached to fittings located on the manifold; in this sense, the system is plug-and-play (PnP). As indicated, all ducts in the PnP system are identical in size and small enough to fit in the ceiling and wall cavities of a house (i.e., less than 3.5-in. outer diameter). These ducts are also more appropriately sized for the lower airflow requirements of modern, energy-efficient homes; therefore, the velocity of the air moving through the duct is between that of conventional duct systems (approximately 700 ft/min) and high-velocity systems (more than 1,500 ft/min) on the market today. The PnP duct system uses semi-rigid plastic pipes, which have a smooth inner wall and are straightforward to install correctly, resulting in a system that has minimal air leakage. However, plastic ducts are currently not accepted by code for use in residential buildings; therefore, the project team considered other duct materials for the system that are currently accepted by code, such as small-diameter, wirehelix, flexible ductwork.

  12. Isolated Common Hepatic Artery Branch Thrombosis: Results and Risk Factors

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-10-01

    Full Text Available Isolated common hepatic artery branch thrombosis with severe gastric ischemia and duodenojejunal infarction is a rare condition; it usually presents with acute abdomen and may be associated with underlying thrombotic risk factors. We present a 35-year-old man admitted to our hospital with five days history of sudden abdominal pain and deteriorating epigastric pain. He was a driver and had no any past medical history. Explorative laparotomy showed: distal 2/3 gastric, duodenojejunal and papilla vater was sloughed. The stomach subtotal and sloughed duodenum and first 20 cm of jejunum were resected, continuity of the gastrointestinal was preserved with anastomosis of the proximal part of jejunum to gastric stump, pancreatic duct, and CBD repaired to the lateral side of jejunum on the guide of two 18 French feeding tube as an external drain. The patient had a good immediate postoperative recovery. Coagulation checkup after operation revealed isolated Hyperhomocysteinemia.

  13. Effect of ursodeoxycholic acid administration on bile duct proliferation and cholestasis in bile duct ligated rat.

    Science.gov (United States)

    Frezza, E E; Gerunda, G E; Plebani, M; Galligioni, A; Giacomini, A; Neri, D; Faccioli, A M; Tiribelli, C

    1993-07-01

    The origin, mechanism, and significance of the bile duct proliferation (BDP) associated with cholestasis remain unexplained. This study examined the effect of oral administration of ursodeoxycholic acid (UDCA) on both BDP and cholestasis in the rat. After bile duct ligation, male Sprague-Dawley rats were treated for 30 days with either UDCA (5 mg/day) (group A) or saline solution (group B). Animals were sacrificed at day 30. The serum activity of aminotransferase (ALT, AST), alkaline phosphatase, and gamma-glutamyltransferase (GGT) was significantly lower (P acids were lower (P animals (33 +/- 11 vs 64 +/- 22 per 1000 cells; P acid and lithocolate and increase periductular bile acid recirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Granular Cell Tumour of the Bile Duct in Association with Intrahepatic Bile Duct Adenomas

    OpenAIRE

    Schweiger, F; Radhi, J; Coop, FW; Murphy, RW

    1994-01-01

    Granular cell tumour of the extrahepatic biliary tract is a rare benign lesion likely of neurogenic origin. Review of the previously reported cases indicates that almost all patients are female, and the majority is Black. Symptoms usually are those of biliary obstruction or cholecystitis. Surgical resection of the tumour is curative. Intrahepatic bile duct adenoma is another rare benign biliary neoplasm that does not manifest clinically but can be confused with metastatic carcinoma, cholangio...

  15. Attenuation of low frequency duct noise by a flute-like silencer

    Science.gov (United States)

    Huang, Lixi

    2009-09-01

    A broadband, duct noise reflection mechanism is introduced in this theoretical study. It consists of side-branch cavities filled with a light gas, e.g. helium, and covered by impervious, tensioned membranes as two apertures, one at the inlet and another at the exit. Incident waves are scattered by the membranes into two passages, one through the central duct and another through the cavity bypass. Due to the faster speed of sound in the bypass, a Herschel-Quincke tube resonance appears and gives a peak in the transmission loss spectrum. Another resonance occurs when the frequency of the incident sound coincides with the vibroacoustic frequency determined by the membrane tension and inertia contributions from the membrane and the fluid media. With appropriate tensile stress, the trough between the two spectral peaks can be elevated to a desirable high level, e.g. 10 dB, and the crucial factor is identified as the low density of the cavity gas filling. The broadband sound reflection performance is comparable with and even exceeds that of the drum-like silencer [L. Huang, Parametric study of a drum-like silencer, Journal of Sound and Vibration 269 (2004) 467-488] with the same cavity geometry, but the current mechanism requires a low tensile stress which is much easier to implement in practice.

  16. Treatment of infants with congenital nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Zhuo Chen

    2014-07-01

    Full Text Available AIM: To explore the different ages of congenital nasolacrimal duct obstruction in infants, take different treatment methods at different times. METHODS:The 87 cases of 102 children were divided into three different age groups: the first group of 25d-3mo of age 21 cases 26 eyes; The second group >3mo-7mo 31 cases 36 eyes; The third group >7-24mo of age 35 cases 40 eyes. For the first group of infants, the implementation of the lacrimal sac nasolacrimal duct massage + eye drops; for the second group of infants, carry lacrimal pressure washing treatment; for the third group of infants, the implementation of the nasolacrimal duct probing treatment. RESULTS:The first group of children through the nasolacrimal duct sac massage + drops tobramycin eye drops treatment unobstructed 12, the cure rate was 46.2%; The second group of children through pressurized irrigation treatment lacrimal patency by 33, the cure rate was 91.7%; The third group of children through the nasolacrimal duct probing unobstructed 36 treatment, the cure rate was 90.0%. The second and third group were better than the first group(χ2=15.71, Pχ2=15.27, Pχ2=0.02, P>0.05.CONCLUSION:Infants with congenital nasolacrimal duct obstruction should distinguish between ages, taking different treatments, in order to obtain a better therapeutic effect, and lacrimal pressure washing is the preferred way of treating infants with congenital nasolacrimal duct obstruction.

  17. Bile duct epithelial tight junctions and barrier function

    Science.gov (United States)

    Rao, R.K.; Samak, G.

    2013-01-01

    Bile ducts play a crucial role in the formation and secretion of bile as well as excretion of circulating xenobiotic substances. In addition to its secretory and excretory functions, bile duct epithelium plays an important role in the formation of a barrier to the diffusion of toxic substances from bile into the hepatic interstitial tissue. Disruption of barrier function and toxic injury to liver cells appear to be involved in the pathogenesis of a variety of liver diseases such as primary sclerosing cholangitis, primary biliary cirrhosis and cholangiocarcinoma. Although the investigations into understanding the structure and regulation of tight junctions in gut, renal and endothelial tissues have expanded rapidly, very little is known about the structure and regulation of tight junctions in the bile duct epithelium. In this article we summarize the current understanding of physiology and pathophysiology of bile duct epithelium, the structure and regulation of tight junctions in canaliculi and bile duct epithelia and different mechanisms involved in the regulation of disruption and protection of bile duct epithelial tight junctions. This article will make a case for the need of future investigations toward our understanding of molecular organization and regulation of canalicular and bile duct epithelial tight junctions. PMID:24665411

  18. Models of lung branching morphogenesis.

    Science.gov (United States)

    Miura, Takashi

    2015-03-01

    Vertebrate airway has a tree-like-branched structure. This structure is generated by repeated tip splitting, which is called branching morphogenesis. Although this phenomenon is extensively studied in developmental biology, the mechanism of the pattern formation is not well understood. Conversely, there are many tree-like structures in purely physical or chemical systems, and their pattern formation mechanisms are well-understood using mathematical models. Recent studies correlate these biological observations and mathematical models to understand lung branching morphogenesis. These models use slightly different mechanisms. In this article, we will review recent progress in modelling lung branching morphogenesis, and future directions to experimentally verify the models. © The Authors 2015. Published by Oxford University Press on behalf of the Japanese Biochemical Society. All rights reserved.

  19. 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...

  20. Lesions of the segmental and lobar hepatic ducts.

    Science.gov (United States)

    Longmire, W P; Tompkins, R K

    1975-01-01

    Despite reports to the contrary, unobstructed drainage of 50% of an otherwise normal liver through either the right or left uninfected hepatic duct is adequate to restore normal liver function, even if the obstructed lobe remains in place. An undrained liver lobe, if present, may require no further treatment. As long as it is completely obstructed and uninfected, it will undergo a progressive asymptomatic atrophy. Cholangitis invariably develops behind a partial lobar ductal obstruction, producing jaundice, pruritis, and fever. Unless unobstructed, uninfected biliary flow can be achieved through a segmental or lobar duct, it is better that the duct be completely obstructed and the affected liver parenchyma allowed to atrophy, provided there is normal biliary flow from the residual 50% of liver. This concept is important in the management of injured anomalous segmental or lobar hepatic duct and in the palliative treatment of bile duct carcinoma. Localized intrahepatic infections communicating with abnormal biliary ducts will require hepatic resection of the infected parenchyma and ducts for cure. The abnormality may be saccular dilatation of the intrahepatic ductal system with abscess formation or intrahepatic abscess associated with stenosis of the ductal system from trauma to the duct, to the duct and liver, or to retained intrahepatic stones. Diffusely situated intrahepatic abscesses secondary to ductal abnormalities can be treated with systemic antibiotics, local drainage of a dmoninant abscess, and efforts to improve biliary drainage. Images Fig. 4. Fig. 5. Fig. 6. Fig. 8. Fig. 9. Fig. 10. Figs. 11A and B Figs. 12A and B. Fig. 13. Fig. 14. Fig. 15. Fig. 16. Fig. 17. PMID:1180585

  1. Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lijun Guan

    2016-01-01

    Full Text Available Percutaneous management of unresectable malignant biliary obstruction remains challenging. Biliary radiofrequency ablation (RFA using the Habib EndoHBP catheter is a new palliation therapy for malignant biliary obstruction. We report our initial experience of RFA for the management of malignant biliary obstruction. A 58-year-old male was diagnosed with gallbladder cancer. Intraductal bipolar RFA was delivered at power of 10 W for 120 s, followed by stent placement. The patient had immediate stricture improvements after RFA. No severe adverse event occurred. Percutaneous RFA seems to be safe and feasible for the treatment of malignant biliary obstruction. Further studies are warranted.

  2. Spontaneous recanalization of the pancreatic duct: case report and review.

    Science.gov (United States)

    Arkovitz, M S; Garcia, V F

    1996-06-01

    An eight-year-old boy received a grade 3 pancreatic injury as a result of a bicycle handlebar accident. Endoscopic retrograde cholangiopancreatography (ERCP) showed a proximal pancreatic duct transection. At laparotomy, a complete transection of the gland and duct was visualized; however, only debridement and external fistulization were performed. Follow-up ERCP performed 3 months postoperatively showed recanalization of the pancreatic duct without further operative intervention. At 1-year follow-up, the patient is pain free and tolerating a regular diet.

  3. ROV [Remotely Operated Vehicle] inspection inside ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, R.E. [AEA Technology, Harwell (United Kingdom)

    1996-12-31

    An instrumentation package for carrying out visual inspections and radiation monitoring within radioactive duct-work has been developed. This paper describes the first application of the package in the main ventilation duct of the Dounreay fuel cycle area. The package was deployed via a commercial ROV within a duct consisting of two parallel runs, over 300 metres long, between 0.9 and 1.7 metres high and 1.1 metres wide. An integrated, computer-controlled station was used for data collection, recording in digital form and on video tape. (UK).

  4. Long chain branching of PLA

    Science.gov (United States)

    Gu, Liangliang; Xu, Yuewen; Fahnhorst, Grant; Macosko, Christopher W.

    2017-05-01

    A trifunctional aziridine linker, trimethylolpropane tris(2-methyl-1-aziridinepropionate) (TTMAP), was melt blended with linear polylactic acid (PLA) to make star branched PLA. Adding pyromellitic dianhydride (PMDA) led to long chain branched (LCB) PLA. Mixing torque evolution during melt processing revealed high reactivity of aziridine with the carboxyl end group on PLA and an incomplete reaction of PMDA with the hydroxyl end group. Star-shaped PLA exhibited higher viscosity but no strain hardening in extensional flow while LCB PLA showed significant extensional hardening. Excess TTMAP in the branching reaction resulted in gel formation, which led to failure at low strain in extension. PMDA conversion was estimated based on gelation theory. The strain rate dependence of extensional hardening indicated that the LCB PLA had a low concentration of long chain branched molecules with an H-shaped topology. Unlike current methods used to branch PLA, free radical chemistry or use of an epoxy functional oligomers, our branching strategy produced strain hardening with less increase in shear viscosity. This study provides guidelines for design of polymers with low shear viscosity, which reduces pressure drop in extrusion, combined with strong extensional hardening, which enhances performance in processes that involve melt stretching.

  5. Structural Mechanics and Dynamics Branch

    Science.gov (United States)

    Stefko, George

    2003-01-01

    The 2002 annual report of the Structural Mechanics and Dynamics Branch reflects the majority of the work performed by the branch staff during the 2002 calendar year. Its purpose is to give a brief review of the branch s technical accomplishments. The Structural Mechanics and Dynamics Branch develops innovative computational tools, benchmark experimental data, and solutions to long-term barrier problems in the areas of propulsion aeroelasticity, active and passive damping, engine vibration control, rotor dynamics, magnetic suspension, structural mechanics, probabilistics, smart structures, engine system dynamics, and engine containment. Furthermore, the branch is developing a compact, nonpolluting, bearingless electric machine with electric power supplied by fuel cells for future "more electric" aircraft. An ultra-high-power-density machine that can generate projected power densities of 50 hp/lb or more, in comparison to conventional electric machines, which generate usually 0.2 hp/lb, is under development for application to electric drives for propulsive fans or propellers. In the future, propulsion and power systems will need to be lighter, to operate at higher temperatures, and to be more reliable in order to achieve higher performance and economic viability. The Structural Mechanics and Dynamics Branch is working to achieve these complex, challenging goals.

  6. Association between serum SPan-1 and lymph node metastasis in invasive intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Yamanaka, Kodai; Masuda, Atsuhiro; Toyama, Hirochika; Shiomi, Hideyuki; Zen, Yoh; Sofue, Keitaro; Takenaka, Mamoru; Kobayashi, Takashi; Sakai, Arata; Yagi, Yosuke; Nakagawa, Takashi; Yoshida, Masaru; Arisaka, Yoshifumi; Okabe, Yoshihiro; Kutsumi, Hiromu; Fukumoto, Takumi; Ku, Yonson; Azuma, Takeshi

    Lymph node metastasis predicts poorer prognoses in patients with invasive intraductal papillary mucinous neoplasms of the pancreas (IPMNs). Factors associated with lymph node metastasis of invasive IPMN remain unclear. Therefore, this study aimed to define factors associated with lymph node metastasis of invasive IPMN. Between June 2000 to August 2015, 156 consecutive patients with IPMN underwent surgical resection at Kobe University Hospital, and were enrolled in this study. The relationship between lymph node metastasis and clinical characteristics, including imaging studies and serum tumor markers, was evaluated. A multivariate logistic regression analysis was performed to assess the relationship between serum tumor markers and the presence of lymph node metastasis of IPMN, adjusted for clinical characteristics. Lymph node metastasis was observed in 7.7% (12/156) of IPMNs via a pathological examination. The multivariate logistic regression analysis revealed that serum SPan-1 was associated with the presence of lymph node metastasis of IPMN (odds ratio [OR] = 7.32; 95% confidence interval [CI] = 1.10 to 56.0; P = 0.04). In addition, survival was poorer among serum SPan-1-positive patients than SPan-1 negative patients (Log-rank test; P = 0.0002). Lymph node enlargement was detected preoperatively on computed tomography scans in only 16.7% (2/12) of cases that were positive for lymph node metastasis. Elevated serum SPan-1 was associated with lymph node metastasis in this cohort of patients who underwent resection for invasive IPMN. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  7. Comparison of intraductal ultrasonography findings between primary sclerosing cholangitis and IgG4-related sclerosing cholangitis.

    Science.gov (United States)

    Naitoh, Itaru; Nakazawa, Takahiro; Hayashi, Kazuki; Miyabe, Katsuyuki; Shimizu, Shuya; Kondo, Hiromu; Nishi, Yuji; Yoshida, Michihiro; Umemura, Shuichiro; Hori, Yasuki; Kato, Akihisa; Okumura, Fumihiro; Sano, Hitoshi; Ohara, Hirotaka; Joh, Takashi

    2015-06-01

    Comparisons of intraductal ultrasonography (IDUS) findings between primary sclerosing cholangitis (PSC) and IgG4-related sclerosing cholangitis (IgG4-SC) have not been elucidated. We aimed to clarify the differences in transpapillary IDUS findings between PSC and IgG4-SC. We retrospectively compared transpapillary IDUS findings between 15 patients with PSC and 35 patients with IgG4-SC between 2004 and 2014. IDUS findings of circular-asymmetric wall thickness, irregular inner margin, diverticulum-like outpouching, unclear outer margin, heterogeneous internal echo, and disappearance of three layers were significantly higher in PSC than in IgG4-SC (P < 0.001). Irregular inner margin, diverticulum-like outpouching, and disappearance of three layers were specific IDUS findings for PSC compared to IgG4-SC. Diverticulum-like outpouching on IDUS and endoscopic retrograde cholangiogram (ERC) was observed in 10 (67%) and five (33%) of 15 patients with PSC, respectively. However, based on IDUS and ERC, diverticulum-like outpouching was not observed in any patient with IgG4-SC. All five patients with diverticulum-like outpouching on ERC had diverticulum-like outpouching on IDUS, and five (50%) of 10 patients without diverticulum-like outpouching on ERC had diverticulum-like outpouching on IDUS. The IDUS findings differed between PSC and IgG4-SC. Irregular inner margin, diverticulum-like outpouching, and disappearance of three layers are specific IDUS findings for PSC compared to IgG4-SC. IDUS is a more useful procedure than ERC for the early detection of diverticulum-like outpouching. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  8. Bile duct adenoma and von Meyenburg complex-like duct arising in hepatitis and cirrhosis: pathogenesis and histological characteristics.

    Science.gov (United States)

    Aishima, Shinichi; Tanaka, Yuki; Kubo, Yuichiro; Shirabe, Ken; Maehara, Yoshihiko; Oda, Yoshinao

    2014-11-01

    Morphologic features and neoplastic potentials of bile duct adenoma (BDA) and von Meyenburg complex (VMC)-like duct arising in chronic liver disease were unknown. Thirty-five BDAs and 12 VMC-like duct lesions were observed in 39 cases with chronic liver disease. BDAs were divided into the EMA-cytoplasmic type (n = 14) and EMA-luminal type (n = 21). EMA-cytoplasmic BDA composed of a proliferation of cuboidal to low-columnar cells forming an open lumen with NCAM(+)/MUC6(-), resembling an interlobular bile duct. EMA-luminal BDA showed uniform cuboidal cells with narrow lumen, and NCAM(++)/MUC6(++), resembling a ductular reaction. VMC-like duct showed positive MUC1 expression and negative MUC6. The expression of S100P, glucose transporter-1 (GLUT-1) and insulin-like growth factor II mRNA-binding protein 3 (IMP-3) were not detected in three lesions. p16 expression was higher than those of the ductular reaction, and the Ki67 and p53 indexes were very low (bile duct type; BDA, ductular/peribiliary gland type; and VMC-like duct. They may be reactive proliferation rather than neoplastic lesions. © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

  9. Technical knacks and outcomes of extended extrahepatic bile duct resection in patients with mid bile duct cancer

    Science.gov (United States)

    Lee, Seung-Jae; Ha, Tae-Yong; Kim, Ki-Hun; Ahn, Chul-Soo; Moon, Deok-Bog; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2013-01-01

    Backgrounds/Aims Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extrahepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgical procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection. Methods We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a ≥2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years. Results The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively. Conclusions We suggest that extended EHBD resection can be performed as a beneficial option to achieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome. PMID:26155223

  10. Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)—Health Professional Version

    Science.gov (United States)

    Bile duct cancer (also called cholangiocarcinoma) can occur in the bile ducts in the liver (intrahepatic) or outside the liver (perihilar or distal extrahepatic). Learn about the types of bile duct cancer, risk factors, clinical features, staging, and treatment for bile duct cancer in this expert-reviewed summary.

  11. Mechanism of primitive duct formation in the pancreas and submandibular glands: a role for SDF-1

    Directory of Open Access Journals (Sweden)

    Courtoy Pierre J

    2009-12-01

    Full Text Available Abstract Background The exocrine pancreas is composed of a branched network of ducts connected to acini. They are lined by a monolayered epithelium that derives from the endoderm and is surrounded by mesoderm-derived mesenchyme. The morphogenic mechanisms by which the ductal network is established as well as the signaling pathways involved in this process are poorly understood. Results By morphological analyzis of wild-type and mutant mouse embryos and using cultured embryonic explants we investigated how epithelial morphogenesis takes place and is regulated by chemokine signaling. Pancreas ontogenesis displayed a sequence of two opposite epithelial transitions. During the first transition, the monolayered and polarized endodermal cells give rise to tissue buds composed of a mass of non polarized epithelial cells. During the second transition the buds reorganize into branched and polarized epithelial monolayers that further differentiate into tubulo-acinar glands. We found that the second epithelial transition is controlled by the chemokine Stromal cell-Derived Factor (SDF-1. The latter is expressed by the mesenchyme, whereas its receptor CXCR4 is expressed by the epithelium. Reorganization of cultured pancreatic buds into monolayered epithelia was blocked in the presence of AMD3100, a SDF-1 antagonist. Analyzis of sdf1 and cxcr4 knockout embryos at the stage of the second epithelial transition revealed transient defective morphogenesis of the ventral and dorsal pancreas. Reorganization of a globular mass of epithelial cells in polarized monolayers is also observed during submandibular glands development. We found that SDF-1 and CXCR4 are expressed in this organ and that AMD3100 treatment of submandibular gland explants blocks its branching morphogenesis. Conclusion In conclusion, our data show that the primitive pancreatic ductal network, which is lined by a monolayered and polarized epithelium, forms by remodeling of a globular mass of non

  12. Mechanism of primitive duct formation in the pancreas and submandibular glands: a role for SDF-1.

    Science.gov (United States)

    Hick, Anne-Christine; van Eyll, Jonathan M; Cordi, Sabine; Forez, Céline; Passante, Lara; Kohara, Hiroshi; Nagasawa, Takashi; Vanderhaeghen, Pierre; Courtoy, Pierre J; Rousseau, Guy G; Lemaigre, Frédéric P; Pierreux, Christophe E

    2009-12-14

    The exocrine pancreas is composed of a branched network of ducts connected to acini. They are lined by a monolayered epithelium that derives from the endoderm and is surrounded by mesoderm-derived mesenchyme. The morphogenic mechanisms by which the ductal network is established as well as the signaling pathways involved in this process are poorly understood. By morphological analyzis of wild-type and mutant mouse embryos and using cultured embryonic explants we investigated how epithelial morphogenesis takes place and is regulated by chemokine signaling. Pancreas ontogenesis displayed a sequence of two opposite epithelial transitions. During the first transition, the monolayered and polarized endodermal cells give rise to tissue buds composed of a mass of non polarized epithelial cells. During the second transition the buds reorganize into branched and polarized epithelial monolayers that further differentiate into tubulo-acinar glands. We found that the second epithelial transition is controlled by the chemokine Stromal cell-Derived Factor (SDF)-1. The latter is expressed by the mesenchyme, whereas its receptor CXCR4 is expressed by the epithelium. Reorganization of cultured pancreatic buds into monolayered epithelia was blocked in the presence of AMD3100, a SDF-1 antagonist. Analyzis of sdf1 and cxcr4 knockout embryos at the stage of the second epithelial transition revealed transient defective morphogenesis of the ventral and dorsal pancreas. Reorganization of a globular mass of epithelial cells in polarized monolayers is also observed during submandibular glands development. We found that SDF-1 and CXCR4 are expressed in this organ and that AMD3100 treatment of submandibular gland explants blocks its branching morphogenesis. In conclusion, our data show that the primitive pancreatic ductal network, which is lined by a monolayered and polarized epithelium, forms by remodeling of a globular mass of non polarized epithelial cells. Our data also suggest that SDF-1

  13. A case of double common bile duct in a deceased donor for transplantation.

    Science.gov (United States)

    Imamura, Hajime; Eguchi, Susumu; Shapiro, A M James; Kin, Tatsuya

    2017-12-01

    A double common bile duct is extremely rare among the anatomical variations in the biliary tract system. We report an incidentally encountered case of the double common bile duct and discuss the novel anatomical findings of the accessory common bile duct from the viewpoint of embryology. A unique point of our case is that the accessory common bile duct bifurcated at the level of the intrapancreatic bile duct. There is no similar case in the previous literature among type II double common bile duct in the viewpoint of anatomical findings of the accessory common bile duct. We assume that this asymptomatic anatomical variation may be present more commonly, but not diagnosed.

  14. 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...

  15. Biliary duct obstruction treatment with aid of percutaneous ...

    African Journals Online (AJOL)

    Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage. Daniel Knap, Natalia Orlecka, Renata Judka, Aleksandra Juza, Michał Drabek, Maciej Honkowicz, Tomasz Kirmes, Bartosz Kadłubicki, Dominik Sieron, Jan Baron ...

  16. Lacrimal gland duct stones: misdiagnosed as chalazion in 3 cases.

    Science.gov (United States)

    Kim, Sung Chul; Lee, Kook; Lee, Sang Un

    2014-02-01

    To report 3 cases of lacrimal gland duct stones misdiagnosed as chalazion. Retrospective case series. Three patients with lacrimal gland duct stones misdiagnosed as chalazion at a local clinic between 2010 and 2012. A thorough review of clinical, imaging, and histopathologic manifestations. Clinical manifestations of lacrimal gland duct stones included conjunctival injection, lid swelling, tenderness, and ocular discharge, which are similar to chalazion symptoms. Computed tomography revealed a relatively well-defined, high-density mass near the lacrimal gland. Histopathologic examination of excised material revealed calcified amorphous stones. Intractable chalazion-like lesions at the lateral canthal area near the lacrimal gland should be carefully examined; imaging studies are required to confirm the presence of lacrimal gland duct stones, which require surgical removal. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  17. 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.

  18. Ducting arrangement for cooling a gas turbine structure

    Science.gov (United States)

    Lee, Ching-Pang; Morrison, Jay A.

    2015-07-21

    A ducting arrangement (10) for a can annular gas turbine engine, including: a duct (12, 14) disposed between a combustor (16) and a first row of turbine blades and defining a hot gas path (30) therein, the duct (12, 14) having raised geometric features (54) incorporated into an outer surface (80); and a flow sleeve (72) defining a cooling flow path (84) between an inner surface (78) of the flow sleeve (72) and the duct outer surface (80). After a cooling fluid (86) traverses a relatively upstream raised geometric feature (90), the inner surface (78) of the flow sleeve (72) is effective to direct the cooling fluid (86) toward a landing (94) separating the relatively upstream raised geometric feature (90) from a relatively downstream raised geometric feature (94).

  19. Minimally invasive treatment of extrahepatic bile duct stones

    Directory of Open Access Journals (Sweden)

    HAN Wurijile

    2015-05-01

    Full Text Available With the continuous improvement of endoscopic technology and equipment, minimally invasive treatment of bile duct stones becomes increasingly diversified. In this paper, the concept of minimally invasive treatment of bile duct stones, surgical indications and contraindications, surgical methods, and the advantages and disadvantages of surgical methods are introduced. It is shown that the application of laparoscope has laid the foundation for the minimally invasive treatment of bile duct stones, and the combined application of choledochoscope and endoscope has brought new ideas for minimally invasive treatment of bile duct stones. The combination of three endoscopes avoids the disadvantages of traditional open surgery: large trauma and long operation time, and reduces the patient′s pain and complications. In the near future, the combination of three endoscopes still has much room for growth. As long as the indications for several surgeries are mastered and the safety and efficacy are evaluated objectively, the combination of three endoscopes will play the biggest role.

  20. 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.

  1. DUCT RETROFIT STRATEGY TO COMPLEMENT A MODULATING FURNACE.

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    2002-10-02

    Some recent work (Walker 2001, Andrews 2002) has indicated that installing a modulating furnace in a conventional duct system may, in many cases, result in a significant degradation in thermal distribution efficiency. The fundamental mechanism was pointed out nearly two decades ago (Andrews and Krajewski 1985). The problem occurs in duct systems that are less-than-perfectly insulated (e.g., R-4 duct wrap) and are located outside the conditioned space. It stems from the fact that when the airflow rate is reduced, as it will be when the modulating furnace reduces its heat output rate, the supply air will have a longer residence time in the ducts and will therefore lose a greater percentage of its heat by conduction than it did at the higher airflow rate. The impact of duct leakage, on the other hand, is not expected to change very much under furnace modulation. The pressures in the duct system will be reduced when the airflow rate is reduced, thus reducing the leakage per unit time. This is balanced by the fact that the operating time will increase in order to meet the same heating load as with the conventional furnace operating at higher output and airflow rates. The balance would be exact if the exponent in the pressure vs. airflow equation were the same as that in the pressure vs. duct leakage equation. Since the pressure-airflow exponent is usually {approx}0.5 and the pressure-leakage exponent is usually {approx}0.6, the leakage loss as a fraction of the load should be slightly lower for the modulating furnace. The difference, however, is expected to be small, determined as it is by a function with an exponent equal to the difference between the above two exponents, or {approx}0.1. The negative impact of increased thermal conduction losses from the duct system may be partially offset by improved efficiency of the modulating furnace itself. Also, the modulating furnace will cycle on and off less often than a single-capacity model, and this may add a small amount

  2. 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.

  3. Surgical versus endoscopic treatment of bile duct stones

    DEFF Research Database (Denmark)

    Martin, D J; Vernon, D R; Toouli, J

    2006-01-01

    10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.......10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery....

  4. Numerical Modeling of a Ducted Rocket Combustor With Experimental Validation

    OpenAIRE

    Hewitt, Patrick

    2008-01-01

    The present work was conducted with the intent of developing a high-fidelity numerical model of a unique combustion flow problem combining multi-phase fuel injection with substantial momentum and temperature into a highly complex turbulent flow. This important problem is very different from typical and more widely known liquid fuel combustion problems and is found in practice in pulverized coal combustors and ducted rocket ramjets. As the ducted rocket engine cycle is only now finding wides...

  5. Better Duct Systems for Home Heating and Cooling

    Energy Technology Data Exchange (ETDEWEB)

    2004-11-01

    Duct systems used in forced-air space-conditioning systems are a vital element in home energy efficiency. How well a system works makes a big difference in the cost and the effectiveness of heating and cooling a home. At the same time, a duct system that is poorly designed or maintained can have a detrimental effect on the health of the people who live in the house, through the unintended distribution of indoor air pollution.

  6. Parotid duct stenosis: interventional radiology to the rescue.

    Science.gov (United States)

    Roberts, D N; Juman, S; Hall, J R; Jonathan, D A

    1995-11-01

    Recurrent parotid sialadenitis due to isolated parotid duct stenosis is an uncommon condition and poses a difficult management problem. Conventional surgical practice carries with it a potentially high morbidity for what is a benign condition. We present three cases where parotid duct stenosis has been treated by balloon dilatation and propose that this is a safe, quick and repeatable method for dealing with this problem.

  7. 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.

  8. Effect of surface deposits on electromagnetic propagation in uniform ducts

    Science.gov (United States)

    Baumeister, Kenneth J.

    1991-01-01

    A finite-element Galerkin formulation has been used to study the effect of material surface deposits on the reflective characteristics of straight uniform ducts with PEC (perfectly electric conducting) walls. Over a wide frequency range, the effect of both single and multiple dielectric surface deposits on the duct reflection coefficient were examined. The power reflection coefficient was found to be significantly increased by the addition of deposits on the wall.

  9. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision.

    Science.gov (United States)

    Pareja, Fresia; Corben, Adriana D; Brennan, Sandra B; Murray, Melissa P; Bowser, Zenica L; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth A; Brogi, Edi

    2016-09-15

    The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society. © 2016 American Cancer Society.

  10. [A Resected Case of Intraductal Pupillary Mucinous Neoplasm of the Pancreas Characterized by Recurrence in the Remnant Pancreas and Multiple Malignant Neoplasms in Other Organs].

    Science.gov (United States)

    Yoshioka, Ryo; Tomimaru, Yoshito; Noguchi, Kozo; Nagase, Hirotsugu; Hamabe, Atsushi; Hirota, Masashi; Oshima, Kazuteru; Tanida, Tsukasa; Kawase, Tomono; Morita, Shunji; Imamura, Hiroshi; Iwazawa, Takashi; Akagi, Kenzo; Adachi, Shiro; Dono, Keizo

    2016-11-01

    A 74-year-old man underwent pancreaticoduodenectomy for intraductal pupillary mucinous neoplasm(IPMN)of the pancreatic head. Histopathological examination of the specimen revealed non-invasive intraductal papillary mucinous carcinoma( IPMC). Two years after surgery, recurrent IPMN developed in the remnant pancreas, and a liver tumor was identified in S8 of the liver. The patient underwent total pancreatectomy of the remnant pancreas and partial resection of S8. These tumors were histopathologically diagnosed as invasive IPMC and hepatocellular carcinoma, respectively. Five years after the resec- tions, another liver tumor was identified in S4/3 of the liver, and partial resection of S4/3 was performed. The tumor was histopathologically identified as cholangiocellular carcinoma. Seven months after the last surgery, the patient remains in good health without any recurrences. IPMN is characterized by IPMN recurrence in the remnant pancreas and malignant neoplasms in other organs, and the present case showed both characteristics. The case suggested the importance of postoperative follow-up of IPMN patents with regard to the characteristics of IPMN.

  11. Parotid duct laceration repair in two horses : case report

    Directory of Open Access Journals (Sweden)

    A. Olivier

    1998-07-01

    Full Text Available Repair of parotid duct lacerations in 2 horses is described using intraluminal silastic tubing as a stent. The duct was lacerated traumatically at the facial vessel notch (incisura vasorum facialium in the 1st horse, and iatrogenically after removal of an intraluminal sialolith after development of infection within the duct in the 2nd horse. In both cases, a silastic tube was passed retrograde into the duct via the salivary papilla, past the wound until the end lay rostroventral to the parotid salivary gland. The severed salivary ducts and the wounds were sutured. The external portion of the silastic tube was sutured to the skin and the tube left in place. Recovery in the 1st case was uneventful. In the 2nd case a salivary duct/cutaneous fistula formed at a wound distant from the sutured wound, which healed spontaneously. This technique differs from a similar described technique in that the stent tube exits the oral cavity and is attached to the outer skin surface.

  12. 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.

  13. Improving Diffusing S-duct Performance by Secondary Flow Control

    Science.gov (United States)

    Reichert, Bruce A.; Wendt, Bruce J.

    1994-01-01

    The objective of this research was to study ways to reduce inlet flow distortion (i.e., total pressure nonuniformity) and improve total pressure recovery in a diffusing S-duct. This was accomplished by controlling the development of secondary flows within the duct through the use of tapered-fin type vortex generators. Reported are results for the bare duct and seven different configurations of vortex generators. Data presented for each configuration include surface static pressure, surface flow visualization, and exit plane total pressure and transverse velocity. The performance of each configuration was assessed by calculating total pressure recovery and inlet distortion descriptors from the data and comparing them to the values for the bare duct. The best configuration tested reduced distortion (as measured by the DC(45) and DC(90) descriptors) by more than 50 percent while improving total pressure recovery by 0.5 percent. These results should provide valuable guidance in designing vortex generator installations in ducts and for assessing the accuracy of computational fluid dynamics (CFD) methods to calculate duct flows with installed vortex generators.

  14. 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.

  15. Natural convection heat transfer along vertical rectangular ducts

    Energy Technology Data Exchange (ETDEWEB)

    Ali, M. [King Saud University, Mechanical Engineering Department, Riyadh (Saudi Arabia)

    2009-12-15

    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. (orig.)

  16. Flow control in a diffusing S-Duct

    Science.gov (United States)

    Vakili, A. D.; Wu, J. M.; Liver, P.; Bhat, M. K.

    1985-01-01

    Accurate measurements have been made of secondary flow in a 1.51 area ratio diffusing 30 deg - 30 deg S-Duct with circulair cross section. Turbulent flow was entering the duct at Mach number of 0.6, the boundary layer thickness at the duct entrance was ten percent of the duct inlet diameter. Through measurements made, local flow velocity vector as well as static and total pressures mapping of the flow at several stations were obtained. Strong secondary flow was measured in the first bend which continued into the second bend with new vorticity produced in there in the opposite direction. Surface oil flow visualization and wall pressures indicated a region of separated flow starting at theta approximately equal to 22 deg on the inside of the first bend up to theta approximately equal to 44 deg on the outside of the second bend. The flow separated in 'cyclone' form and never reattached in the duct. As a result of the secondary flow and the flow separation, significant total pressure distortion was observed at the exit of the duct. Using flow control devices the separation was eliminated while the exit distortion was improved.

  17. Integrin-linked Kinase Controls Renal Branching Morphogenesis via Dual Specificity Phosphatase 8.

    Science.gov (United States)

    Smeeton, Joanna; Dhir, Priya; Hu, Di; Feeney, Meghan M; Chen, Lin; Rosenblum, Norman D

    2016-05-01

    Integrin-linked kinase (ILK) is an intracellular scaffold protein with critical cell-specific functions in the embryonic and mature mammalian kidney. Previously, we demonstrated a requirement for Ilk during ureteric branching and cell cycle regulation in collecting duct cells in vivo Although in vitro data indicate that ILK controls p38 mitogen-activated protein kinase (p38MAPK) activity, the contribution of ILK-p38MAPK signaling to branching morphogenesis in vivo is not defined. Here, we identified genes that are regulated by Ilk in ureteric cells using a whole-genome expression analysis of whole-kidney mRNA in mice with Ilk deficiency in the ureteric cell lineage. Six genes with expression in ureteric tip cells, including Wnt11, were downregulated, whereas the expression of dual-specificity phosphatase 8 (DUSP8) was upregulated. Phosphorylation of p38MAPK was decreased in kidney tissue with Ilk deficiency, but no significant decrease in the phosphorylation of other intracellular effectors previously shown to control renal morphogenesis was observed. Pharmacologic inhibition of p38MAPK activity in murine inner medullary collecting duct 3 (mIMCD3) cells decreased expression of Wnt11, Krt23, and Slo4c1 DUSP8 overexpression in mIMCD3 cells significantly inhibited p38MAPK activation and the expression of Wnt11 and Slo4c1. Adenovirus-mediated overexpression of DUSP8 in cultured embryonic murine kidneys decreased ureteric branching and p38MAPK activation. Together, these data demonstrate that Ilk controls branching morphogenesis by regulating the expression of DUSP8, which inhibits p38MAPK activity and decreases branching morphogenesis. Copyright © 2016 by the American Society of Nephrology.

  18. 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.

  19. 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.

  20. Branch prediction in the pentium family

    DEFF Research Database (Denmark)

    Fog, Agner

    1998-01-01

    How the branch prediction mechanism in the Pentium has been uncovered with all its quirks, and the incredibly more effective branch prediction in the later versions.......How the branch prediction mechanism in the Pentium has been uncovered with all its quirks, and the incredibly more effective branch prediction in the later versions....

  1. A Serous Cystic Neoplasm of the Pancreas Coexisting with High-Grade Pancreatic Intraepithelial Neoplasia Mimicking an Intraepithelial Papillary Mucinous Neoplasm: A Case Report.

    Science.gov (United States)

    Kawanishi, Aya; Hirabayashi, Kenichi; Kono, Hirotaka; Takanashi, Yumi; Hadano, Atsuko; Kawashima, Yohei; Ogawa, Masami; Kawaguchi, Yoshiaki; Yamada, Misuzu; Nakagohri, Toshio; Nakamura, Naoya; Mine, Tetsuya

    2017-01-01

    Serous cystic neoplasms of the pancreas are rare exocrine pancreatic neoplasms, most of which are benign and do not communicate with the pancreatic duct. Pancreatic intraepithelial neoplasm (PanIN) is considered a precursor of ductal adenocarcinoma that is microscopically recognized in pancreatic ducts. A 67-year-old Japanese woman presented with a 10-mm multilocular cystic lesion at the pancreatic body. Magnetic resonance pancreatography showed stenosis of the main pancreatic duct at the pancreatic body and dilatation of the distal side of the main pancreatic duct. Furthermore, communication between the cystic lesion and the main pancreatic duct was suspected based on magnetic resonance pancreatography findings. Distal pancreatectomy was performed under the preoperative diagnosis of intraductal papillary mucinous neoplasm. Histologically, the cystic lesion was lined with a non-atypical cuboidal or flat epithelium with clear cytoplasm and was thus diagnosed as a serous cystic neoplasm. High-grade PanIN lesions with stromal fibrosis were observed at the main and branch pancreatic ducts. Histological examination revealed no communication between the serous cystic neoplasm and the pancreatic ducts. Immunohistochemically, the epithelium of the serous cystic neoplasm showed positive anti-von Hippel-Lindau antibody staining, whereas the epithelium of the PanIN showed negative staining. A serous cystic neoplasm coexisting with another pancreatic neoplasm is rare. When dilatation of the main or branch pancreatic ducts coexists with a serous cystic neoplasm, as in this case, the lesion clinically mimics an intraductal papillary mucinous neoplasm.

  2. In situ and intraductal epithelial proliferations of prostate: definitions and treatment implications. Part 1: Prostatic intraepithelial neoplasia.

    Science.gov (United States)

    Clouston, David; Bolton, Damien

    2012-04-01

    What's known on the subject? and What does the study add? In the era of extended biopsy sampling of the prostate, multifocal high-grade prostatic intraepithelial neoplasia (HGPIN) is associated with a significantly higher rate of cancer diagnosis than unifocal HGPIN or a benign diagnosis. In addition, the cancers that are subsequently diagnosed in men with HGPIN on their initial biopsy tend to be smaller, lower grade and more commonly organ-confined. This has led to a reappraisal of the need and timing of repeat biopsies. The present paper provides a series of recommendations on the optimal timing of repeat biopsies in men with HGPIN on biopsy, based on the current available evidence. This is the first of a two part series reviewing the nature and clinical significance of in situ cellular proliferations in the prostate gland. This first part examines prostatic intraepithelial neoplasia (PIN), while the second part in the next supplement discusses intraductal carcinoma and ductal adenocarcinoma of the prostate. PIN is a precursor lesion in the development of some forms of adenocarcinoma of the prostate. In the 1990 s, high-grade PIN (HGPIN) on biopsy was a significant predictor of carcinoma, but this was due to incomplete sampling with sextant biopsies. With more extensive sampling in the last decade, the likelihood of identifying cancer after a diagnosis of HGPIN is not significantly different from a benign diagnosis. In several recent studies, it is now recognised that multifocal HGPIN is a better predictor of cancer than unifocal HGPIN. Most cases of cancer will be detected in the vicinity of the HGPIN, but up to 40% of cancers will occur in different sextants. In assessing potential markers for carcinoma in men with HGPIN on biopsy, α-methylacyl coenzyme-A racemase (AMACR) has emerged as a promising diagnostic tool. HGPIN with strong staining for AMACR is associated with a higher rate of cancer detection in subsequent biopsies compared with AMACR-negative HGPIN

  3. Anisometropia and amblyopia in nasolacrimal duct obstruction.

    Science.gov (United States)

    Kipp, Michael A; Kipp, Michael A; Struthers, William

    2013-06-01

    To investigate an association of childhood nasolacrimal duct obstruction (NLDO) with anisometropia and amblyopia. The medical records of patients from newborn to 6 years of age with a diagnosis of NLDO seen from 2000 to 2010 were retrospectively reviewed. Data collected included age at onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥1 D), and diagnosis of amblyopia with amblyopia subtype (anisometropic vs other). A total of 1,218 patients with NLDO were included. Of these, 887 cases (72.8%) were unilateral; 331 (27.2%), bilateral. Anisometropia was found in 67 (7.6%) unilateral cases and 12 (3.6 %) bilateral cases on initial examination (χ2=5.48, P anisometropia patients (χ(2) = 33.01, P anisometropia for a total of 105 of 1218 (8.6%). Of the 482 patients, 28 (5.8%) developed amblyopia, 16 cases of which were purely attributable to anisometropia. Of 41 patients with anisometropia who were in the follow-up, 9 (22%) developed amblyopia. Anisometropia occurred at a greater rate in unilateral NLDO patients compared with bilateral NLDO patients and occurred at a greater rate in this NLDO cohort than expected in the general pediatric population. Several patients with anisometropia developed clinical amblyopia. Measurement of cycloplegic refraction in all NLDO patients at initial examination should be considered. Periodic follow-up is appropriate for patients with NLDO and anisometropia. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  4. Ejaculatory duct obstruction in infertile men.

    Science.gov (United States)

    Paick, J; Kim, S H; Kim, S W

    2000-04-01

    To analyse our experience of ejaculatory duct obstruction (EDO) in infertile men, evaluating the diagnostic steps and the outcome of management according to the aetiology. Over a 7-year period, 50 infertile men were diagnosed with EDO as a contributory factor to male infertility. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy, transrectal ultrasonography (TRUS) and/or vasography. Thirty-one patients with EDO were treated by transurethral resection (26) or forced lavage via a vasotomy (five). In 45 of the 50 men, semen analyses showed the typical characteristics of complete EDO. Seminal values were variable in five cases of partial EDO; the semen fructose levels were EDO was a midline cyst in 16, Wolffian malformation in four, tuberculosis in 17, previous genitourinary infection in five and idiopathic in eight men. In 17 patients the seminal vesicles appeared to be atrophied on TRUS; 15 of these patients had a history of pulmonary tuberculosis and subsequent vasography in five showed multiple bilateral vasal obstruction. TRUS findings correlated well with vasography except in one case. The overall rate of improved semen values and paternity was 61% and 26%, respectively. Of 16 patients with midline cysts, 14 had improved semen variables and achieved paternity, seven after transurethral resection. TRUS should be the first diagnostic procedure used when infertile men are suspected of having EDO, but vasography should still be considered for a more comprehensive diagnosis. In patients with atrophic seminal vesicles on TRUS and with a history of pulmonary tuberculosis, further study is unnecessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. The measurement of semen fructose may be helpful in diagnosing partial EDO. Patients with midline cysts who are treated by transurethral resection are expected to have the best outcome.

  5. National Zoological Park Branch Library.

    Science.gov (United States)

    Kenyon, Kay A.

    1988-01-01

    Describes the functions of the National Zoological Park Branch of the Smithsonian Institution Libraries, which is dedicated to supporting the special information needs of the zoo. Topics covered include the library's history, collection, programs, services, future plans, and relations with other zoo libraries. (two references) (Author/CLB)

  6. Branching diffusion with particle interactions

    OpenAIRE

    Engländer, János; Zhang, Liang

    2016-01-01

    A $d$-dimensional branching diffusion, $Z$, is investigated, where the linear attraction or repulsion between particles is competing with an Ornstein-Uhlenbeck drift, with parameter $b$ (we take $b>0$ for inward O-U and $b0$) or repulsion ($\\gamma 0$, while escapes to infinity exponentially fast (rate $|b|$) when $b

  7. 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.

  8. Parametric study of electromagnetic waves propagating in absorbing curved S ducts

    Science.gov (United States)

    Baumeister, Kenneth J.

    1989-01-01

    A finite-element Galerkin formulation has been developed to study attenuation of transverse magnetic (TM) waves propagating in two-dimensional S-curved ducts with absorbing walls. In the frequency range where the duct diameter and electromagnetic wave length are nearly equal, the effect of duct length, curvature (duct offset), and absorber wall thickness was examined. For a given offset in the curved duct, the length of the S-duct was found to significantly affect both the absorptive and reflective characteristics of the duct. For a straight and a curved duct with perfect electric conductor terminations, power attenuation contours were examined to determine electromagnetic wall properties associated with maximum input signal absorption. Offset of the S-duct was found to significantly affect the value of the wall permittivity associated with the optimal attenuation of the incident electromagnetic wave.

  9. The Effects of Vortex Ingestion on the Flow in a Diffusing S-duct

    Science.gov (United States)

    Wendt, B. J.; Reichert, B. A.

    1994-01-01

    An experimental study of the effects of an ingested vortex on the flowfield of a diffusing S-duct is reported. The vortex is generated through the use of a stationary pinwheel device mounted upstream of the diffusing S-duct. Three test conditions vary the location of the vortex in the duct inlet crossplane. For each condition of ingested vortex, a baseline S-duct and an S-duct with an array of vortex generators is examined. The data taken consist of duct inlet and exit crossplane surveys of velocity and total pressure. Duct surface flow visualization and static pressure are also recorded. The data acquired in these tests are compared to identical S-duct data taken in the absence of the ingested vortex. The ingested vortex is observed to have a strong influence on the flowfield inside (and exiting) the S-duct, but only when the vortex impinges at the inlet crossplane location coincident with the crossplane location of downstream flow separation within the duct. When the ingested vortex impinges at this location it reduces the extent of flowfield separation inside the baseline duct and promotes stronger crossflow in the exit plane of both the baseline duct and the duct with installed vortex generators. This enhanced crossflow also strengthens the vortices shed from the vortex generators. The other impingement locations of the ingested vortex are found to produce little effect on the flowfield of the duct with or without vortex generators.

  10. Optimum design of the injection duct system of a stenter machine

    Energy Technology Data Exchange (ETDEWEB)

    Juraeva, Makhsuda; Song, Dong Joo [Yeungnam University, Geyongsan (Korea, Republic of); Ryu, Kyung Jin [Ajou Motor College, Boryeong (Korea, Republic of)

    2017-05-15

    Stenter machines are used for drying fabrics in the textile industry and have a heater, injection duct system, and fans inside a chamber. The injection duct system has ducts and air-injecting holes. Plane-type injection duct systems were investigated to obtain uniform airflow at the air-injecting holes. The flow field of the injection duct systems was computed using ANSYS CFX with different heights of the duct end and different shapes for the air-injecting holes. There was a high mass flow rate at the air-injecting holes and high airflow circulation inside both plane-type and mountain-type ducts at the ends. The height of the duct end was varied between 40 mm and 160 mm. The injection duct systems were analyzed with four different shapes of air-injecting holes. The circular and elliptical holes had lower standard deviations of the mass flow rate than other shapes. Relatively uniform mass flow rates were obtained in the plane-type and mountain-type duct systems when the height of the duct end was 40 mm and the shape of the air-injecting holes was circular or elliptical. The developed injection duct systems were improved by obtaining a uniform mass flow rate at the air-injecting holes. A stenter prototype was fabricated with the developed injection duct system to confirm the numerical results. The developed injection duct system had better performance than the original system.

  11. Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy

    Directory of Open Access Journals (Sweden)

    Alampath Praveen

    2012-01-01

    Full Text Available Thoracic duct embolization (TDE is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

  12. Trastuzumab in Treating Patients With Locally Advanced or Metastatic Gallbladder Cancer or Bile Duct Cancer That Cannot Be Removed by Surgery

    Science.gov (United States)

    2014-05-15

    Adenocarcinoma of the Extrahepatic Bile Duct; Adenocarcinoma of the Gallbladder; Malignant Neoplasm; Recurrent Extrahepatic Bile Duct Cancer; Recurrent Gallbladder Cancer; Unresectable Extrahepatic Bile Duct Cancer; Unresectable Gallbladder Cancer

  13. Does salivary duct repositioning prevent complications after tumor resection or salivary gland surgery?

    Science.gov (United States)

    Sakakibara, Akiko; Minamikawa, Tsutomu; Hashikawa, Kazunobu; Sakakibara, Shunsuke; Hasegawa, Takumi; Akashi, Masaya; Furudoi, Shungo; Komori, Takahide

    2015-05-01

    Tissue that is resected for the treatment of oral tumors often includes salivary gland ducts. At their institution, the authors conserve and transfer as much of the salivary duct as possible during these procedures to avoid obstructive complications. Differentiating these obstructive complications from a metastatic node can be challenging and can confound subsequent oncologic management. This study compared and examined the effectiveness of salivary duct repositioning in decreasing the incidence of obstructive complications. Cases of oromandibular disease treated with salivary duct resection at Kobe University Graduate School of Medicine from 2008 to 2013 were retrospectively analyzed. Thirty-two cases (25 patients) of Wharton duct resection and 31 cases (31 patients) of Stensen duct resection were included. The incidence of complications after salivary duct repositioning, duct ligation, and retention of the sublingual gland around the Wharton duct was compared. Wharton ducts were repositioned in 30 cases and ligated in 2 cases. Complications, including oral swelling at the Wharton duct, were observed in 5 cases of repositioning and 2 cases of ligation. Stensen ducts were repositioned in 9 cases and ligated in 22 cases. The only complication reported was a single case of salivary fistula after ligation. Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones.

    Science.gov (United States)

    Konstantakis, Christos; Triantos, Christos; Theopistos, Vasileios; Theocharis, Georgios; Maroulis, Ioannis; Diamantopoulou, Georgia; Thomopoulos, Konstantinos

    2017-01-16

    To evaluate the rate of recurrence of symptomatic choledocholithiasis and identify factors associated with the recurrence of bile duct stones in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for bile duct stone disease. All patients who underwent ERCP and EST for bile duct stone disease and had their bile duct cleared from 1/1/2005 until 31/12/2008 was enrolled. All symptomatic recurrences during the study period (until 31/12/2015) were recorded. Clinical and laboratory data potentially associated with common bile duct (CBD) stone recurrence were retrospectively retrieved from patients' files. A total of 495 patients were included. Sixty seven (67) out of 495 patients (13.5%) presented with recurrent symptomatic choledocholithiasis after 35.28 ± 16.9 mo while twenty two (22) of these patients (32.8%) experienced a second recurrence after 35.19 ± 23.2 mo. Factors associated with recurrence were size (diameter) of the largest CBD stone found at first presentation (10.2 ± 6.9 mm vs 7.2 ± 4.1 mm, P = 0.024), diameter of the CBD at the first examination (15.5 ± 6.3 mm vs 12.0 ± 4.6 mm, P = 0.005), use of mechanical lithotripsy (ML) (P = 0.04) and presence of difficult lithiasis (P = 0.04). Periampullary diverticula showed a trend towards significance (P = 0.066). On the contrary, number of stones, angulation of the CBD, number of ERCP sessions required to clear the CBD at first presentation, more than one ERCP session needed to clear the bile duct initially and a gallbladder in situ did not influence recurrence. Bile duct stone recurrence is a possible late complication following endoscopic stone extraction and CBD clearance. It appears to be associated with anatomical parameters (CBD diameter) and stone characteristics (stone size, use of ML, difficult lithiasis) at first presentation.

  15. Investigations of a building-integrated ducted wind turbine module

    Science.gov (United States)

    Dannecker, Robert K. W.; Grant, Andrew D.

    2002-01-01

    So far, wind energy has not played a major role in the group of technologies for embedded generation in the built environment. However, the wind flow around conventional tall buildings generates differential pressures, which may cause an enhanced mass flow through a building-integrated turbine. As a first step, a prototype of a small-scale ducted wind turbine has been developed and tested, which seems to be feasible for integration into the leading roof edge of such a building. Here an experimental and numerical investigation of the flow through building-integrated ducting is presented. Pressure and wind speed measurements have been carried out on a wind tunnel model at different angles of incident wind, and different duct configurations have been tested. It was confirmed that wind speeds up to 30% higher than in the approaching freestream may be induced in the duct, and good performance was obtained for angles of incident wind up to ±60°. The experimental work proceeded in parallel with computational fluid dynamics (CFD) modelling. The geometry of the system was difficult to represent to the required level of accuracy, and modelling was restricted to a few simple cases, for which the flow field in the building-integrated duct was compared with experimental results. Generally good agreement was obtained, indicating that CFD techniques could play a major role in the design process. Predicted power of the proposed device suggests that it will compare favourably with conventional small wind turbines and photovoltaics in an urban environment.

  16. 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.

  17. Guideline for design requirement on KALIMER driver fuel assembly duct

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Woan; Kang, H. Y.; Nam, C.; Kim, J. O.; Lim, J. S.; Ryu, W. S.; Min, B. T.; Kim, D. H.; Kim, Y. J.

    1998-01-01

    This document describes design requirements which are needs for designing the driver fuel assembly duct of the KALIMER as design guidance. The driver fuel assembly duct of the KALIMER consists of fuel rods, mounting rail, nosepiece, duct with pad, handling socket with pad. Fuel rod consists of top end plug, bottom end plug with solid ferritic-martensitic steel rod and key way, fuel slug, cladding, and wire wrap. In the assembly, the rods are in a triangular pitch array, and the rod bundle attaches to the nosepiece with mounting rails. The bottom end of the assembly duct is formed by a long nosepiece which provides the lower restraint function and the coolant inlet. It contains functional requirements, performance and operational requirements, interfacing systems requirements, core restraint and interface requirements, design limits and strength requirements, structural requirements, environmental requirements, reliability and safety requirements, standard and codes, QA programs, and other requirements. The design requirements are intended to be used for the design of the driver fuel assembly duct of the KALIMER. (author). 16 refs., 4 figs.

  18. G Plus Industrial touts new ventilation ducting product

    Energy Technology Data Exchange (ETDEWEB)

    Larmour, A.

    2010-09-01

    This article discussed a new line of industrial-strength plastic duct work for underground mine ventilation. G Plus Industrial Plastics manufactures an extensive line of industrial-strength plastic products that help solve corrosion, wear, impact, and weight problems commonly found in mining and related industries. The new ventilation ducting product is impact and corrosion resistant, and it produces better air-flow resulting in significant cost savings. Plastic helps overcome wear and corrosion problems encountered in mines, and it can be designed to be stronger than aluminum, wood, or steel because it reacts better to impact and slides better. Standard duct work for mine ventilation is either flexible vinyl cloth or sheet metal, both of which create air restriction and weaknesses causing cracks, resulting in air loss. Plastic performs better, requiring less energy to bring the same amount of air to the end point. The ducting has been in development for almost a year. With the high energy rates in Ontario, plastic ducting is expected to result in substantial cost savings. 1 fig.

  19. Ducts in the Attic? What Were They Thinking? Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, D.; Winkler, J.

    2010-08-01

    As energy-efficiency efforts focus increasingly on existing homes, we scratch our heads about construction decisions made 30, 40, 50-years ago and ask: 'What were they thinking?' A logical follow-on question is: 'What will folks think in 2050 about the homes we're building today?' This question can lead to a lively discussion, but the current practice that we find most alarming is placing ducts in the attic. In this paper, we explore through literature and analysis the impact duct location has on cooling load, peak demand, and energy cost in hot climates. For a typical new home in these climates, we estimate that locating ducts in attics rather than inside conditioned space increases the cooling load 0.5 to 1 ton, increases cooling costs 15% and increases demand by 0.75 kW. The aggregate demand to service duct loss in homes built in Houston, Las Vegas, and Phoenix during the period 2000 through 2009 is estimated to be 700 MW. We present options for building homes with ducts in conditioned space and demonstrate that these options compare favorably with other common approaches to achieving electricity peak demand and consumption savings in homes.

  20. Does the bile duct angulation affect recurrence of choledocholithiasis?

    Science.gov (United States)

    Seo, Dong Beom; Bang, Byoung Wook; Jeong, Seok; Lee, Don Haeng; Park, Shin Goo; Jeon, Yong Sun; Lee, Jung Il; Lee, Jin-Woo

    2011-01-01

    AIM: To investigate whether bile duct angulation and T-tube choledochostomy influence the recurrence of choledocholithiasis. METHODS: We conducted a retrospective study inclu-ding 259 patients who underwent endoscopic sphincterotomy and cholecystectomy for choledocholithiasis between 2000 and 2007. The imaginary line was drawn along the center of the bile duct and each internal angle was measured at the two angulation sites of the bile duct respectively. The values of both angles were added together. We then tested our hypothesis by examining whether T-tube choledochostomy was performed and stone recurrence occurred by reviewing each subject’s medical records. RESULTS: The overall recurrence rate was 9.3% (24 of 259 patients). The mean value of sums of angles in the recurrence group was 268.3° ± 29.6°, while that in the non-recurrence group was 314.8° ± 19.9° (P bile duct angulation and T-tube choledochostomy may be risk factors of recurrence of bile duct stones. PMID:22039327

  1. Branching processes in disease epidemics

    Science.gov (United States)

    Singh, Sarabjeet

    Branching processes have served as a model for chemical reactions, biological growth processes and contagion (of disease, information or fads). Through this connection, these seemingly different physical processes share some common universalities that can be elucidated by analyzing the underlying branching process. In this thesis, we focus on branching processes as a model for infectious diseases spreading between individuals belonging to different populations. The distinction between populations can arise from species separation (as in the case of diseases which jump across species) or spatial separation (as in the case of disease spreading between farms, cities, urban centers, etc). A prominent example of the former is zoonoses -- infectious diseases that spill from animals to humans -- whose specific examples include Nipah virus, monkeypox, HIV and avian influenza. A prominent example of the latter is infectious diseases of animals such as foot and mouth disease and bovine tuberculosis that spread between farms or cattle herds. Another example of the latter is infectious diseases of humans such as H1N1 that spread from one city to another through migration of infectious hosts. This thesis consists of three main chapters, an introduction and an appendix. The introduction gives a brief history of mathematics in modeling the spread of infectious diseases along with a detailed description of the most commonly used disease model -- the Susceptible-Infectious-Recovered (SIR) model. The introduction also describes how the stochastic formulation of the model reduces to a branching process in the limit of large population which is analyzed in detail. The second chapter describes a two species model of zoonoses with coupled SIR processes and proceeds into the calculation of statistics pertinent to cross species infection using multitype branching processes. The third chapter describes an SIR process driven by a Poisson process of infection spillovers. This is posed as a

  2. Thyroid cancer in lingual thyroid and thyroglossal duct cyst.

    Science.gov (United States)

    Sturniolo, Giacomo; Vermiglio, Francesco; Moleti, Mariacarla

    2017-01-01

    Ectopy is the most common embryogenetic defect of the thyroid gland, representing between 48 and 61% of all thyroid dysgeneses. Persistence of thyroid tissue in the context of a thyroglossal duct remnant and lingual thyroid tissue are the most common defects. Although most cases of ectopic thyroid are asymptomatic, any disease affecting the thyroid may potentially involve the ectopic tissue, including malignancies. The prevalence of differentiated thyroid carcinoma in lingual thyroid and thyroglossal duct cyst is around 1% of patients affected with the above thyroid ectopies. We here review the current literature concerning primary thyroid carcinomas originating from thyroid tissue on thyroglossal duct cysts and lingual thyroid. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Design of a Mobile Robot for Air Ducts Exploration

    Directory of Open Access Journals (Sweden)

    Moses A. Koledoye

    2017-10-01

    Full Text Available This work presents the solutions adopted for the design and the implementation of an autonomous wheeled robot developed for the exploration and mapping of air ventilation ducts. The hardware is based on commercial off-the-shelf devices, including sensors, motors, processing devices and interfaces. The mechanical chassis was designed from scratch to meet a trade-off between small size and available volume to host the components. The software stack is based on the Robot Operating System (ROS. Special attention was dedicated to the design of the mobility strategy, which must take into account some constraints and issues that are specific to the considered application, such as the relatively small size of ducts, the need to detect and avoid possible holes on the floor of the duct and other unusual obstacles and the unavailability of external reference frameworks for localization. The main contribution of this paper lies in the design, implementation and experimentation of the overall system.

  4. 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....

  5. Endoscopic management of difficult common bile duct stones

    Science.gov (United States)

    Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

    2013-01-01

    Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

  6. 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.

  7. 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). © 2011 Acoustical Society of America

  8. Branched endografts for thoracoabdominal aneurysms.

    Science.gov (United States)

    Greenberg, Roy; Eagleton, Matthew; Mastracci, Tara

    2010-12-01

    Endovascular management of thoracoabdominal aneurysms has been studied since 2001, with marked advances allowing for the treatment of complex anatomic situations including chronic aortic dissections, tortuous anatomy, and extensive aneurysms that involve the visceral segment, aortic arch, and iliacs as well. However, the technology is not widely disseminated, and a thorough understanding of the engineering principles, imaging techniques, and devices available is required. Reinforced fenestrated branches coupled with balloon expandable stent grafts, and side-arm branch designs mated with self-expanding stent grafts have been used. Pure fenestrated designs were used for juxtarenal aneurysms, whereas thoracoabdominal aneurysms were treated with reinforced fenestrated branches or hybrid devices including side-arm branches and reinforced fenestrated branches. Intraoperative fusion techniques have been used since 2009, whereby preoperative computed tomographic data are fused with intraoperative fluoroscopy. Long-term survival in accordance with extent of disease was assessed with life table analysis techniques, and differences were analyzed using the log rank test. Intermediate-term data pertaining to patency related to both types of branches and paraplegia have been evaluated and previously published. A total of 406 patients with thoracoabdominal aneurysms and 227 patients with juxtarenal aneurysms have been enrolled in a prospective study. Perioperative and 2-year survival were most closely related to extent of initial disease and were estimated to be 1.8% and 82% for juxtarenal aneurysms, 2.3% and 82% for type IV, and 5.2% and 74% for type II and III thoracoabdominal aneurysms at 24 months, respectively. When patients undergoing endovascular repair (ER group) were matched with those having contemporary surgical repair (SR group) for anatomic disease extent, mortality was similar at 30 days (5.7% ER vs 8.3% SR; P = .2) and at 12 months (15.6% ER vs 15.9% SR; P = .9

  9. 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.

  10. K+ channels on resting duct cells from rat pancreas.

    Science.gov (United States)

    Hayashi, Mikio; Matsuda, Hiroko

    2009-01-01

    The ductal system of the exocrine pancreas produces HCO(3)(-)-rich fluid in response to secretin and other stimuli. HCO(3)(-) efflux across the luminal membrane is mediated by a Cl(-)-HCO(3)(-) exchanger operating in parallel with the cystic fibrosis transmembrane conductance regulator (CFTR) Cl(-) channel. Basolateral K(+) channels provide an exit pathway for K(+) and play a vital role in maintaining the membrane potential, which is a crucial component of the driving force for anion secretion. Measurements of membrane potential with intracellular microelectrodes suggested that Ba(2+)-sensitive K(+) conductance accounts for more than 60% of the total basolateral ionic conductance in resting ducts (1). To identify the Ba(2+)-sensitive K(+) channels, we isolated ducts from normal rat pancreas by collagenase digestion. We first demonstrated that the ducts did not express a vascular endothelial marker PECAM-1 (platelet/endothelial cell adhesion molecule-1), but expressed cytokeratin 20, a marker of duct cells (2), using immunofluorescent staining. In addition, monoclonal anti-CFTR antibody was detected near the luminal membrane of these cells. In cell-attached single-channel recordings, we observed three types of K(+) channels on basolateral membrane in unstimulated duct cells. The 40 pS K(+) channels are likely to mediate whole-cell inwardly rectifying K(+) (Kir) currents, which were blocked by extracellular Ba(2+) in a voltage-dependent manner. The properties of 90 pS and 170 pS K(+) channels are similar to those of Ca(2+)-activated K(+) channels. We then identified Kir2.0 and SK4/IK1 (intermediate conductance Ca(2+)-activated K(+) channel) subunits as molecular candidates of the K(+) channels using RT-PCR analysis. The present results suggest that these subunits may mediate native K(+) currents in resting duct cells. Further functional studies with specific blockers are required to evaluate which of these K(+) channels contribute to the resting membrane potential

  11. Surgical strategy for bile duct cancer: Advances and current limitations

    Science.gov (United States)

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Hashimoto, Daijo

    2011-01-01

    The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon’s ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud’s segment IV coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pylorus-preserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant

  12. 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...

  13. Electrostatically anchored branched brush layers.

    Science.gov (United States)

    Liu, Xiaoyan; Dedinaite, Andra; Rutland, Mark; Thormann, Esben; Visnevskij, Ceslav; Makuska, Ricardas; Claesson, Per M

    2012-11-06

    A novel type of block copolymer has been synthesized. It consists of a linear cationic block and an uncharged bottle-brush block. The nonionic bottle-brush block contains 45 units long poly(ethylene oxide) side chains. This polymer was synthesized with the intention of creating branched brush layers firmly physisorbed to negatively charged surfaces via the cationic block, mimicking the architecture (but not the chemistry) of bottle-brush molecules suggested to be present on the cartilage surface, and contributing to the efficient lubrication of synovial joints. The adsorption properties of the diblock copolymer as well as of the two blocks separately were studied on silica surfaces using quartz crystal microbalance with dissipation monitoring (QCM-D) and optical reflectometry. The adsorption kinetics data highlight that the diblock copolymers initially adsorb preferentially parallel to the surface with both the cationic block and the uncharged bottle-brush block in contact with the surface. However, as the adsorption proceeds, a structural change occurs within the layer, and the PEO bottle-brush block extends toward solution, forming a surface-anchored branched brush layer. As the adsorption plateau is reached, the diblock copolymer layer is 46-48 nm thick, and the water content in the layer is above 90 wt %. The combination of strong electrostatic anchoring and highly hydrated branched brush structures provide strong steric repulsion, low friction forces, and high load bearing capacity. The strong electrostatic anchoring also provides high stability of preadsorbed layers under different ionic strength conditions.

  14. Esrrg functions in early branch generation of the ureteric bud and is essential for normal development of the renal papilla.

    Science.gov (United States)

    Berry, Rachel; Harewood, Louise; Pei, Liming; Fisher, Malcolm; Brownstein, David; Ross, Allyson; Alaynick, William A; Moss, Julie; Hastie, Nicholas D; Hohenstein, Peter; Davies, Jamie A; Evans, Ronald M; FitzPatrick, David R

    2011-03-01

    Congenital anomalies of the kidney and urinary tract (CAKUTs) are common disorders of human development affecting the renal parechyma, renal pelvis, ureter, bladder and urethra; they show evidence of shared genetic aetiology, although the molecular basis of this remains unknown in the majority of cases. Breakpoint mapping of a de novo, apparently balanced, reciprocal translocation associated with bilateral renal agenesis has implicated the gene encoding the nuclear steroid hormone receptor ESRRG as a candidate gene for CAKUT. Here we show that the Esrrg protein is detected throughout early ureteric ducts as cytoplasmic/sub-membranous staining; with nuclear localization seen in developing nephrons. In 14.5-16.5 dpc (days post-conception) mouse embryos, Esrrg localizes to the subset of ductal tissue within the kidney, liver and lung. The renal ductal expression becomes localized to renal papilla by 18.5 dpc. Perturbation of function was performed in embryonic mouse kidney culture using pooled siRNA to induce knock-down and a specific small-molecule agonist to induce aberrant activation of Esrrg. Both resulted in severe abnormality of early branching events of the ureteric duct. Mouse embryos with a targeted inactivation of Esrrg on both alleles (Esrrg(-/-)) showed agenesis of the renal papilla but normal development of the cortex and remaining medulla. Taken together, these results suggest that Esrrg is required for early branching events of the ureteric duct that occur prior to the onset of nephrogenesis. These findings confirm ESRRG as a strong candidate gene for CAKUT.

  15. Variable stromal periductular expression of CD34 and smooth muscle actin (SMA in intraductal carcinoma of the breast.

    Directory of Open Access Journals (Sweden)

    Xavier Catteau

    Full Text Available In breast carcinoma, the stromal loss of CD34 expression and acquisition of SMA myofibroblastic features may constitute a prerequisite for tumor invasiveness. However, this hypothesis remains controversial, with some authors describing the loss of CD34 fibrocytes in the absence of SMA myofibroblastic-like cells in the stroma of invasive carcinoma. Others have also described the disappearance of CD34 fibrocytes from in situ carcinoma. To clarify this issue, we compared the distribution of CD34 fibrocytes and SMA reactive myofibroblasts between stromal areas of tumor-free mammary tissue, ductal carcinoma in situ (DCIS and invasive ductal carcinoma (IDC. In addition to 28 IDC, 300 normal duct-lobular units and 600 ducts with DCIS (158 low-grade, 266 intermediate, and 176 high-grade were scored. The relationships between staining patterns and different histological features (grade of DCIS and presence or absence of necrosis were compared. Loss of CD34 expression and acquisition of SMA expression were more frequent in high-grade in situ lesions than in intermediate and low-grade lesions (p<0.001. When necrosis was found in association with grade 2 or 3 DCIS, the decrease in CD34 expression was higher than in lesions without necrosis and that independently of the grade of DCIS (p<0.05. Necrosis did not appear to play a significant role in the expression of SMA (p = 0.35. In all cases, the stroma of invasive carcinomas showed a complete loss of CD34 fibrocytes. Future research on both CD34 fibrocytes and mechanisms stromal changes are essential in the future and may potentially lead to new treatment approaches.

  16. 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.

  17. Effects of small boundary perturbation on the MHD duct flow

    Directory of Open Access Journals (Sweden)

    Mahabaleshwar Ulavathi Shettar

    2017-01-01

    Full Text Available In this paper, we investigate the effects of small boundary perturbation on the laminar motion of a conducting fluid in a rectangular duct under applied transverse magnetic field. A small boundary perturbation of magnitude Є is applied on cross-section of the duct. Using the asymptotic analysis with respect to Є, we derive the effective model given by the explicit formulae for the velocity and induced magnetic field. Numerical results are provided confirming that the considered perturbation has nonlocal impact on the asymptotic solution.

  18. Sterility caused by functional absence of ejaculatory ducts.

    Science.gov (United States)

    Arce, B; Padrón, R S; Pérez-Plaza, M

    1981-01-01

    Five patients with functional absence of genital excretory ducts are presented, with emphasis on the scarcity of physical and complementary data obtained. The low impairment of spermatogenesis is pointed out. Seminal characteristics are analysed and the diagnostic importance of spermogram data stressed. The importance of the qualitative determination of fructose for the diagnosis of this syndrome is noted, as well as the incidence of this syndrome as the cause of azoospermia and sterility. The existence of a unilateral congenital absence of ejaculatory ducts is demonstrated. Cases of this sort cannot be detected unless a contralateral acquired lesion occurs.

  19. Sound propagation through a variable area duct - Experiment and theory

    Science.gov (United States)

    Silcox, R. J.; Lester, H. C.

    1981-01-01

    A comparison of experiment and theory has been made for the propagation of sound through a variable area axisymmetric duct with zero mean flow. Measurement of the acoustic pressure field on both sides of the constricted test section was resolved on a modal basis for various spinning mode sources. Transmitted and reflected modal amplitudes and phase angles were compared with finite element computations. Good agreement between experiment and computation was obtained over a wide range of frequencies and modal transmission variations. The study suggests that modal transmission through a variable area duct is governed by the throat modal cut-off ratio.

  20. Diverticular bile duct lesion in chronic active hepatitis

    DEFF Research Database (Denmark)

    Vyberg, M

    1989-01-01

    of a not previously described diverticular type were revealed. The diverticuli were of varying shape with a diameter of 30 to 110 microns and a length of 75 to 150 microns budding from small (12 to 25 microns), slightly ectatic bile ducts. The diverticular epithelium was disordered. Some cells appeared as bile duct...... cells, but most were larger, with rounded nuclei, prominent nucleoli and abundant eosinophilic cytoplasm, sometimes with periodic acid-Schiff-positive, diastase-resistant granules. The lesions were only partly surrounded by a basement membrane. They were all embedded in a tight mononuclear inflammatory...

  1. Common bile duct stones: analysis of the videolaparoscopic surgical treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio Santo

    2012-03-01

    Full Text Available CONTEXT: About 9% of the Brazilian population has gallstones and the incidence increases significantly with aging. The choledocholithiasis is found around 15% of these patients, and a third to half of these cases presented as asymptomatic. Once the lithiasis in the common bile duct is characterized through intraoperative cholangiography, the laparoscopic surgical exploration can be done through the transcystic way or directly through choledochotomy. OBJECTIVE: To evaluate the results and outcomes of the laparoscopic treatment of common bile duct lithiasis. METHODS: Seventy consecutive patients were evaluated. They prospectively underwent the treatment of the lithiasis in the common bile duct and the exploration ways were compared according to the following parameters: criteria on their indication, success in the clearance, surgical complications. It was verified that about ½ of the choledocholithiasis carriers did not show any expression of predictive factors (clinical antecedents of jaundice and/or acute pancreatitis, compatible sonographic data and the pertaining lab tests. The laparoscopic exploration through the transcystic way is favored when there are no criteria for the practice of primary choledochotomy, which are: lithiasis in the proximal bile duct, large (over 8 mm or numerous calculi (multiple calculosis. RESULTS: The transcystic way was employed in about 50% of the casuistic and the choledochotomy in about 30%. A high success rate (around 80% was achieved in the clearance of the common bile duct stones through laparoscopic exploration. The transcystic way, performed without fluoroscopy or choledochoscopy, attained a low rate of success (around 45%, being 10% of those by transpapilar pushing of calculi less than 3 mm. The exploration through choledochotomy, either primary or secondary, if the latter was performed after the transcystic route failure, showed high success rate (around 95%. When the indication to choledochotomy was

  2. [Mini invasive treatment of common biliary duct lithiasis].

    Science.gov (United States)

    Deacu, Adriana

    2003-01-01

    The aim of the paper is to show modern techniques of treatment in common biliary duct lithiasis, in the context of the remarkable development of laparoscopic surgery. The text, trays to mark some directions for the surgeon to know when and which of the modern techniques to chose for safe treatment of common biliary duct lithiasis. The criteria are bound to the moment of diagnosis, clinical state of the patient and laboratory tests. Of course, a final commitment will be taken after an objective evaluation of the technique possibilities and the experience of the team.

  3. 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.

  4. 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.

  5. 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

  6. Workshop on Branching Processes and Their Applications

    CERN Document Server

    Gonzalez Velasco, Miguel; Martinez, Rodrigo; Molina, Manuel

    2010-01-01

    Contains papers presented at the Workshop on Branching Processes and Their Applications (WBPA09), held in Badajoz, Spain, April 20-23, 2009, which deal with theoretical and practical aspects of branching process theory

  7. Coulomb branch localization in quiver quantum mechanics

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Kazutoshi; Sasai, Yuya [Institute of Physics, Meiji Gakuin University,1518 Kamikurata-cho, Yokohama, 244-8539 (Japan)

    2016-02-16

    We show how to exactly calculate the refined indices of N=4U(1)×U(N) supersymmetric quiver quantum mechanics in the Coulomb branch by using the localization technique. The Coulomb branch localization is discussed from the viewpoint of both non-linear and gauged linear sigma models. A classification of fixed points in the Coulomb branch differs from one in the Higgs branch, but the derived indices completely agree with the results which were obtained by the localization in the Higgs branch. In the Coulomb branch localization, the refined indices can be written as a summation over different sets of the Coulomb branch fixed points. We also discuss a space-time picture of the fixed points in the Coulomb branch.

  8. Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation.

    Science.gov (United States)

    Raval, Abhishek; Thakkar, Bhavesh; Madan, Tarun; Oswal, Nilesh; Garg, Rajiv; Umalkar, Rhshikesh; Shah, Komal; Maheriya, Bhumika

    2016-11-01

    We aimed to study the feasibility and outcomes of ductal stenting in patients with duct-dependent pulmonary blood flow (PBF). Duct-dependent hypoxic patients with confluent pulmonary artery (PA) branches were enrolled for ductal stenting and followed regularly. Sixty patients, with a median age of 12 (1-1095) days and weight of 2.8 (2.2-8.9) kg, were enrolled. Median right PA (RPA) and left PA (LPA) Z-scores were -1.23 (-10.54 to 2.81) and -0.96 (-8.03 to 3.0), respectively. Mean narrowest ductal diameter was 1.73±0.57 mm and length was 12.78±3.32 mm. Sixty-four stents with mean diameter of 4.21±0.32 mm and length of 14.34±3.44 mm were deployed in 59 patients. The procedure was unsuccessful in one. Post-stenting mean oxygen saturation (SO2) increased significantly from baseline of 68.88±7.47% to 90.43±6.04% (pedema in one patient and acute stent occlusion in another. At a median follow-up of eight (2-14) months, mean SO2 (80.04±7.54%) was significantly higher than baseline (p<0.0001). Median RPA and LPA Z-scores, 0.56 (-2.89 to 3.29) and -0.02 (-2.81 to 3.86), respectively, were significantly higher than baseline. Six patients required re-interventions (shunt in three and angioplasty in three). Six patients died, three due to sepsis and another three with worsened cyanosis due to impaired PBF, probably due to ductal occlusion. Ductal stenting is an effective palliation in patients with duct-dependent PBF. It maintains adequate SO2 and promotes balanced PA growth at mid-term follow-up. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Autoantibodies Targeting a Collecting Duct-Specific Water Channel in Tubulointerstitial Nephritis

    DEFF Research Database (Denmark)

    Landegren, Nils; Pourmousa Lindberg, Mina; Skov, Jakob

    2016-01-01

    with autoimmune polyendocrine syndrome type 1 who developed tubulointerstitial nephritis and ESRD in association with autoantibodies against kidney collecting duct cells. One of the patients developed autoantibodies targeting the collecting duct-specific water channel aquaporin 2, whereas autoantibodies...

  10. 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.

  11. Chemo Drug May Buy Time for Those with Bile Duct Cancer

    Science.gov (United States)

    ... Chemo Drug May Buy Time for Those With Bile Duct Cancer For patients with the rare disease, survival ... system cancer, a new study finds. People with bile duct cancer who received the medication lived for an ...

  12. The Effects of a Branch Campus

    Science.gov (United States)

    Lien, Donald; Wang, Yaqin

    2012-01-01

    We examine the effects of a branch campus on the social welfare of the host country and the foreign university. Overall, we find that a branch campus increases both the domestic social welfare (measured by the aggregate student utility) and the tuition revenue of the foreign university. The effect of a branch campus on the brain drain is…

  13. Introduction of Branching Degrees of Octane Isomers.

    Science.gov (United States)

    Perdih, Anton

    2016-01-01

    The concept of branching degrees is introduced. In the case of octane isomers it is derived from the values of a set of their physicochemical properties, calculating for each isomer the average of the normalized values and these averages are defined as branching degrees of octane isomers. The sequence of these branching degrees of octane isomers does not differ much from the »regular« one defined earlier. 2,2-Dimethylhexane appears to be less branched than 3,4-dimethylhexane and 3-ethyl, 2-methylpentane, whereas 2,3,4-trimethylpentane appears to be less branched than 3-ethyl, 3-methylpentane. While the increasing number of branches gives rise to increasing branching degrees, the peripheral position of branches and the separation between branches decreases the value of the branching degree. The central position of branches increases it. A bigger branch increases it more than a smaller one. The quantification of these structural features and their correlations with few indices is given as well.

  14. Structural dynamics branch research and accomplishments

    Science.gov (United States)

    1990-01-01

    Summaries are presented of fiscal year 1989 research highlights from the Structural Dynamics Branch at NASA Lewis Research Center. Highlights from the branch's major work areas include aeroelasticity, vibration control, dynamic systems, and computation structural methods. A listing of the fiscal year 1989 branch publications is given.

  15. 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.

  16. 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.

  17. 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.

  18. Surgical management of Stenson's duct injury using epidural catheter

    African Journals Online (AJOL)

    2012-07-05

    rediffmail.com ... and silk worm gut as a indwelling stent inside the parotid duct before repairing have been reported.[6] Only ... of trauma from a road traffic accident 2 h before reporting was noted. Patient was conscious when ...

  19. Design requirement on KALIMER blanket fuel assembly duct

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Woan; Kang, H. Y.; Nam, C.; Kim, J. O

    1998-03-01

    This document describes design requirements which are needed for designing the blanket fuel assembly duct of the KALIMER as design guidance. The blanket fuel assembly duct of the KALIMER consists of fuel rods, mounting rail, nosepiece, duct with pad, handling socket with pad. Blanket fuel rod consists of top end plug, bottom end plug with solid ferritic-martensitic steel rod and key way blanket fuel slug, cladding, and wire wrap. In the assembly, the rods are in a triangular pitch array, and the rod bundle is attached to the nosepiece with mounting rails. The bottom end of the assembly duct is formed by a long nosepiece which provides the lower restraint function and the paths for coolant inlet. This report contains functional requirements, performance and operational requirements, interfacing systems requirements, core restraint and interface requirements, design limits and strength requirements, system configuration and essential feature requirements, seismic requirements, structural requirements, environmental requirements, reliability and safety requirements, standard and codes, QA programs, and other requirements. (author). 20 refs., 4 figs.

  20. 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.

  1. Reconstruction of major bile duct injuries after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Holte, Kathrine; Bardram, Linda; Wettergren, André

    2010-01-01

    Bile duct injury (BDI) after cholecystectomy remains a serious complication with major implications for patient outcome. For most major BDIs, the recommended method of repair is a hepaticojejunostomy (HJ). We conducted a retrospective review aiming to examine the perioperative and the long...

  2. Effect of duct orientation on particle deposition in the human ...

    African Journals Online (AJOL)

    ... of alveolar re-circulation and gravity orientation are key factors in determining the deposition in the last four generations of the human respiratory tract. Keywords: duct orientation, particle deposition, respiratory tract, discretization approach. African Journal of Educational Studies in Mathematics and Sciences Vol. 9, 2011 ...

  3. Clear cell carcinoid tumor of the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Tsukada Katsuhiko

    2007-01-01

    Full Text Available Abstract Background Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC tumors in the distal bile duct (DBD to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. Case presentation A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT and magnetic resonance cholangiopancreaticography (MRCP demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2nd portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size. The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE, chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. Conclusion Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct.

  4. Bidirectional infrasonic ducts associated with sudden stratospheric warming events

    Science.gov (United States)

    Assink, J. D.; Waxler, R.; Smets, P.; Evers, L. G.

    2014-02-01

    In January 2011, the state of the polar vortex in the midlatitudes changed significantly due to a minor sudden stratospheric warming event. As a result, a bidirectional duct for infrasound propagation developed in the middle atmosphere that persisted for 2 weeks. The ducts were due to two zonal wind jets, one between 30 and 50 km and the other around 70 km altitude. In this paper, using microbarom source modeling, a previously unidentified source region in the eastern Mediterranean is identified, besides the more well known microbarom source regions in the Atlantic Ocean. Infrasound data are then presented in which the above mentioned bidirectional duct is observed in microbarom signals recorded at the International Monitoring System station I48TN in Tunisia, from the Mediterranean region to the east and from the Atlantic Ocean to the west. While the frequency bands of the two sources overlap, the Mediterranean signal is coherent up to about 0.6 Hz. This observation is consistent with the microbarom source modeling; the discrepancy in the frequency band is related to differences in the ocean wave spectra for the two basins considered. This work demonstrates the sensitivity of infrasound to stratospheric dynamics and illustrates that the classic paradigm of a unidirectional stratospheric duct for infrasound propagation can be broken during a sudden stratospheric warming event.

  5. Biliary cystadenoma of the left intrahepatic duct (2007: 2b)

    NARCIS (Netherlands)

    Seidel, R.; Weinrich, M.; Pistorius, G.; Fries, P.; Schneider, G.

    2007-01-01

    Biliary cystadenoma is a rare epithelial cystic neoplasm representing only 5% of intrahepatic cystic lesions of biliary origin. Commonly, the lesions are solitary cystic structures with multiple thin-walled septa predominantly arising from the right hepatic duct. Although the lesions are generally

  6. Persistent Mullerian duct syndrome: the hidden normal or abnormal ...

    African Journals Online (AJOL)

    Persistent Mullerian duct syndrome (PMDS) is a rare disorder of male sexual development. It is characterized by the presence of a uterus, fallopian tubes, and upper vagina in an otherwise phenotypically and genotypically normal male. This malformation is usually an incidental finding during the operative treatment of other ...

  7. 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…

  8. Symptomatic vitelline duct anomalies in children | Ameh | South ...

    African Journals Online (AJOL)

    A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel\\'s diverticulum, while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children ...

  9. Laparoscopic managment of common bile duct stones: our initial experience.

    Science.gov (United States)

    Aroori, S.; Bell, J. C.

    2002-01-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

  10. 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...

  11. Duct injection technology prototype development. Materials corrosion report, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Harper, S.L. [Babcock and Wilcox Co., Alliance, OH (United States). Research and Development Div.

    1991-08-01

    This report describes a test program conducted to determine the corrosion rate of materials in the dry scrubber or duct injection systems. Four materials were evaluated: 1010 carbon steel, Corten, 317SS and Hastelloy C-276. The results show that acidic conditions result in higher corrosion rates than alkaline conditions for all the materials. The carbon steel, Corten and stainless steel show moderate to heavy pitting attack in the acidic environment. For the alkaline conditions, the corrosion rates of carbon steel and Corten were higher than the stainless steel or Hastelloy C-276. Also, the corrosion rate of abraded specimens were four time those of unabraded specimens in the flue gas. It is probable that areas of wall-wetting and plugging in the duct injection process will exhibit high rates of corrosion for the carbon steel, Corten, and stainless steel materials. General corrosion and pitting corrosion will predominate. Additionally, abraded duct areas will corrode at a significantly higher rate than unabraded duct materials. 6 refs., 11 figs., 7 tabs.

  12. Echinococcal Cyst of the Pancreas with Cystopancreatic Duct Fistula ...

    African Journals Online (AJOL)

    Echinococcal Cyst of the Pancreas with Cystopancreatic. Duct Fistula Successfully Treated by Partial Cystectomy and. Cystogastrostomy. Ahmed Elaffand, Adarsh Vijay1, Samah Mohamed, Hassan Hani Al-Battah1, Ayda Youssef, Ahmed Farahat. INTRODUCTION. Hydatid disease (HD) is a rare endemic disease in.

  13. A Rare Case of Mediastinal Cyst: Thoracic Duct Cyst

    Directory of Open Access Journals (Sweden)

    Duygu Mergan

    2016-01-01

    Full Text Available Thoracic duct cysts are very rarely observed cysts of the mediastinum. These cysts, which can become established in the costovertebral sulcus or the visceral compartment, have generally been reported at the level of the 10th and 11th vertebrae; however, they can be observed at any location along the ductus [1]. A 37-year-old male patient complained of chest pain for the last 3 months that especially increased after meals. He complained of shortness of breath while walking or going up the stairs, for the last month. The lung graphy showed an increased darkening at a 5x6cm smooth (clean-cut, regular, orderly bordered shadow just behind the heart shadow. The patient%u2019s computed thorax tomography showed a retrocardiac-paravertebral, middle line positioned, 8.5x7x6 cm proportioned, regular bordered, thin walled, homogenous cystic bulk at the subcarinal level. The patient, who could not be relieved with medical treatment, was taken to surgery. The lesion was reached by right posterolateral thoracotomy, and drainage of lymph-containing cystic fluid and excision of the cyst walls were performed by incising the thoracic duct cyst with a mediastinal pleura incision. Mass ligation was then performed to the thoracic duct. We wanted to present our thoracic duct cyst case in this article due to the currently limited number of actual cases reported in the literature.

  14. Heuristic approach to the passive optical network with fibre duct ...

    African Journals Online (AJOL)

    PON) plan- ning problem ... This paper uses concepts from network flow optimisation to incorporate fibre duct shar- ing into a ...... 682–686. [31] Yen JY, 1971, Finding the k shortest loopless paths in a network, Management Science, 17(11), pp.

  15. High-Lift Low Reynolds Number Aerofoils With Specified Pressure Drop for Ducted Wind Turbine

    NARCIS (Netherlands)

    Tang, J.; van Bussel, G.J.W.

    2017-01-01

    A new high-lift aerofoil modification for the duct has been developed and will be experimentally tested in a small wind tunnel. Aerofoils for such wind tunnel ducts typically operate in the low Reynolds number range from 2 × 105 to 6 × 105. The effect of a duct and of rotor on power and pressure

  16. Resin duct characteristics in the wood of fire-scarred North American conifers

    Science.gov (United States)

    Estelle Arbellay; Markus Stoffel; Elaine K. Sutherland; Kevin T. Smith; Donald A. Falk

    2013-01-01

    Traumatic resin ducts form in xylem and phloem tissue of conifers in response to abiotic wounding, fungal invasion, and insect attack. Little is known about resin duct characteristics in the wood of fire-scarred trees. The aim of this study is to quantify changes in traits of both axial and radial resin ducts, along with those of associated epithelial cells and...

  17. Causes and Prevention of Laparoscopic Bile Duct Injuries

    Science.gov (United States)

    Way, Lawrence W.; Stewart, Lygia; Gantert, Walter; Liu, Kingsway; Lee, Crystine M.; Whang, Karen; Hunter, John G.

    2003-01-01

    Objective To apply human performance concepts in an attempt to understand the causes of and prevent laparoscopic bile duct injury. Summary Background Data Powerful conceptual advances have been made in understanding the nature and limits of human performance. Applying these findings in high-risk activities, such as commercial aviation, has allowed the work environment to be restructured to substantially reduce human error. Methods The authors analyzed 252 laparoscopic bile duct injuries according to the principles of the cognitive science of visual perception, judgment, and human error. The injury distribution was class I, 7%; class II, 22%; class III, 61%; and class IV, 10%. The data included operative radiographs, clinical records, and 22 videotapes of original operations. Results The primary cause of error in 97% of cases was a visual perceptual illusion. Faults in technical skill were present in only 3% of injuries. Knowledge and judgment errors were contributory but not primary. Sixty-four injuries (25%) were recognized at the index operation; the surgeon identified the problem early enough to limit the injury in only 15 (6%). In class III injuries the common duct, erroneously believed to be the cystic duct, was deliberately cut. This stemmed from an illusion of object form due to a specific uncommon configuration of the structures and the heuristic nature (unconscious assumptions) of human visual perception. The videotapes showed the persuasiveness of the illusion, and many operative reports described the operation as routine. Class II injuries resulted from a dissection too close to the common hepatic duct. Fundamentally an illusion, it was contributed to in some instances by working too deep in the triangle of Calot. Conclusions These data show that errors leading to laparoscopic bile duct injuries stem principally from misperception, not errors of skill, knowledge, or judgment. The misperception was so compelling that in most cases the surgeon did not

  18. Invasive thyroglossal duct cyst papillary carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Aghaghazvini Shirin

    2009-12-01

    Full Text Available Abstract Introduction A thyroglossal duct cyst is the most common congenital anomaly of the thyroid gland and midline masses in childhood (70% abnormality in childhood, 7% in adult. Carcinomas arising from a thyroglossal duct cyst are rare (only 1% of thyroglossal duct cyst cases and characterized by relatively non-aggressive behavior and rare lymphatic spread. They are also diagnosed mostly during the third and fourth decades of life. About 85% to 92% of all thyroglossal duct cyst carcinomas are papillary carcinomas. Case presentation We present the case of a 44-year-old Iranian woman with Cacausian ethnicity with a painless anterior neck mass that appeared gradually over three months. She had a history of frequent painful swelling of the anterior part of her neck, which subsided with antibiotic therapy. Thyroid functional tests were normal and a thyroid scinitigraphy showed a cold nodule in the left lobe of her thyroid. A computed tomography scan revealed a large, heterogeneous enhancing soft tissue mass with cystic components in the midline of the anterior neck space. This extended from the base of the tongue,(completely separated from its muscles, to the inferior aspect of the thyroid gland and showed the destruction of the hyoid bone and the thyroid cartilage. The diagnosis of a thyroglossal duct cyst with malignant transformation was maintained. A fine needle aspiration revealed papillary carcinoma. Conclusion This patient's case is presented because of its rare, aggressive, and invasive nature and rare and unusual manifestation, as well as its rapid increase in size, the destruction of the hyoid bone, chondrolysis of the thyroid cartilage, lymph adenopathy and the existence of a cold nodule in the thyroid gland.

  19. 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.

  20. Branched-Chain Amino Acids.

    Science.gov (United States)

    Yamamoto, Keisuke; Tsuchisaka, Atsunari; Yukawa, Hideaki

    Branched-chain amino acids (BCAAs), viz., L-isoleucine, L-leucine, and L-valine, are essential amino acids that cannot be synthesized in higher organisms and are important nutrition for humans as well as livestock. They are also valued as synthetic intermediates for pharmaceuticals. Therefore, the demand for BCAAs in the feed and pharmaceutical industries is increasing continuously. Traditional industrial fermentative production of BCAAs was performed using microorganisms isolated by random mutagenesis. A collection of these classical strains was also scientifically useful to clarify the details of the BCAA biosynthetic pathways, which are tightly regulated by feedback inhibition and transcriptional attenuation. Based on this understanding of the metabolism of BCAAs, it is now possible for us to pursue strains with higher BCAA productivity using rational design and advanced molecular biology techniques. Additionally, systems biology approaches using augmented omics information help us to optimize carbon flux toward BCAA production. Here, we describe the biosynthetic pathways of BCAAs and their regulation and then overview the microorganisms developed for BCAA production. Other chemicals, including isobutanol, i.e., a second-generation biofuel, can be synthesized by branching the BCAA biosynthetic pathways, which are also outlined.

  1. Escaping from Flatland: clinical and biological aspects of human mammary duct anatomy in three dimensions.

    Science.gov (United States)

    Going, James J; Moffat, David F

    2004-05-01

    Accurate knowledge of breast duct anatomy in three dimensions is needed to understand normal breast development, how intraepithelial neoplasia may spread through a breast, and the potential for diagnostic and therapeutic access to breast parenchyma via the nipple. This paper reports three related exploratory studies. In study 1, the median number of milk-collecting ducts in the nipple was determined in 72 breasts excised for cancer; in study 2, the volumes of all 20 complete duct systems ("lobes") in an autopsy breast were measured from 2 mm serial "subgross" sections; and in study 3, a 3D digital model of all collecting ducts in a mastectomy nipple was made from 68 100 micro m serial sections. The mastectomy nipples contained 11-48 central ducts (median 27, inter-quartile range 21-30). In the autopsy breast, the largest "lobe" drained 23% of breast volume; half of the breast was drained by three ducts and 75% by the largest six. Conversely, eight small duct systems together accounted for only 1.6% of breast volume. The 3D model of the nipple revealed three distinct nipple duct populations. Seven ducts maintained a wide lumen up to the skin surface (population A); 20 ducts tapered to a minute lumen at their origin in the vicinity of skin appendages (population B) on the apex of the nipple; and a minor duct population (C) arose around the base of the papilla. Major variations in duct morphology and extent define highly variable territories in which intraepithelial neoplasia could grow. While population A ducts appear accessible to duct endoscopy or lavage, population B and population C ducts may be less accessible. Copyright 2004 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

  2. Spontaneous perforation of the bile duct in a neonate: Drainage or resection?

    Directory of Open Access Journals (Sweden)

    Te-Zhung Chen

    2012-07-01

    Full Text Available Spontaneous perforation of the bile duct is a rare disease, and delayed diagnosis without optimal treatment can be fatal. Abdominal drainage with or without repair of perforation seems to be adequate in most case series. We report on a 10-day-old female neonate with spontaneous perforation of the bile duct over the junction of cystic duct and common hepatic duct, who recovered uneventfully with follow-up for 3 years after receiving a single-stage operation of cholecystectomy and biliary reconstruction. Drainage only or resection of the gall bladder or bile duct should depend on the patient's clinical conditions and intraoperative findings.

  3. Acute pancreatitis after thoracic duct ligation for iatrogenic chylothorax. A case report.

    Science.gov (United States)

    Bédat, Benoît; Scarpa, Cosimo Riccardo; Sadowski, Samira Mercedes; Triponez, Frédéric; Karenovics, Wolfram

    2017-01-23

    To report the association between thoracic duct ligation and acute pancreatitis. The association between sudden stop of lymphatic flow and pancreatitis has been established in experimental models. A 57-year-old woman operated for thymoma presented a iatrogenic chylothorax. After thoracic duct ligation, she presented an acute pancreatitis which resolved after conservative treatment. The chylothorax disappeared within 4 days of thoracic duct ligation. This is the first report of acute pancreatitis following thoracic duct ligation. The pancreas and digestive tract should be assessed in symptomatic patients after thoracic duct ligation.

  4. Redefining the surface anatomy of the parotid duct: an in vivo ultrasound study.

    Science.gov (United States)

    Stringer, Mark D; Mirjalili, S Ali; Meredith, Susan J; Muirhead, Jill C

    2012-11-01

    The surface anatomy of the parotid duct is important when assessing facial lacerations and in facial rejuvenation surgery but is inconsistently described in reference texts. The aim of this study was to map the surface anatomy of the adult parotid duct using ultrasound. Fifty healthy adults (31 women; mean age, 33 years) were scanned by an experienced sonographer using a 13-5 MHz linear probe and a Siemens Sonoline Antares ultrasound machine. The caliber, length, and course of the parotid duct were recorded bilaterally. The parotid duct was identified bilaterally in all participants. One subject had a double duct bilaterally. In the remaining 49 individuals (98 ducts), the duct had a mean maximum internal caliber of 0.6 ± 0.2 mm and length 42 ± 7.5 mm. Ninety-two (94 percent) ducts were below the most popular surface marking, which is reported as a line between the lower border of the tragus and mid philtrum. In 93 percent of individuals, the duct was within 1.5 cm of the middle half of a line between the lower border of the tragus and cheilion. A more accurate description of the surface anatomy of the parotid duct should assist with early diagnosis of parotid duct injuries and avoidance of iatrogenic injury. Diagnostic, IV.

  5. Heat Pump Water Heater Ducting Strategies with Encapsulated Attics in Climate Zones 2 and 4

    Energy Technology Data Exchange (ETDEWEB)

    Sweet, M. L. [Southface Energy Inst., Upper Marlboro, MD (United States); Francisco, A.; Roberts, S. G.

    2016-05-01

    The focus of this study is on the performance of HPWHs with several different duct configurations and their effects on whole building heating, cooling, and moisture loads. A.O. Smith 60 gallon Voltex (PHPT-60) heat pump water heaters (HPWHs) were included at two project sites and ducted to or located within spray foamed encapsulated attics. The effect of ducting a HPWH's air stream does not diminish its efficiency if the ducting does not reduce intake air temperature, which expands HPWH application to confined areas. Exhaust ducts should be insulated to avoid condensation on the exterior, however this imposes a risk of condensation occurring in the duct's interior near the HPWH due to large variation of temperatures between the compressor and the duct and the presence of bulk moisture around the condenser. The HPWH's air conditioning impact on HVAC equipment loads is minimal when the intake and exhaust air streams are connected to a sealed attic and not the living space. A HPWH is not suitable as a replacement dehumidifier in sealed attics as peak moisture loads were observed to only be reduced if the heat pump operated during the morning. It appears that the intake air temperature and humidity was the most dominant variable affecting HPWH performance. Different ducting strategies such as exhaust duct only, intake duct only, and exhaust and intake ducting did not have any effect on HPWH performance.

  6. Combined extrahepatic bile duct resection for locally advanced gallbladder carcinoma: does it work?

    Science.gov (United States)

    Igami, Tsuyoshi; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Mizuno, Takashi; Yamaguchi, Junpei; Shimoyama, Yoshie; Nagino, Masato

    2015-07-01

    Prophylactic combined extrahepatic bile duct resection remains controversial for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion. The aim of this study is to resolve this issue and establish an appropriate surgery for locally advanced gallbladder carcinoma. A total of 52 patients underwent surgical resection combined with extrahepatic bile duct resection for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion, and their medical records were retrospectively reviewed for microvessel invasion (MVI), including lymphatic, venous, and/or perineural invasions, around the extrahepatic bile duct. Of the 52 patients, 8 (15 %) had MVI around the extrahepatic bile duct. All of the 8 patients had Stage IV disease. According to a survival analysis of the 50 patients who tolerated surgery, MVIs around the extrahepatic bile duct and distant metastasis were identified as independent prognostic factors. Survival for patients with MVI around the extrahepatic bile duct was dismal, with a lack of 2-year survivors. MVI around the extrahepatic bile duct is a sign of extremely locally advanced gallbladder carcinoma; therefore, prophylactic combined bile duct resection has no survival impact for patients without extrahepatic bile duct invasion.

  7. Duplicated common bile duct: a recipe for biliary injury. Report of a new variant.

    Science.gov (United States)

    Nuamah, Nabil M; Ibis, Cem; Gok, Ali F K; Ekiz, Feza; Acunas, Bulent

    2017-02-01

    Duplicated common bile duct, often associated with conditions like lithiasis, biliary cysts and pancreatobiliary maljunction, could result in highly morbid and potentially fatal biliary injuries. Precise preoperative diagnosis and classification still remain a challenge. A female patient undergoing emergency laparoscopic cholecystectomy for acute calculous cholecystitis sustained iatrogenic bile duct injury. A drainage tube was placed into the injured duct for post-operative conservative management. Post-operative tube cholangiogram revealed a double common bile duct with cystic duct opening distally. This was identified as a new variant not previously reported or classified. However rare, duplicated common bile duct could result in serious iatrogenic bile duct injury if unidentified during surgery. Knowledge of its existence is essential to avoid such injuries as preoperative diagnosis still remains a challenge. A thorough clinical and morphological study of previously reported variants is needed for a comprehensive classification to encompass newly discovered variants.

  8. Common bile duct villous adenoma: a case report and review of the literature.

    Science.gov (United States)

    Čekas, Karolis; Rudaitis, Vilius; Beiša, Virgilijus; Jotautas, Valdemaras; Rutkauskaitė, Dileta; Meškauskas, Raimundas; Stratilatovas, Eugenijus

    2016-01-21

    According to the literature, benign bile duct tumors are exceedingly uncommon. To the best of our knowledge, we report the largest extrahepatic bile duct villous adenoma described in the literature. We present a case of a 77-year-old Caucasian woman with obstructive jaundice. Laboratory tests revealed that she had elevated bilirubin and liver enzyme levels. A computed tomographic scan showed a homogeneous 5 × 3-cm mass obstructing the common bile duct. The results of brush cytology were consistent with a bile duct villous papilloma. However, on the basis of the tumor's radiological features, a preliminary diagnosis of extrahepatic bile duct malignant tumor was made. After discussion among the multidisciplinary team, a surgical resection of the bile duct tumor was performed. Histopathological examination confirmed a villous adenoma. The patient's postoperative course was uneventful. In patients with bulky extrahepatic bile duct tumors, surgical resection alone may be safe and curative.

  9. Cigarette smoking impairs pancreatic duct cell bicarbonate secretion.

    Science.gov (United States)

    Kadiyala, Vivek; Lee, Linda S; Banks, Peter A; Suleiman, Shadeah; Paulo, Joao A; Wang, Wei; Rosenblum, Jessica; Sainani, Nisha I; Mortele, Koenraad; Conwell, Darwin Lewis

    2013-01-10

    To compare pancreatic duct cell function in smokers (current and past) and never smokers by measurement of secretin-stimulated peak bicarbonate concentration ([HCO3-]) in endoscopic collected pancreatic fluid (PF). This retrospective study was cross-sectional in design, recording demographic information (age, gender, etc.), smoking status (former, current, never), alcohol intake, clinical data (imaging, endoscopy), and laboratory results (peak PF [HCO3-]) from subjects evaluated for pancreatic disease at a tertiary pancreas center. Univariate and multivariate statistical analysis (SAS Version 9.2, Cary, NC, USA) was performed to assess the relationship between cigarette smoking and secretin-stimulated pancreatic fluid bicarbonate concentration. A total of 131 subjects underwent pancreatic fluid collection (endoscopic pancreatic function test, ePFT) for bicarbonate analysis: 25.2% (33 out of 131) past smokers, 31.3% (41 out of 131) current smokers, and 43.5% (57 out of 131) were never smokers. Measures of Association: The mean peak PF [HCO3-] in never smokers (81.3 ± 18.5 mEq/L) was statistically higher (indicating better duct cell function) when compared to past smokers (66.8 ± 24.7 mEq/L, P=0.005) and current smokers (70.0 ± 20.2 mEq/L, P=0.005). However, the mean peak [HCO3-] in past smokers was not statistically different from that in current smokers (P=0.575), and therefore, the two smoking groups were combined to form a single "smokers cohort". When compared to the never smokers, the smokers cohort was older (P=0.037) and had a greater proportion of subjects with definite chronic pancreatitis imaging (P=0.010), alcohol consumption ≥20 g/day (P=0.012), and abnormal peak PF [HCO3-] (Psmoking (risk ratio, RR: 2.2, 95% CI: 1.3-3.5; PSmoking (odds ratio, OR: 3.8, 95% CI: 1.6-9.1; P=0.003) and definite chronic pancreatitis imaging (OR: 5.7, 95% CI: 2.2-14.8; Psmoking status and alcohol intake in predicting duct cell dysfunction (P=0.571). Measurement of

  10. A QUANTITATIVE METHOD FOR ANALYSING 3-D BRANCHING IN EMBRYONIC KIDNEYS: DEVELOPMENT OF A TECHNIQUE AND PRELIMINARY DATA

    Directory of Open Access Journals (Sweden)

    Gabriel Fricout

    2011-05-01

    Full Text Available The normal human adult kidney contains between 300,000 and 1 million nephrons (the functional units of the kidney. Nephrons develop at the tips of the branching ureteric duct, and therefore ureteric duct branching morphogenesis is critical for normal kidney development. Current methods for analysing ureteric branching are mostly qualitative and those quantitative methods that do exist do not account for the 3- dimensional (3D shape of the ureteric "tree". We have developed a method for measuring the total length of the ureteric tree in 3D. This method is described and preliminary data are presented. The algorithm allows for performing a semi-automatic segmentation of a set of grey level confocal images and an automatic skeletonisation of the resulting binary object. Measurements of length are automatically obtained, and numbers of branch points are manually counted. The final representation can be reconstructed by means of 3D volume rendering software, providing a fully rotating 3D perspective of the skeletonised tree, making it possible to identify and accurately measure branch lengths. Preliminary data shows the total length estimates obtained with the technique to be highly reproducible. Repeat estimates of total tree length vary by just 1-2%. We will now use this technique to further define the growth of the ureteric tree in vitro, under both normal culture conditions, and in the presence of various levels of specific molecules suspected of regulating ureteric growth. The data obtained will provide fundamental information on the development of renal architecture, as well as the regulation of nephron number.

  11. 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.

  12. CPI-613 in Treating Patients With Advanced or Metastatic Bile Duct Cancer That Cannot Be Removed By Surgery

    Science.gov (United States)

    2017-08-14

    Adult Primary Cholangiocellular Carcinoma; Advanced Adult Primary Liver Cancer; Cholangiocarcinoma of the Extrahepatic Bile Duct; Cholangiocarcinoma of the Gallbladder; Localized Unresectable Adult Primary Liver Cancer; Metastatic Extrahepatic Bile Duct Cancer; Recurrent Adult Primary Liver Cancer; Recurrent Extrahepatic Bile Duct Cancer; Unresectable Extrahepatic Bile Duct Cancer

  13. Vegetation survey of PEN Branch wetlands

    Energy Technology Data Exchange (ETDEWEB)

    1991-01-01

    A survey was conducted of vegetation along Pen Branch Creek at Savannah River Site (SRS) in support of K-Reactor restart. Plants were identified to species by overstory, understory, shrub, and groundcover strata. Abundance was also characterized and richness and diversity calculated. Based on woody species basal area, the Pen Branch delta was the most impacted, followed by the sections between the reactor and the delta. Species richness for shrub and groundcover strata were also lowest in the delta. No endangered plant species were found. Three upland pine areas were also sampled. In support of K Reactor restart, this report summarizes a study of the wetland vegetation along Pen Branch. Reactor effluent enters Indian Grove Branch and then flows into Pen Branch and the Pen Branch Delta.

  14. Classification conundrum: Persistent mullerian duct syndrome with hypospadias

    Directory of Open Access Journals (Sweden)

    Sheetal Arora

    2016-01-01

    Full Text Available The disorders of sex development (DSD are uncommon and have wide phenotypic variation. Due to this, they often cannot be classified properly and go unreported. This case is an 18-month-old child with penoscrotal hypospadias with bilateral undescended testes. The karyotyping was 46 XY. Serum testosterone and progesterone were normal. Histopathological examination showed the right gonad with few testicular tubules containing sertoli cells and fibro-collagenization of the stroma. The left Mullerian structures showed epididymis with fallopian tube, with absent testis. Persistent Mullerian duct with hypospadias is a rare anomaly, not classifiable under any of the 46 XY DSD. The possible genesis of this unique case is due to markedly reduced sertoli cells producing low levels of anti-Mullerian hormone which led to the failure of regression of Mullerian duct structures. The associated hypospadias is probably because of impaired action of testosterone possibly due to the deficiency of 5β reductase enzyme.

  15. Flow Through a Rectangular-to-Semiannular Diffusing Transition Duct

    Science.gov (United States)

    Foster, Jeff; Wendt, Bruce J.; Reichert, Bruce A.; Okiishi, Theodore H.

    1997-01-01

    Rectangular-to-semiannular diffusing transition ducts are critical inlet components on supersonic airplanes having bifucated engine inlets. This paper documents measured details of the flow through a rectangular-to-semiannular transition duct having an expansion area ratio of 1.53. Three-dimensional velocity vectors and total pressures at the exit plane of the diffuser are presented. Surface oil-flow visualization and surface static pressure data are shown. The tests were conducted with an inlet Mach number of 0.786 and a Reynolds number based on the inlet centerline velocity and exit diameter of 3.2 x 10(exp 6). The measured data are compared with previously published computational results. The ability of vortex generators to reduce circumferential total pressure distortion is demonstrated.

  16. Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

    Directory of Open Access Journals (Sweden)

    Yohei Honkura

    2015-02-01

    Full Text Available Nasopalatine duct cysts are the most common non-odontogenic cysts in the maxilla, and are conventionally treated through a sublabial or palatine approach. Recently, the endoscopic approach has been used, but experience is extremely limited. We treated a 29-year-old male with nasopalatine duct cyst by endoscopic marsupialization, but paresthesia of the incisor region occurred after surgery. This paresthesia gradually remitted within 6 months. The nasopalatine nerve, which innervates the upper incisor region, enters two lateral canals separately at the nasal floor and exits the central main canal at the palate. Damage to the bilateral nasopalatine nerves might lead to paresthesia, so we recommend careful examination for nerve fibers during endoscopic surgery, especially if fenestration is performed on both sides.

  17. An analytical theory of heated duct flows in supersonic combustors

    Directory of Open Access Journals (Sweden)

    Chenxi Wu

    2014-01-01

    Full Text Available One-dimensional analytical theory is developed for supersonic duct flow with variation of cross section, wall friction, heat addition, and relations between the inlet and outlet flow parameters are obtained. By introducing a selfsimilar parameter, effects of heat releasing, wall friction, and change in cross section area on the flow can be normalized and a self-similar solution of the flow equations can be found. Based on the result of self-similar solution, the sufficient and necessary condition for the occurrence of thermal choking is derived. A relation of the maximum heat addition leading to thermal choking of the duct flow is derived as functions of area ratio, wall friction, and mass addition, which is an extension of the classic Rayleigh flow theory, where the effects of wall friction and mass addition are not considered. The present work is expected to provide fundamentals for developing an integral analytical theory for ramjets and scramjets.

  18. [Experience in thyroglossal duct pathology: clinical case series].

    Science.gov (United States)

    Cieri, Patricio; Udaquiola, Julia E; Calello, Santiago E; Libero, Daniel H

    2016-10-01

    The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45). Sociedad Argentina de Pediatría.

  19. Primary sclerosing cholangitis – The arteriosclerosis of the bile duct?

    Science.gov (United States)

    Fickert, Peter; Moustafa, Tarek; Trauner, Michael

    2007-01-01

    Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of unknown aetiology affecting the large bile ducts and characterized by periductal fibrosis and stricture formation, which ultimately result in biliary cirrhosis and liver failure. Arteriosclerosis involves the accumulation of altered lipids and lipoproteins in large arteries; this drives inflammation and fibrosis and ultimately leads to narrowing of the arteries and hypoperfusion of dependent organs and tissues. Knowledge of the causative factors is crucial to the understanding of disease mechanisms and the development of specific treatment. Based on pathogenetic similarities between PSC and arteriosclerosis, we hypothesize that PSC represents "arteriosclerosis of the bile duct" initiated by toxic biliary lipids. This hypothesis is based on common molecular, cellular, and morphological features providing the conceptual framework for a deeper understanding of their pathogenesis. This hypothesis should stimulate translational research to facilitate the search for novel treatment strategies for both diseases. PMID:17254334

  20. Generation of ionospheric ducts by the HAARP HF heater

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, J A; Pradipta, R; Burton, L M; Labno, A; Lee, M C [Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Watkins, B J; Fallen, C [University of Alaska Fairbanks, Fairbanks, AK 99775 (United States); Kuo, S P [New York University, Brooklyn, NY 11201 (United States); Burke, W J [Air Force Research Laboratory, Hanscom AFB, MA 01731 (United States); Mabius, D; See, B Z, E-mail: mclee@mit.edu [Boston University, Boston, MA 02215 (United States)

    2010-12-15

    We report an investigation of ionospheric ducts having the shape of large plasma sheets, generated by vertically transmitted HAARP HF heater waves in several experiments conducted in Gakona, Alaska. Theory predicts that O-mode heater wave-created ionospheric ducts form parallel-plate waveguides within the meridional plane, and those generated by the X-mode heater waves are orthogonal to the meridional plane. Our theoretical prediction is supported by measurements of ionosonde data (namely ionograms), range-time-intensity (RTI) plots of UHF and HF backscatter radars, as well as magnetometer data analyses. When these plasma sheets experienced ExB drifts, they were intercepted by the HAARP UHF radar and seen as slanted stripes in the RTI plots. This striking feature was also observed in our earlier experiments using the Arecibo UHF radar.

  1. Molecular Analysis of Salivary Gland Branching Morphogenesis

    National Research Council Canada - National Science Library

    Sakai, Takayoshi; Larsen, Melinda; Kogo, Mikihiko; Yamada, Kenneth M

    2004-01-01

    .... This mini-review describes a recently developed and tested set of approaches for identifying and characterizing molecules essential for branching morphogenesis and other developmental processes...

  2. Axis deviation without left bundle branch block.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Mancuso, Antonia

    2010-04-15

    It has been rarely reported changing axis deviation in the presence of left bundle branch block also during atrial fibrillation and with acute myocardial infarction too. It has also been rarely reported changing axis deviation with changing bundle branch block with onset of atrial fibrillation during acute myocardial infarction. We present a case of axis deviation without left bundle branch block and without atrial fibrillation and acute myocardial infarction in a 65-year-old Italian man. To our knowledge, this is the first report of axis deviation without left bundle branch block and without atrial fibrillation and acute myocardial infarction. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

  3. Clinical and Translational Epidemiology Branch (CTEB)

    Science.gov (United States)

    The Clinical and Translational Epidemiology Branch focuses on factors that influence cancer progression, recurrence, survival, and other treatment outcomes, and factors associated with cancer development.

  4. Toward improved branch prediction through data mining.

    Energy Technology Data Exchange (ETDEWEB)

    Hemmert, K. Scott; Johnson, D. Eric (University of Texas at Austin)

    2009-09-01

    Data mining and machine learning techniques can be applied to computer system design to aid in optimizing design decisions, improving system runtime performance. Data mining techniques have been investigated in the context of branch prediction. Specifically, a comparison of traditional branch predictor performance has been made to data mining algorithms. Additionally, the possiblity of whether additional features available within the architectural state might serve to further improve branch prediction has been evaluated. Results show that data mining techniques indicate potential for improved branch prediction, especially when register file contents are included as a feature set.

  5. Particle loading rates for HVAC filters, heat exchangers, and ducts.

    Science.gov (United States)

    Waring, M S; Siegel, J A

    2008-06-01

    The rate at which airborne particulate matter deposits onto heating, ventilation, and air-conditioning (HVAC) components is important from both indoor air quality (IAQ) and energy perspectives. This modeling study predicts size-resolved particle mass loading rates for residential and commercial filters, heat exchangers (i.e. coils), and supply and return ducts. A parametric analysis evaluated the impact of different outdoor particle distributions, indoor emission sources, HVAC airflows, filtration efficiencies, coils, and duct system complexities. The median predicted residential and commercial loading rates were 2.97 and 130 g/m(2) month for the filter loading rates, 0.756 and 4.35 g/m(2) month for the coil loading rates, 0.0051 and 1.00 g/month for the supply duct loading rates, and 0.262 g/month for the commercial return duct loading rates. Loading rates are more dependent on outdoor particle distributions, indoor sources, HVAC operation strategy, and filtration than other considered parameters. The results presented herein, once validated, can be used to estimate filter changing and coil cleaning schedules, energy implications of filter and coil loading, and IAQ impacts associated with deposited particles. The results in this paper suggest important factors that lead to particle deposition on HVAC components in residential and commercial buildings. This knowledge informs the development and comparison of control strategies to limit particle deposition. The predicted mass loading rates allow for the assessment of pressure drop and indoor air quality consequences that result from particle mass loading onto HVAC system components.

  6. Atmospheric ducts can transport sound in two directions

    Science.gov (United States)

    Schultz, Colin

    2014-07-01

    When conditions are right, temperature gradients and fast jets of wind can help to establish atmospheric ducts—pathways in the atmosphere that promote the propagation of low-frequency acoustic waves (infrasound)—across long distances. Atmospheric ducts are part of the basis behind over-the-horizon radar, the source of some particularly clear mirages, and a channel through which sounds can travel relatively unperturbed across vast distances.

  7. Monograph on propagation of sound waves in curved ducts

    Science.gov (United States)

    Rostafinski, Wojciech

    1991-01-01

    After reviewing and evaluating the existing material on sound propagation in curved ducts without flow, it seems strange that, except for Lord Rayleigh in 1878, no book on acoustics has treated the case of wave motion in bends. This monograph reviews the available analytical and experimental material, nearly 30 papers published on this subject so far, and concisely summarizes what has been learned about the motion of sound in hard-wall and acoustically lined cylindrical bends.

  8. Multidisciplinary management of lacrimal sac/nasolacrimal duct carcinomas.

    Science.gov (United States)

    El-Sawy, Tarek; Frank, Steven J; Hanna, Ehab; Sniegowski, Matthew; Lai, Stephen Y; Nasser, Qasiem J; Myers, Jeffrey; Esmaeli, Bita

    2013-01-01

    To determine the rates of globe-sparing treatment and useful final visual function in patients with primary lacrimal sac/nasolacrimal duct carcinomas treated with multidisciplinary therapy. The medical records of 14 patients with primary lacrimal sac/nasolacrimal duct carcinoma treated at 1 institution were retrospectively reviewed. The patients were 9 men and 5 women; the median age at diagnosis was 58.5 years (range, 45-73 years). Seven patients presented with epiphora, 7 with a palpable mass in the inferomedial orbit, and 2 with dacryocystitis. In 3 patients, the diagnosis of cancer was not considered until during or after dacryocystorhinostomy. Seven patients had squamous cell carcinoma, 2 transitional cell carcinoma, 2 adenoid cystic carcinoma, and 1 each adenocarcinoma, poorly differentiated carcinoma, and inverted papilloma with carcinoma in situ transformation. Nine patients underwent surgical resection of the lacrimal sac and nasolacrimal duct and resection of the medial upper and lower eyelids, including canaliculi, partial ethmoidectomy, and medial maxillectomy. One patient underwent lacrimal sac biopsy only as another primary malignancy was discovered during the work-up for systemic disease. Four patients underwent orbital exenteration because of extensive involvement of the orbital soft tissue. Radiotherapy was recommended for 13 patients; in 1 patient, radiotherapy was not recommended because the patient had an inverted papilloma with carcinoma in situ transformation that was completely excised. The median radiation dose was 60 Gy. Eight patients received chemotherapy either concurrent with radiation therapy (5 patients), as neoadjuvant treatment (1 patient), or for progressive or metastatic disease (3 patients). The median follow-up time was 27 months (range, 6-96 months). In 10 patients, the globe was spared. In 9 of these 10 patients, visual acuity was the same as at baseline or better than 20/40 at last follow up. With multidisciplinary therapy

  9. Molecular basis of potassium channels in pancreatic duct epithelial cells

    DEFF Research Database (Denmark)

    Hayashi, M.; Novak, Ivana

    2013-01-01

    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...

  10. Theoretical models for duct acoustic propagation and radiation

    Science.gov (United States)

    Eversman, Walter

    1991-01-01

    The development of computational methods in acoustics has led to the introduction of analysis and design procedures which model the turbofan inlet as a coupled system, simultaneously modeling propagation and radiation in the presence of realistic internal and external flows. Such models are generally large, require substantial computer speed and capacity, and can be expected to be used in the final design stages, with the simpler models being used in the early design iterations. Emphasis is given to practical modeling methods that have been applied to the acoustical design problem in turbofan engines. The mathematical model is established and the simplest case of propagation in a duct with hard walls is solved to introduce concepts and terminologies. An extensive overview is given of methods for the calculation of attenuation in uniform ducts with uniform flow and with shear flow. Subsequent sections deal with numerical techniques which provide an integrated representation of duct propagation and near- and far-field radiation for realistic geometries and flight conditions.

  11. Congenital nasolacrimal duct fistula in Brown Swiss cattle.

    Science.gov (United States)

    Braun, Ueli; Jacober, Simon; Drögemüller, Cord

    2014-02-18

    An increased incidence of nasolacrimal duct fistula in the offspring of dam J and three of her sons (bulls A, B and C) prompted a study to investigate the prevalence and clinical manifestation of this anomaly. The dam J, bull B, 255 direct offspring of bulls A, B, and C and eight other direct and indirect offspring of cow J were examined. The periocular region of each animal was examined for unilateral or bilateral nasolacrimal duct fistula and the location, appearance and size of the lesions. Of 265 cattle examined, 54 had unilateral (n = 24) or bilateral fistula (n = 30). The prevalence of affected offspring differed significantly among the three bulls. The fistulae were located medial to the medial canthus of the eye and were 1 to 10 mm (median, 1 mm) in height and 1 to 12 mm (median, 2 mm) in length. The shape of the opening was circular in 58, oval in 23 and slit-like in three. One other animal had a large opening with an atypical shape and another had an abnormal medial canthus with several fistulous openings. Seventy openings were pigmented and 52 were hairless. The fistulae were clinically significant in 12 animals. The findings suggest a hereditary cause of nasolacrimal duct fistula in Brown Swiss cattle.

  12. Homeostatic Imbalance in Epithelial Ducts and Its Role in Carcinogenesis

    Directory of Open Access Journals (Sweden)

    Katarzyna A. Rejniak

    2012-01-01

    Full Text Available An epithelial duct is a well-defined multicellular structure composed of tightly packed cells separating and protecting body compartments that are used for enzyme secretion and its transport across the internal. The structural and functional integrity (homeostasis of such ducts is vital in carrying many life functions (breathing, lactation, production of hormones. However, the processes involved in maintaining the homeostatic balance are not yet fully understood. On the other hand, the loss of epithelial tissue architecture, such as filled lumens or ductal disorganization, are among the first symptoms of the emerging epithelial tumors (carcinomas. Using the previously developed biomechanical model of epithelial ducts: IBCell, we investigated how different signals and mechanical stimuli imposed on individual epithelial cells can impact the homeostatic (imbalance and integrity of the whole epithelial tissue. We provide a link between erroneous responses of individual epithelial cells to specific signals and the emerging ductal morphologies characteristic for preinvasive cancers observed in pathology specimens, or characteristic for multicellular structures arising from mutated cells cultured in vitro. We summarize our finding in terms of altered properties of epithelial cell polarization, and discuss the relative importance of various polarization signals on the formation of tumor-like multicellular structures.

  13. Examination of Duct Physiology in the Human Mammary Gland.

    Science.gov (United States)

    Mills, Dixie; Gomberawalla, Ameer; Gordon, Eva J; Tondre, Julie; Nejad, Mitra; Nguyen, Tinh; Pogoda, Janice M; Rao, Jianyu; Chatterton, Robert; Henning, Susanne; Love, Susan M

    2016-01-01

    The human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit. We examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data. We found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid. Our results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas.

  14. Fatigue life prediction of oil ducts under service loads

    Energy Technology Data Exchange (ETDEWEB)

    Meggiolaro, Marco A.; Castro, Jaime T.P. [Pontificia Univ. Catolica do Rio de Janeiro, RJ (Brazil)

    2003-07-01

    A methodology to calculate the residual initiation and propagation lives of fatigue cracks in oil pipelines with corrosion-like defects is proposed and applied to predict the residual life of an old duct made of API 5L Gr. B steel, in service for more than 40 years. Since its inauguration, this pipeline has carried several heated products under variable temperatures and pressures. The calculated (nominal) service stresses are very high, due to thermal loads that induce significant bending in curved parts of the duct, with peaks close to the yield strength of the steel. The elastic- plastic fatigue damage at a notch or a corrosion pit root is calculated using the {epsilon}N method, and the effects of surface semi-elliptical cracks in its internal (or external) wall is studied considering appropriate stress intensity factor expressions and the actual service loads. In the presence of surface flaws associated to stress concentration factors of the order of three, a fatigue crack likely will initiate in the pipeline. However, if these surface cracks are small compared to the duct wall thickness, their predicted propagation rates are very low. (author)

  15. Endoscopic-assisted probing for congenital nasolacrimal duct obstruction.

    Science.gov (United States)

    Wallace, E J; Cox, A; White, P; Macewen, C J

    2006-09-01

    To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.

  16. Lower Rate of Major Bile Duct Injury and Increased Intraoperative Management of Common Bile Duct Stones after Implementation of Routine Intraoperative Cholangiography

    NARCIS (Netherlands)

    Buddingh, K. Tim; Weersma, Rinse K.; Savenije, Rolf A. J.; van Dam, Gooitzen M.; Nieuwenhuijs, Vincent B.

    BACKGROUND: Our university medical center is the only center in The Netherlands that has adopted a policy of routine intraoperative cholangiography (IOC) during cholecystectomy. This study aimed to describe the rate of bile duct injury (BDI) and management of common bile duct (CBD) stones before and

  17. Observations on the anterior testicular ducts in snakes with emphasis on sea snakes and ultrastructure in the yellow-bellied sea snake, Pelamis platurus.

    Science.gov (United States)

    Sever, David M; Freeborn, Layla R

    2012-03-01

    The anterior testicular ducts of squamates transport sperm from the seminiferous tubules to the ductus deferens. These ducts consist of the rete testis, ductuli efferentes, and ductus epididymis. Many histological and a few ultrastructural studies of the squamate reproductive tract exist, but none concern the Hydrophiidae, the sea snakes and sea kraits. In this study, we describe the anterior testicular ducts of six species of hydrophiid snakes as well as representatives from the Elapidae, Homolapsidae, Leptotyphlopidae, and Uropeltidae. In addition, we examine the ultrastructure of these ducts in the yellow-bellied Sea Snake, Pelamis platurus, only the third such study on snakes. The anterior testicular ducts are similar in histology in all species examined. The rete testis is simple squamous or cuboidal epithelium and transports sperm from the seminiferous tubules to the ductuli efferentes in the extratesticular epididymal sheath. The ductuli efferentes are branched, convoluted tubules composed of simple cuboidal, ciliated epithelium, and many species possess periodic acid-Schiff+ granules in the cytoplasm. The ductus epididymis at the light microscopy level appears composed of pseudostratified columnar epithelium. At the ultrastructural level, the rete testis and ductuli efferentes of P. platurus possess numerous small coated vesicles and lack secretory vacuoles. Apocrine blebs in the ductuli efferentes, however, indicate secretory activity, possibly by a constitutive pathway. Ultrastructure reveals three types of cells in the ductus epididymis of P. platurus: columnar principal cells, squamous basal cells, and mitochondria-rich apical cells. This is the first report of apical cells in a snake. In addition, occasional principal cells possess a single cilium, which has not been reported in reptiles previously but is known in some birds. Finally, the ductus epididymis of P. platurus differs from other snakes that have been studied in possession of apical, biphasic

  18. Research on Duct Flow Field Optimisation of a Robot Vacuum Cleaner

    Directory of Open Access Journals (Sweden)

    Xiao-bo Lai

    2011-11-01

    Full Text Available The duct of a robot vacuum cleaner is the length of the flow channel between the inlet of the rolling brush blower and the outlet of the vacuum blower. To cope with the pressure drop problem of the duct flow field in a robot vacuum cleaner, a method based on Pressure Implicit with Splitting of Operators (PRISO algorithm is introduced and the optimisation design of the duct flow field is implemented. Firstly, the duct structure in a robot vacuum cleaner is taken as a research object, with the computational fluid dynamics (CFD theories adopted; a three-dimensional fluid model of the duct is established by means of the FLUENT solver of the CFD software. Secondly, with the k-∊ turbulence model of three-dimensional incompressible fluid considered and the PRISO pressure modification algorithm employed, the flow field numerical simulations inside the duct of the robot vacuum cleaner are carried out. Then, the velocity vector plots on the arbitrary plane of the duct flow field are obtained. Finally, an investigation of the dynamic characteristics of the duct flow field is done and defects of the original duct flow field are analysed, the optimisation of the original flow field has then been conducted. Experimental results show that the duct flow field after optimisation can effectively reduce pressure drop, the feasibility as well as the correctness of the theoretical modelling and optimisation approaches are validated.

  19. Research on Duct Flow Field Optimisation of a Robot Vacuum Cleaner

    Directory of Open Access Journals (Sweden)

    Xiao-bo Lai

    2011-11-01

    Full Text Available The duct of a robot vacuum cleaner is the length of the flow channel between the inlet of the rolling brush blower and the outlet of the vacuum blower. To cope with the pressure drop problem of the duct flow field in a robot vacuum cleaner, a method based on Pressure Implicit with Splitting of Operators (PRISO algorithm is introduced and the optimisation design of the duct flow field is implemented. Firstly, the duct structure in a robot vacuum cleaner is taken as a research object, with the computational fluid dynamics (CFD theories adopted; a three‐dimensional fluid model of the duct is established by means of the FLUENT solver of the CFD software. Secondly, with the k‐ε turbulence model of three‐ dimensional incompressible fluid considered and the PRISO pressure modification algorithm employed, the flow field numerical simulations inside the duct of the robot vacuum cleaner are carried out. Then, the velocity vector plots on the arbitrary plane of the duct flow field are obtained. Finally, an investigation of the dynamic characteristics of the duct flow field is done and defects of the original duct flow field are analysed, the optimisation of the original flow field has then been conducted. Experimental results show that the duct flow field after optimisation can effectively reduce pressure drop, the feasibility as well as the correctness of the theoretical modelling and optimisation approaches are validated.

  20. Autoimmune pancreatitis: Assessment of the enhanced duct sign on multiphase contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, Yuichi, E-mail: kawai.yuichi@a.mbox.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan); Suzuki, Kojiro, E-mail: kojiro@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan); Itoh, Shigeki, E-mail: shigeito@nagoya-1st.jrc.or.jp [Department of Diagnostic Radiology, Japan Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya 453-8511 (Japan); Takada, Akira, E-mail: takadaa@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan); Mori, Yoshine, E-mail: yoshine@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan); Naganawa, Shinji, E-mail: naganawa@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan)

    2012-11-15

    Purpose: To assess the usefulness of the computed tomography (CT) finding of main pancreatic duct (MPD) wall enhancement, termed the 'enhanced duct sign', for diagnosis of autoimmune pancreatitis (AIP) in comparison with diagnosis of pancreatic carcinoma and chronic pancreatitis. Materials and methods: Two radiologists independently evaluated the presence or absence of the enhanced duct sign on multiphase contrast-enhanced CT in patients with AIP (n = 55), pancreatic carcinoma (n = 50), and chronic pancreatitis (n = 50). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of AIP were calculated. In patients demonstrating the enhanced duct sign, additional findings were evaluated by consensus. Results: The enhanced duct sign was more frequently observed in patients with AIP (37/55, 67%) than in patients with pancreatic carcinoma (5/50, 10%) or chronic pancreatitis (0/50, 0%) (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the finding were 0.67, 0.95, 0.85, 0.88, and 0.84, respectively. In AIP, the lumen within the enhanced duct was completely or partially invisible in 29 of 37 (78%) patients, and the enhanced duct was observed within the affected pancreatic parenchyma in 35 of 37 (95%) patients. In pancreatic carcinoma, the lumen within the enhanced duct was visible in all patients (5/5, 100%), and the enhanced duct was observed downstream of the tumor (5/5, 100%). Conclusion: The enhanced duct sign is highly specific of AIP.