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Abstract
We have experienced a case of mucinous ductal ectasia of the pancreas. The patient visited hospital with the symptoms of acute pancreatitis. The plasma levels of amylase and lipase checked at hospital were elevated. Abdominal ultrasonography and CT scan showed cystlike, intrapancreatic defects localized in the uncinate process of pancreatic head, On duodenoscopy, bulging ampulla of Vater and patulous papillary orifice were seen. Mucin leaked out of the patulous opening. Endoscopic retrograde pancreatography was performed and the localized, grape-like cyatic dilatation of the side branch of a main pancreatic duct on the uncinate process was shown. The main pancreatic duct was also dilated and had multiple filling defects in it. Whipple' s operation was performed and the histologic diagnosis was a benign intraductal papillary mucinous neoplasm of the pancreas.
Wednesday, June 9, 2010
Pancreatic mucinous ductal ectasia and intraductal papillary neoplasms. A single malignant clinicopathologic entity.
Pancreatic mucinous ductal ectasia and intraductal papillary neoplasms. A single malignant clinicopathologic entity.
Mucinous ductal ectasia and IPN differed histopathologically only in degree of mucin secretion and tumor location. Mucinous ductal ectasia, but not IPN, was characteristically mucin-hypersecreting and more frequently involved the head of the gland than did IPN (11/16 vs. 1/8 p < 0.04). All patients were explored surgically and 20 (83%) of 24 of the tumors were resectable with frozen section control of the duct margins (9 pancreatoduodenectomies, 4 distal pencreatectomies, 7 total pancreatectomies).
Mucinous ductal ectasia and IPN differed histopathologically only in degree of mucin secretion and tumor location. Mucinous ductal ectasia, but not IPN, was characteristically mucin-hypersecreting and more frequently involved the head of the gland than did IPN (11/16 vs. 1/8 p < 0.04). All patients were explored surgically and 20 (83%) of 24 of the tumors were resectable with frozen section control of the duct margins (9 pancreatoduodenectomies, 4 distal pencreatectomies, 7 total pancreatectomies).
Mucinous Tumors of the Exocrine Pancreas: Intraductal Mucin-Hypersecreting Neoplasms
Mucinous Tumors of the Exocrine Pancreas: Intraductal Mucin-Hypersecreting Neoplasms
MRCP has emerged as a new noninvasive technology to assess both pancreatic and bile ducts without the use of contrast material or endoscopy. A study by Koito and colleagues [14] compared MRCP to ERCP in the diagnosis of mucin-hypersecreting tumors of the pancreas. MRCP showed cystic dilated branches of the pancreas better than ERCP. The numbers of nodules or septa that were detectable by MRCP and ERCP were similar. The authors concluded that MRCP appears to be more effective than ERCP for the detection of intraductal cystic lesions of mucin-producing pancreatic tumors. Because some of these tumors are not malignant and do not require surgery, MRCP offers a less invasive alternative to ERCP for follow-up studies. In the study by Yamaguchi et al, [15] the details of cystic lesions of the branch ducts (eg, mural nodule, communication with main pancreatic duct) were more clearly demonstrated by ERCP than by MRCP. ERCP was clear-ly superior in demonstration of normal main pancreatic duct and its branches. These two studies suggest that both ERCP and MRCP are complementary studies that are helpful in the diagnosis and follow-up of patients with IPMTs.
MRCP has emerged as a new noninvasive technology to assess both pancreatic and bile ducts without the use of contrast material or endoscopy. A study by Koito and colleagues [14] compared MRCP to ERCP in the diagnosis of mucin-hypersecreting tumors of the pancreas. MRCP showed cystic dilated branches of the pancreas better than ERCP. The numbers of nodules or septa that were detectable by MRCP and ERCP were similar. The authors concluded that MRCP appears to be more effective than ERCP for the detection of intraductal cystic lesions of mucin-producing pancreatic tumors. Because some of these tumors are not malignant and do not require surgery, MRCP offers a less invasive alternative to ERCP for follow-up studies. In the study by Yamaguchi et al, [15] the details of cystic lesions of the branch ducts (eg, mural nodule, communication with main pancreatic duct) were more clearly demonstrated by ERCP than by MRCP. ERCP was clear-ly superior in demonstration of normal main pancreatic duct and its branches. These two studies suggest that both ERCP and MRCP are complementary studies that are helpful in the diagnosis and follow-up of patients with IPMTs.
Tuesday, June 8, 2010
Gallstones: Complications - MayoClinic.com
Gallstones: Complications - MayoClinic.com
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
Pancreatitis - Wellsphere
Pancreatitis - Wellsphere
Acute Pancreatitis
Some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis occurs more often in men than women.
Acute pancreatitis is usually caused by gallstones or by drinking too much alcohol, but these aren't the only causes. If alcohol use and gallstones are ruled out, other possible causes of pancreatitis should be carefully examined so that appropriate treatment—if available—can begin.
Symptoms
Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant—just in the abdomen—or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include
swollen and tender abdomen
nausea
vomiting
fever
rapid pulse
Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.
Acute Pancreatitis
Some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis occurs more often in men than women.
Acute pancreatitis is usually caused by gallstones or by drinking too much alcohol, but these aren't the only causes. If alcohol use and gallstones are ruled out, other possible causes of pancreatitis should be carefully examined so that appropriate treatment—if available—can begin.
Symptoms
Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant—just in the abdomen—or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include
swollen and tender abdomen
nausea
vomiting
fever
rapid pulse
Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.
Mucinous cystadenoma of the pancreas associated wi... [Am Surg. 2005] - PubMed result
Mucinous cystadenoma of the pancreas associated wi... [Am Surg. 2005] - PubMed result
The differentiation between a pancreatic pseudocyst and benign cystic neoplasms of the pancreas is crucial to determine treatment options. Cystic neoplasms of the pancreas, whether mucinous or serous, have the potential to harbor malignancy, and resection is recommended.
The differentiation between a pancreatic pseudocyst and benign cystic neoplasms of the pancreas is crucial to determine treatment options. Cystic neoplasms of the pancreas, whether mucinous or serous, have the potential to harbor malignancy, and resection is recommended.
Pancreatic cysts: Tests and diagnosis - MayoClinic.com
Pancreatic cysts: Tests and diagnosis - MayoClinic.com
Although the majority of pancreatic cysts are benign pseudocysts, doctors may suspect another type of cyst if it occurs with no previous history of pancreatitis or abdominal injury or if it has internal walls.
In some cases, the location of the cyst in your pancreas — along with your age and sex — can help doctors pinpoint what type of cyst you have.
Mucinous cystadenoma. These cysts are usually located in the body or tail of the pancreas and occur most often in middle-aged women. They are precancerous, and some may already be cancerous when discovered. Larger cysts are more likely to be cancerous.
Mucinous duct ectasia. More common in men, these cysts consist of dilated ductal segments, usually within the head of the pancreas. Also known as intraductal papillary mucinous neoplasms, these growths are often cancerous.
Serous cystadenoma. These growths can become large enough to displace nearby organs, causing such symptoms as abdominal pain and a feeling of fullness. They occur most frequently in middle-aged women and become cancerous only rarely.
Papillary cystic tumor. The least common of the nonpseudocysts, papillary cystic tumors — also known as papillary cystic neoplasm or solid and pseudopapillary neoplasm — occur most often in young women and are usually located in the body or tail of the pancreas. They are usually cancerous.
Islet cell tumors, also known as neuroendocrine tumors, are less common. Normally, the pancreas's islet cells produce insulin and other hormones. Islet cell tumors can also produce these hormones.
Although the majority of pancreatic cysts are benign pseudocysts, doctors may suspect another type of cyst if it occurs with no previous history of pancreatitis or abdominal injury or if it has internal walls.
In some cases, the location of the cyst in your pancreas — along with your age and sex — can help doctors pinpoint what type of cyst you have.
Mucinous cystadenoma. These cysts are usually located in the body or tail of the pancreas and occur most often in middle-aged women. They are precancerous, and some may already be cancerous when discovered. Larger cysts are more likely to be cancerous.
Mucinous duct ectasia. More common in men, these cysts consist of dilated ductal segments, usually within the head of the pancreas. Also known as intraductal papillary mucinous neoplasms, these growths are often cancerous.
Serous cystadenoma. These growths can become large enough to displace nearby organs, causing such symptoms as abdominal pain and a feeling of fullness. They occur most frequently in middle-aged women and become cancerous only rarely.
Papillary cystic tumor. The least common of the nonpseudocysts, papillary cystic tumors — also known as papillary cystic neoplasm or solid and pseudopapillary neoplasm — occur most often in young women and are usually located in the body or tail of the pancreas. They are usually cancerous.
Islet cell tumors, also known as neuroendocrine tumors, are less common. Normally, the pancreas's islet cells produce insulin and other hormones. Islet cell tumors can also produce these hormones.
Pancreatic cysts - MayoClinic.com
Pancreatic cysts - MayoClinic.com
Pancreatic cysts are abnormal, sac-like pockets of fluid on or within your pancreas. Though it may be alarming to learn you have a pancreatic cyst, the good news is that most pancreatic cysts aren't cancerous — and many don't even cause symptoms.
Pancreatic cysts are abnormal, sac-like pockets of fluid on or within your pancreas. Though it may be alarming to learn you have a pancreatic cyst, the good news is that most pancreatic cysts aren't cancerous — and many don't even cause symptoms.
How long do people survive after Whipple procedure? Can you still be athletic after Whipple Procedure?
All Two questions: How long do people survive after Whipple procedure? Can you still be athletic after Whipple Procedure? messages
Today is 8 months after my Whipple. I had Ampullary carcinoma of the Ampulla of Vader. The Whipple procedure was successful in removing the tumor, but also took 1/3 of the stomach and 1/3 of the pancreas, duodenum, gall bladder, etc. I lost around 20 pounds from the surgery and reduced appetite from the stomach reduction.
Today is 8 months after my Whipple. I had Ampullary carcinoma of the Ampulla of Vader. The Whipple procedure was successful in removing the tumor, but also took 1/3 of the stomach and 1/3 of the pancreas, duodenum, gall bladder, etc. I lost around 20 pounds from the surgery and reduced appetite from the stomach reduction.
Monday, June 7, 2010
Middle Pancreatectomy: Indications, Short- and Long-term Ope... : Annals of Surgery
Middle Pancreatectomy: Indications, Short- and Long-term Ope... : Annals of Surgery
Conclusions: MP is a safe and effective procedure for treatment of benign and low-grade malignant neoplasms of the mid pancreas and is associated with a low risk of development of exocrine and endocrine insufficiency. MP should be avoided in patients affected by main-duct IPMN.
Conclusions: MP is a safe and effective procedure for treatment of benign and low-grade malignant neoplasms of the mid pancreas and is associated with a low risk of development of exocrine and endocrine insufficiency. MP should be avoided in patients affected by main-duct IPMN.
Why does Steve Jobs look so thin? - Apple 2.0 - Fortune Tech
Why does Steve Jobs look so thin? - Apple 2.0 - Fortune Tech
Jobs has never spoken publicly about what life is like after the Whipple, so we can't be sure that he has any of the post-operative problems associated with the procedure. But they would go long way toward explaining why he looked the way did on Monday. And none of them would indicate that his cancer has returned, or that his capacity for work is diminished. Post-operative guides for patients suggest that there will be lifestyle changes but that they need not be drastic. And a survey of patients at Johns Hopkins Hospital found that the overall quality of life of long-term survivors of the surgery is nearly comparable to that of healthy people.
Jobs has never spoken publicly about what life is like after the Whipple, so we can't be sure that he has any of the post-operative problems associated with the procedure. But they would go long way toward explaining why he looked the way did on Monday. And none of them would indicate that his cancer has returned, or that his capacity for work is diminished. Post-operative guides for patients suggest that there will be lifestyle changes but that they need not be drastic. And a survey of patients at Johns Hopkins Hospital found that the overall quality of life of long-term survivors of the surgery is nearly comparable to that of healthy people.
Life Expectancy After Whipple Procedure | eHow.com
Life Expectancy After Whipple Procedure eHow.com
Life Expectancy and Survival Rate
Life expectancy can be difficult to determine, especially in the case of serious conditions including cancers. Life expectancy is not only affected by the illness, including the stage, grade and characteristics, but also by age and overall health. Therefore, life expectancy is usually discussed as survival rates, which is a percentage of the number of people that live for a specified period of time after diagnosis.
Survival Rate
Patients suffering from pancreatic cancer have a 5 percent survival rate at five years, meaning that only 5 percent of the patients will live five years after their diagnosis. Those patients that undergo the Whipple procedure, however, increase their survival rate to 20 percent at five years. For those patients whose cancer has not spread to lymph nodes, they have a 40 percent survival rate at five years. For patients with a benign (noncancerous) tumor or chronic pancreatitis, the procedure is curative, meaning they will enjoy a long natural life.
Life Expectancy and Survival Rate
Life expectancy can be difficult to determine, especially in the case of serious conditions including cancers. Life expectancy is not only affected by the illness, including the stage, grade and characteristics, but also by age and overall health. Therefore, life expectancy is usually discussed as survival rates, which is a percentage of the number of people that live for a specified period of time after diagnosis.
Survival Rate
Patients suffering from pancreatic cancer have a 5 percent survival rate at five years, meaning that only 5 percent of the patients will live five years after their diagnosis. Those patients that undergo the Whipple procedure, however, increase their survival rate to 20 percent at five years. For those patients whose cancer has not spread to lymph nodes, they have a 40 percent survival rate at five years. For patients with a benign (noncancerous) tumor or chronic pancreatitis, the procedure is curative, meaning they will enjoy a long natural life.
Sunday, June 6, 2010
Chronic pancreatitis. [Am Fam Physician. 2007] - PubMed result
Chronic pancreatitis. [Am Fam Physician. 2007] - PubMed result
Abstract
Chronic pancreatitis is the progressive and permanent destruction of the pancreas resulting in exocrine and endocrine insufficiency and, often, chronic disabling pain. The etiology is multifactorial. Alcoholism plays a significant role in adults, whereas genetic and structural defects predominate in children. The average age at diagnosis is 35 to 55 years. Morbidity and mortality are secondary to chronic pain and complications (e.g., diabetes, pancreatic cancer). Contrast-enhanced computed tomography is the radiographic test of choice for diagnosis, with ductal calcifications being pathognomonic. Newer modalities, such as endoscopic ultrasonography and magnetic resonance cholangiopancreatography, provide diagnostic results similar to those of endoscopic retrograde cholangiopancreatography. Management begins with lifestyle modifications (e.g., cessation of alcohol and tobacco use) and dietary changes followed by analgesics and pancreatic enzyme supplementation. Before proceeding with endoscopic or surgical interventions, physicians and patients should weigh the risks and benefits of each procedure. Therapeutic endoscopy is indicated for symptomatic or complicated pseudocyst, biliary obstruction, and decompression of pancreatic duct. Surgical procedures include decompression for large duct disease (pancreatic duct dilatation of 7 mm or more) and resection for small duct disease. Lateral pancreaticojejunostomy is the most commonly performed surgery in patients with large duct disease. Pancreatoduodenectomy is indicated for the treatment of chronic pancreatitis with pancreatic head enlargement. Patients with chronic pancreatitis are at increased risk of pancreatic neoplasm; regular surveillance is sometimes advocated, but formal guidelines and evidence of clinical benefit are lacking.
Abstract
Chronic pancreatitis is the progressive and permanent destruction of the pancreas resulting in exocrine and endocrine insufficiency and, often, chronic disabling pain. The etiology is multifactorial. Alcoholism plays a significant role in adults, whereas genetic and structural defects predominate in children. The average age at diagnosis is 35 to 55 years. Morbidity and mortality are secondary to chronic pain and complications (e.g., diabetes, pancreatic cancer). Contrast-enhanced computed tomography is the radiographic test of choice for diagnosis, with ductal calcifications being pathognomonic. Newer modalities, such as endoscopic ultrasonography and magnetic resonance cholangiopancreatography, provide diagnostic results similar to those of endoscopic retrograde cholangiopancreatography. Management begins with lifestyle modifications (e.g., cessation of alcohol and tobacco use) and dietary changes followed by analgesics and pancreatic enzyme supplementation. Before proceeding with endoscopic or surgical interventions, physicians and patients should weigh the risks and benefits of each procedure. Therapeutic endoscopy is indicated for symptomatic or complicated pseudocyst, biliary obstruction, and decompression of pancreatic duct. Surgical procedures include decompression for large duct disease (pancreatic duct dilatation of 7 mm or more) and resection for small duct disease. Lateral pancreaticojejunostomy is the most commonly performed surgery in patients with large duct disease. Pancreatoduodenectomy is indicated for the treatment of chronic pancreatitis with pancreatic head enlargement. Patients with chronic pancreatitis are at increased risk of pancreatic neoplasm; regular surveillance is sometimes advocated, but formal guidelines and evidence of clinical benefit are lacking.
Radiologic spectrum of intraductal papillary mucin... [Radiographics. 2001 Mar-Apr] - PubMed result
Radiologic spectrum of intraductal papillary mucin... [Radiographics. 2001 Mar-Apr] - PubMed result
Abstract
"Intraductal papillary mucinous tumor" is now the preferred term to describe a spectrum of proliferation of the pancreatic ductal epithelium. The tumor produces an excessive amount of mucin and results in progressive dilation of the main pancreatic duct or cystic dilation of the branch ducts, depending on the location of the tumor. This tumor is small and localized in a segment of the main pancreatic duct or in branch ducts, particularly in the branch ducts of the uncinate process, but it may also be diffuse, involving a wide area of the pancreatic ducts. Excessive mucin may impede the pancreatic duct flow and, in turn, produce symptoms of chronic pancreatitis. The following findings are seen on imaging studies: lobulated multicystic dilatation of the branch ducts, diffuse dilatation of the main pancreatic duct, intraductal papillary tumors, elongated or globlike mucous plugs in the dilated ducts, and bulging of the papilla into the duodenal lumen. The diagnosis is suggested at ultrasonography, computed tomography, or magnetic resonance cholangiopancreatography. Endoscopic retrograde cholangiopancreatography is the imaging modality of choice for the diagnosis, because it depicts the communication between the cystically dilated branch ducts and the diffusely dilated main pancreatic duct, as well as intraductal papillary tumor and mucous plugs.
Abstract
"Intraductal papillary mucinous tumor" is now the preferred term to describe a spectrum of proliferation of the pancreatic ductal epithelium. The tumor produces an excessive amount of mucin and results in progressive dilation of the main pancreatic duct or cystic dilation of the branch ducts, depending on the location of the tumor. This tumor is small and localized in a segment of the main pancreatic duct or in branch ducts, particularly in the branch ducts of the uncinate process, but it may also be diffuse, involving a wide area of the pancreatic ducts. Excessive mucin may impede the pancreatic duct flow and, in turn, produce symptoms of chronic pancreatitis. The following findings are seen on imaging studies: lobulated multicystic dilatation of the branch ducts, diffuse dilatation of the main pancreatic duct, intraductal papillary tumors, elongated or globlike mucous plugs in the dilated ducts, and bulging of the papilla into the duodenal lumen. The diagnosis is suggested at ultrasonography, computed tomography, or magnetic resonance cholangiopancreatography. Endoscopic retrograde cholangiopancreatography is the imaging modality of choice for the diagnosis, because it depicts the communication between the cystically dilated branch ducts and the diffusely dilated main pancreatic duct, as well as intraductal papillary tumor and mucous plugs.
Clinical significance of main pancreatic duct dila... [World J Gastroenterol. 2007] - PubMed result
Clinical significance of main pancreatic duct dila... [World J Gastroenterol. 2007] - PubMed result
Division of Digestive Diseases, 1365 Clifton Road, NE, Suite B1262, Emory University School of Medicine, Atlanta, GA 30322, USA.
Abstract
AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.
METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.
RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis (CP) and pancreatic cancer (PC) were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.
CONCLUSION:
1. Patients with pancreatic double duct dilation (DDD) need extensive work up and careful follow-up since a majority of these patients are ultimately diagnosed with pancreatic cancer.
2. Patients with single duct dilation (SDD), especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.
Terminology: SDD- Single duct dilation; DDD- Double Duct Dilation
Cause of main duct dilation is CP and PC.
SDD- majority SDD patients had CP, 1/3 of patients with SDD but without CP had pancrease malignancies
DDD-pancreastic cancer.
Mine is a SDD.
Division of Digestive Diseases, 1365 Clifton Road, NE, Suite B1262, Emory University School of Medicine, Atlanta, GA 30322, USA.
Abstract
AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.
METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.
RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis (CP) and pancreatic cancer (PC) were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.
CONCLUSION:
1. Patients with pancreatic double duct dilation (DDD) need extensive work up and careful follow-up since a majority of these patients are ultimately diagnosed with pancreatic cancer.
2. Patients with single duct dilation (SDD), especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.
Terminology: SDD- Single duct dilation; DDD- Double Duct Dilation
Cause of main duct dilation is CP and PC.
SDD- majority SDD patients had CP, 1/3 of patients with SDD but without CP had pancrease malignancies
DDD-pancreastic cancer.
Mine is a SDD.
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