ViSE Seminar Series: Issues of access and visualization in managing diseases of the pancreas: Engineering approaches to therapy, SC 5326, Thursday March 27, 11:50. Refreshments provided.
Title: Issues of access and visualization in managing diseases of the pancreas: Engineering approaches to therapy
Speakers:
Dr. William Nealon, MD
Vice-Chairman, Department of Surgery, Associate Surgeon-in-Chief, VUMC
Dr. Charles Caskey, PhD
Assistant Professor of Radiology and Radiological Sciences
Date: Thursday, March 27th, 2014
Time: Noon start, 11:50 lunch social
Place: Stevenson Center 5326
Abstract:
Clinical Perspective: Although access to pancreatic tissue or surrounding structures is critical in both benign and malignant diseases I plan to discuss specific issues related to the management of the consequences of an episode of severe necrotizing pancreatitis. Since the pancreas is the source of the digestive enzymes which are capable of digesting the dietary products we consume, these proteins are capable of digesting our own tissues when activated by an episode of severe pancreatitis. A common area of clinical concern in these patients is the management of the devitalized debris found in and around the pancreas after such an episode. This debris is semisolid, is prone to infection and when infected is associated with a very high mortality unless intervention is undertake. Historically the intervention involved an extensive open operation requiring placement of many drains and carrying with is a high rate of morbidity and a high rate of requiring multiple operations. Over the past decade some centers have proposed less invasive means of accessing the debris with some remarkable successes. Here at Vanderbilt I have initiated a novel approach to this technique. Limitations to this intervention are twofold. There may be times when direct percutaneous access to these debris fields is limited by intervening structures. In addition, once access has been achieved there are challenges to combine access with visualization. The potential gains with some creative bio-engineering solutions would be vast.
Engineering Perspective: The development of targeted imaging agents, acoustically active drugs, and the combination of therapeutic ultrasound with other imaging modalities are areas where exciting progress is being made. This talk will cover targeted ultrasonic imaging, which has the opportunity to become a commonly used tool where molecules expressed on the vascular endothelium can be tracked to assess disease progression and therapeutic efficacy. On the therapeutic side, the combination of ultrasound with MRI allows for highly accurate, noninvasive heating, ablation, or mechanical agitation within the body. A combined MRI-ultrasound system can act as a noninvasive heated scalpel, and this technology is currently undergoing clinical trials for ablation of ovarian cysts at Vanderbilt. Finally, the use of MR-guided ultrasound in conjunction with drugs is an area that is seeing much exploration with progress towards localizing treatment while reducing the systemic load of chemotherapy. We are currently exploring this technology to increase delivery of drugs beyond the stromal barrier in pancreatic cancer. In this work, we are increasing delivery by using heat and examining pharmacokinetics of a well-studied radiolabeled model drug.