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Background: Despite continuous improvement of diagnostic and therapeutic procedures, the number of new pancreatic ductal adenocarcinoma (PDAC) cases diagnosed annually almost equals the number of PDAC-related deaths. Prerequisite for curative treatment is a resectable tumor at the time of diagnosis. Individuals with genetic and/or familial risk profiles should therefore be screened and included in structured surveillance programs., Objectives: Description of the status quo and usefulness of current PDAC screening and surveillance concepts., Methods: A selective literature search of current national and international guidelines including underlying literature was performed., Results: Nearly half of pancreatic cancer cases are missed by currently available surveillance programs, even in high-risk cohorts. Magnetic resonance imaging and endoscopic ultrasound supplemented by CA19‑9 (± HbA 1c ) are not accurate enough to ensure robust earlier pancreatic cancer detection. Complementary biomarker panels will take on a crucial diagnostic role in the future., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Cystic pancreatic lesions are detected incidentally at an increasing rate. Often, the patients present asymptomatically. Hence, the resulting clinical consequences remain challenging and unsettling for both physicians and patients., Objectives: Status of current recommendations in handling cystic pancreatic lesions., Materials and Methods: Selective literature search of PubMed while taking current guidelines into account., Results: Correct diagnostic classification of the cystic lesion is crucial since further action depends on the type of cystic lesion. Resection is generally recommended for mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN), and intraductal papillary mucinous neoplasms (IPMN) with relevant risk criteria such as prominent main-duct dilation. Surveillance is recommended for IPMN without risk criteria, as long as comorbidities and life expectancy of the patient will allow preventive resection over the years. SCNs are benign and only symptomatic SCNs require resection. Inflammatory pancreatic cysts should only be treated under certain circumstances., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Acute pancreatitis is a primary sterile inflammation of the pancreas, which is characterized by an unphysiological enzyme activation. This leads to an inflammatory reaction with edema, vascular damage and cell decay. The first German interdisciplinary S3 guidelines on chronic pancreatitis were published in 2012. Under the auspices of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and with the participation of various societies and patient representatives, the guidelines were recently revised and extended, Comprehensive S3 guidelines on acute and chronic pancreatitis were compiled and agreed by consensus. This article presents the important clinical aspects on acute pancreatitis from these guidelines in a compact form and the recommendations are justified., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Leitlinienreport veröffentlicht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Anhang veröffentlicht.

The cardinal symptom of chronic pancreatitis is severe belt-like upper abdominal pain, which requires immediate and adequate treatment. Furthermore, advanced stage chronic pancreatitis is often associated with complications, such as pancreatic pseudocysts, pancreatic duct stones and stenosis as well as biliary stenosis. The various endoscopic and surgical treatment options for chronic pancreatitis patients have been controversially discussed for decades. The new German S3 guidelines on pancreatitis now clearly define the best treatment options depending on the indications for treatment. For the treatment of pain in chronic pancreatitis it has been known for a long time that a surgical intervention is superior to endoscopic intervention concerning long-term pain relief. The recently published ESCAPE study has further underlined this by showing that early surgical intervention was superior to a step-up approach with initial endoscopic treatment. For the treatment of pancreatic pain, an initial endoscopic treatment attempt is therefore justified for short-term pain relief but in the midterm and long term, surgical intervention is the treatment of choice. In contrast, pancreatic pseudocysts, solitary proximally situated pancreatic duct stones and benign biliary strictures (except in calcifying pancreatitis) can nowadays generally be managed endoscopically. For distal pancreatic duct stones and symptomatic pancreatic duct stenosis surgical treatment is again the method of choice. This review article discusses these indication-related procedures in detail and explains them in relation to the recently published S3 guidelines on pancreatitis of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS)., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In Germany, an estimated 19 000 people will develop pancreatic carcinoma in 2018. The 5-year survival rate of all pancreatic carcinoma patients is very low at around 6 %, and the potentially curative operation is only possible in 15 - 20 % of patients. More frequent use and combination of systemic chemotherapeutic agents has led to improved life expectancy in recent years. In this article we will summarize recent therapeutic strategies depending on tumor status and current approaches to personalized medicine in pancreatic carcinoma., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic pancreatitis is a fibroinflammatory syndrome of the exocrine pancreas, which is characterized by an increasing incidence, high morbidity and lethality. Common etiologies besides alcohol and nicotine consumption include genetic causes and risk factors. The life time risk for the development of pancreatic cancer is elevated 13- to 45-fold depending on the underlying etiology. In patients with chronic pancreatitis clinical, laboratory and imaging surveillance for early detection of complications, including pancreatic cancer, is recommended, although the available methods lack the desired sensitivity and specificity. In this article we review the epidemiology, etiologies and risk factors for chronic pancreatitis and pancreatic cancer and discuss current recommendations for screening and management of patients at risk for tumor development., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

A 23-year-old woman with preexisting Graves' disease who received thiamazole treatment presented with fever, dysphagia, hyperthyroidism and leukopenia. With suspicion of thyreotoxicosis accompanied by drug-induced agranulocytosis she was successfully managed by plasmapheresis, G‑CSF administration and inhibition of periphereal conversion of thyroid hormones. In due course she underwent thyroidectomy. Thiamazole is frequently associated with drug-induced agranulocytosis. Long-term therapy with thiamazole requires critical evaluation and alternatives should be considered early. Plasmapheresis is an adequate treatment option to achieve normal thyroid hormonal status.

Autoimmune pancreatitis is a relatively rare form of chronic pancreatitis which is characterized by a lymphoplasmatic infiltrate with a storiform fibrosis and often goes along with painless jaundice and discrete discomfort of the upper abdomen. Clinically we distinguish between two subtypes, which differ in terms of their histology, clinical picture and prognosis. Type 1 autoimmune pancreatitis is the pancreatic manifestation of the IgG4-associated syndrome which also involves other organs. About one third of the patients can only be diagnosed after either histological prove or a successful steroid trail. Type 2 is IgG4-negative with the histological picture of an idiopathic duct centric pancreatitis and is to higher degree associated with inflammatory bowel disease. A definitive diagnosis can only be made using biopsy. Usually both forms show response to steroid treatment, but in type 1 up to 50 % of the patients might develop a relapse. The biggest challenge and most important differential diagnosis remains the discrimination of AIP from pancreatic cancer, because also AIP can cause mass of the pancreatic head, lymphadenopathy and ductal obstruction. This article summarizes recent advances on epidemiology, clinical presentation, diagnostic strategy, therapy and differential diagnosis in this relatively unknown disease., (© Georg Thieme Verlag KG Stuttgart · New York.)

Only little is known about the personal experiences and feelings of demented elderly persons in geriatric care institutions. We conducted an intense qualitative case study with a 75-year old woman with Alzheimer dementia (Mrs. R.). Our main research method was participating observation during a period of almost four weeks. Information concerning the nursing staff's point of view was gathered by semi-structured interviews. The results indicated two different frames of reference. The past formed the basis for the present experience of Mrs. R. Her behaviour revealed a lot of signs of normality. This was especially evident during her daily stays in a corner seating unit of the living area. Mrs. R. behaved like feeling at home in that particular place. The behaviour and attitudes of the nursing staff were mainly determined by their perception of Mrs. R. as a frail and ill person. It seemed that the staff had only little knowledge of Mrs. R.'s biography that could have broadened their syndrome-oriented point of view.

Tetrodotoxin (TTX) has been presented as an ultra-long-acting local anesthetic. Because its duration of action on myelinated nerve fibers of warm-blooded animals is unknown the effect of TTX on natural spike activity (A-delta fibers) of rabbit aortic nerve in vivo was studied. In 13 animals, a segment of the aortic nerve was placed in a perfusion chamber and exposed to increasing concentrations of TTX (n = 8) and, for comparison, of procaine (n = 8), which like TTX has a high pka. Total nerve activity and its change as related to drug concentrations was recorded continuously (concentration effect curves). The half-lives (t1/2) of onset time after drug administration and recovery following drug washout were also determined. TTX blocked nerve activity in a concentration-related manner, as did procaine; however, the potency of TTX (EC50 = 3.3 +/- 0.8.10(-9), cm = 1.3 +/- 0.4.10(-8) mol/l) was about 50,000 times higher than that of procaine (EC50 = 1.6 +/- 0.2.10(-4), cm = 2.5 4/- 0.3.10(-4) mol/l). Onset time did not differ statistically (p = 0.08) between TTX (t1/2 = 3.5 +/- 0.4 min) and procaine (t1/2 = 2.2 +/- 0.5 min). Most importantly, TTX block could not be reversed within 1-5 h of drug washout (n = 5) or was reversed incompletely (13%, 66%, and 90% of control activity) with t1/2 16 to 21 min. In contrast, all the procaine-blocked nerves recovered completely (t1/2 = 3.0 +/- 0.4 min). TTX blocks myelinated A-delta fibers of warm-blooded animals with lower concentrations and for a longer time than nonmyelinated fibers.(ABSTRACT TRUNCATED AT 250 WORDS)