Idiopathic pancreatitis is often caused by small gallstones that are difficult to observe prior to surgery, shows a study from the University of Eastern Finland. Small gallstones were found in surgery from two out of three idiopathic pancreatitis patients. The study also showed that acute pancreatitis was more common in statin users than non-users.

The main causes of acute pancreatitis in Finland are alcohol and cholelithiasis. In up to 10-20 per cent of cases, the underlying cause remains unclear. These cases may be explained by small gallstones that are not found during regular examination. A gallstone can get stuck in the junction of the common bile duct and the pancreatic duct, thus causing pancreatitis.

In a multi-centre gastrointestinal surgery study, first-time idiopathic pancreatitis patients were randomized into a surgery group and a control group. 39 patients underwent gallbladder removal surgery, and 46 were controls. During an average follow-up of three years, pancreatitis recurred in 14 persons in the control group and in four persons in the surgery group, so recurrence was clearly more likely in controls. Similarly, there were 23 pancreatitis cases in controls and only eight in the surgery group. Small gallstones were found in surgery from two out of three patients, although not observed in repeated abdominal ultrasound prior to surgery.

This finding is important when charting the causes of idiopathic pancreatitis and courses of treatment. For instance, alcohol use may too often be suspected as the cause. The recurrence of idiopathic pancreatitis can in many cases be prevented by laparoscopic gallbladder removal surgery.

The study also analysed the association of pancreatitis with the use of cholesterol-lowering drugs, statins, as gallstones often contain crystallised cholesterol.  Animal studies have shown statins to dissolve gallstones. The majority of gallstones are found in the elderly, often asymptomatic. Researchers assumed that statins may also reduce the size of gallstones in humans, enabling gallstones to travel from the gallbladder to the junction of the common bile duct and the pancreatic duct, and then manifest as pancreatitis.

In a retrospective study carried out in Kuopio University Hospital, idiopathic pancreatitis was found to be more common in statin users than in non-users.  On the other hand, statin users

Postponing the start of adjuvant chemotherapy for more than 90 days following surgery may significantly increase risk of death for breast cancer patients, particularly those with triple-negative breast cancer (TNBC), according to a new study from The University of Texas MD Anderson Cancer Center. Further, the researchers found that factors such as socio-economic status, insurance coverage and ethnicity were associated with delayed treatment.
Adjuvant chemotherapy, which is given after primary surgery, has been demonstrated to benefit patients by decreasing the risk of recurrence and death, explained Mariana Chavez Mac Gregor, M.D., assistant professor, Health Services Research and Breast Medical Oncology. However, delaying the start of adjuvant chemotherapy may allow small remnants of the tumour to grow or become drug-resistant.
Currently, there are no guidelines recommending the optimal time to initiation of adjuvant chemotherapy. The Centers for Medicare & Medicaid Services (CMS) considers the administration of adjuvant chemotherapy within 120 days of diagnosis for certain patients as a quality metric. Eleven cancer hospitals, including MD Anderson, are now reporting on this metric.
Past studies have suggested that delaying the initiation of therapy could result in adverse patient outcomes, but the optimal timing for starting adjuvant therapy has not been defined. To clarify this time frame relative to modern treatments and identify factors contributing to delayed treatment, the researchers analysed data from the California Cancer Registry.
This population-based study examined data from 24,823 patients with Stage I to III invasive breast cancer diagnosed between January 1, 2005 and December 31, 2010 and treated with adjuvant chemotherapy. This is the largest study investigating the effects of delayed chemotherapy initiation with contemporary treatment regimens.

A teenage girl faced with sudden rapid heart deterioration, a man in the prime years of his life suffering from debilitating heart failure and a former NFL athlete crippled by end-stage heart failure were all successfully treated with a surgical approach pioneered by cardiac experts at University of California, San Diego School of Medicine.
The work demonstrated significant benefits of implanting a left ventricular assist device (LVAD) in the right atrium to provide better blood flow through the lungs, giving complete biventricular circulatory support and fully replacing the heart’s function.
An LVAD is a small mechanical pump traditionally placed inside the left ventricle – one of four chambers of the heart, located in the lower left of the organ – to help restore blood flow throughout the body. Unlike an artificial heart, the LVAD doesn’t replace the heart, but it can mean the difference between life and death for a person waiting for a transplant or suffering from advanced heart failure.
‘An LVAD relieves symptoms, such as being constantly tired or short of breath in patients with advanced heart disease,’ said Victor Pretorius, MBchB, lead author of the report and surgical director of cardiac transplant and mechanical circulatory support at UC San Diego Health. ‘The caveat is that the LVAD still depends on the right side of the patient’s heart to function optimally, and right ventricle failure is a common condition after an LVAD implantation, leaving some patients only partially treated. It is difficult to predict and increases mortality.’
Pretorius said biventricular support is required for up to 30 percent of LVAD recipients. Currently, no durable, long-term right ventricular assist device (RVAD) has received Food and Drug Administration approval, and placing an LVAD in the right ventricle, for which it was not designed, may jeopardize the device and heart function.
‘An alternative strategy would be to remove the heart completely and replace it with a total artificial heart, but this strategy does not allow for the failing heart to potentially recover, and there is the risk of the device malfunctioning,’ said Pretorius. ‘All three patients involved in the study were in desperate need of right-sided circulatory support. Our team placed an additional HeartWare HVAD, the smallest available LVAD, in the right atrium, the upper chamber of the heart, to provide right heart support.’
The right atrium is considered a more ideal chamber for placing a mechanical pump to support right-sided circulation. The absence of valve structures ensures unobstructed blood flow into the pump, and the location next to the right lung makes accommodation for the pump’s motor in the chest cavity more feasible.
An LVAD is composed of a computer controller, a power pack and a reserve power pack that remain outside the body and are recharged at night. Patients with the innovative BiVAD approach have to carry a duplicate set for each pump, but Pretorius said this is generally well tolerated.
Two of three patients in the study received successful heart transplants after receiving right-sided circulatory support, and the third patient remains in good condition with both LVADs still implanted.

University San Diego Healthhttp://tinyurl.com/zsjjwuh

University of Miami Miller School of Medicine researchers have found a link between

Pancreatic cancer is the third leading cause of cancer deaths in the United States, in part because it is very difficult for chemotherapy drugs to reach the pancreas, which is located deep within the abdomen.

To help overcome that obstacle, researchers from MIT and Massachusetts General Hospital have now developed a small, implantable device that delivers chemotherapy drugs directly to pancreatic tumours. In a study of mice, they found that this approach was up to 12 times more effective than giving chemotherapy drugs by intravenous injection, which is how most pancreatic cancer patients are treated.