Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and\\/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop
Hans G Beger; Bettina M Rau
Severity stratification is a critical issue in acute pancreatitis that strongly influences diagnostic and therapeutic decision\\u000a making. According to the widely used Atlanta classification, “severe” disease comprises various local and systemic complications\\u000a that are associated with an increased risk of mortality. However, results from recent clinical studies indicate that these\\u000a complications vary in their effect on outcome, and many are
Bettina M. Rau
Background: A large array of parameters has been proposed for the biochemical stratification of severity and prediction of complications in acute pancreatitis. However, the number of accurate and readily available variables for routine application is still limited. Methods: The literature was reviewed for laboratory markers of acute pancreatitis with special regard to their clinical usefulness and test performance for stratifying
B. Rau; M. K. Schilling; H. G. Beger
. The metabolic management of severe acute pancreatitis involves early identification of patients with severe pancreatitis,\\u000a aggressive fluid resuscitation, organ support, and careful monitoring in an intensive care environment. Recent evidence has\\u000a helped to define the roles of enteral feeding, prophylactic antibiotics, endoscopic retrograde cholangiopancreatography, computed\\u000a tomography, and fine-needle aspiration for bacteriology. The most difficult decision in the management of
John A. Windsor; Hisham Hammodat
Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, ?-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein. PMID:23551669
Stefanutti, Claudia; Labbadia, Giancarlo; Morozzi, Claudia
BACKGROUND & AIMS: Pancreatic necrosis and organ failure are principal determinants of severity in acute pancreatitis. The purpose of this study was to determine the relationship of necrosis to organ failure in severe acute pancreatitis. METHODS: Patients with necrotizing pancreatitis from May 1992 to January 1996 were retrospectively studied. Pancreatic necrosis was identified by characteristic findings on dynamic contrast-enhanced computerized
S Tenner; G Sica; M Hughes; E Noordhoek; S Feng; M Zinner; PA Banks
Significant literature on the management of acute severe acute pancreatitis has emerged in recent years. The new information ranges from data on newer single or multiparameter severity assessment tools and classification systems to therapeutic modalities. However, a few basic issues-the ideal severity assessment modality, volume of intravenous fluids required in the first 48 to 72 h, and the role of prophylactic antibiotics-are still not clear and are subject to controversy. The International Working Group has devised the Revised Atlanta Classification, which will be published soon. This new classification is eagerly awaited worldwide, and hopefully clarifies many of the problems of the original Atlanta Classification. In this article, we discuss the developments that have arisen in the past 2 to 3 years concerning the classification, prognostication, and early management of severe acute pancreatitis. PMID:21243452
Talukdar, Rupjyoti; Swaroop Vege, Santhi
Acute pancreatitis (AP) is a common disease, which usually exists in its mild form. However, in a fifth of cases, the disease is severe, with local pancreatic complications or systemic organ dysfunction or both. Because the development of organ failure is the major cause of death in AP, early identification of patients likely to develop organ failure is important. AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas. Destruction of the pancreatic parenchyma first induces an inflammatory reaction locally, but may lead to overwhelming systemic production of inflammatory mediators and early organ failure. Concomitantly, anti-inflammatory cytokines and specific cytokine inhibitors are produced. This anti-inflammatory reaction may overcompensate and inhibit the immune response, rendering the host at risk of systemic infection. At present, there is no specific treatment for AP. Increased understanding of the pathogenesis of systemic inflammation and development of organ dysfunction may provide us with drugs to ameliorate physiological disturbances.
Kylanpaa, Marja-Leena; Repo, Heikki; Puolakkainen, Pauli Antero
Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early stage of SAP.
Tsuji, Yoshihisa; Takahashi, Naoki; Tsutomu, Chiba
The clinical course of an episode of acute pancreatitis varies from a mild, transitory illness to a severe often necrotizing form with distant organ failure and a mortality rate of 20–40%. Patients with severe pancreatitis, representing about 15–20% of all patients with acute pancreatitis, need to be identified as early as possible after onset of symptoms allowing starting intensive care
Pietro Renzulli; Stephan M. Jakob; Martin Täuber; Daniel Candinas; Beat Gloor
Acute pancreatitis is a common digestive disease of which the severity may vary from mild, edematous to severe, necrotizing disease. An improved outcome in the severe form of the disease is based on early identification of disease severity and subsequent focused management of these high-risk patients. However, the ability of clinicians to predict, upon presentation, which patient will have mild or severe acute pancreatitis is not accurate. Prospective systems using clinical criteria have been used to determine severity in patients with acute pancreatitis, such as the Ranson's prognostic signs, Glasgow score, and the acute physiology and chronic health evaluation II score (APACHE II). Their application in clinical practise has been limited by the time delay of at least 48 h to judge all parameters in the former two and by being cumbersome and time-consuming in the latter. Contrast-enhanced computed tomography is presently the most accurate non-invasive single method to evaluate the severity of acute pancreatitis. It cannot, however, be performed to all patients with acute pancreatitis. Therefore, considerable interest has grown in the development of reliable biochemical markers that reflect the severity of acute pancreatitis. In this article we critically appraise current and new severity markers of acute pancreatitis in their ability to distinguish between mild and severe disease and their clinical utility. PMID:16111093
Lempinen, M; Puolakkainen, P; Kemppainen, E
Background Severe acute pancreatitis results in significant morbidity and mortality. Clinical experience suggests a significantly reduced quality of life for patients, but few studies exist to confirm this experience. We sought to objectively demonstrate patient quality of life after severe acute pancreatitis. Methods Forty-two patients were assessed 24–36 months after an episode of severe acute pancreatitis. Patients completed the English Standard Short Form 36 survey (SF-36) and a questionnaire about pancreatic function to assess both their health-related quality of life and symptoms of pancreatic dysfunction. Results Compared with the general Canadian population, survivors of severe acute pancreatitis had significantly reduced SF-36 scores. There is also a significant correlation between the Ranson score at presentation and the SF-36 Physical Composite Score at time of follow-up (rho = –0.47, p = 0.03). Seventy-six percent of patients had ongoing symptoms suggestive of pancreatic dysfunction. These included abdominal pain, diarrhea, unintentional weight loss, new onset of diabetes mellitus and the need for regular pancreatic enzyme supplementation. Conclusions Survivors of severe acute pancreatitis had a reduced quality of life compared with healthy controls. Higher Ranson scores at presentation may predict which patients are more likely to have poorer outcomes in the first few years of their recovery.
Hochman, David; Louie, Brian; Bailey, Robert
Haemorrhage can be a lethal complication of severe acute pancreatitis. Management includes identification and control of the source of bleeding and supportive therapy such as blood transfusion. Individuals who refuse transfusion on the grounds of religious belief can provide a further major challenge. The management in these individuals can be focused from the outset with a strategy that aims to avert anaemia and transfusion. This article reports a case of severe acute pancreatitis in a woman of the Jehovah's Witness faith. The episode was complicated by infected pancreatic necrosis requiring surgical intervention. Careful strategic planning is critical to the management of severe acute pancreatitis in patients of the Jehovah's Witness faith. In this case, acute pancreatitis complicated by infected necrosis was successfully managed by the use of preoperative erythropoietin, venesection using paediatric blood vials, meticulous intraoperative attention to haemostasis and the use of adjunctive intraoperative techniques such as argon diathermy. PMID:16236094
Jamdar, S; Siriwardena, A K
Complexes of granulocyte elastase and a1-antitrypsin are markers for granulocyte activation. In 75 patients with acute pancreatitis these complexes were immunologically determined daily in plasma during the first week of hospitalization. Patients were classified into three groups: mild pancreatitis (I, =1 complication, N=34), severe pancreatitis (II, =2 complications, N= 29), lethal outcome (III, N=12). Initially, granulocyte elastase (mean±sem) was lower
V. Gross; J. Schölmerich; H.-G. Leser; R. Salm; M. Lausen; K. Rückauer; U. Schöffel; L. Lay; A. Heinisch; E. H. Farthmann; W. Gerok
BACKGROUND & AIMS: Previous studies have documented the effectiveness of interleukin (IL)-10 if given before the onset of experimental acute pancreatitis. This study examined whether IL-10, a cytokine that inhibits macrophage release of inflammatory mediators, would alter the severity of acute pancreatitis if given before or after the induction of disease.METHODS: Eighty-four Sprague-Dawley rats were divided into four groups. Group
AJ Rongione; AM Kusske; K Kwan; SW Ashley; HA Reber; DW McFadden
Background: Microcirculatory disorders play a major part in the pathogenesis of acute pancreatitis. Improvement of microcirculation is hypothesized to open a therapeutic window. The aim of this study was to evaluate the effects of small-volume resuscitation in acute pancreatitis. Methods: In rats, acute pancreatitis of graded severity was induced and pancreatic microcirculation was observed in vivo with an epiluminescent microscope.
Oliver Mann; Jussuf Kaifi; Christian Bloechle; Claus G. Schneider; Emre Yekebas; Dietrich Kluth; Jakob R. Izbicki; Tim Strate
One out of ten cases of acute pancreatitis develops into severe acute pancreatitis which is a life threatening disorder with a high mortality rate. The other nine cases are self limiting and need very little therapy. The specificity of good clinical judgement on admission, concerning the prognosis of the attack, is high (high specificity) but misses a lot of severe cases (low sensitivity). The prediction of severity in acute pancreatitis was first suggested by John HC Ranson in 1974. Much effort has been put into finding a simple scoring system or a good biochemical marker for selecting the severe cases of acute pancreatitis immediately on admission. Today C-reactive protein is the method of choice although this marker is not valid until 48-72 hours after the onset of pain. Inflammatory mediators upstream from CRP like interleukin-6 and other cytokines are likely to react faster and preliminary results for some of these mediators look promising. Another successful approach has been to study markers for the activation of trypsinogen such as TAP and CAPAP. This is based on studies showing that active trypsin is the initial motor of the inflammatory process in acute pancreatitis. In the near future a combined clinical and laboratory approach for early severity prediction will be the most reliable. Clinical judgement predicts 1/3 of the severe cases on admission and early markers for either inflammation or trypsinogen activation should accurately identify 50-60% of the mild cases among the rest, thus missing only 2-4% of the remaining severe cases. One problem is that there is no simple and fast method to analyze any of these parameters. PMID:12221326
Sandberg, Ake Andrén; Borgström, Anders
BACKGROUND: Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis. METHODS: In this multicentre randomised, double-blind, placebo-controlled trial, 298 patients with predicted severe acute pancreatitis (Acute Physiology
Marc GH Besselink; Hjalmar C van Santvoort; Erik Buskens; Marja A Boermeester; Harry van Goor; Harro M Timmerman; Vincent B Nieuwenhuijs; Thomas L Bollen; Bert van Ramshorst; Ben JM Witteman; Camiel Rosman; Rutger J Ploeg; Menno A Brink; Alexander FM Schaapherder; Cornelis HC Dejong; Peter J Wahab; Cees JHM van Laarhoven; Erwin van der Harst; Casper HJ van Eijck; Miguel A Cuesta; Louis MA Akkermans; Hein G Gooszen
Leptospirosis is a disease caused by pathogenic spirochetes of genus Leptospira. It is considered the most common zoonosis in the world. Acute pancreatitis is a rare complication of leptospirosis (25%). We present the case of a 34-year-old male patient with severe leptospirosis complicated with acute renal failure. After 9 days from the onset of the disease, the patient developed acute necrotizing pancreatitis, infected from the very beginning, associated with multiple organ failure, septic shock and severe anemia. The diagnosis was clinically and biologically stated and confirmed by CT-scan. The patient underwent surgery for infected necrotizing acute pancreatitis of the head and neck of the pancreas, with left retroperitoneal expansion down to the left iliac fossa. We performed a necrosectomy with the evacuation of the tisular debris, multiple drainage of the peritoneal cavity, followed by an open abdomen with synthetic mesh. The postoperative evolution was difficult but constantly progressive. Two reinterventions were necessary. The patient left the hospital in good condition after 75 days postoperatively. PMID:24146692
Popa, D; Vasile, D; Ilco, A
Phospholipase A2 (PLA2) is the rate limiting enzyme in the formation of prostaglandins and probably plays a key part in the pathology of various inflammatory diseases. In acute pancreatitis, the catalytic activity of PLA2 in serum correlates with the severity of the disease. The cellular source of the catalytically active PLA2 in serum of patients suffering from acute pancreatitis and other diseases is unknown. Immunoassays for the measurement of pancreatic group I PLA2 and nonpancreatic synovial type group II PLA2 have recently been developed and the present study investigated the presence of group I and group II PLA2s in serum samples from 36 patients with severe acute pancreatitis. The catalytic activity of PLA2 showed a highly significant correlation with the concentration of synovial type PLA2 (r = 0.939, p = 0.001) but not with the concentration of pancreatic PLA2 (r = 0.067, p = 0.698). The results suggest that pancreatic PLA2 circulates mostly as inactive enzyme in patients with acute pancreatitis whereas synovial type PLA2 is responsible for the increased catalytic activity of the enzyme and thus might be associated with the pathophysiology of the disease.
Nevalainen, T J; Gronroos, J M; Kortesuo, P T
Recent diagnostic and therapeutic progress for severe acute pancreatitis (SAP) remarkably decreased the case-mortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examinations or by clinical signs, reducing the defect values of the severity factors. Moreover, the severity criteria considered laboratory/clinical severity scores and contrast-enhanced computed tomography (CE-CT) findings as independent risk factors. Thus, CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis. There was no fatal case in mild AP diagnosed by the CE-CT severity score, whereas case-mortality rate in those with SAP was 14.8%. Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%. It is recommended, therefore, to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria. Because the mortality rate of these patients with SAP is high, such patients should be transferred to advanced medical units.
Otsuki, Makoto; Takeda, Kazunori; Matsuno, Seiki; Kihara, Yasuyuki; Koizumi, Masaru; Hirota, Masahiko; Ito, Tetsuhide; Kataoka, Keisho; Kitagawa, Motoji; Inui, Kazuo; Takeyama, Yoshifumi
Background and Aims. Nutritional support in severe acute pancreatitis (SAP) is controversial concerning the merits of enteral or parenteral nutrition in the management of patients with severe acute pancreatitis. Here, we assess the therapeutic efficacy of gradually combined treatment of parenteral nutrition (PN) with enteral nutrition (EN) for SAP. Methods. The clinical data of 130 cases of SAP were analyzed retrospectively. Of them, 59 cases were treated by general method of nutritional support (Group I) and the other 71 cases were treated by PN gradually combined with EN (Group II). Results. The APACHE II score and the level of IL-6 in Group II were significantly lower than Group I (P < 0.05). Complications, mortality, mean hospital stay, and the cost of hospitalization in Group II were 39.4 percent, 12.7 percent, 32 ± 9 days, and 30869.4 ± 12794.6 Chinese Yuan, respectively, which were significantly lower than those in Group I. The cure rate of Group II was 81.7 percent which is obviously higher than that of 59.3% in Group I (P < 0.05). Conclusions. This study indicates that the combination of PN with EN not only can improve the natural history of pancreatitis but also can reduce the incidence of complication and mortality.
Singh, Akanand; Chen, Ming; Li, Tao; Yang, Xiao-Li; Li, Jin-Zheng; Gong, Jian-Ping
After excluding the typical causes, the underlying etiology of severe acute pancreatitis is often elusive; tumors are on the differential but may be difficult to prove in the absence of a discrete mass on imaging. In this report, we describe the case of an elderly woman with diffuse large B-cell lymphoma masquerading as acute pancreatitis. To our knowledge, only twelve other cases of pancreatic B-cell lymphoma presenting as acute pancreatitis have been described. However, while other cases involved well-circumscribed tumors of the pancreas, this is the first known case of pancreatic lymphoma of a diffusely infiltrating pattern presenting as acute pancreatitis.
To, Christina A.; Quigley, Michael M.; Saven, Alan
Summary\\u000a Background The diagnosis, early assessment, and management of severe acute pancreatitis remain difficult clinical problems. This article\\u000a presents the consensus obtained at a meeting convened to consider the evidence in these areas. The aim of the article is to\\u000a provide outcome statements to guide clinical practice, with an assessment of the supporting evidence for each statement.\\u000a \\u000a \\u000a \\u000a Method Working groups considered the
C. Dervenis; C. D. Johnson; C. Bassi; E. Bradley; C. W. Imrie; M. J. McMahon; I. Modlin
The prognosis of patients with acute pancreatitis and severe uremia is very poor. The mortality is nearly 80 per cent. In uremia requiring dialysis the mortality is 90 per cent in published materials. The slightly uremic patients, when dialysed, had a better prognosis than the severely uremic patients. The mortality in our material, consisting of cases usually dialysed at a
J. Holm; I. Lafvas; B. Lindqvist; L. Steen
AIM: To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and naso-intestinal (NI) (beyond the ligament of Treitz) feeding in severe acute pancreatitis (SAP). METHODS: After bedside intragastric insertion, tube position was assessed, and enteral nutrition (EN) started at day 4, irrespective of tube localization. Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric (NG) or NI tube. RESULTS: Spontaneous tube migration to a NI site occurred in 10/25 (40%) prospectively enrolled SAP patients, while in 15 (60%) nutrition was started with a NG tube. Groups were similar for demographics and pancreatitis aetiology but computed tomography (CT) severity index was higher in NG tube patients than in NI (mean 6.2 vs 4.7, P = 0.04). The CT index seemed a risk factor for failed obtainment of spontaneous distal migration. EN trough NG or NI tube were similar in terms of tolerability, safety, clinical goals, complications and hospital stay. CONCLUSION: Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.
Piciucchi, Matteo; Merola, Elettra; Marignani, Massimo; Signoretti, Marianna; Valente, Roberto; Cocomello, Lucia; Baccini, Flavia; Panzuto, Francesco; Capurso, Gabriele; Fave, Gianfranco Delle
Objective: To compare the safety of enteral nutrition and total parenteral nutrition in nutrition support of patients with severe acute pancreatitis. Methods: Data sources: Medline, Embase, and manual search. Study selection: 295 articles were screened for randomized controlled studies (RCTs) that compared enteral nutrition with total parenteral nutrition in patients with severe acute pancreatitis. Finally, six RCTs were identified and
Yunfei Cao; Yinglong Xu; Tingna Lu; Feng Gao; Zengnan Mo
Endotoxaemia and circulating tumour necrosis factor are important prognostic factors in severe sepsis and are implicated in the pathogenesis of septic shock. Because clinical and pathological features in acute pancreatitis are similar to septic shock this study sought to determine whether endotoxin and tumour necrosis factor were prognostic factors in 38 patients with prognostically severe acute pancreatitis. Endotoxaemia, present in
A R Exley; T Leese; M P Holliday; R A Swann; J Cohen
Background: Implementation of guidelines for the therapy of acute pancreatitis (e.g. those of the International Association of Pancreatology, IAP) into clinical practice has been assumed but not been evaluated. Aim: To verify the knowledge and acceptance of guidelines for the management of severe acute pancreatitis among German surgeons. Methods: A questionnaire consisting of five short questions concerning key points in
T. Foitzik; E. Klar
Context: We describe a patient with alcohol- induced pancreatitis who developed severe life-threatening hypophosphatemia of multifactorial origin during hospitalization. Case Report: Decreased phosphate levels along with urine phosphate wasting were already noticed on the patient's admission due to underlying chronic alcoholism. However, a further deterioration of hypophosphatemia appeared on the second day of hospitalization presumably resulting from an increased transfer
Evagelos Rizos; George Alexandrides; Moses S Elisaf
AIM: To compare effects of different resuscitation fluid on microcirculation, inflammation, intestinal barrier and clinical results in severe acute pancreatitis (SAP). METHODS: One hundred and twenty patients with SAP were enrolled at the Pancreatic Disease Institute between January 2007 and March 2010. The patients were randomly treated with normal saline (NS group), combination of normal saline and hydroxyethyl starch (HES) (SH group), combination of normal saline, hydroxyethyl starch and glutamine (SHG group) in resuscitation. The ratio of normal saline to HES in the SH and SHG groups was 3:1. The glutamine (20% glutamine dipeptide, 100 mL/d) was supplemented into the resuscitation liquid in the SHG group. Complications and outcomes including respiratory and abdominal infection, sepsis, abdominal hemorrhage, intra-abdominal hypertension, abdominal compartment syndrome (ACS), renal failure, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), operation intervention, length of intensive care unit stay, length of hospital stay, and mortality at 60 d were compared. Moreover, blood oxygen saturation (SpO2), gastric intramucosal pH value (pHi), intra-abdominal pressure (IAP), inflammation cytokines, urine lactulose/mannitol (L/M) ratio, and serum endotoxin were investigated to evaluate the inflammatory reaction and gut barrier. RESULTS: Compared to the NS group, patients in the SH and SHG groups accessed the endpoint more quickly (3.9 ± 0.23 d and 4.1 ± 0.21 d vs 5.8 ± 0.25 d, P < 0.05) with less fluid volume (67.26 ± 28.53 mL/kg/d, 61.79 ± 27.61 mL/kg per day vs 85.23 ± 21.27 mL/kg per day, P < 0.05). Compared to the NS group, incidence of renal dysfunction, ARDS, MODS and ACS in the SH and SHG groups was obviously lower. Furthermore, incidence of respiratory and abdominal infection was significantly decreased in the SH and SHG groups, while no significant difference in sepsis was seen. Moreover, less operation time was needed in the SH and SHG group than the NS group, but the difference was not significant. The mortality did not differ significantly among these groups. Blood SpO2 and gastric mucosal pHi in the SH and SHG groups increased more quickly than in the NS group, while IAP was significantly decreased in the SH and SHG group. Moreover, the serum tumor necrosis factor-?, interleukin-8 and C-reactive protein levels in the SH and SHG groups were obviously lower than in the NS group at each time point. Furthermore, urine L/M ratio and serum endotoxin were significantly lower in the SH group and further decreased in the SHG group. CONCLUSION: Results indicated that combination of normal saline, HES and glutamine are more efficient in resuscitation of SAP by relieving inflammation and sustaining the intestinal barrier.
Zhao, Gang; Zhang, Jun-Gang; Wu, He-Shui; Tao, Jin; Qin, Qi; Deng, Shi-Chang; Liu, Yang; Liu, Lin; Wang, Bo; Tian, Kui; Li, Xiang; Zhu, Shuai; Wang, Chun-You
OBJECTIVE: A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA: Secondary pancreatic infection is the major cause of death in patients with acute necrotizing pancreatitis. Controlled clinical trials to study the effect of selective decontamination in such patients are not available. METHODS: Between April 22, 1990 and April 19, 1993, 102 patients with severe acute pancreatitis were admitted to 16 participating hospitals. Patients were entered into the study if severe acute pancreatitis was indicated, on admission, by multiple laboratory criteria (Imrie score > or = 3) and/or computed tomography criteria (Balthazar grade D or E). Patients were randomly assigned to receive standard treatment (control group) or standard treatment plus selective decontamination (norfloxacin, colistin, amphotericin; selective decontamination group). All patients received full supportive treatment, and surveillance cultures were taken in both groups. RESULTS: Fifty patients were assigned to the selective decontamination group and 52 were assigned to the control group. There were 18 deaths in the control group (35%), compared with 11 deaths (22%) in the selective decontamination group (adjusted for Imrie score and Balthazar grade: p = 0.048). This difference was mainly caused by a reduction of late mortality (> 2 weeks) due to significant reduction of gram-negative pancreatic infection (p = 0.003). The average number of laparotomies per patient was reduced in patients treated with selective decontamination (p < 0.05). Failure of selective decontamination to prevent secondary gram-negative pancreatic infection with subsequent death was seen in only three patients (6%) and transient gram-negative pancreatic infection was seen in one (2%). In both groups of patients, all gram-negative aerobic pancreatic infection was preceded by colonization of the digestive tract by the same bacteria. CONCLUSION: Reduction of gram-negative colonization of the digestive tract, preventing subsequent pancreatic infection by means of selective decontamination, significantly reduces morbidity and mortality in patients with severe acute necrotizing pancreatitis.
Luiten, E J; Hop, W C; Lange, J F; Bruining, H A
For many decades two types of acute pancreatitis have been recognized: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary ?-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess.
Geokas, Michael C.
BACKGROUND—The pharmacological inhibition of exocrine pancreatic secretion with the somatostatin analogue octreotide has been advocated as a specific treatment of acute pancreatitis.?AIM—To investigate the efficacy of octreotide in acute pancreatitis in a randomised, placebo controlled trial.?METHODS—302 patients from 32 hospitals, fulfilling the criteria for moderate to severe acute pancreatitis within 96 hours of the onset of symptoms, were randomly assigned to one of three treatment groups: group P (n=103) received placebo, while groups O1 (n=98) and O2 (n=101) received 100 and 200 µg of octreotide, respectively, by subcutaneous injection three times daily for seven days. The primary outcome variable was a score composed of mortality and 15 typical complications of acute pancreatitis.?RESULTS—The three groups were well matched with respect to pretreatment characteristics. An intent to treat analysis of all 302 patients revealed no significant differences among treatment groups with respect to mortality (P: 16%; O1: 15%; O2: 12%), the rate of newly developed complications, the duration of pain, surgical interventions, or the length of the hospital stay. A valid for efficacy analysis (251 patients) also revealed no significant differences.?CONCLUSIONS—This trial shows no benefit of octreotide in the treatment of acute pancreatitis.???Keywords: acute pancreatitis; somatostatin; octreotide; randomised controlled multicentre trial
Uhl, W; Buchler, M; Malfertheiner, P; Beger, H; Adler, G; Gaus, W; the, G
Background—Interleukin 10 (IL-10) decreases the severity of experimental acute pancreatitis. The role of endogenous IL-10 in modulating the course of pancreatitis is currently unknown. ?Aims—To examine the systemic release of IL-10 and its messenger RNA production in the pancreas, liver, and lungs and analyse the effects of IL-10 neutralisation in caerulein induced acute pancreatitis in mice. ?Methods—Acute necrotising pancreatitis was induced by intraperitoneal caerulein. Serum levels of IL-10 and tumour necrosis factor (TNF), and tissue IL-10 and TNF-? gene expression were assessed. After injecting control antibody or after blocking the activity of endogenous IL-10 by a specific monoclonal antibody, the severity of acute pancreatitis was assessed in terms of serum enzyme release, histological changes, and systemic and tissue TNF production. ?Results—In control conditions, serum IL-10 levels increased and correlated with the course of pancreatitis, with a maximal value eight hours after induction. Both IL-10 and TNF-? messengers showed a similar course, and were identified in the pancreas, liver, and lungs. Neutralisation of endogenous IL-10 significantly increased the severity of pancreatitis and associated lung injury as well as serum TNF protein levels (+75%) and pancreatic, pulmonary, and hepatic TNF messenger expression (+33%, +29%, +43%, respectively). ?Conclusions—In this non-lethal model, systemic release of IL-10 correlates with the course of acute pancreatitis. This anti-inflammatory response parallels the release of TNF and both cytokines are produced multisystemically. Endogenous IL-10 controls TNF-? production and plays a protective role in the local and systemic consequences of the disease. ?? Keywords: pancreatitis; interleukin 10; tumour necrosis factor ?; adult respiratory distress syndrome
Van Laethem, J-L; Eskinazi, R; Louis, H; Rickaert, F; Robberecht, P; Deviere, J
OBJECTIVE: A randomized, controlled, multicenter trial was undertaken in\\u000a 102 patients with objective evidence of severe acute pancreatitis to\\u000a evaluate whether selective decontamination reduces mortality. SUMMARY\\u000a BACKGROUND DATA: Secondary pancreatic infection is the major cause of\\u000a death in patients with acute necrotizing pancreatitis. Controlled clinical\\u000a trials to study the effect of selective decontamination in such patients\\u000a are not available. METHODS:
Ernest J. T. Luiten; Wim C. J. Hop; Johan F. Lange; Hajo A. Bruining
BACKGROUNDInfected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance.AIMAnalysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN).PATIENTS64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous
C A Müller; W Uhl; G Printzen; B Gloor; H Bischofberger; O Tcholakov; M W Büchler
Background/Aims The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. Methods Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). Results The accuracy of BISAP (? 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (? 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. Conclusions BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.
Kim, Byung Geun; Ryu, Choong Heon; Nam, Hwa Seong; Woo, Su Mi; Ryu, Seung Hee; Jang, Jin Seok; Lee, Jong Hun; Choi, Seok Ryeol; Park, Byeong Ho
The clinical course of acute pancreatitis varies from mild to severe. Assessment of severity and etiology of acute pancreatitis\\u000a is important to determine the strategy of management for acute pancreatitis. Acute pancreatitis is classified according to\\u000a its morphology into edematous pancreatitis and necrotizing pancreatitis. Edematous pancreatitis accounts for 80–90% of acute\\u000a pancreatitis and remission can be achieved in most of
Hodaka Amano; Tadahiro Takada; Shuji Isaji; Yoshifumi Takeyama; Koichi Hirata; Masahiro Yoshida; Toshihiko Mayumi; Eigoro Yamanouchi; Toshifumi Gabata; Masumi Kadoya; Takayuki Hattori; Masahiko Hirota; Yasutoshi Kimura; Kazunori Takeda; Keita Wada; Miho Sekimoto; Seiki Kiriyama; Masamichi Yokoe; Morihisa Hirota; Shinju Arata
Peroxisome proliferator-activated receptor-? (PPAR-?) ligand regulates adipocyte differentiation and insulin sensitivity, and exerts antihyperlipidemic and anti-inflammatory effects. However, the mechanisms by which PPAR-? ligands affect hyperlipidemia with severe acute pancreatitis (SAP) have not been fully elucidated. The present study investigated the effects of rosiglitazone, a PPAR-? ligand, on hyperlipidemia with SAP in a rat model. The hyperlipidemia was induced with a high-fat diet and SAP was induced by the administration of sodium taurocholate (TCA). The hyperlipidemia was shown to aggravate the severity of the sodium taurocholate-induced SAP. However, rosiglitazone demonstrated significant antihyperlipidemic and anti-inflammatory effects in the rats with high-lipid diet-induced hyperlipidemia and SAP.
NIYAZ, BATUR; ZHAO, KAI-LIANG; LIU, LI-MIN; CHEN, CHEN; DENG, WEN-HONG; ZUO, TENG; SHI, QIAO; WANG, WEI-XING
Background: One of the main problems in the management of acute pancreatitis (AP) is the scarcity of accurate predictors of disease severity. Methods: In a prospective design, we compared APACHE II score, C-reactive protein (CRP) level, and infrared (IR) spectral absorption of serum (wavelength 940 nm) in 167 consecutive patients with AP, 34 with predicted severe and 133 with mild
Maxim S. Petrov; Alexander S. Gordetzov; Mikhail V. Kukosh
Acute pancreatitis represents numerous unique challenges to the practicing digestive disease specialist. Clinical presentations of acute pancreatitis vary from trivial pain to severe acute illness with a significant risk of death. Urgent endoscopic treatment of acute pancreatitis is considered when there is causal evidence of biliary pancreatitis. This article focuses on the diagnosis and endoscopic treatment of acute biliary pancreatitis. PMID:24079788
Kuo, Vincent C; Tarnasky, Paul R
Background—In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis. ?Aims—To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis. ?Methods—Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated. ?Results—SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p<0.005; APACHE II scores 8 (6-10) to 6 (4-8), p<0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC. ?Conclusion—TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial. ?? Keywords: acute pancreatitis; enteral nutrition; bacterial translocation; oxidative stress
Windsor, A; Kanwar, S; Li, A; Barnes, E; Guthrie, J; Spark, J; Welsh, F; Guillou, P; Reynolds, J
OBJECTIVES:About 210,000 new cases of acute pancreatitis (AP) involving reversible inflammation of the pancreas are reported in the United States every year. About one-fourth of all patients with AP go on to develop severe acute pancreatitis (SAP), which, unlike uncomplicated or mild acute pancreatitis (MAP, usually a self-limiting disease), constitutes a life-threatening condition with systemic complications, chiefly multiorgan dysfunction. An
Subhankar Chakraborty; Sukhwinder Kaur; Venkata Muddana; Neil Sharma; Uwe A Wittel; Georgios I Papachristou; David Whitcomb; Randall E Brand; Surinder K Batra
Context Nasogastric tube feeding is safe and well tolerated in most critically ill patients. However, its safety and tolerance in the setting of severe acute pancreatitis is debatable. Objective We aimed to review all available studies on nasogastric feeding in patients with severe acute pancreatitis to determine the safety and tolerance of this approach. A further aim was to perform
Maxim S Petrov; M Isabel; John A Windsor
Background: The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome
Gary Gecelter; Bashar Fahoum; Syed Gardezi; Moshe Schein
Aims: Bacterial translocation from the intestinal tract plays an important role in severe acute pancreatitis (AP). Human ?-defensins are a family of antimicrobial peptides present at the mucosal surface. The aim of this study was to investigate the relevance of single nucleotide polymorphisms (SNPs) in the DEFB1 gene and copy number polymorphisms of the DEFB4 genes in AP. Methods: 124
Z. Tiszlavicz; A. Szabolcs; T. Takács; G. Farkas; R. Kovács-Nagy; E. Szántai; M. Sasvári-Székely; Y. Mándi
Severe acute pancreatitis (SAP) is a common acute abdomen clinical problem characterized by high mortality, multiple complications,\\u000a complicated pathogenesis and difficult treatment. Recent studies found traditional Chinese medicine (TCM) monomers have markedly\\u000a good effect for treating SAP. Many TCM monomers can inhibit pancreatin, resist inflammation, improve microcirculation and\\u000a immunoloregulation, etc. to block the pathological progress of SAP in multiple ways,
Xi-ping Zhang; Da-ren Liu; Yan Shi
Severe acute pancreatitis remains a life-threatening disease with a high mortality rate among a defined proportion of those affected. Apoptosis has been hypothesized to be a beneficial form of cell death in acute pancreatitis. Honokiol, a low-molecular-weight natural product, possesses the ability of anti-inflammation and apoptosis induction. Here, we investigate whether honokiol can ameliorate severe acute pancreatitis and the associated acute lung injury in a mouse model. Mice received six injections of cerulein at 1-h intervals, then given one intraperitoneal injection of bacterial lipopolysaccharide for the induction of severe acute pancreatitis. Moreover, mice were intraperitoneally given vehicle or honokiol 10 min after the first cerulein injection. Honokiol protected against the severity of acute pancreatitis in terms of increased serum amylase and lipase levels, pancreas pathological injury, and associated acute lung injury. Honokiol significantly reduced the increases in serum tumor necrosis factor-?, interleukin 1, and nitric oxide levels 3 h and serum high-mobility group box 1 24 h after acute pancreatitis induction. Honokiol also significantly decreased myeloperoxidase activities in the pancreas and the lungs. Endoplasmic reticulum stress-related molecules eIF2? (phosphorylated) and CHOP protein expressions, apoptosis, and caspase-3 activity were increased in the pancreas of mice with severe acute pancreatitis, which was unexpectedly enhanced by honokiol treatment. These results suggest that honokiol protects against acute pancreatitis and limits the spread of inflammatory damage to the lung in a severe acute pancreatitis mouse model. The acceleration of pancreatic cell apoptosis by honokiol may play a pivotal role. PMID:22258232
Weng, Te I; Wu, Hsiao Yi; Chen, Bo Lin; Liu, Shing Hwa
Amyloid A (SAA) and procalcitonin (PCT) have been reported as useful indicators of inflammation. Our aim was to assess the utility of SAA and PCT in establishing the severity of acute pancreatitis in comparison to C-reactive protein (CRP): ~Thirty-one patients with acute pancreatitis enrolled within 24 hr from the onset of pain and 31 healthy subjects were studied. Nineteen patients
Raffaele Pezzilli; Gian Vico Melzi D'eril; Antonio Maria Morselli-Labate; Gianpaolo Merlini; Bahjat Barakat; Tiziana Bosoni
The present study examines the value of C-reactive protein (CRP) determinations in the assessment of the severity of acute pancreatitis and the correlation of CRP with serum phospholipase A2 activity and the clinical status. Fifty three patients with acute pancreatitis were studied; 17 with haemorrhagic pancreatitis and 36 with a mild form of the disease. S-phospholipase A2 activity increased significantly
P Puolakkainen; V Valtonen; A Paananen; T Schröder
AIM: To evaluate the use of the trypsinogen-2 dipstick (Actim Pancreatitis) test for early diagnosis and prediction of severity in acute pancreatitis (AP). METHODS: Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test (UTDT) and conventional diagnostic tests were performed in all
Erdinc Kamer; Haluk Recai Unalp; Hayrullah Derici; Tugrul Tansug; Mehmet Ali Onal
One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and\\/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety
S Block; W Maier; R Bittner; M Büchler; P Malfertheiner; H G Beger
We report the case of a 42-year-old man admitted for a multi-organ failure with a coma, a hemodynamic instability, a respiratory distress syndrome, an acute renal failure and a thrombocytopenia. The blood samples highlighted a milky serum and allowed to diagnose an acute pancreatitis associated with a major dyslipidemia: hypertriglyceridemia 11,800mg/dL and hypercholesterolemia 1195mg/dL. The CT-scans do not reveal any cerebral abnormalities but highlighted pancreatic lesions without biliary obstruction. A multi-organ failure complicating a severe acute pancreatitis secondary of a major hypertriglyceridemia was mentioned. Despite the absence of clear guidelines, a session of plasma exchange was started in emergency. Symptomatic treatment with protective ventilation, vasopressors, continuous heparin and insulin was continued. The clinical and biological course was good in parallel of the normalization of lipid abnormalities. The patient was discharged at day 17 with a lipid-lowering therapy. We discuss the various treatments available for the management of acute pancreatitis complicating a severe hypertriglyceridemia and their actual relevance in the absence of clear recommendations. PMID:23948029
Degardin, J; Pons, B; Ardisson, F; Gallego, J-P; Thiery, G
AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CVVH\\/LVVH), short-term veno-venous hemofiltration (SVVH),
Kun Jiang; Xin-Zu Chen; Qing Xia; Wen-Fu Tang; Lei Wang; Xia Q; Tang WF
This study aimed to investigate the protective effect of emodin on endoplasmic reticulum (ER) stress in rats with severe acute pancreatitis (SAP) and the underlying molecular mechanism. Sprague-Dawley male rats were randomly divided into sham operation group, SAP model group, and emodin treatment group. SAP was constructed through injecting sodium taurocholate into pancreatic and biliary duct in rats. Half an hour before establishing the animal model, emodin or sodium carboxymethylcellulose was intragastrically administrated to the rats in respective group. Rats were killed at 3, 6, and 12 h postdisease induction. The amylase, tumor necrosis factor-alpha (TNF-?) and interleukin-6 (IL-6) levels in serum, pancreatic histopathology, acinar ER ultrastructure, protein expression of Bip, IRE1?,TRAF2, ASK1, p-JNK, and p-p38 MAPK in pancreas were examined. Sodium taurocholate induced pancreatic injury and ER lumen dilated in exocrine pancreas in rats at 3-, 6-, and 12-h time points. ER stress transducers Bip, IRE1?, and their downstream molecules TRAF2, ASK1 in pancreatitis were upregulated. Furthermore, phosphorylation of JNK and p38MAPK in pancreas was increased, which induced high expression level of inflammatory cytokines such as TNF-? and IL-6. Treatment with emodin obviously ameliorated pancreatic injury and decreased the release of amylase and inflammatory cytokines. Further studies showed that emodin significantly decreased the expression of Bip, IRE1?, TRAF2, and ASK1, inhibited phosphorylation of JNK and p38 MAPK in pancreas in rats at all time points. Emodin could reduce pancreatic injury and restrain inflammatory reaction in SAP rats partly via inhibiting ER stress transducers IRE1? and its downstream molecules. PMID:23605470
Wu, Li; Cai, Baochang; Zheng, Shizhong; Liu, Xiao; Cai, Hao; Li, Huan
The present study examines the value of C-reactive protein (CRP) determinations in the assessment of the severity of acute pancreatitis and the correlation of CRP with serum phospholipase A2 activity and the clinical status. Fifty three patients with acute pancreatitis were studied; 17 with haemorrhagic pancreatitis and 36 with a mild form of the disease. S-phospholipase A2 activity increased significantly (p less than 0.05) in patients with fatal pancreatitis but not in those with mild disease. Phospholipase A2 concentrations were below 10 nmol FFA/ml min in mild, while they rose to 20-40 nmol FFA/ml min in haemorrhagic pancreatitis. In fatal cases very high (up to 50-60 nmol FFA/ml min) serum phospholipase A2 concentrations were recorded. The increase in CRP was greater in the patients with severe pancreatitis. One day after admission mean CRP was 280 mg/l in patients with haemorrhagic and 45 mg/l in those with the mild pancreatitis (p less than 0.001). High CRP values also correlated with the prognostic signs indicative of severe pancreatitis. CRP and S-phospholipase A2 determinations are valuable in the early assessment of the severity of acute pancreatitis, but the CRP assay is much easier to include in hospital routine.
Puolakkainen, P; Valtonen, V; Paananen, A; Schroder, T
We report a 49-year-old man with alcoholic severe acute pancreatitis (SAP) complicated by drug-induced acute tubulointerstitial nephritis (DI-AIN). Oliguria persisted and became anuric again on day 17 despite improvement of pancreatitis. He presented rash, fever and eosinophilia from day 20. Renal biopsy was performed for dialysis-dependent acute kidney injury (AKI), DI-AIN was revealed, and prompt use of corticosteroids fully restored his renal function. This diagnosis might be missed because it is difficult to perform renal biopsy in such a clinical situation. If the patient's general condition allows, renal biopsy should be performed and reversible AKI must be distinguished from many cases of irreversible AKI complicated by SAP. This is the first report of biopsy-proven DI-AIN associated with SAP, suggesting the importance of biopsy for distinguishing DI-AIN in persisting AKI of SAP. PMID:23645698
Yoshioka, Wakako; Mori, Takayasu; Nagahama, Kiyotaka; Tamura, Teiichi
Severe acute pancreatitis is a common critical disease, which may cause severe complications such as sepsis and multiple organ dysfunction syndrome (MODS), and has a high mortality. A 31-year-old woman with 25-weeks pregnancy presented with hyperlipidemic pancreatitis, sepsis and MODS. Based on conventional treatment, 125 h of continuous veno-venous hemofiltration (CVVH) and 3 sessions of hemoperfusion (HP) were carried out. The treatment turned out to be very successful. We suggest that early intervention by blood purification therapy, and CVVH combined with HP could be effective in severe acute pancreatitis. PMID:21424372
Tang, Yi; Zhang, Ling; Fu, Ping; Kang, Yan; Liu, Fang
Acute pancreatitis is a disease still not fully understood. Early pathophysiologic event escape clinical observation because patients typically present only some time after the acute onset of the disease. Also, many ethiologic factors can lead to acute pancreatitis and the clinical course can range from mild, self-limiting to severe and life- threatening. Therefore, experimental models are necessary for any research into early acute pancreatitis. In accordance with the varying clinical picture of acute pancreatitis, many different model exist. In this article, we describe the most commonly used models and show their advantages and disadvantages. PMID:23207612
Kahl, S; Mayer, J M
Study on the action mechanism of inflammatory mediators generated by the severe acute pancreatitis (SAP) in multiple organ injury is a hotspot in the surgical field. In clinical practice, the main complicated organ dysfunctions are shock, respiratory failure, renal failure, encephalopathy, with the rate of hepatic diseases being closely next to them. The hepatic injury caused by SAP cannot only aggravate the state of pancreatitis, but also develop into hepatic failure and cause patient death. Its complicated pathogenic mechanism is an obstacle in clinical treatment. Among many pathogenic factors, the changes of vasoactive substances, participation of inflammatory mediators as well as OFR (oxygen free radical), endotoxin, etc. may play important roles in its progression.
Zhang, Xi-ping; Wang, Lei; Zhang, Jie
The role of the inflammatory response in acute pancreatitis and its relation with the clinical course was examined. This study examined if the serial measurement of polymorphonuclear granulocyte (PMN) elastase\\/A1PI complex, phospholipase A catalytic activity, C reactive protein, and other acute phase proteins, and the protease inhibitor alpha 2-macroglobulin, provides meaningful information for prognosis. Eighty non-consecutive patients with acute pancreatitis,
J A Viedma; M Pérez-Mateo; J Agulló; J E Domínguez; F Carballo
Introduction Patients with severe acute pancreatitis are at risk of candidal infections carrying the potential risk of an increase in mortality. Since early diagnosis is problematic, several clinical risk scores have been developed to identify patients at risk. Such patients may benefit from prophylactic antifungal therapy while those patients who have a low risk of infection may not benefit and may be harmed. The aim of this study was to assess the validity and discrimination of existing risk scores for invasive candidal infections in patients with severe acute pancreatitis. Methods Patients admitted with severe acute pancreatitis to the intensive care unit were analysed. Outcomes and risk factors of admissions with and without candidal infection were compared. Accuracy and discrimination of three existing risk scores for the development of invasive candidal infection (Candida score, Candida Colonisation Index Score and the Invasive Candidiasis Score) were assessed. Results A total of 101 patients were identified from 2003 to 2011 and 18 (17.8%) of these developed candidal infection. Thirty patients died, giving an overall hospital mortality of 29.7%. Hospital mortality was significantly higher in patients with candidal infection (55.6% compared to 24.1%, P = 0.02). Candida colonisation was associated with subsequent candidal infection on multivariate analysis. The Candida Colonisation Index Score was the most accurate test, with specificity of 0.79 (95% confidence interval [CI] 0.68 to 0.88), sensitivity of 0.67 (95% CI 0.41 to 0.87), negative predictive value of 0.91 (95% CI 0.82 to 0.97) and a positive likelihood ratio of 3.2 (95% CI 1.9 to 5.5). The Candida Colonisation Index Score showed the best discrimination with area under the receiver operating characteristic curve of 0.79 (95% CI 0.69 to 0.87). Conclusions In this study the Candida Colonisation Index Score was the most accurate and discriminative test at identifying which patients with severe acute pancreatitis are at risk of developing candidal infection. However its low sensitivity may limit its clinical usefulness.
Prognostic factor scoring systems provide one method of predicting severity of acute pancreatitis. This paper reports the prospective assessment of a system using nine factors available within 48 hours of admission. This assessment does not include patient data used to compile the system. Of 405 episodes of acute pancreatitis occurring in a seven year period, 72% had severity correctly predicted
S L Blamey; C W Imrie; J ONeill; W H Gilmour; D C Carter
Background. Severe acute pancreatitis (SAP) is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU). Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010. Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8)). The most common aetiologies were alcohol (40%) and gallstones (30%). On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI) was 4. Forty patients (80%) tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, P = 0.0001). ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy. Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity.
Pavlidis, Polychronis; Crichton, Siobhan; Lemmich Smith, Joanna; Morrison, David; Atkinson, Simon; Wyncoll, Duncan; Ostermann, Marlies
Intestinal barrier failure and subsequent bacterial translocation have been implicated in the development of organ dysfunction and septic complications associated with severe acute pancreatitis. Splanchnic hypoperfusion and ischemia/reperfusion injury have been postulated as a cause of increased intestinal permeability. The urinary concentration of intestinal fatty acid binding protein (IFABP) has been shown to be a sensitive marker of intestinal ischemia, with increased levels being associated with ischemia/reperfusion. The aim of the current study was to assess the relationship between excretion of IFABP in urine, gut mucosal barrier failure (intestinal hyperpermeability and systemic exposure to endotoxemia), and clinical severity. Patients with a clinical and biochemical diagnosis of acute pancreatitis were studied within 72 hours of onset of pain. Polyethylene glycol probes of 3350 kDa and 400 kDa were administered enterally, and the ratio of the percentage of retrieval of each probe after renal excretion was used as a measure of intestinal macromolecular permeability. Collected urine was also used to determine the IFABP concentration (IFABP-c) and total IFABP (IFABP-t) excreted over the 24-hour period, using an enzyme-linked immunosorbent assay technique. The systemic inflammatory response was estimated from peak 0 to 72-hour plasma C-reactive protein levels, and systemic exposure to endotoxins was measured using serum IgM endotoxin cytoplasmic antibody (EndoCAb) levels. The severity of the attack was assessed on the basis of the Atlanta criteria. Sixty-one patients with acute pancreatitis (severe in 19) and 12 healthy control subjects were studied. Compared to mild attacks, severe attacks were associated with significantly higher urinary IFABP-c (median 1092 pg/ml vs. 84 pg/ml; P < 0.001) and IFABP-t (median 1.14 microg vs. 0.21 microg; P = 0.003). Furthermore, the control group had significantly lower IFABP-c (median 37 pg/ml; P = 0.029) and IFABP-t (median 0.06 microg; P = 0.005) than patients with mild attacks. IFABP correlated positively with the polyethylene glycol 3350 percentage retrieval (r = 0.50; P < 0.001), CRP (r = 0.51; P < 0.001), and inversely with serum IgM EndoCAb levels (r = -0.32; P = 0.02). The results of this study support the hypothesis that splanchnic hypoperfusion contributes to the loss of intestinal mucosal integrity associated with a severe attack of pancreatitis. PMID:12559182
Rahman, Sakhawat H; Ammori, Basil J; Holmfield, John; Larvin, Michael; McMahon, Michael J
The diagnosis of acute pancreatitis is still mainly based on the clinical signs and symptoms of the patients. Systemic organ failure, peritonitis and/or shock indicate severe disease, but to obtain optimal results of treatment the diagnosis of individual patients at high risk should be done before the development of systemic manifestations. A number of laboratory tests are valuable in the follow-up of the patients, but immediate onset of intensive therapy cannot be based on these tests. At present, contrast enhanced CT seems to be the most accurate method for the early detection of hemorrhagic/necrotizing forms of acute pancreatitis. PMID:2424764
Lempinen, M; Schröder, T
AIM: To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation?II?(APACHEII) and bedside index for severity in acute pancreatitis (BISAP) scoring systems. METHODS: APACHEII and BISAP scores were calculated for 55 patients with acute physiology (AP) in the first 24 h of admission to the hospital. Additionally, morning (6:00 AM) serum melatonin concentrations were measured on the first day after admission. According to the diagnosis and treatment guidelines for acute pancreatitis in China, 42 patients suffered mild AP (MAP). The other 13 patients developed severe AP (SAP). A total of 45 healthy volunteers were used in this study as controls. The ability of melatonin and the APACHEII and BISAP scoring systems to predict SAP was evaluated using a receiver operating characteristic (ROC) curve. The optimal melatonin cutoff concentration for SAP patients, based on the ROC curve, was used to classify the patients into either a high concentration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEII and BISAP scoring systems, were compared between the two groups. RESULTS: The MAP patients had increased melatonin levels compared to the SAP (38.34 ng/L vs 26.77 ng/L) (P = 0.021) and control patients (38.34 ng/L vs 30.73 ng/L) (P = 0.003). There was no significant difference inmelatoninconcentrations between the SAP group and the control group. The accuracy of determining SAP based on the melatonin level, the APACHEII score and the BISAP score was 0.758, 0.872, and 0.906, respectively, according to the ROC curve. A melatonin concentration ? 28.74 ng/L was associated with an increased risk of developing SAP. The incidence of high scores (? 3) using the BISAP system was significantly higher in patients with low melatonin concentration (? 28.74 ng/L) compared to patients with high melatonin concentration (> 28.74 ng/L) (42.9% vs 14.7%, P = 0.02). The incidence of high APACHEII scores (? 10) between the two groups was not significantly different. CONCLUSION: The melatonin concentration is closely related to the severity of AP and the BISAP score. Therefore, we can evaluate the severity of disease by measuring the levels of serum melatonin.
Jin, Yin; Lin, Chun-Jing; Dong, Le-Mei; Chen, Meng-Jun; Zhou, Qiong; Wu, Jian-Sheng
Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis. PMID:24160930
Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J
OBJECTIVE: Our purpose was to determine the cause and describe the natural history of acute pancreatitis complicating pregnancy and its effect on maternal and perinatal outcomes.STUDY DESIGN: Over the last decade we admitted 43 pregnant women with acute pancreatitis to our hospital. We reviewed presentation, diagnosis, management, and maternal and perinatal outcomes.RESULTS: The incidence of acute pancreatitis was one in
Kirk D. Ramin; Susan M. Ramin; Sherrie D. Richey; F. Gary Cunningham
Background:Patients with acute pancreatitis (AP) who require mechanical ventilation have high morbidity and mortality rates. Noninvasive positive pressure ventilation (NPPV) delivered through a mask has become increasingly popular for the treatment of acute respiratory failure (ARF) and may limit some mechanical ventilation complications. Objectives: The purpose of this retrospective, observational study was to evaluate our clinical experience with the use
Samir Jaber; Gérald Chanques; Mustapha Sebbane; Farida Salhi; Jean-Marc Delay; Pierre-François Perrigault; Jean-Jacques Eledjam
Background & Aims: Antibiotic prophylaxis in severe pancreatitis has recently yielded promising clinical results, with imipenem significantly reducing the incidence of infected necrosis compared with an untreated control group. On the bases of pefloxacin's spectrum of action and pancreatic penetration, we investigated whether such drugs represent a valid alternative to imipenem. Methods: In a multicenter study, 60 patients with severe
Claudio Bassi; Massimo Falconi; Giorgio Talamini; Generoso Uomo; Guido Papaccio; Christos Dervenis; Roberto Salvia; Elisa Bertazzoni Minelli; Paolo Pederzoli
Acute pancreatitis is a common, costly, potentially lethal, and poorly understood disease, mostly caused by gallstones. In the past decade the incidence of acute pancreatitis in the Netherlands increased by 50% to over 3400 admissions in 2006, most likely due to an increase of gallstone disease. About 20% of patients will develop severe acute pancreatitis, a disease characterized by organ
M. G. H. Besselink
Background Based on equivocal clinical data, intravenous antioxidant therapy has been used for the treatment of severe acute pancreatitis. To date there is no randomised comparison of this therapy in severe acute pancreatitis. Methods We conducted a randomised, double blind, placebo controlled trial of intravenous antioxidant (n?acetylcysteine, selenium, vitamin C) therapy in patients with predicted severe acute pancreatitis. Forty?three patients were enrolled from three hospitals in the Manchester (UK) area over the period June 2001 to November 2004. Randomisation stratified for APACHE?II score and hospital site, and delivered groups that were similar at baseline. Results Relative serum levels of antioxidants rose while markers of oxidative stress fell in the active treatment group during the course of the trial. However, at 7 days, there was no statistically significant difference in the primary end point, organ dysfunction (antioxidant vs placebo: 32% vs 17%, p?=?0.33) or any secondary end point of organ dysfunction or patient outcome. Conclusions This study provides no evidence to justify continued use of n?acetylcysteine, selenium, vitamin C based antioxidant therapy in severe acute pancreatitis. In the context of any future trial design, careful consideration must be given to the risks raised by the greater trend towards adverse outcome in patients in the treatment arm of this study.
Siriwardena, Ajith K; Mason, James M; Balachandra, Srinivasan; Bagul, Anil; Galloway, Simon; Formela, Laura; Hardman, Jonathan G; Jamdar, Saurabh
AIM: To observe the changes in interstitial cells of Cajal (ICC) in rats with experimental severe acute pancreatitis (SAP). METHODS: A total of twenty-four SD rats were randomly divided into two groups (n = 12), namely the sham (S) group and the SAP group; the SAP rat model was established by retrograde injection of 5% sodium taurocholate (1.0 mL/kg) into the pancreatic duct. Twenty-four hours later intestinal motility was assessed by testing small intestinal propulsion rate, and then the rats were sacrificed. The pancreas and jejunum were resected and underwent routine pathologic examination. Immunohistochemical staining was used to detect c-kit-positive cells in the jejunum. Expression of c-kit mRNA was detected by real-time polymerase chain reaction, and the expression of c-kit protein was evaluated by Western blotting. Ultrastructure of ICC was evaluated by transmission electron microscopy. RESULTS: There was bleeding, necrosis and a large amount of inflammatory cell infiltration in pancreatic tissue in the SAP group, while in jejunal tissue we observed a markedly denuded mucosal layer, loss of villous tissue and a slightly dilated muscular layer. The small intestinal propulsion rate was 68.66% ± 2.66% in the S group and 41.55% ± 3.85% in the SAP group. Compared with the S group, the rate of the SAP group decreased sharply. The density of c-kit-positive cells in the SAP group was significantly lower than in the S group; the respective mean densities were 88.47 ± 10.49 in the S group and 56.11 ± 7.09 in the SAP group. The levels of c-kit protein and mRNA were 0.36 ± 0.04 and 1.29 ± 0.91 in the SAP group, respectively, which were significantly lower than those in the S group (0.53 ± 0.06, 0.64 ± 0.33, respectively). In the SAP group, ICC profiles showed the same change tendency, such as vacuolation of mitochondria, irregular vacuoles and loosened desmosome-like junctions. CONCLUSION: Decreased c-kit-positive cells and ultrastructural changes in ICC resulting from blockade of the c-kit signaling pathway are involved in the intestinal dysmotility associated with SAP.
Shi, Liang-Liang; Liu, Ming-Dong; Chen, Min; Zou, Xiao-Ping
Context The assessment of the severity of pancreatitis is important for proper management of this challenging disease. A highly accurate system which could predict the severity and identify the local extent and complications of a serious inflammation, is beneficial for patient outcome. Objective The aim was to establish the value of the computed tomography severity index in predicting the severity
Günay Gürleyik; Seyfi Emir; Gamze Kiliçoglu; Alper Arman; Abdullah Saglam
Background: Obese patients appear to be at risk for complications of acute pancreatitis (AP). APACHE-O score has been suggested to improve APACHE-II accuracy in predicting severe outcome in AP. Aims: To determine if APACHE-O adds any predictive value to APACHE-II score and to test the hypothesis that obese patients are at increased risk of severe AP (SAP) because of a
Georgios I. Papachristou; Dionysios J. Papachristou; Haritha Avula; Adam Slivka; David C. Whitcomb
Acute pancreatitis comprises, in terms of clinical, pathologic, biochemical, and bacteriologic data, four entities. Interstitial\\u000a edematous pancreatitis and necrotizing pancreatitis are the most frequent clinical manifestations; pancreatic pseudocyst and\\u000a pancreatic abscess are late complications after necrotizing pancreatitis, developing after 3 to 5 weeks. Determinants of the\\u000a natural course of acute pancreatitis are pancreatic parenchymal necrosis, extrapancreatic retroperitoneal fatty tissue necrosis,
H. G. Beger; B. Rau; J. Mayer; U. Pralle
Acute pancreatitis is not infrequent after allogenic marrow transplantation. Several causes can predispose to pancreatitis, including Graft-Versus-Host Disease (GVHD), a condition which is probably underestimated. In the literature, few description of pancreatic GVHD can be found. Pancreatic GVHD diagnosis can be difficult if pancreatic involvement occurs without other typical manifestations of GVHD. We report the case of a woman, 54 years old, suffering from prolonged, painful pancreatitis two months after allogenic bone marrow transplantation for acute myeloid leucemia. Pancreatic GVHD diagnosis was performed after five weeks on duodenal biopsies despite the absence of diarrheoa. The patient dramatically improved within few days on corticosteroids. PMID:18378104
De Singly, B; Simon, M; Bennani, J; Wittnebel, S; Zagadanski, A-M; Pacault, V; Gornet, J-M; Allez, M; Lémann, M
A number of laboratory and clinical studies have shown that interleukin-6 is the principal mediator of the acute phase protein response. In this study the relationship between serum concentrations of interleukin-6 and C-reactive protein in acute pancreatitis are examined and the ability of interleukin-6 to discriminate between severe and mild attacks is assessed. We have studied 24 patients (10 severe
D I Heath; A Cruickshank; M Gudgeon; A Jehanli; A Shenkin; C W Imrie
Fresh frozen plasma (FFP) has been proposed as a specific therapy for acute pancreatitis. It may replenish important circulating proteins, particularly the naturally occurring anti-protease system. To investigate this potential therapy, 72 patients with predicted severe disease were selected from 301 admissions with acute pancreatitis using the modified Glasgow prognostic scoring system. They were randomised within 6 h of diagnosis to receive FFP (8 units daily for 3 days) or a similar volume of colloid control as part of their intravenous fluid therapy. Clinical progress was monitored and specific blood proteins were measured on days 1, 3 and 7. FFP therapy significantly increased the day 3 concentrations of some of the acute phase proteins (C1-reactive protein P less than 0.02, D-dimer P less than 0.05 and fibrinogen P less than 0.05) as well as some proteins which showed a fall in circulating concentration during the early stages of the disease (alpha 2 macroglobulin P less than 0.001, antithrombin III P less than 0.01 and fibronectin P less than 0.001). However, there was no significant difference between the two groups in terms of clinical outcome. Mortality was 20% in patients who received FFP and 18% in the colloid control group. Despite the ability of FFP therapy to supplement circulating concentrations of several potentially useful proteins during acute pancreatitis, it does not appear to improve clinical outcome.
Leese, T.; Holliday, M.; Watkins, M.; Thomas, W. M.; Neoptolemos, J. P.; Hall, C.; Attard, A.
Bacterial infection of pancreatic necrotic tissue is a frequent complication of severe acute pancreatitis. Infected pancreatic necrotic tissue is observed in 30–70% of all patients suffering from necrotizing pancreatitis. It is the leading cause of deaths in severe acute pancreatitis, with mortality rates ranging from 15 to 30%. The incidence of infection increases with the extent of the necrotic areas
Rainer Isenmann; Hans G. Beger
Pancreatitis, once thought to be almost exclusively a disease of adults, is increasingly being found as the cause of abdominal pain in adolescents. The authors review the pathophysiology, diagnosis, managment, and complications of acute and chronic pancreatitis, noting that a high index of suspicion is needed to properly diagnose and provide optimal care to these patients. PMID:10358323
Background We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP). The determination is important because patient outcome may be improved through volume-based selective referral. Methods In this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009) from Taiwan’s National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year). The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1), and additional treatment variables (model 2). Results Irrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase). The patients treated in the highest volume quartile (?14 cases per hospital-year) had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year) after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83). However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures. Conclusions These findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume effect.
A 44-year-old man presenting to our hospital emergency room with abdominal pain was hospitalized for hyperlipidemic acute pancreatitis. A pig-tail catheter was placed percutaneously to drain an abscess on day 22. Although the abscess improved gradually and good clinical progress was seen, pancreatic duct disruption was strongly suspected and endoscopic retrograde cholangiopancreatography was performed on day 90. An endoscopic nasopancreatic drainage tube was placed, but even with concurrent use of a somatostatin analogue, treatment was ineffective. Surgical treatment was elected, but was subsequently postponed as the abscess culture was positive for extended-spectrum ?-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus aureus. Drainage tubography showed a small fistula of the colon at the splenic flexure on day 140. Colonoscopy was performed on day 148. After indigo carmine had been injected, a fistula into the splenic flexure of the colon showed blue staining. The over-the-scope clip (OTSC) system was used to seal the fistula and complete closure was shown. A liquid diet was started on day 159 and was smoothly upgraded to a full diet. Following removal of the pancreatic stent on day 180, drainage volume immediately decreased and the percutaneous drain was removed. On day 189, computed tomography showed no exacerbation of the abscess and the patient was discharged on day 194. This case of colonic fistula caused by severe acute pancreatitis was successfully treated using the OTSC system, avoiding the need for an open procedure.
Ito, Ken; Igarashi, Yoshinori; Mimura, Takahiko; Kishimoto, Yui; Kamata, Itaru; Kobayashi, Shunsuke; Yoshimoto, Kensuke; Okano, Naoki
Acute pancreatitis is a common condition (thought to be increasing in incidence worldwide), which has a highly variable clinical course. The radiologist plays a key role in the management of such patients, from diagnosis and staging to identification and treatment of complications, as well as in determining the underlying aetiology. The aim of this article is (i) to familiarise the reader with the pathophysiology of acute pancreatitis, the appearances of the various stages of pancreatitis, the evidence for the use of staging classifications and the associated complications and (ii) to review current thoughts on optimising therapy.
Koo, B C; Chinogureyi, A; Shaw, A S
Objective: To investigate the protective effects and mechanisms of action of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis (SAP). Methods: The rats were divided into sham-operated, model control, dexamethasone treated, and Salvia miltiorrhiza treated groups. At 3, 6, and 12 h after operation, the mortality rate of different groups, pathological changes, Bcl-2-associated X protein (Bax) and nuclear factor-?B (NF-?B) protein expression levels in multiple organs (the pancreas, liver, kidneys, and lungs), toll-like receptor 4 (TLR-4) protein levels (only in the liver), intercellular adhesion molecule 1 (ICAM-1) protein levels (only in the lung), and terminal deoxynucleotidy transferase mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) staining expression levels, as well as the serum contents of amylase, glutamate-pyruvate transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), blood urea nitrogen (BUN), and creatinine (CREA) were observed. Results: The mortality rate of the dexamethasone treated group was significantly lower than that of the model control group (P<0.05). The pathological changes in multiple organs in the two treated groups were relieved to different degrees (P<0.05 and P<0.01, respectively), the expression levels of Bax and NF-?B proteins, and apoptotic indexes of multiple organs were reduced (P<0.05 and P<0.01, respectively). The contents of amylase, GPT, GOT, BUN, and CREA in the two treated groups were significantly lower than those in model control groups (P<0.05 and P<0.01, respectively). The expression level of ICAM-1 protein in the lungs (at 3 and 12 h) in the dexamethasone treated group was significantly lower than that in the Salvia miltiorrhiza treated group (P<0.05). The serum contents of CREA (at 12 h) and BUN (at 6 h) of the Salvia miltiorrhiza treated group were significantly lower than those in the dexamethasone treated group (P<0.05). Conclusions: Both dexamethasone and Salvia miltiorrhiza can reduce the inflammatory reaction, regulate apoptosis, and thus protect multiple organs of rats with SAP.
Ou, Jing-min; Zhang, Xi-ping; Wu, Cheng-jun; Wu, Di-jiong; Yan, Ping
The aim of this study was to compare the sensitivity, specificity, and diagnostic accuracy of serum interleukin-6, interleukin-8,?2-microglobulin, and C-reactive protein in the assessment of the severity of acute pancreatitis using commercial kits for their respective assays. Thirty-eight patients with acute pancreatitis (25 men, 13 women, mean age 59 years, range 16–97) were studied; the diagnosis was based on prolonged
Raffaele Pezzilli; Paola Billi; Rita Miniero; Manuela Fiocchi; Onda Cappelletti; Antonio Maria Morselli-Labate; Bahjat Barakat; Giuseppe Sprovieri; Mario Miglioli
Summary Background: Biliary tract involvement in acute necrotizing pancreatitis is rare. Case Report: We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up. Conclusions: Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.
Brar, Rahat; Singh, Iqbal; Brar, Preetinder; Prasad, Abhishek; Doley, Rudra Prasad; Wig, Jai Dev
Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism. Urinary trypsinogen?2 is convenient, of comparable diagnostic accuracy, and provides greater (99%) negative predictive value. Early prediction of the severity of acute pancreatitis can be made by well validated scoring systems at 48 hours, but the novel serum markers procalcitonin and interleukin?6 allow earlier prediction (12 to 24 hours after admission). Serum alanine transaminase >150?IU/l and jaundice suggest a gallstone aetiology, requiring endoscopic retrograde cholangiopancreatography. For obscure aetiologies, serum calcium and triglycerides should be measured. Genetic polymorphisms may play an important role in “idiopathic” acute recurrent pancreatitis.
Matull, W R; Pereira, S P; O'Donohue, J W
AIM: To determine if serum inter-cellular adhesion molecule 1 (ICAM-1) is an early marker of the diagnosis and prediction of severe acute pancreatitis (SAP) within 24 h of onset of pain, and to compare the sensitivity, specificity and prognostic value of this test with those of acute physiology and chronic health evaluation (APACHE)?II?score and interleukin-6 (IL-6). METHODS: Patients with acute pancreatitis (AP) were divided into two groups according to the Ranson’s criteria: mild acute pancreatitis (MAP) group and SAP group. Serum ICAM-1, APACHE?IIand IL-6 levels were detected in all the patients. The sensitivity, specificity and prognostic value of the ICAM-1, APACHE?IIscore and IL-6 were evaluated. RESULTS: The ICAM-1 level in 36 patients with SAP within 24 h of onset of pain was increased and was significantly higher than that in the 50 patients with MAP and the 15 healthy volunteers (P < 0.01). The ICAM-1 level (25 ng/mL) was chosen as the optimum cutoff to distinguish SAP from MAP, and the sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio were 61.11%, 71.42%, 0.6111, 0.7142, 2.1382 and 0.5445, respectively. The area under the curve demonstrated that the prognostic accuracy of ICAM-1 (0.712) was similar to the APACHE-IIscoring system (0.770) and superior to IL-6 (0.508) in distinguishing SAP from MAP. CONCLUSION: ICAM-1 test is a simple, rapid and reliable method in clinical practice. It is an early marker of diagnosis and prediction of SAP within the first 24 h after onset of pain or on admission. As it has a relatively low NPV and does not allow it to be a stand-alone test for the diagnosis of AP, other conventional diagnostic tests are required.
Zhu, Hai-Hang; Jiang, Lin-Lin
The effectiveness of continuous regional arterial infusion therapy using protease inhibitors and antibiotics for severe acute pancreatitis has been previously reported. Carbapenem antibiotics, which have a broad antibacterial spectrum, and nafamostat mesilate are often used for this therapeutic approach. We investigated the compatibility of various carbapenem antibiotics with nafamostat mesilate. Carbapenem antibiotics were dissolved in 30 mL of saline or 5% glucose and the appearance, pH, and stability of the solutions were determined. The changes in each carbapenem antibiotic solution after mixing with nafamostat mesilate were then investigated. Biapenem and doripenem showed a residual rate of > or = 90% at 8 hours after dissolution in saline or 5% glucose and exhibited an appropriate appearance and residual rate (> or = 90%). After mixing with nafamostat mesilate, biapenem maintained a residual rate of > or = 90% for the longest time period (8 hours) and exhibited a slight coloration, followed by doripenem (6 hours) and meropenem dissolved in saline. The other carbapenem antibiotics that were tested exhibited changes in appearance or their residual rate. Biapenem and doripenem, which exert their effects in a time-dependent manner, can be infused for prolonged periods for the treatment of not only severe acute pancreatitis, but also other severe infections. PMID:23259254
Hamada, Yukihiro; Imaizumi, Hiroshi; Miyazawa, Shirou; Kida, Mitsuhiro; Souma, Kazui; Koizumi, Wasaburou; Sunakawa, Keisuke; Kuroyama, Masakazu
Local parenchymal damage in acute pancreatitis has been well recognized for many years. This damage leads to a considerable leak of extracellular fluid and so to gross hypovolemia. It also produces the pain that is a major clinical feature of the disease. More recently, the autodigestive process has been recognized to generate, within and around the gland, a “broth” of
John E. Trapnell
Septic complications owing to infection of necrotic areas are the main cause of mortality during severe acute pancreatitis. The necrotic tissue, originally sterile, constitutes an ideal pabulum for several bacterial species, translocated from the colon or originating from distant septic foci. The most important predisposing factor to infection is the extent of pancreatic necrosis, which correlates significantly with the risk
C. Bassi; M. Falconi; A. Bonora; R. Salvia; E. Caldiron; L. De Santis; N. Sartori; G. Butturini; G. Talamini; P. Pederzoli
AIM: To compare the beneficial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP). METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE ? score, Balthazar's CT score and CRP were assessed daily during
Tarkan Karakan; Meltem Ergun; Ibrahim Dogan; Mehmet Cindoruk; Selahattin Unal
Acute pancreatitis is a common disease. Despite the frequent use of cannabis worldwide, only six reports have described cases of acute pancreatitis secondary to the use of tetrahydrocannabinoid (THC). Here we describe two cases of THC-induced pancreatitis. The first case occurred in a 38-year-old man with multiple admissions for THC-induced pancreatitis; the second case involved a 22-year-old man with no previous medical history. In both cases, other possible causes of acute pancreatitis were ruled out. Key words: common disease, tetrahydrocannabinoid, etiology. PMID:23892868
Mikolaševi?, Ivana; Mili?, Sandra; Mijandruši?-Sin?i?, Brankica; Licul, Vanja; Stimac, Davor
Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a two-day history of altered conscious state. A diagnosis of severe falciparum malaria was made based on the clinical presentation and a positive blood smear with parasitaemia of 45%. Despite adequate anti-malarial therapy with artesunate, the patient had persistent and worsening abdominal pain. Investigations suggested a diagnosis of acute pancreatitis, a rare association with falciparum malaria. However, in spite of supportive therapy for acute pancreatitis and a 10-day course of intravenous artesunate and oral doxycycline at recommended doses, he continued to be febrile with peripheral blood smear showing persistence of ring forms. Antimalarial therapy was, therefore, changed to quinine on the suspicion of possible artesunate resistance. On the 17th day of stay in hospital, the patient developed generalized tonic-clonic seizures. Computerized tomography of the brain showed bilateral fronto-parietal subdural haematomas that were surgically drained. His fever persisted beyond 30-days despite broad-spectrum antibiotics, quinine therapy and negative malarial smears. A possibility of drug fever was considered and all drugs were ceased. He subsequently became afebrile and was discharged on the 38th hospital admission day. Recognition of complications and appropriate management at each stage facilitated successful outcome. This report has been presented to highlight the occurrence of several rare complications of falciparum malaria in the same patient.
Seshadri, Pratibha; Dev, Anand Vimal; Viggeswarpu, Surekha; Sathyendra, Sowmya; Peter, John Victor
Acute pancreatitis is a clinical syndrome defined by a discrete episode of abdominal pain and elevations in serum enzyme levels.\\u000a Seventy-five percent to 85% of all pancreatic episodes are considered mild and self-limiting and do not require intervention\\u000a with nutrition support. Considering the significant risk of malnutrition in moderate to severe forms of pancreatic injury,\\u000a enteral nutrition has more recently
Leah Gramlich; Kendall Taft
To evaluate the effects of pulse high-volume hemofiltration (PHVHF) on severe acute pancreatitis (SAP) with multiple organ dysfunction syndrome (MODS). Thirty patients were divided into two groups: PHVHF group and continuous venovenous hemofiltration (CVVH) group. They were evaluated in terms of clinical symptoms, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, simplified acute physiology (SAPS) II score and biochemical changes. The levels of IL-6, IL-10 and TNF-? in plasma were assessed by ELISA before and after treatment. The doses of dopamine used in shock patients were also analyzed. In the two groups, symptoms were markedly improved after treatment. Body temperature (BT), breath rate (BR), heart rate (HR), APACHE II score, SOFA score, SAPS II score, serum amylase, white blood cell count and C-reactive protein were decreased after hemofiltration (P < 0.05). The PHVHF group was superior to the CVVH group, especially in APACHE II score, CRP (P < 0.01), HR, temperature, SOFA score and SAPS II score (P < 0.05). The doses of dopamine for shock patients were also decreased in the two groups (P < 0.05), with more reduction in the PHVHF group than the CVVH group (P < 0.05). The levels of IL-6, IL-10 and TNF-? decreased (P < 0.05) in the PHVHF group more significantly than the CVVH group (P < 0.01). PHVHF appears to be superior to CVVH in the treatment of SAP with MODS. PMID:23379498
Chu, La-Ping; Zhou, Jun-Jing; Yu, Ya-Fen; Huang, Yang; Dong, Wen-Xia
Objective To assess the sensitivity and specificity of the serum carboxypeptidase B activation peptide in diagnosing and determining the severity of acute pancreatitis. Patients Twenty consecutive patients with acute pancreatitis were studied on admission to the Emergency Room: 11 patients had mild pancreatitis, and 9 patients, severe pancreatitis. Twenty consecutive patients with non-pancreatic acute abdomen and 20 healthy subjects were
Raffaele Pezzilli; Antonio Maria Morselli-Labate; Anna Rita Barbieri
Polyamines are essential for normal cellular growth and function. Activation of polyamine catabolism in transgenic rats overexpressing spermidine/spermine N1-acetyltransferase, the key enzyme in polyamine catabolism, results in severe acute pancreatitis. Here, we investigated the role of polyamine catabolism in pancreatitis and studied the effect of polyamine analogues on the outcome of the disease. Polyamine depletion was associated with arginine- and cerulein-induced pancreatitis as well as with human acute necrotizing and chronic secondary pancreatitis. Substitution of depleted polyamine pools with methylspermidine partially prevented arginine-induced necrotizing pancreatitis whereas cerulein-induced edematous pancreatitis remained unaffected. Transgenic rats receiving methylated polyamine analogues after the induction of pancreatitis showed less pancreatic damage than the untreated rats. Most importantly, polyamine analogues dramatically rescued the animals from pancreatitis-associated mortality. Induction of spermidine/spermine N1-acetyltransferase in acinar cells isolated from transgenic rats resulted in increased trypsinogen activation. Pretreatment of acini with bismethylspermine prevented trypsinogen activation, indicating that premature proteolytic activation is one of the effects triggered by polyamine depletion. Our data suggest that activation of polyamine catabolism is a general pathway in the pathogenesis of acute pancreatitis and that experimental disease can be ameliorated with stable polyamine analogues.
Hyvonen, Mervi T.; Herzig, Karl-Heinz; Sinervirta, Riitta; Albrecht, Elke; Nordback, Isto; Sand, Juhani; Keinanen, Tuomo A.; Vepsalainen, Jouko; Grigorenko, Nikolay; Khomutov, Alex R.; Kruger, Burkhard; Janne, Juhani; Alhonen, Leena
AIM: To investigate the role and potential mechanisms of bone marrow mesenchymal stem cells (MSCs) in severe acute peritonitis (SAP). METHODS: Pancreatic acinar cells from Sprague Dawley rats were randomly divided into three groups: non-sodium deoxycholate (SDOC) group (non-SODC group), SDOC group, and a MSCs intervention group (i.e., a co-culture system of MSCs and pancreatic acinar cells + SDOC). The cell survival rate, the concentration of malonaldehyde (MDA), the density of superoxide dismutase (SOD), serum amylase (AMS) secretion rate and lactate dehydrogenase (LDH) leakage rate were detected at various time points. In a separate study, Sprague Dawley rats were randomly divided into either an SAP group or an SAP + MSCs group. Serum AMS, MDA and SOD, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-? levels, intestinal mucosa injury scores and proliferating cells of small intestinal mucosa were measured at various time points after injecting either MSCs or saline into rats. In both studies, the protective effect of MSCs was evaluated. RESULTS: In vitro, The cell survival rate of pancreatic acinar cells and the density of SOD were significantly reduced, and the concentration of MDA, AMS secretion rate and LDH leakage rate were significantly increased in the SDOC group compared with the MSCs intervention group and the Non-SDOC group at each time point. In vivo, Serum AMS, IL-6, TNF-? and MAD level in the SAP + MSCs group were lower than the SAP group; however serum IL-10 level was higher than the SAP group. Serum SOD level was higher than the SAP group at each time point, whereas a significant between-group difference in SOD level was only noted after 24 h. Intestinal mucosa injury scores was significantly reduced and the proliferating cells of small intestinal mucosa became obvious after injecting MSCs. CONCLUSION: MSCs can effectively relieve injury to pancreatic acinar cells and small intestinal epithelium, promote the proliferation of enteric epithelium and repair of the mucosa, attenuate systemic inflammation in rats with SAP.
Tu, Xiao-Huang; Song, Jing-Xiang; Xue, Xiao-Jun; Guo, Xian-Wei; Ma, Yun-Xia; Chen, Zhi-Yao; Zou, Zhong-Dong; Wang, Lie
Enterobacterial common antigen is a highly immunogenic component of the Gram negative bacterial cell wall that is common to all enteric bacteria. In the present study, the humoral antibody response against enteric bacteria was investigated by measuring antibodies to enterobacterial common antigen in paired serum samples in 38 patients with acute pancreatitis and in 31 healthy subjects. In mild pancreatitis (11 patients), no changes in anti-enterobacterial common antigen titres were observed as compared with healthy controls. Nine of the 10 patients had a significant increase (greater than or equal to 8 times) in anti-enterobacterial common antigen titres during the disease. Similarly, in patients with fulminant (haemorrhagic) pancreatitis who survived, a significant increase in anti-enterobacterial common antigen titres occurred during the course of the disease (in nine of the 11 patients). Paradoxically, only one of the six patients with fulminant pancreatitis with fatal outcome showed a significant increase in his anti-enterobacterial common antigen titre. The results suggest that Gram negative bacterial components escape into the systemic circulation in acute pancreatitis. This may have pathophysiologic significance in this disease. PMID:6479681
Kivilaakso, E; Valtonen, V V; Malkamäki, M; Palmu, A; Schröder, T; Nikki, P; Mäkelä, P H; Lempinen, M
Enterobacterial common antigen is a highly immunogenic component of the Gram negative bacterial cell wall that is common to all enteric bacteria. In the present study, the humoral antibody response against enteric bacteria was investigated by measuring antibodies to enterobacterial common antigen in paired serum samples in 38 patients with acute pancreatitis and in 31 healthy subjects. In mild pancreatitis (11 patients), no changes in anti-enterobacterial common antigen titres were observed as compared with healthy controls. Nine of the 10 patients had a significant increase (greater than or equal to 8 times) in anti-enterobacterial common antigen titres during the disease. Similarly, in patients with fulminant (haemorrhagic) pancreatitis who survived, a significant increase in anti-enterobacterial common antigen titres occurred during the course of the disease (in nine of the 11 patients). Paradoxically, only one of the six patients with fulminant pancreatitis with fatal outcome showed a significant increase in his anti-enterobacterial common antigen titre. The results suggest that Gram negative bacterial components escape into the systemic circulation in acute pancreatitis. This may have pathophysiologic significance in this disease.
Kivilaakso, E; Valtonen, V V; Malkamaki, M; Palmu, A; Schroder, T; Nikki, P; Makela, P H; Lempinen, M
A Randomized Controlled Trial of Enteral versus Parenteral Feeding in Patients with Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications with Total Enteral Nutrition
Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with
Maxim S. Petrov; Mikhail V. Kukosh; Nikolay V. Emelyanov
An example of acute pancreatitis developing five weeks after initial treatment with 5-aminosalicylic acid (5-ASA) and methylprednisolone for severe Crohn's disease is reported in a 37 year old female patient. She had undergone cholecystectomy for gall stones some years earlier. There was no evidence of acute or chronic pancreatitis. No morphological changes of the upper gastrointestinal tract were found except for some irregularity of the main pancreatic duct and the secondary ducts on endoscopic retrograde pancreatography. Rechallenge with 5-ASA did not induce recurrent pancreatitis or changes in pancreatic enzymes. This case report supports the concept of an association between acute pancreatitis and Crohn's disease. Images Figure 3
Tromm, A; Huppe, D; Micklefield, G H; Schwegler, U; May, B
Background Severe acute pancreatitis (SAP) remains a potentially life-threatening disease. Gastrointestinal motility disturbance such as intestinal ileus is seen in every case. By now, the mechanisms of pancreatitis-induced ileus are largely unknown. The main purpose of the present study was to observe changes of nitric oxide synthase-immunoreactive (NOS-IR) neurons in ileal myenteric ganglia in SAP rats with gastrointestinal dysmotility, trying to explore underlying nervous mechanisms of pancreatitis-induced ileus. Methods Twenty Sprague Dawley rats were randomly divided into sham operated group and SAP group. SAP was induced by retrograde cholangiopancreatic duct injection of 5% sodium taurocholate. Abdominal X-ray and intestinal transit were performed to detect the existence of paralytic ileus and intestinal dysmotility. Pathological damage of pancreas was evaluated. Double-immunolabeling was employed for the whole-mount preparations of ileal myenteric ganglia. The morphology of NOS-IR neurons were observed and the percentage of NOS-IR neurons was calculated based on the total Hu-immunoreactive neurons. Total RNA of ileum was extracted according to Trizol reagent protocol. Neuronal NOS (nNOS) mRNA expression was evaluated by RT-PCR. Results The small intestinal transit index in the SAP group was significantly lower compared with the sham operated group (29.21 ± 3.68% vs 52.48 ± 6.76%, P <0.01). The percentage of NOS-IR neurons in ileal myenteric ganglia in the SAP group was significantly higher than that in the sham operated group (37.5 ± 12.28% vs 26.32 ± 16.15%, P <0.01). nNOS mRNA expression in ileum of SAP group was significantly higher than that in the sham operated group (1.02 ± 0.10 vs 0.70 ± 0.06, P < 0.01). Conclusions The increased quantity of NOS-IR neurons in ileal myenteric ganglia and increased nNOS mRNA expression may suggest nNOS over expression as one of the nervous mechanisms of gastrointestinal dysmotility in SAP rat.
This article reports a case of acute pancreatitis in a patient taking the oral contraceptive pill. A 32 year old mother had been on combined contraceptive pills since 1975. In 1978 she started having upper abdominal and retrosternal pain. She became critically ill with peripheral circulatory collapse, dyspnoea and cyanosis. A superficial thrombophlebitis was noted on the medial aspect of the right thigh. The diagnosis of pancreatitis was considered with history of recurrent abdominal pain. After several tests and supportive therapy (intravenous fluids, antibiotics, steriods), the woman started showing improvements in 48 hours and recovered in 10 days. This case differs from previously described cases in that the cholesterol and triglyceride levels were normal. The hypoglycemia has not been described previously. PMID:7320005
Mehrotra, T N; Mital, H S; Gupta, S K
Animal models of acute and chronic pancreatitis have been created to examine mechanisms of pathogenesis, test therapeutic interventions, and study the influence of inflammation on the development of pancreatic cancer. In vitro models can be used to study early stage, short-term processes that involve acinar cell responses. Rodent models reproducibly develop mild or severe disease. One of the most commonly used pancreatitis models is created by administration of supraphysiologic concentrations of caerulein, an ortholog of cholecystokinin. Induction of chronic pancreatitis with factors thought to have a role in human disease, such as combinations of lipopolysaccharide and chronic ethanol feeding, might be relevant to human disease. Models of autoimmune chronic pancreatitis have also been developed. Most models, particularly of chronic pancreatitis, require further characterization to determine which features of human disease they include. PMID:23622127
Lerch, Markus M; Gorelick, Fred S
Objective Nuclear factor-?B (NF-?B) is a transcription factor which plays a pivotal role in the induction of genes involved in the response to injury and inflammation. Calpain I inhibitor is a potent antioxidant which is an effective inhibitor of NF-?B. This study examined whether the postulate that calpain I inhibitor attenuates experimental acute pancreatitis. Design and setting In a murine
Ioannis Virlos; Emanuela Mazzon; Ivana Serraino; Tiziana Genovese; Rosanna Di Paola; Christoph Thiemerman; Ajith Siriwardena; Salvatore Cuzzocrea
Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.
Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping
Melatonin, a product of the pineal gland, is released from the gut mucosa in response to food ingestion. Specific receptors for melatonin have been detected in many gastrointestinal tissues including the pancreas. Melatonin as well as its precursor, L-tryptophan, attenuates the severity of acute pancreatitis and protects the pancreatic tissue from the damage caused by acute inflammation. The beneficial effect of melatonin on acute pancreatitis, which has been reported in many experimental studies and supported by clinical observations, is related to: (1) enhancement of antioxidant defense of the pancreatic tissue, through direct scavenging of toxic radical oxygen (ROS) and nitrogen (RNS) species, (2) preservation of the activity of antioxidant enzymes; such as superoxide dismutase (SOD), catalase (CAT), or glutathione peroxidase (GPx), (3) the decline of pro-inflammatory cytokine tumor necrosis ? (TNF?) production, accompanied by stimulation of an anti-inflammatory IL-10, (4) improvement of pancreatic blood flow and decrease of neutrophil infiltration, (5) reduction of apoptosis and necrosis in the inflamed pancreatic tissue, (6) increased production of chaperon protein (HSP60), and (7) promotion of regenerative process in the pancreas. Conclusion. Endogenous melatonin produced from L-tryptophan could be one of the native mechanisms protecting the pancreas from acute damage and accelerating regeneration of this gland. The beneficial effects of melatonin shown in experimental studies suggest that melatonin ought to be employed in the clinical trials as a supportive therapy in acute pancreatitis and could be used in people at high risk for acute pancreatitis to prevent the development of pancreatic inflammation.
Jaworek, Jolanta; Szklarczyk, Joanna; Jaworek, Andrzej K.; Nawrot-Porabka, Katarzyna; Leja-Szpak, Anna; Bonior, Joanna; Kot, Michalina
Background Acute pancreatitis is a substantial clinical problem accounting for 240,000 hospital admissions yearly in the United States.\\u000a Obesity is epidemic and is clearly an independent risk factor for increased severity of acute pancreatitis (AP). Adipose tissue\\u000a is an endocrine organ that secretes a variety of metabolically active substances termed adipokines. However, the role of adipokines\\u000a in modulating acute pancreatitis severity
Hayder H. Al-Azzawi; Terence E. Wade; Deborah A. Swartz-Basile; Sue Wang; Henry A. Pitt; Nicholas J. Zyromski
Introduction: The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis. Statements: Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence
R. Pezzilli; A. Zerbi; V. Di Carlo; C. Bassi; G. F. Delle Fave
The aim of this study was to evaluate the RBC deformability and oxidative stress parameters during acute pancreatitis. Healthy volunteers and patients with mild or severe acute pancreatitis were evaluated. There were no changes in erythrocyte's deformability in patients with mild acute pancreatitis. In severe acute pancreatitis loss of deformability of erythrocytes was observed. Serum lipofuscin level increased both in mild and severe form of the disease. The superoxide dismutase (SOD) activity was increased in erythrocytes from mild and severe form without systemic complications and was positively correlated with erythrocyte's deformability in a severe form of acute pancreatitis. Significant positive correlation between serum total antioxidant status and deformability of erythrocytes in healthy humans and negative correlation in mild pancreatitis were found. PMID:12454371
Chmiel, B; Grabowska Bochenek, R; Piskorska, D; Skorupa, A; Cierpka, L; Ku?mierski, S
Acute pancreatitis has a large number of causes. Major causes are alcohol and gallstones. Toxic causes, mainly represented by medication-induced pancreatitis account for less than 2% of the cases. Cannabis is an anecdotally reported cause of acute pancreatitis. Six cases have previously been reported. Herein we report a new case of cannabis-induced recurrent acute pancreatitis. PMID:23402090
Howaizi, Mehran; Chahine, Mouhamad; Haydar, Fadi; Jemaa, Yassine; Lapoile, Emmanuel
The indications for surgery in acute pancreatitis have changed significantly in the past two decades. Medical charts of patients\\u000a with acute pancreatitis treated at our institution were analyzed to assess the effects of changes in surgical treatment on\\u000a patient outcomes. A total of 136 patients with radiologically defined severe pancreatitis were primarily treated or referred\\u000a to our institution between 1980
Werner Hartwig; Sasa-Marcel Maksan; Thomas Foitzik; Jan Schmidt; Christian Herfarth; Ernst Klar
BACKGROUND: Many case reports of acute pancreatitis have been reported but, up to now, pancreatic abnormalities during acute gastroenteritis have not been studied prospectively. OBJECTIVES: To evaluate the incidence and the clinical significance of hyperamylasemia in 507 consecutive adult patients with acute gastroenteritis. METHODS: The clinical significance of hyperamylasemia, related predisposing factors and severity of gastroenteritis were assessed. RESULTS: Hyperamylasemia
Giulia Tositti; Paolo Fabris; Eleonor Barnes; Francesca Furlan; Marzia Franzetti; Clara Stecca; Elena Pignattari; Valeria Pesavento; Fausto de Lalla
The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis (AP) based on experimental animal models and clinical trials. Somatostatin (SS) and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against Post Endoscopic retrograde cholangiopancreatography Pancreatitis (PEP). The protease inhibitor Gabexate mesilate (GM) is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin (NGL) is a nitrogen oxide (NO) donor, which relaxes the sphincter of Oddi. Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs (NSAID) indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 (IL-10) is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results. Antibodies against tumor necrosis factor-alpha (TNF-?) have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics beta-lactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted.
Bang, Ulrich Christian; Semb, Synne; N?jgaard, Camilla; Bendtsen, Flemming
The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis (AP) based on experimental animal models and clinical trials. Somatostatin (SS) and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The protease inhibitor gabexate mesilate (GM) is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin (NGL) is a nitrogen oxide (NO) donor, which relaxes the sphincter of Oddi. Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs (NSAID) indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 (IL-10) is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results. Antibodies against tumor necrosis factor-alpha (TNF-alpha) have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics beta-lactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted. PMID:18494044
Bang, Ulrich-Christian; Semb, Synne; Nojgaard, Camilla; Bendtsen, Flemming
Background Infectious complications are the major cause of death in acute pancreatitis. Small bowel bacterial overgrowth and subsequent bacterial translocation are held responsible for the vast majority of these infections. Goal of this study is to determine whether selected probiotics are capable of preventing infectious complications without the disadvantages of antibiotic prophylaxis; antibiotic resistance and fungal overgrowth. Methods/design PROPATRIA is a double-blind, placebo-controlled randomised multicenter trial in which 200 patients will be randomly allocated to a multispecies probiotic preparation (Ecologic 641) or placebo. The study is performed in all 8 Dutch University Hospitals and 7 non-University hospitals. The study-product is administered twice daily through a nasojejunal tube for 28 days or until discharge. Patients eligible for randomisation are adult patients with a first onset of predicted severe acute pancreatitis: Imrie criteria 3 or more, CRP 150 mg/L or more, APACHE II score 8 or more. Exclusion criteria are post-ERCP pancreatitis, malignancy, infection/sepsis caused by a second disease, intra-operative diagnosis of pancreatitis and use of probiotics during the study. Administration of the study product is started within 72 hours after onset of abdominal pain. The primary endpoint is the total number of infectious complications. Secondary endpoints are mortality, necrosectomy, antibiotic resistance, hospital stay and adverse events. To demonstrate that probiotic prophylaxis reduces the proportion of patients with infectious complications from 50% to 30%, with alpha 0,05 and power 80%, a total sample size of 200 patients was calculated. Conclusion The PROPATRIA study is aimed to show a reduction in infectious complications due to early enteral use of multispecies probiotics in severe acute pancreatitis.
Besselink, Marc GH; Timmerman, Harro M; Buskens, Erik; Nieuwenhuijs, Vincent B; Akkermans, Louis MA; Gooszen, Hein G
Recently, the original Atlanta classification of 1992 was revised and updated by the Working Group using a web-based consultative process involving multiple international pancreatic societies. The new understanding of the disease, its natural history, and objective description and classification of pancreatic and peripancreatic fluid collections make this new 2012 classification a potentially valuable means of international communication and interest. This revised classification identifies 2 phases of acute pancreatitis - early (first 1 or 2 weeks) and late (thereafter). Acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis, the latter involving necrosis of the pancreatic parenchyma and peripancreatic tissues (most common), pancreatic parenchyma alone (least common), or just the peripancreatic tissues (~20%). Severity of the disease is categorized into 3 levels: mild, moderately severe, and severe. Mild acute pancreatitis lacks both organ failure (as classified by the modified Marshal scoring system) and local or systemic complications. Moderately severe acute pancreatitis has transient organ failure (organ failure of <2 days), local complications, and/or exacerbation of coexistent disease. Severe acute pancreatitis is defined by the presence of persistent organ failure (organ failure that persists for ?2 days). Local complications are defined by objective criteria based primarily on contrast-enhanced computed tomography; these local complications are classified as acute peripancreatic fluid collections, pseudocyst (which are very rare in acute pancreatitis), acute (pancreatic/peripancreatic) necrotic collection, and walled-off necrosis. This classification will help the clinician to predict the outcome of patients with acute pancreatitis and will allow comparison of patients and disease treatment/management across countries and practices. PMID:23396317
Sarr, Michael G
We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of “chyle” occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.
Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis
A 17-year-old woman presented with acute abdominal pain and vomiting 3 h after she attempted to commit suicide by ingesting 30×500 mg paracetamol tablets. The woman was found to have a raised amylase level, and a CT scan confirmed the diagnosis of acute pancreatitis. According to the Naranjo adverse drug reaction probability scale, it is likely that the pancreatitis was induced by the paracetamol ingestion. A literature search reported 36 cases of pancreatitis following excessive doses of paracetamol, however this possible drug reaction is not widely recognised and not documented in the British National Formulary (BNF) list of possible adverse reactions from paracetamol. Being aware of the possibility that abdominal pain following paracetamol overdose may be a manifestation of pancreatitis can help the early detection and initiation of treatment for pancreatitis. PMID:22096469
A 36-year-old male patient, after 3 months' treatment with fluvastatin 40 mg/d for hypercholesterolemia, presented with acute pancreatitis. The pancreatitis was mild, and the patient settled on medical treatment. Other causes of the disease were ruled out. Some months later, the patient reintroduced fluvastatin on his own initiative, which caused a recurrence of pancreatitis within a few days. Previous reports are reviewed, showing that statin-induced acute pancreatitis may occur within the first day of therapy or after several months. It is generally mild and runs a benign course, and no mortality has been reported. The frequency of this side effect is unknown, but it is most likely rare. PMID:12394230
Tysk, Curt; Al-Eryani, Adel Y; Shawabkeh, Amin A
Seventy nine pancreatic specimens were obtained from patients treated with pancreatic resection for acute necrotising pancreatitis. The necrotising process had started in the periphery of the gland, so that eight of seventy nine cases contained peripancreatic (mainly fat) necrosis only without any parenchymal necrosis. Peripheral parenchymal necrosis was characterised by a severe inflammatory reaction, with multinucleated leucocytes and microabscess. In the deep parts of the pancreas coagulation necrosis was found. Vascular changes (thrombosis, vessel necrosis) correlated with postoperative haemorrhagic complications, but they did not seem to have any important role in the necrotising process. The vascular changes seemed to be a secondary phenomenon. In clinical practice the most important aspects in reporting the histology of acute necrotising pancreatitis are the extent of parenchymal necrosis, because the surgeon may overestimate its extent, and the existence of vascular changes, because of the correlation with postoperative recovery. Images
Nordback, I; Lauslahti, K
Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swollen and echogenic pancreas, loss of peripancreatic fat plane and pancreatic duct was not dilated. Vildagliptin was stopped and the pancreatits resolved. On Follow up, no secondary cause was not identified. This appears to be the first reported case of acute pancreatitis from India probably attributable to use of vildagliptin, thus raising the possibility that this rare reaction may be a class effect of the DPP-4 inhibitors. PMID:23565473
Saraogi, Ravikant; Mallik, Ritwika; Ghosh, Sujoy
Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swollen and echogenic pancreas, loss of peripancreatic fat plane and pancreatic duct was not dilated. Vildagliptin was stopped and the pancreatits resolved. On Follow up, no secondary cause was not identified. This appears to be the first reported case of acute pancreatitis from India probably attributable to use of vildagliptin, thus raising the possibility that this rare reaction may be a class effect of the DPP-4 inhibitors.
Saraogi, Ravikant; Mallik, Ritwika; Ghosh, Sujoy
Late infection of devitalized pancreatic and peripancreatic tissue has become the major cause of morbidity in severe acute pancreatitis. Previous experience found that peritoneal lavage for periods of 48 to 96 hours may reduce early systemic complications but did not decrease late pancreatic sepsis. A fortunate observation led to the present study of the influence of a longer period of lavage on late sepsis. Twenty-nine patients receiving primary nonoperative treatment for severe acute pancreatitis (three or more positive prognostic signs) were randomly assigned to short peritoneal lavage (SPL) for 2 days (15 patients) or to long peritoneal lavage (LPL) for 7 days (14 patients). Positive prognostic signs averaged 5 in both groups but the frequency of five or more signs was higher in LPL (71%) than in SPL (47%). Eleven patients in each group had early computed tomographic (CT) scans. Peripancreatic fluid collections were shown more commonly in LPL (82%) than in SPL (54%) patients. Longer lavage dramatically reduced the frequency of both pancreatic sepsis (22% LPL versus 40% SPL) and death from sepsis (0% LPL versus 20% SPL). Among patients with fluid collections on early CT scan, LPL led to a more marked reduction in both pancreatic sepsis (33% LPL versus 83% SPL) and death from sepsis (0% LPL versus 33% SPL). The differences were even more striking among 17 patients with five or more positive prognostic signs. In this group the incidence of pancreatic sepsis was 30% LPL versus 57% SPL and of death from sepsis 0% (LPL) versus 43% (SPL) (p = 0.05). In these patients, overall mortality was also reduced (20% LPL versus 43% SPL). When 20 patients treated by LPL were compared with 91 other patients with three or more positive prognostic signs who were treated without lavage or by lavage for periods of 2 to 4 days, the frequency of death from pancreatic sepsis was reduced from 13% to 5%. In those with five or more signs, the incidence of sepsis was reduced from 40% to 27% (p = 0.03) and of death for sepsis from 30% to 7% (p = 0.08). These findings indicate that lavage of the peritoneal cavity for 7 days may significantly reduce both the frequency and mortality rate of pancreatic sepsis in severe acute pancreatitis.
Ranson, J H; Berman, R S
Acute pancreatitis (AP) has a wide range of pathological features, radiological appearances, and treatment options (1). In most cases, it is a mild and self-limiting disease. However, severe disease develops in approximately 20% of patients\\u000a associated with local and systemic complications (2–5). Fluid collections commonly complicate AP and occur in up to half of cases of patients with moderate-to-severe cases
Michael F. Byrne; John Baillie
. Efforts to unravel the events in the evolution of tissue damage in acute pancreatitis have shown a number of inflammatory\\u000a mediators to be involved. The pathways of damage are similar, whatever the etiology of pancreatitis, with three phases of\\u000a progression: local acinar injury, systemic response, and generalized sepsis. The proinflammatory response is countered by\\u000a an anti-inflammatory response, and an
Rohit Makhija; Andrew N. Kingsnorth
Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.
Lee, Woo Sun; Kim, Mi Yeon; Kim, Sang Woo; Paik, Chang Nyol; Kim, Hyung Ok
Ethyl pyruvate significantly inhibits tumour necrosis factor-?, interleukin-1? and high mobility group box 1 releasing and attenuates sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury.
In this study, we examined the effect of ethyl pyruvate (EP) on pulmonary inflammation in rats with severe pancreatitis-associated acute lung injury (ALI). Severe acute pancreatitis (SAP) was induced in rats by the retrograde injection of 5% sodium taurocholate into the pancreatic duct. Rats were randomly divided into the following experimental groups: control group, SAP group and EP-treated group. The tissue specimens were harvested for morphological studies, Streptavidin-peroxidase immunohistochemistry examination. Pancreatic or lung tissue oedema was evaluated by tissue water content. Serum amylase and lung tissue malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. Meanwhile, the nuclear factor-?B (NF-?B) activation, tumour necrosis factor-? (TNF-?), interleukin-1? (IL-1?) levels and HMGB1 protein expression levels in the lung were studied. In the present study, we demonstrated that treatment with EP after SAP was associated with a reduction in the severity of SAP and lung injury. Treatment with EP significantly decreased the expression of TNF-?, IL-1?, HMGB1 and ameliorated MDA concentration, MPO activity in the lung in SAP rats. Compared to SAP group, administration of EP prevented pancreatitis-induced increases in nuclear translocation of NF-?B in the lung. Similarly, treatment with EP significantly decreased the accumulation of neutrophils and markedly reduced the enhanced lung permeability. In conclusion, these results demonstrate that EP might play a therapeutic role in pulmonary inflammation in this SAP model. PMID:23600830
Luan, Z-G; Zhang, J; Yin, X-H; Ma, X-C; Guo, R-X
A 13 year old boy who was admitted for acute viral hepatitis due to hepatitis A virus developed acute pancreatitis which resolved completely with conservative treatment. Extensive evaluation did not reveal any other cause of pancreatitis and it was presumed that hepatitis A may result in acute pancreatitis. PMID:8693583
Amarapurkar, D N; Begani, M M; Mirchandani, K
Acute oedematous pancreatitis and acute haemorrhagic pancreatitis were studied using the low pressure duct perfusion models of alcoholic pancreatitis in cats. After creating either form over 24 hours, each pancreas was histologically graded and assigned an inflammatory score (0-16; absent-severe). Urinary trypsinogen activation peptide concentrations were also used as a measure of severity. Using the model of acute haemorrhagic pancreatitis, it was previously shown that low dose dopamine (5 micrograms/kg.m) reduced the inflammatory score at 24 hours and that this effect was mediated by a reduction in pancreatic microvascular permeability acting via dopaminergic and beta adrenergic receptors. Further studies were conducted and are reported here. In experiment 1 different doses of dopamine in established alcoholic acute haemorrhagic pancreatitis were studied. In group 1 control cats (no dopamine), the inflammatory score was 10.5 (interquartile range (IQR)4). In groups 2, 3, and 4, haemorrhagic pancreatitis was induced. Twelve hours later dopamine was infused for six hours, in the doses of 2 micrograms/kg.min, 5 micrograms/kg.min, and 50 micrograms/kg.min respectively. The inflammatory score in group 2 was 7 (IQR 0.5, p < 0.05 v group 1), in group 3 it was 7 (IQR 2, p < 0.05 v group 1), and in group 4 it was 7 (IQR 4, p < 0.05 v group 1). This was matched by significantly lower levels of urinary tripsinogen activation peptide at 24 hours. In experiment 2 (group 5) we tried to reduce microvascular permeability further by combining dopamine with antihistamines, but there was no improvement in the inflammatory score. As oedematous pancreatitis is the commoner and milder form of acute pancreatitis in clinical practice, in experiment 3 we looked at the effect of dopamine in this model. In group 6 control cats (no treatment), the inflammatory score was 7 (IQR 3, p < 0.05 v group 1). In group 7 cats given dopamine (5 micrograms/kg.min for six hours) from 12 hours after the onset of actue oedematous pancreatitis, the inflammatory score was reduced to 4(IQR 2, p < 0.05 v group 6). This was matched by a significant reduction in the 24 hour urinary tripsin activation peptide concentration.
Karanjia, N D; Widdison, A L; Lutrin, F J; Reber, H A
Background: In a small group of patients with acute pancreatitis, Balthazar and Ranson demonstrated the applicability of computed tomography (CT) criteria to predict mortality. Building upon their work with a larger group of patients with acute pancreatitis, we set out not only to demonstrate that the CT severity index can predict death, but also length of hospital stay and need
Erik J Simchuk; L. William Traverso; Yuji Nukui; Richard A Kozarek
The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock. PMID:12638488
Bagnenko, S F; Tolsto?, A D; Rukhliada, N V; Goltsov, V R; Skorodumov, A V; Bondarev, M R; Sheianov, D S; Zakharova, E V
Children with acute pancreatitis have been treated by fasting and parenteral nutritional support, and to date, the efficacy of drugs for acute pancreatitis in children is unclear. Gabexate mesilate is a synthetic serine protease inhibitor used to prevent or treat acute pancreatitis in adult patients. The purpose of this study was to evaluate the clinical efficacy of gabexate for acute pancreatitis in children. Fifty-three children hospitalized with acute pancreatitis between 2004 and 2012 were divided between a gabexate-treated group (n?=?26) and a control group without gabexate infusion (n?=?27). The severity of acute pancreatitis was graded according to Balthazar scoring of computed tomography images. All subjects had a Balthazar score of <4 without pancreatic necrosis or organ failure. The median age of the patients was 11.8 years (range, 18 months-17 years). The durations of hospitalization, abdominal pain, and parenteral nutrition in the gabexate-treated group were significantly shorter than in control subjects (P?=?0.032, P?=?0.000, and P?=?0.016, respectively). Serum levels of amylase and lipase were significantly lower in gabexate-infused children than in control subjects on day 7 (median amylase, 81 vs. 137 IU/L, P?=?0.001; median lipase, 273 vs. 523 IU/L, P?=?0.031). Conclusion: The present study showed that gabexate infusion has some clinical benefits for acute pancreatitis in children. The clinical application of gabexate for managing acute pancreatitis in children may be appropriate beyond conventional therapy. PMID:23812506
Kim, Soon Chul; Yang, Hye Ran
The timing of biliary surgery remains controversial in patients with acute pancreatitis associated with cholelithiasis. Eighty hospital admissions for acute pancreatitis, occurring in 74 patients with cholelithiasis, have therefore been reviewed. Among 22 patients who underwent abdominal surgery during the first week of treatment, there were five deaths (23%) and four patients (18%) who required more than seven days of intensive care. Fifty-eight episodes of pancreatitis were managed nonoperatively during the first week of treatment, with no deaths, although six (10%) required more than seven days of intensive care. Biliary surgery was undertaken later during the same admission in 37 patients, with no deaths. Twenty-one patients were discharged without biliary operation, but seven (33%) developed further pancreatitis. Previously reported prognostic signs were used to divide pancreatitis into 57 “mild” episodes (1.8% mortality) and 23 “severe” episodes (17% mortality). Early (day 0-7) definitive biliary surgery was undertaken in 11 patients with “mild” pancreatitis, with one death (9%), and in six patients with “severe” pancreatitis, with four deaths (67%). In three recent patients with “severe” pancreatitis, early biliary surgery was limited to cholecystostomy, with no deaths. These findings suggest that although early correction of associated biliary disease may be undertaken safely in many patients with “mild” acute pancreatitis, early definitive surgery is hazardous in “severe” pancreatitis and should, if possible, be deferred until pancreatitis has subsided. In most patients biliary surgery should precede hospital discharge.
Ranson, John H. C.
Surgical intervention in acute pancreatitis may have varied goals. Early laparotomy may be required for diagnostic purposes. There is, however, no convincing evidence that attempts to reduce the morbidity of severe pancreatitis by early operative pancreatic drainage, early formal pancreatic resection, or early biliary procedures have been effective. In fact, they may be harmful. Peritoneal lavage by catheter induced under local anesthesia may ameliorate early cardiovascular and respiratory complications in some patients. Preliminary experience suggests that early operative debridement of devitalized pancreatic tissue with postoperative lavage may be helpful in selected patients. Patients with infections of devitalized pancreatic or peripancreatic tissue require operative debridement and drainage or packing. Other complications such as colonic necrosis or pseudocysts also require operative treatment. Rarely do patients require operation to relieve protracted pancreatitis. Patients with gallstone-associated pancreatitis should usually undergo surgical correction of their cholelithiasis as soon as their pancreatitis has subsided. Images Fig. 2. Fig. 3. Fig. 5.
Ranson, J H
A large retrospective autopsy study of patients was analyzed to evaluate the major etiologic and pathologic factors contributing to fatal acute pancreatitis (AP). From an autopsy population of 50,227 patients, 405 cases were identified where AP was defined as the official primary cause of death. AP was classified according to morphological and histological, but not biochemical, criteria. Patients with AP
Ian G. Renner; William T. Savage; Jose L. Pantoja; V. Jayne Renner
Opinion statement \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a There are no drugs that cure or abate pancreatitis. The treatment of patients with mild and moderate episodes of pancreatitis\\u000a (85%) is supportive and expectant. Central issues include the removal of the initiating process (if possible), relief of pain,\\u000a and maintenance of fluid and electrolyte balance. Endoscopic retrograde cholangiopancreatography may be required for stone\\u000a extraction in patients
Steven L. Werlin
Endoscopic ultrasonography (EUS) can be a useful tool for detecting underlying causes of acute pancreatitis and establishing the severity of fibrosis in chronic pancreatitis. Ancillary techniques include fine needle aspiration and core biopsy, bile collection for crystal analysis, pancreatic function testing, and celiac plexus block. This review focuses on the role of EUS in the diagnosis of acute and chronic pancreatitis. PMID:24079787
An experience with using 340 operations of extracorporeal hemocorrection in complex intensive therapy of 160 patients with acute pancreatitis has been generalized. In 111 of these patients (69%) pancreatic necrosis complicated by the syndrome of multiple organ failure was diagnosed. Based on the mechanisms of medical efficiency the authors have developed differential indications for using different extracorporeal technologies depending on the clinico-laboratory profile of the endogenous intoxication, structure and degree of organic and systemic dysfunctions. The adoption of such technologies allowed lethality to be reduced from 37.5 to 27.6%. PMID:11011409
Romanchishen, A F; Chalenko, V V; Dubchenko, S G; Pastukhova, N K; Zotikov, A G
Intra-abdominal hypertension (IAH) contributes to organ dysfunction and leads to the development of the abdominal compartment syndrome (ACS). IAH and ACS are relatively frequent findings in patiens with severe acute pancreatitis (SAP) and are associated with deterioration in organ functions. The most affected are cardiovascular, respiratory and renal functions. The incidence of IAH in patients with SAP is approximately 60-80%. There is an accumulating evidence in human and animal studies that changes of perfusion, particularly to the microvasculature, are crucial events in the progression of acute pancreatitis (AP). The perfusion of the small and large intestine is impaired due to reduced arterial pressure, increased vascular resistence and diminished portal blood flow. Bacterial translocation has been described in patients with ACS, and this may apply to patients with SAP. Approximately 30-40% of SAP patients develop ACS because of pancreatic (retroperitoneal) inflammation, peripancreatic tissue edema, formation of fluid collections or abdominal distension. Surgical debridement was the preferred treatment to control necrotizing pancreatitis in the past. However, the management of necrotizing pancreatitis has changed over the last decade. The main objective of this article is to describe the association between IAH and AP and to emphasize this situation in clinical praxis as well (Fig. 1, Ref. 38). PMID:23406186
Mifkovic, A; Skultety, J; Sykora, P; Prochotsky, A; Okolicany, R
Acute pancreatitis has a mortality of about 10%: this figure has not changed over the last 20 years. A retrospective audit of fatal acute pancreatitis was performed in a teaching hospital with a catchment population of about 750,000 patients to examine patient characteristics. Using Hospital Activity Analysis code 577.0, all fatal cases of acute pancreatitis were studied in a six-year
A. K. Banerjee; A. Kaul; E. Bache; A. C. Parberry; J. Doran; M. L. Nicholson
Ischemia has been considered to play a role in the development of acute pancreatitis. The aim of this study was to investigate the effect of ischemia, caused by hemorrhagic shock, on cerulein-induced acute pancreatitis in rats. Acute pancreatitis was induced by the intravenous infusion of a supramaximally stimulating dose of cerulein (10 µg\\/kg\\/hr) for 6 hr. Hemorrhagic shock was induced
Takahisa Kyogoku; Tadao Manabe; Takayoshi Tobe
Background: Comparative outcomes after endoscopic drainage of specific types of symptomatic pancreatic fluid collections, defined by using standardized nomenclature, have not been described. This study sought to determine outcome differences after attempted endoscopic drainage of pancreatic fluid collections classified as pancreatic necrosis, acute pseudocyst, and chronic pseudocyst. Methods: Outcomes were retrospectively analyzed for consecutive patients with symptoms caused by pancreatic
Todd H. Baron; Gavin C. Harewood; Desiree E. Morgan; Munford Radford Yates
The value of six prognostic markers was assessed prospectively in 198 attacks of acute pancreatitis with specific attention to their ability to predict pancreatic necrosis. The Imrie Prognostic Score (IPS) was recorded within 48 h of diagnosis. The serum C-reactive protein (CRP) alpha 1 antiprotease (A1AP), alpha 2 macroglobulin (A2M), amylase and white cell count (WCC) were measured on days 1, 3 and 7. When comparing all severe clinical outcomes to mile outcomes, serum CRP concentrations were higher on all three days (P less than 0.02, less than 0.001, less than 0.001), A1AP concentrations were higher on day 3 (P less than 0.05), A2M concentrations were lower on day 7 (P less than 0.01) and WCC was higher on all three days (P less than 0.001, less than 0.001, less than 0.001). Serum amylase concentrations showed no significant differences. None of the measured parameters were helpful in distinguishing patients who subsequently developed pancreatic necrosis from patients who had other severe outcomes. Multivariate analysis revealed that the initial IPS showed greatest independent significance in predicting severe outcome followed by the WCC (days 1 and 7) and CRP (day 3). CRP and WCC may be clinically useful predictors of severe outcome to supplement the initial IPS. These methods are unlikely to distinguish pancreatic necrosis from other severe outcomes, but they may supplement clinical judgment in selecting a high risk group of patients for contrast enhanced computed tomography.
Leese, T.; Shaw, D.; Holliday, M.
Establishing a biliary etiology in acute pancreatitis is clinically important because of the potential need for invasive treatment, such as endoscopic retrograde cholangiopancreatography. The etiology of acute biliary pancreatitis (ABP) is multifactorial and complex. Passage of small gallbladder stones or biliary sludge through the ampulla of Vater seems to be important in the pathogenesis of ABP. Other factors, such as
Donald L. van der Peet; Pranav Bhagirath; Chris J. J. Mulder; Marco J. Bruno; Erwin J. M. van Geenen
Interleukin (IL)-17A is a proinflammatory cytokine, which has recently attracted much interest due to its pathogenic role in various inflammatory conditions such as ischemia/reperfusion injury, chronic inflammation, and autoimmune diseases, but the role of IL-17A in acute pancreatitis remains unclear. This study aimed to investigate the role of IL-17A in experimental acute necrotizing pancreatitis (ANP). We analyzed the expression of IL-17A during the pathogenesis of ANP in vivo induced by 3 % sodium taurocholate (NaTc), by microarray test, quantitative real-time PCR, Western blotting, enzyme-linked immunosorbent assay, and immunohistochemistry. The effects of IL-17A on pancreatic acinar cells and pancreatic stellate cells (PSCs) were further investigated in vitro using recombinant rat IL-17A (rIL-17A). Expression of IL-17A was significantly increased following experimental acute pancreatitis. In addition, rIL-17A induced rat pancreatic acinar cell necrosis and promoted expression of several target genes, including IL-6, IL-1?, CXCL1, CXCL2, and CXCL5, in acinar cells and PSCs. These findings suggest that IL-17A may be involved in pancreatic damage by regulating the expression of inflammatory cytokines and chemokines during experimental acute pancreatitis. PMID:22990529
Ni, Jianbo; Hu, Guoyong; Xiong, Jie; Shen, Jie; Shen, Jiaqing; Yang, Lijuan; Tang, Maochun; Zhao, Yan; Ying, Guojian; Yu, Ge; Hu, Yanling; Xing, Miao; Wan, Rong; Wang, Xingpeng
Abstract There is a convincing body of evidence that oxidative stress is involved in the pathogenesis of acute pancreatitis. The effects of different radical scavengers suggested that reactive oxygen metabolites are generated at very early stage of disease and contribute to amplify the pancreatic damage. Oxidative stress is also involved in the progression of the disease from a local damage to a systemic organ failure. However, therapeutic use of antioxidants failed to clearly show a clinical benefit in different trials. Therefore, although antioxidants alone seem to be not enough for the treatment of severe acute pancreatitis, future combined therapeutic strategies should include antioxidants in its composition. PMID:23895210
Twenty-one patients with acute fulminant alcoholic pancreatitis were randomly allocated to either pancreatic resection group (11 patients) or nonoperative peritoneal lavage group (10 patients). Only patients under 50 years were included in the study to minimize the role of other severe disease. These patients represented the most severe cases of acute pancreatitis at our Department, constituting only 2% of all patients with acute pancreatitis during this period. The diagnosis was based on clinical symptoms and on signs indicating severely impaired systemic organ functions. All patients underwent contrast-enhanced computed tomography (CT), which showed contrast enhancement below 30 Hounsfield units. In the operated cases, the diagnosis of necrotizing pancreatitis was verified histologically. All patients with conservative treatment had dark brown fluid at peritoneal puncture. There was a difference (nonsignificant) in mortality (3/11 and 1/10, respectively), complication rate, or in the need of reoperations between the groups. Nonoperative peritoneal lavage was followed with shorter treatment at the intensive care unit (16.2 versus 25.9 days, respectively). The hospital stay also was significantly shorter in the nonoperative group (44.3 versus 56.1 days). The results indicate that intensive conservative treatment is justified as an initial therapy even in the most severe cases of acute pancreatitis.
Schroder, T; Sainio, V; Kivisaari, L; Puolakkainen, P; Kivilaakso, E; Lempinen, M
Twenty-one patients with acute fulminant alcoholic pancreatitis were randomly allocated to either pancreatic resection group (11 patients) or nonoperative peritoneal lavage group (10 patients). Only patients under 50 years were included in the study to minimize the role of other severe disease. These patients represented the most severe cases of acute pancreatitis at our Department, constituting only 2% of all patients with acute pancreatitis during this period. The diagnosis was based on clinical symptoms and on signs indicating severely impaired systemic organ functions. All patients underwent contrast-enhanced computed tomography (CT), which showed contrast enhancement below 30 Hounsfield units. In the operated cases, the diagnosis of necrotizing pancreatitis was verified histologically. All patients with conservative treatment had dark brown fluid at peritoneal puncture. There was a difference (nonsignificant) in mortality (3/11 and 1/10, respectively), complication rate, or in the need of reoperations between the groups. Nonoperative peritoneal lavage was followed with shorter treatment at the intensive care unit (16.2 versus 25.9 days, respectively). The hospital stay also was significantly shorter in the nonoperative group (44.3 versus 56.1 days). The results indicate that intensive conservative treatment is justified as an initial therapy even in the most severe cases of acute pancreatitis. PMID:1741645
Schröder, T; Sainio, V; Kivisaari, L; Puolakkainen, P; Kivilaakso, E; Lempinen, M
Department of Surgery,University of Liverpool,Royal Liverpool University Hospital,5th Floor UCD Block,Daulby Street, Liverpool L69 3GA, UK Correspondence to: Professor Neoptolemos. A greater understanding of the natural history of acute pancreatitis combined with greatly improved radiological imaging has led to improvement in the hospital mortality from acute pancreatitis, from around 25-30% to 6-10% in the past 30 years. Moreover, it is now recognised that the first phase of severe acute phase pancreatitis is a systemic inflammatory response syndrome (SIRS), during which multiple organ failure and death often supervene. Survival into the second phase may be accompanied by local complications, such as infected pancreatic necrosis, which may be prevented by prophylactic antibiotics and treated by judicious surgery. Intensive care unit costs can be substantial, but might be justified because of the excellent quality of life of survivors. Reduction in multiple organ failure by agents such as lexipafant, an antagonist of platelet activating factor (PAF) (which plays a critical role in generating the SIRS), may contribute to intensive care unit cost containment, as well as reducing the incidence of local complications and deaths from acute pancreatitis. A further improvement in the human and financial costs also requires the centralisation of the management of patients with severe acute pancreatitis, to single hospital units whose concentrated expertise equips them to intervene most effectively in what is still recognised as a highly complex disease. ?(GUT 1998;:886-891)?
NEOPTOLEMOS, J; RARATY, M; FINCH, M; SUTTON, R
The underlying mechanisms involved in the pathogenesis of acute pancreatitis are ill understood. The mortality rate of this disease has not significantly improved over the past few decades. Current treatment options are limited, and predominantly aimed at supportive therapy. A key feature of severe acute pancreatitis is the presence of extensive tissue necrosis with both local and systemic manifestations of inflammatory response syndromes. A better understanding of the underlying pathophysiology of severe acute pancreatitis may lead to more targeted therapeutic options, potentially leading to improved survival. Animal models of acute pancreatitis are therefore an essential investigative tool for these aims to be achieved. This review discusses the suitability of recent non-invasive models of acute pancreatitis such as hormone-induced, alcohol-induced, immune-mediated, diet-induced, gene knockout and L-arginine; and invasive models including closed duodenal loop, antegrade pancreatic duct perfusion, biliopancreatic duct injection, combination of secretory hyperstimulation with minimal intraductal bile acid exposure, vascular-induced, ischaemia/reperfusion and duct ligation.
Hue Su, Kim; Cuthbertson, Christine
A retrospective analysis of 47 patients with pancreatic trauma is presented. A total of 43 patients presented with acute pancreatic injury, 32 after blunt abdominal trauma. Isolated blunt pancreatic injuries were a considerable diagnostic problem with a mean delay from trauma to operation of 9.4 days. At operation peripancreatic drainage in mild injuries and distal resection in cases of ductal injury were the commonest procedures. The overall mortality was 19 per cent, but only three of the eight deaths were attributable to the pancreatic injury. The overall complication rate was 63 per cent and the pancreatic complication rate was 33 per cent. Four patients presented with chronic pancreatitis resulting from previously untreated blunt abdominal trauma 0.5-21 years earlier. Clinically, they did not differ from the manifestations of chronic pancreatitis of other aetiological origins. PMID:3349308
Leppäniemi, A; Haapiainen, R; Kiviluoto, T; Lempinen, M
Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' requirements. (2) Four cases of all patients were complicated with severe acute pancreatitis (SAP); 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.
Qihui, Cheng; Xiping, Zhang; Xianfeng, Ding
A prospective study was undertaken to find the incidence of hyperamylasemia and acute pancreatitis in patients with anticholinesterase poisoning. This was done by serial estimation of total serum amylase and pancreatic imaging by ultrasonography and confirmed, if necessary, by computerized tomography. Anticholinesterase poisoning was caused by either ingestion or accidental exposure to organophosphates or carbamates; it was diagnosed when patients
Surjit Singh; Udaybhan Bhardwaj; Suresh k. Verma; Ashish Bhalla; Kirandip Gill
The Annual American Pancreas Club is an important event for communicating around clinical pancreatic disorders, just as the European, Japanese, Indian, and the International Pancreatic association. Even though the meeting is only 1½ day there were 169 different abstracts and a “How do I do it session.” Among all these abstracts on the pancreas there are some real pearls, but they are almost always well hidden, never highlighted – all abstracts are similarly presented – and will too soon be forgotten. The present filing of the abstracts is one way (not the way) to get the pancreatic abstracts a little more read and a little more remembered – and perhaps a little more cited. It should also be understood that most of the abstracts are short summaries of hundreds of working hours (evenings, nights, weekends, holidays, you name them …) in the laboratory or in the clinic, often combined with blood, sweat and tears. The authors should be shown at least some respect, and their abstracts should not only be thought of as “just another little abstract” – and the best respect they can be shown are that they will be remembered to be another brick in our scientific wall. Now the pancreatic abstracts of American Pancreas Club 2011 are gathered and filed with the aim to give them a larger audience than they have had in their original abstract book. However, it is obvious that most of clinical fellows do not have time to read all the abstracts. For them I have made a “clinical highlight section” of 10 percent of all the pancreatic abstracts. If someone else should have done some collection of abstract, there should probably have been other selections, but as this is not the case, the editor's choices are the highlighted ones. The article as series I of clinical highlight section is present, and more series will be present in the following issues. If readers will remember some of the abstracts better after reading this “abstract of abstracts”, it was worth the efforts – and without efforts there will be little progress.
Patients with acute pancreatitis (AP) usually present with sudden onset of abdominal pain, nausea, and vomiting. Approximately\\u000a 80% of patients have interstitial pancreatitis with mild-to-moderate symptoms, and 20% have life-threatening necrotizing disease.\\u000a Careful clinical assessment and the judicial use of biochemical tests and radiological imaging enables the practitioner to\\u000a differentiate AP from other causes of acute abdomen and to assess
Frank R. Burton
Acute pancreatitis is a multifactorial disease associated with the premature activation of digestive enzymes. The genes expressed in pancreatic acinar cells determine the severity of the disease. The present study determined the differentially expressed genes in pancreatic acinar cells treated with cerulein as an in vitro model of acute pancreatitis. Pancreatic acinar AR42J cells were stimulated with 10-8 M cerulein for 4 h, and genes with altered expression were identified using a cDNA microarray for 4,000 rat genes and validated by real-time PCR. These genes showed a 2.5-fold or higher increase with cerulein: lithostatin, guanylate cyclase, myosin light chain kinase 2, cathepsin C, progestin-induced protein, and pancreatic trypsin 2. Stathin 1 and ribosomal protein S13 showed a 2.5-fold or higher decreases in expression. Real-time PCR analysis showed time-dependent alterations of these genes. Using commercially available antibodies specific for guanylate cyclase, myosin light chain kinase 2, and cathepsin C, a time-dependent increase in these proteins were observed by Western blotting. Thus, disturbances in proliferation, differentiation, cytoskeleton arrangement, enzyme activity, and secretion may be underlying mechanisms of acute pancreatitis.
Yu, Ji Hoon; Lim, Joo Weon
BACKGROUND—Proinflammatory and anti-inflammatory cytokines are involved in the pathogenesis of acute pancreatitis.?AIMS—To measure the serial serum levels of interleukin 10 and interleukin 11 in patients with acute pancreatitis and analyse the relation of these anti-inflammatory cytokines to disease severity.?METHODS—In 50 patients with acute pancreatitis, the serum concentrations of interleukin 10 and interleukin 11 were determined on days one, two, three, four, and seven after admission. Serum C reactive protein levels were evaluated on days one and two. Severity of pancreatitis was determined according to the Atlanta criteria.?RESULTS—Serum concentrations of interleukin 10 on days one to seven were significantly higher in patients with severe pancreatitis than in those with mild pancreatitis. Patients with severe attacks had significantly elevated serum interleukin 11 concentrations on days two to four compared with those with mild attacks, but not on days one and seven. With cut off levels of 30 pg/ml for interleukin 10, 10.5 pg/ml for interleukin 11, and 115 mg/l for C reactive protein, the accuracy rates for detecting severe pancreatitis were 84%, 64%, and 78% respectively on day one and 82%, 74%, and 84% respectively on day two.?CONCLUSIONS—Serum interleukin 10 and interleukin 11 concentrations reflect the severity of acute pancreatitis. Interleukin 10 is a useful variable for early prediction of the prognosis of acute pancreatitis.???Keywords: acute pancreatitis; C reactive protein; interleukin 10; interleukin 11
Chen, C; Wang, S; Lu, R; Chang, F; Lee, S
BACKGROUND—The time course and relationship between circulating and local cytokine concentrations, pancreatic inflammation, and organ dysfunction in acute pancreatitis are largely unknown.?PATIENTS AND METHODS—In a prospective clinical study, we measured the proinflammatory cytokines interleukin (IL)-1?, IL-6 and IL-8, the anti-inflammatory cytokine IL-10, interleukin 1? receptor antagonist (IL-1RA), and the soluble IL-2 receptor (sIL-2R), and correlated our findings with organ and systemic complications in acute pancreatitis. In 51 patients with acute pancreatitis admitted within 72 hours after the onset of symptoms, these parameters were measured daily for seven days. In addition, 33 aspirates from ascites and the lesser sac were measured.?RESULTS—Sixteen patients had mild acute pancreatitis (AP) and 35 severe AP (Atlanta classification); 18 patients developed systemic complications requiring treatment. All mediators were increased in AP. sIL-2R, IL-10, and IL-6 were significantly elevated in patients with distant organ failure. An imbalance in IL-1?/IL-1RA was found in severe AP and pulmonary failure. Peak serum sIL-2R predicted lethal outcome and IL-1RA was an early marker of severity. IL-6 was the best prognostic parameter for pulmonary failure.?CONCLUSION—Our results suggest that local mediator release, with a probable IL-1?-IL-1RA imbalance in severe cases, is followed by the systemic appearance of pro- and anti-inflammatory mediators. The pattern of local and systemic mediators in complicated AP suggests a role for systemic lymphocyte activation (triggered by local release of mediators) in distant organ complications in severe AP.???Keywords: pancreatitis; cytokines; lymphocyte activation; pancreatic necrosis; organ complications
Mayer, J; Rau, B; Gansauge, F; Beger, H
Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a
Pratibha Seshadri; Anand Vimal Dev; Surekha Viggeswarpu; Sowmya Sathyendra; John Victor Peter
Accurate diagnosis and description of the various findings in acute pancreatitis is important for treatment. The original Atlanta classification for acute pancreatitis sought to create a uniform system for classifying the severity of acute pancreatitis as well as common language to describe the various events that can occur in acute pancreatitis. The goal was to allow accurate communication between physicians using standardized language so correct treatment options could be used. Since that time, advances in the understanding of acute pancreatitis as well as improvements in both interventions and imaging have led to criticisms of the system and its abandonment by physicians. A 2007 revision of the Atlanta classifications sought to address many of these issues. This article will explain the changes to the Atlanta classification system and provide pictorial examples of the findings in acute pancreatitis as described by the Atlanta classification system. PMID:22160496
Sheu, Y; Furlan, A; Almusa, O; Papachristou, G; Bae, K T
Background: The systemic manifestations of acute pancreatitis are responsible for the majority of pancreatitis-associated morbidity and mortality and are now believed to be due to the actions of specific inflammatory cytokines. This report summarizes what is known about the role of cytokines in the pathogenesis of acute pancreatitis.Methods: Comprehensive literature review of experimental pancreatitis as well as all reports of
Elderly patients show increased incidence of multiple organ dysfunction in acute pancreatitis possibly due to bacterial translocation. This is associated with increased susceptibility to infections in older people. Several reports have related this increased susceptibility to a proinflammatory status called inflammaging, which decreases the capacity of the immunological system to respond to antigens. Cellular senescence also contributes to this low-grade chronic inflammation in older subjects. We discuss here the effect of ageing on systemic inflammation, focusing on that induced by acute pancreatitis and some of the mechanisms involved. It is important to understand the immunological changes in the elderly to adjust treatment strategies in order to reduce the morbidity and mortality associated with acute pancreatitis and other conditions that lead to systemic inflammation.
Machado, Marcel Cerqueira Cesar; Coelho, Ana Maria Mendonca; Carneiro D'Albuquerque, Luiz Augusto; Jancar, Sonia
Somatostatin and somatostatin analogues are considered very useful for the treatment of hormone producing tumors and acute variceal bleeding. They have also been proposed for the treatment of acute pancreatitis and for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis although clinical trials have failed to show any efficacy. The authors report the case of a 45-year-old man, recently diagnosed of acromegaly, which developed an acute pancreatitis shortly after his first injection of lanreotide autogel. The patient developed a severe dilatation of his hypocontractile gallbladder with distension of the intra and extrahepatic biliary ducts, the choledochus and the main pancreatic duct, without lithiasis or other abnormalities at the papilla, which resolved spontaneously in a month. We consider that lanreotide most likely induced a functional spasm of the Sphincter of Oddi, with impairment of the biliary-pancreatic outflow, leading to an acute pancreatitis, and review the literature concerning this drug related pancreatitis. PMID:22749514
Sequeira Lopes da Silva, José Tiago; González Casas, Olga; Bejarano Moguel, Verónica; Lobo Pascua, Maria; López-Santamaría Redondo, Antonio; Cordero Torres, Remigio
Acute fulminant pancreatitis is associated with significant morbidity and mortality. To examine the outcome of conservative and surgical treatment of this disorder, 36 patients who survived an initial episode were restudied after a mean of six years. Fifty three per cent had developed diabetes mellitus, half of whom required insulin therapy. Pancreatic resection was associated with a 100% frequency of
J Eriksson; M Doepel; E Widén; L Halme; A Ekstrand; L Groop; K Höckerstedt
Endoscopy plays an important role in both the diagnosis and the initial management of recurrent acute pancreatitis, as well as the investigation of refractory disease, but it has known limitations and risks. Sound selective use of these therapies, complemented with other lines of investigation such as genetic testing, can dramatically improve frequency of attacks and associated quality of life. Whether endoscopic therapy can reduce progression to chronic pancreatitis, or reduce the risk of malignancy, is debatable, and remains to be proven. PMID:24079791
Roberts, Jason R; Romagnuolo, Joseph
Summary \\u000a Conclusion: Elevation of serum pancreatic stone protein- (PSP) S1 suggests activation of trypsinogen in the pancreas. This information would prompt the start of intensive treatment and may\\u000a improve prognosis of acute pancreatitis (AP).\\u000a \\u000a \\u000a Background: PSP exists in two molecular forms, PSP-S2–5 and PSP-S1. PSP-S1 is produced by enzyme cleavage of PSP-S2–5 by trypsin. Total serum PSP rose in AP,
Yasuyuki Nakae; Satoru Naruse; Motoji Kitagawa; Hiroshi Ishiguro; Masanori Kato; Shinobu Hayakawa; Takaharu Kondo; Tetsuo Hayakawa
Among the causative factors for acute pancreatitis, adverse drug reactions are considered to be rare. The diagnosis of drug-induced pancreatitis (DIP) is challenging to establish, and is often underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected agent. We present the case of an 80-year-old woman who presented with complaints of abdominal pain. Her medications included methimazole (MMI) which she had been on for the past 3 months. Computed tomography of her abdomen showed peripancreatic fat stranding with trace amount of surrounding fluid, along with amylase and lipase levels suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to MMI use was made. Withdrawal of the drug from her medication regimen was accompanied by relief of symptoms and resolution of clinical evidence of pancreatitis. The aim of this paper is to report only the fourth case of MMI-induced pancreatitis in the published literature, and to illustrate the significance of an appropriate and timely diagnosis of DIP.
Abraham, Albin; Raghavan, Pooja; Patel, Rajshree; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul
Background\\/Aims: Little is known about risk factors for acute pancreatitis other than gallstones and alcohol consumption. The aim of this study was to investigate if smoking or body mass index (BMI) are associated with acute pancreatitis and to determine relative risks (RR) for acute pancreatitis related to smoking, BMI, and alcohol consumption. Methods: From 1974 to 1992, selected birth-year cohorts
Björn Lindkvist; Stefan Appelros; Jonas Manjer; Göran Berglund; Anders Borgström
HWTI is a 55-residue protein isolated from the venom of the spider Ornithoctonus huwena. It is a potent trypsin inhibitor and a moderate voltage-gated potassium channel blocker. Here, we designed and expressed two HWTI mutants, HWTI-mut1 and HWTI-mut2, in which the potassium channel inhibitory activity was reduced while the trypsin inhibitory activity of the wild type form (approximately 5 EPU/mg) was retained. Animal studies showed that these mutants were less toxic than HWTI. The effects of HWTI and HWTI-mut1 were examined in a mouse model of acute pancreatitis induced by intraperitoneal injection of a large dose of L-arginine (4 mg/kg, twice). Serum amylase and serum lipase activities were assessed, and pathological sections of the pancreas were examined. Treatment with HWTI and HWTI-mut1 significantly reduced serum amylase and lipase levels in a dose dependent manner. Compared with the control group, at 4 mg/kg, HWTI significantly reduced serum amylase level by 47% and serum lipase level by 73%, while HWTI-mut1 significantly reduced serum amylase level by 59% and serum lipase level by 72%. Moreover, HWTI and HWTI-mut1 effectively protected the pancreas from acinar cell damage and inflammatory cell infiltration. The trypsin inhibitory potency and lower neurotoxicity of HWTI-mut1 suggest that it could potentially be developed as a drug for the treatment of acute pancreatitis with few side effects. PMID:23613780
Ning, Weiwen; Wang, Yongjun; Zhang, Fan; Wang, Hengyun; Wang, Fan; Wang, Xiaojuan; Tang, Huaxin; Liang, Songping; Shi, Xiaoliu; Liu, Zhonghua
Previous studies have shown that pancreatic ischemic preconditioning or heparin, applied before induction of acute pancreatitis inhibit the development of this disease and accelerate pancreatic recovery. The aim of the study was to determine the influence of treatment with heparin on protective effect of ischemic preconditioning (IP) in ischemia/reperfusion-induced acute pancreatitis. Heparin was administered twice, before and during induction of acute pancreatitis. IP was performed by short-term clamping of celiac artery, 30 min before induction of acute pancreatitis. Acute pancreatitis was induced in rats by clamping of inferior splenic artery for 30 min followed by reperfusion. Rats were sacrificed after 6-h and 24-h reperfusion. Results: IP applied alone caused a mild pancreatic damage associated with a limited increase in plasma amylase activity, concentration of pro-inflammatory interleukin-1? and plasma level of D-dimer. Pretreatment with heparin or IP applied alone reduced the severity of acute pancreatitis. Both these procedures caused a similar reduction in plasma lipase, amylase and interleukin-1?, as well as in histological signs of pancreatic damage. These changes were associated with partial reversion of the pancreatitis-evoked fall of pancreatic blood flow and DNA synthesis. Combination of heparin plus IP reduced the protective effect of heparin or IP applied alone. It was manifested by an increase in pancreatic damage and plasma level of lipase, amylase and interleukin-1?, as well as by reduction in pancreatic DNA synthesis and plasma concentration of D-dimer and interleukin-10. Conclusions: heparin abolishes the protective effect of ischemic preconditioning in ischemia reperfusion-induced pancreatitis. This observation suggests that initial clot formation is necessary to induce pancreatic protection by IP. PMID:23070084
Warzecha, Z; Dembinski, A; Ceranowicz, P; Dembinski, M; Sendur, R; Cieszkowski, J; Sendur, P; Tomaszewska, R
The present study reports 18 patients operated on for chronic pancreatitis complicated by bleeding in the upper gastrointestinal tract, the peritoneal cavity or the retroperitoneal space. Damage to the splenic artery by a pancreatic pseudocyst was the most common reason for the bleeding (10 patients, 56%) and the most common site was the duodenum (10 patients, 56%). Eleven patients were treated by transcystic multiple suture ligations combined with external drainage of the pseudocyst, and seven by pancreatic resection or total pancreatectomy. Hospital mortality was 33% (6 patients); two patients had undergone transcystic suture ligation, and four pancreatic resection. Five patients needed a reoperation because of further bleeding, four of them having been treated initially by transcystic suture ligation. Our results suggest that haemostasis by suture ligation is a method to be recommended if the patient's condition has been exacerbated by severe haemorrhage. PMID:6334475
Kiviluoto, T; Schröder, T; Kivilaakso, E; Lempinen, M
There is a recognised but poorly understood association between hypothermia and acute pancreatitis. A histological study of the pancreas was made in eight patients with accidental hypothermia who had evidence of pancreatitis at necropsy. From an analysis of the patterns of parenchymal necrosis in the pancreas it was thought that there were at least three possible mechanisms for the relation between hypothermia and pancreatitis. Firstly, that ischaemic pancreatitis may result from the "microcirculatory shock" of hypothermia. Secondly, that both hypothermia and pancreatitis may be secondary to alcohol abuse: and finally, that severe pancreatitis may be the primary disease and that hypothermia results from the patients' social circumstances. Images
Foulis, A K
A case of acute pancreatitis induced by azathioprine presented in a 22-year-old patient with Crohn's disease is reported. The patient erroneously took the drug once again repeating the appearance of acute pancreatitis, earlier and with greater severity. PMID:10349790
Velicia, M R; González, J M; Fernández, P; Remacha, B; Martín, M A; Sánchez, G; Goyeneche, M L; Caro-Paton, A
Background Conservative treatment of patients with severe acute pancreatitis (SAP) may be associated with development of intra-abdominal hypertension (IAH), deterioration of visceral perfusion and increased risk of multiple organ dysfunction. Fluid balance is essential for maintenance of adequate organ perfusion and control of the third space. Timely application of continuous veno-venous haemofiltration (CVVH) may help in balancing fluid replacement and removal of cytokines from the blood and tissue compartments. The aim of the present study was to determine whether CVVH can be recommended as a constituent of conservative treatment in patients with SAP who suffer IAH. Methods A retrospective analysis of 10 years' experience with low-flow CVVH application in patients with SAP who develop IAH was. In all patients, measurement of the intra-abdominal pressure (IAP) was done indirectly through the urinary bladder. Sequential organ failure assessment (SOFA) score was calculated for severity assessment, and necrotizing forms were verified by contrast-enhanced computed tomography. Dynamics of IAP were analysed in parallel with signs of systemic inflammation, dynamics of C-reactive protein and cumulative fluid balance. All variables, complication rate and outcomes were analysed in the whole group and in patients with IAH (CVVH and no-CVVH groups). Results From the total of 130 patients, 75 were treated with application of CVVH and 55 without CVVH. Late hospitalization was associated with application of CVVH. Infection was observed in 28.5% of cases regardless of the type of treatment received, with a similar necessity for surgical intervention. IAH was observed in 68.5% of patients, and they had significantly higher SOFA scores compared to patients with normal IAP. CVVH treatment resulted in negative cumulative fluid balance starting from day 5 in patients with IAH, whereas without this treatment, fluid balance remained increasingly positive after a week. Finally, application of CVVH resulted in a lower infection rate and shorter hospital stay, 26.7% vs. 37.9%, and a median of 32 (interquartile range (IQR) = 60 to 12) days vs. 24 (IQR = 34 to 4) days, p = 0.05, comparing CVVH vs. no-CVVH group. Mortality rate reached 11.7% in the CVVH group and 13.8% in the no-CVVH group. Conclusions Early application of CVVH facilitates negative fluid balance and reduction of IAH in patients with SAP; it is not associated with increased infection or mortality rate and may reduce hospital stay.
The role of pancreatic acinar cells in initiating fibrogenic responses during the early stages of alcoholic acute pancreatitis has not been evaluated. We investigated the ability of injured acinar cells to generate pancreatic fibrosis in acute pancreatitis. Rats were fed either an ethanol-containing or control diet over 14 weeks and euthanized 3 or 24 hours after a single lipopolysaccharide injection. Profibrotic transforming growth factor-? of acinar cells and pancreatic fibrosis were assessed by immunofluorescence, histological characteristics, and electron microscopy. Human pancreatic tissues were also evaluated. Periacinar cell fibrosis and collagen were exacerbated 24 hours after endotoxemia in alcohol-fed rats. Alcohol exposure exacerbated acinar cell-specific production of transforming growth factor ? in response to lipopolysaccharide in vivo and in acinar cell-like AR42J cells in vitro. Although a morphological examination showed no visible signs of necrosis, early pancreatic fibrosis can be initiated by little or no pancreatic necrosis. Transforming growth factor ? was also significantly increased in human acinar cells from patients with acute/recurrent pancreatitis compared with chronic pancreatitis tissue. Alcohol exacerbates lipopolysaccharide-induced pancreatic fibrosis during the early onset of mild, subclinical, acute pancreatitis. We suggest that multiple, subclinical, acute pancreatitis episodes can accumulate in fibrosis during the development of chronic pancreatitis, even if there is no history of acute pancreatitis. PMID:24091223
Gu, Haitao; Fortunato, Franco; Bergmann, Frank; Büchler, Markus W; Whitcomb, David C; Werner, Jens
The inflammatory response during pancreatitis regulates necrotic and apoptotic rates of parenchymal cells. Neutrophil depletion by use of anti-polymorphonuclear serum (anti-PMN) increases apoptosis in experimental pancreatitis but the mechanism has not been determined. Our study was designed to investigate signaling mechanisms in pancreatic parenchymal cells regulating death responses with neutrophil depletion. Rats were neutrophil depleted with anti-PMN treatment. Then cerulein pancreatitis was induced, followed by measurements of apoptosis signaling pathways. There was greater activation of executioner caspases-3 in the pancreas with anti-PMN treatment compared with control. There were no differences between these groups of animals in mitochondrial cytochrome c release or in activities of initiator caspase-8 and -9. However, there was greater activation of caspase-2 with anti-PMN treatment during cerulein pancreatitis. The upstream regulation of caspases-2 includes p53, which was increased; the p53 negative regulator, Mdm2, was decreased by anti-PMN treatment during cerulein pancreatitis. In vitro experiments using isolated pancreatic acinar cells a pharmacological inhibitor of Mdm2 increased caspase-2/-3 activities, and an inhibitor of p53 decreased these activities during cholecystokinin-8 treatment. Furthermore, experiments using the AR42J cell line Mdm2 small interfering RNA (siRNA) increased caspase-2/-3 activities, and p53 siRNA decreased these activities during cholecystokinin-8 treatment. These results suggest that during acute pancreatitis the inflammatory response inhibits apoptosis. The mechanism of this inhibition involves caspase-2 and its upstream regulation by p53 and Mdm2. Because previous findings indicate that promotion of apoptosis decreases necrosis and severity of pancreatitis, these results suggest that strategies to inhibit Mdm2 or activate p53 will have beneficial effects for treatment of pancreatitis.
Nakamura, Yuji; Do, Jae Hyuk; Yuan, Jingzhen; Odinokova, Irina V.; Mareninova, Olga; Gukovskaya, Anna S.
Epidemiological studies on pancreaticpseudocysts are retrospective analyses on alcoholicpatients. The aims of this study were to investigate theincidence, natural history, and predictors of theappearance and disappearance of pancreatic fluidcollections and pseudocysts after nonalcoholic acutepancreatitis. We carried out a prospective cohort studyin a series of 926 patients with acute pancreatitis.Pancreatic fluid collections or pseudocysts were treatedonly after complications. We studied pancreatic
Alberto Maringhini; Generoso Uomo; Rosalia Patti; Piergiorgio Rabitti; Anna Termini; Antonietta Cavallera; Gabriella Dardanoni; Gianpiero Manes; Maddalena Ciambra; Marco Laccetti; Patrizia Biffarella; Luigi Pagliaro
Morphological changes of the lung occur frequently in fatal acute hemorrhagic pancreatitis. The pulmonary alterations are independent of mechanical ventilation and therefore not due to iatrogenic damage caused by high inspired oxygen concentrations. The histological findings are similar to those seen in the so-called shock lung syndrome. The pulmonary lesion develops progressively and three stages can be separated: early, late,
P. G. Lankisch; G. Rahlf; H. Koop
Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100 000 of the population.\\u000a The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion\\u000a of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence\\u000a of acute alcoholic pancreatitis
Miho Sekimoto; Tadahiro Takada; Yoshifumi Kawarada; Koichi Hirata; Toshihiko Mayumi; Masahiro Yoshida; Masahiko Hirota; Yasutoshi Kimura; Kazunori Takeda; Shuji Isaji; Masaru Koizumi; Makoto Otsuki; Seiki Matsuno
BACKGROUND: Recent guidelines have been issued for the management of acute pancreatitis. The aim of this study was to audit the management of acute pancreatitis in one district general hospital, to determine the problems and benefits associated with the implementation of such guidelines. METHODS: Data were collected over the period 1991-1995 for all patients diagnosed as having acute pancreatitis who were admitted to one district general hospital. Data regarding severity grading, determination of aetiology and treatment of mild and severe pancreatitis were analysed in conjunction with the recommendations issued by the British Society of Gastroenterology Working Party on the management of acute pancreatitis in 1995. RESULTS: A total of 210 patients were admitted on 263 occasions; 16% of cases were severe but severity prediction was inaccurate. 56.1% had gallstone pancreatitis and 20.9% had idiopathic pancreatitis. Definitive treatment of gallstones was within the recommended time limit in only 70.1%. 27 patients experienced recurrent attacks of pancreatitis before definitive treatment of their gallstones, due either to inadequate investigation for gallstones after suboptimal ultrasound examination (n = 12) or to inappropriate delay before definitive treatment of gallstones (n = 15). Recommendations for the management of severe cases with early ITU/HDU admissions and CT scanning were not followed. 28 day mortality was 6.3%, median age of those dying was 80.5 years. CONCLUSIONS: Acceptable mortality can be achieved for acute pancreatitis despite failure to implement BSG guidelines for the management of severe acute pancreatitis. Inadequate investigation and treatment of gallstone disease leads to an unacceptable incidence of recurrent acute pancreatitis.
Norton, S. A.; Cheruvu, C. V.; Collins, J.; Dix, F. P.; Eyre-Brook, I. A.
We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.
Smith, Emily K; Ek, Edmund; Croagh, Daniel; Spain, Lavinia A; Farrell, Stephen
Summary We report a case of recurrent acute pancreatitis in a 57-year-old man with reactivation of Wegener's granulomatosis. An association between acute pancreatitis and Wegener's granulomatosis has not been reported previously. Six episodes of abdominal pain and hyperamylasemia occurred and were complicated by development of a pancreatic pseudocyst. New cavitary lung lesions typical of Wegener's granulomatosis led to treatment with
James Alan Kemp; Sanjeev Arora; Karim Fawaz
Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication, there is a very high mortality. The most common cause of HAP is iatrogenic trauma such as liver biopsy, transhepatic biliary drainage, cholecystectomy and hepatectomy. HAP may also occur with complications such as infections or inflammation associated with septic emboli. HAP has been reported rarely in patients with acute pancreatitis. As far as we are aware, there is no report of a case caused by acute idiopathic pancreatitis, particularly. We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman. The woman initially presented with acute pancreatitis due to unknown cause. After conservative management, her symptoms seemed to have improved. But eight days after admission, abdominal pain abruptly became worse again. Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT. Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain. ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram. Without any particular treatment such as embolization or surgical ligation, HAP thrombosed spontaneously. Three months after discharge, abdominal CT demonstrated that HAP in the left lateral segment had disappeared.
Yu, Yeon Hwa; Sohn, Joo Hyun; Kim, Tae Yeob; Jeong, Jae Yoon; Han, Dong Soo; Jeon, Yong Cheol; Kim, Min Young
Chicken pox is a benign self limited disease. But it may rarely be complicated with acute pancreatitis in otherwise healthy patient. We present a case of varicella pancreatitis and its marked recovery with acyclovir. PMID:23781673
Roy, Pinaki; Maity, Pranab; Basu, Arindam; Dey, Somitra; Das, Biman; Ghosh, U S
Objectives The use of prophylactic antibiotics in severe acute pancreatitis (SAP) is controversial. The aim of this study was to compare the effects of antibiotics administered as prophylaxis and as treatment on demand, respectively, in two prospective, non-randomized cohorts of patients. Methods The study population consisted of 210 patients treated for SAP. In Group 1 (n = 103), patients received prophylactic antibiotics (ciprofloxacin, metronidazole). In Group 2 (n = 107), patients were treated on demand. Ultrasound-guided drainage and/or surgical debridement of infected necrosis were performed when the presence of infected pancreatic necrosis was demonstrated. The primary endpoints were infectious complication rate, need for and timing of surgical interventions, incidence of nosocomial infections and mortality rate. Results Ultrasound-guided fine needle aspiration [in 18 (16.8%) vs. 13 (12.6%) patients; P = 0.714], ultrasound-guided drainage [in 15 (14.0%) vs. six (5.8%) patients; P = 0.065] and open surgical necrosectomy [in 10 (9.3%) vs. five (4.9%) patients; P = 0.206] were performed more frequently and earlier [at 16.6 ± 7.8 days vs. 17.2 ± 6.7 days (P = 0.723); at 19.5 ± 9.4 days vs. 24.5 ± 14.2 days (P = 0.498), and at 22.6 ± 13.5 days vs. 26.7 ± 18.1 days (P = 0.826), respectively] in Group 2 compared with Group 1. There were no significant differences between groups in mortality and duration of stay in the surgical ward or intensive care unit. Conclusions The results of this study support the suggestion that the use of prophylactic antibiotics does not affect mortality rate, but may decrease the need for interventional and surgical management, and lower the number of reoperations.
Ignatavicius, Povilas; Vitkauskiene, Astra; Pundzius, Juozas; Dambrauskas, Zilvinas; Barauskas, Giedrius
Plasma values of immunoreactive interleukin-6, C-reactive protein and phospholipase A have been determined in serial samples from 24 patients with acute pancreatitis ('mild' pancreatitis nine, 'severe' pancreatitis 15). Median plasma concentrations of interleukin-6, C-reactive protein, and phospholipase A activity were significantly higher in patients with 'severe' illness (p < 0.001) than those with 'mild' illness. A particularly marked increase in
J A Viedma; M Pérez-Mateo; J E Domínguez; F Carballo
Summary To clarify the relationship between changes in serum pancreatic enzymes and pathological changes in pancreatic parenchyma,\\u000a this study was performed by using rat models with acute pancreatitis. The models were rats with edematous and necrotizing\\u000a pancreatitis. Amylase, lipase, ribonuclease (RNase), and deoxyribonuclease (DNase I, II) in the serum were determined for\\u000a 48 h after the development of pancreatitis. Amylase and
Yoshio Kinami; Ichiro Kita
Background Suitable experimental models of gallstone pancreatitis with systemic inflammation and mortality are limited. We developed a novel murine model of duct-ligation-induced acute pancreatitis associated with multiorgan dysfunction and severe mortality. Methods Laparotomy was done on C57/BL6 mice followed by pancreatic duct (PD) ligation, bile duct (BD) ligation without PD ligation, or sham operation. Results Only mice with PD ligation developed acute pancreatitis and had 100% mortality. Pulmonary compliance was significantly reduced after PD ligation but not BD ligation. Bronchoalveolar lavage fluid neutrophil count and interleukin-1? concentration, and the plasma creatinine level, were significantly elevated with PD ligation but not BD ligation. Pancreatic nuclear factor ?B (p65) and activator protein 1 (c-Jun) were activated within 1 h of PD ligation. Conclusion PD-ligation-induced acute pancreatitis in mice is associated with systemic inflammation, acute lung injury, multiorgan dysfunction and death. The development of this novel model is an exciting and notable advance in the field.
Samuel, Isaac; Yuan, Zuobiao; Meyerholz, David K.; Twait, Erik; Williard, Deborah E.; Kempuraj, Duraisamy
The capacity for intercellular communication (IC) via gap junctions is found in normal pancreatic acinar cells. The major role of IC is considered to be the maintenance of tissue homeostasis and the regulation of signal transmissions. Up to now, the participation of IC via gap junctions in acute pancreatitis has not been reported. We investigated the role of IC in cerulein (Cn)-induced acute pancreatitis in rats using irsogladine, an enhancer of IC via gap junction. Acute edematous pancreatitis was induced in rats by two intraperitoneal injections of 40 micrograms/kg Cn. Rats received various doses (25, 50, or 100 mg/kg body weight) of irsogladine orally, 15 and 2 h before the first Cn injection. The normal control group received only vehicle. The severity of pancreatitis was evaluated enzymatically and histologically 5 h after the first Cn injection. In Cn-induced acute pancreatitis, irsogladine significantly lowered the serum amylase level, the pancreatic wet weight, and the pancreatic amylase and DNA contents, in a dose-dependent manner. Particularly, the amylase content improved to the level of the normal controls. Histologically, the severity of pancreatitis was reduced significantly by treatment with irsogladine and no discernible vacuolization was seen in the group with 100 mg/kg irsogladine treatment. By immunofluorostaining pancreata with anti-connexin 32 (Cx32; a gap junction protein) antibody, we found that pancreatic acini were diffusely positive for Cx32 in the control group, but the number of Cx32-positive grains decreased markedly, to 19%, in the pancreatitis group. With 100 mg/kg irsogladine treatment, the number of Cx32 grains recovered to 70% of the normal control value. These findings indicate that IC via gap junction is disturbed in Cn-induced pancreatitis, which may result in the breakdown of tissue homeostasis and the progression of acute pancreatitis. PMID:9336795
Ito, T; Ogoshi, K; Nakano, I; Ueda, F; Sakai, H; Kinjo, M; Nawata, H
Computed tomography (CT) has proven reliable in the early detection of acute haemorrhagic pancreatitis. In the present study the extrapancreatic changes at CT were studied in 60 patients with acute pancreatitis. The CT findings were correlated to the early "prognostic signs" by Ranson and the clinical course of the disease. All the patients with minor extrapancreatic changes recovered without complications. When moderate to severe extrapancreatic changes were seen the incidence of haemorrhagic pancreatitis and the risk of development of pseudocyst or abscess was high. In these patients a dynamic contrast enhanced CT should be done in order to select the patients with haemorrhagic pancreatitis. PMID:3878784
Schröder, T; Kivisaari, L; Somer, K; Standertskjöld-Nordenstam, C G; Kivilaakso, E; Lempinen, M
Forensic pathologists can help in the investigation of sudden unexpected deaths in co-operation with the officials responsible for the maintenance of law and order to administer justice. Sudden unexpected deaths form the subject of medicolegal investigation if they occur in apparently healthy individuals, wherein an autopsy would shed light regarding the cause of death. A 4 year retrospective review of autopsy files at the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India was undertaken for cases of sudden unexpected deaths due to acute haemorrhagic pancreatitis occurring between May 2004 and April 2008. A total of seven cases of acute haemorrhagic pancreatitis diagnosed at autopsy as the cause of sudden unexpected death during the study period are discussed herein. PMID:20650420
Shetty, B Suresh Kumar; Boloor, Archith; Menezes, Ritesh G; Shetty, Mahabalesh; Menon, Anand; Nagesh, K R; Pai, Muktha R; Mathai, Alka Mary; Rastogi, Prateek; Kanchan, Tanuj; Naik, Ramadas; Salian, Preetham Raj; Jain, Vipul; George, Aneesh T
Background: The efficacy of octreotide, the synthetic analogue of the hormone somatostatin, for the treatment of acute pancreatitis is controversial. Octreotide has been commonly administered in subcutaneous bolus injections; however, continuous intravenous infusion may be advantageous for acute conditions. Methods: Acute experimental pancreatitis was induced in rats by intraparenchymal injections of 1 ml 10% sodium taurocholate, and octreotide (1 µg\\/kg\\/h,
R. Greenberg; R. Haddad; H. Kashtan; E. Brazowski; E. Graff; Y. Skornick; O. Kaplan
A review of acute pancreatitis occurring over a 20-year period in the Bristol clinical area is reported. A total of 590 cases were available for analysis. The yearly incidence was 53-8 per million population at risk, with a mortality of 9-0 per million. This compares favourably with 11-4 deaths per million for England and Wales as a whole during the
J E Trapnell; E H Duncan
Background We have reported that peripheral lymphocyte reduction due to apoptosis is linked to the development of subsequent infectious\\u000a complications in patients with severe acute pancreatitis and that Th1 (helper T cell type 1)\\/Th2 (helper T cell type 2) balance\\u000a tends to cause Th1 suppression in experimental severe acute pancreatitis. It has been reported that interleukin (IL)-18 is\\u000a a cytokine produced
Takashi Ueda; Yoshifumi Takeyama; Takeo Yasuda; Naoki Matsumura; Hidehiro Sawa; Takahiro Nakajima; Tetsuo Ajiki; Yasuhiro Fujino; Yasuyuki Suzuki; Yoshikazu Kuroda
BACKGROUND & AIMS: We recently identified a single R117H mutation in the cationic trypsinogen gene in several kindreds with an inherited form of acute and chronic pancreatitis (HP1), providing strong evidence that trypsin plays a central role in premature zymogen activation and pancreatitis. However, not all families studied have this mutation. The aim of this study was to determine the
M. C. Gorry; D. Gabbaizedeh; W. Furey; L. K. Gates; RA Preston; C. E. Aston; Y Zhang; C Ulrich; GD Ehrlich; DC Whitcomb
Introduction Blood leukocytes play a major role in mediating local and systemic inflammation during acute pancreatitis. We hypothesize that peripheral blood mononuclear cells (PBMC) in circulation exhibit unique changes in gene expression, and could provide a “reporter” function that reflects the inflammatory response in pancreas of acute pancreatitis. Methods To determine specific changes in blood leukocytes during acute pancreatitis, we studied gene transcription profile of in peripheral blood mononuclear cells (PBMC) in a rat model of experimental pancreatitis (sodium taurocholate). Normal rats, saline controls and a model of septic shock were used as a controls. cRNA obtained from PBMC of each group (n = 3) were applied to Affymetrix rat genome DNA Gene Chip Arrays. Results From the 8,799 rat genes analyzed, 140 genes showed unique significant changes in their expression in PBMC during the acute phase of pancreatitis, but not in sepsis. Among the 140 genes, 57 were upregulated, while 69 were downregulated. Platelet-derived growth factor receptor, prostaglandin E2 receptor and phospholipase D1 are among the top upregulated genes. Others include genes involved in G protein-coupled receptor and TGF-?-mediated signaling pathways, while genes associated with apoptosis, glucocorticoid receptors and even the cholecystokinin receptor are downregulated. Conclusions Microarray analysis in transcriptional profiling of PBMC showed that genes that are uniquely related to molecular and pancreatic function display differential expression in acute pancreatitis. Profiling genes obtained from an easily accessible source during severe pancreatitis may identify surrogate markers for disease severity.
Bluth, Martin; Lin, Yin-yao; Zhang, Hong; Viterbo, Dominick; Zenilman, Michael
Summary Rat exocrine pancreatic function was studied structurally and biochemically after the in vivo production of acute interstitial pancreatitis by supramaximal stimulation with caerulein. Two major phases in the reaction of the gland were observed: During the first two days after cessation of the supramaximal stimulation a progressive infiltration of the interstitium and the pancreatic tissue with polymorphonuclear leucocytes, lymphocytes
Guido Adler; Thomas Hupp; Horst F. Kern
Aims: To avoid the progression from mild edematous acute pancreatitis (AP) to the severe necrotizing form, one therapeutic option is to improve pancreatic microcirculation and tissue oxygenation. The aim of the study was to evaluate the influence of improved rheology (isovolemic hemodilution) plus enhanced oxygen supply (bovine hemoglobin HBOC-301) on pancreatic microcirculation, tissue oxygenation and survival in severe acute experimental
Marc Freitag; Thomas G. Standl; Helge Kleinhans; André Gottschalk; Oliver Mann; Christian Rempf; Kai Bachmann; Andreas Gocht; Susan Petri; Jakob R. Izbicki; Tim Strate
Acute pancreatitis (AP) continues to be a clinical challenge. The mortality of patients with AP with adverse outcomes like organ failure and infected necrosis can be as high as 43 %. Highly accurate predictors of adverse outcomes are necessary to identify the high-risk patients so that they can be meticulously monitored and managed. However, there are no ideal predictors till date. Over the past several years, a number of single- and multi-parameter predictors have been identified and tested for prediction of adverse outcomes in AP. Out of the different tools tested, blood urea nitrogen and the harmless acute pancreatitis score appears to be useful and feasible in the management of AP under Indian conditions. Other single-parameter predictors like serum creatinine, hematocrit, erythrocyte sedimentation rate, C-reactive protein, and D-dimer need to be put to further tests in high-quality prospective studies with large sample size at the community level. Multi-parameter prediction tools like the bedside index of severity of acute pancreatitis may not be appealing in day-to-day clinical practice. PMID:23475525
Talukdar, Rupjyoti; Nageshwar Reddy, D
AIM: To observe the effect of resveratrol on nuclear factor Kappa-B (NF-?B) activation and the inflammatory response in sodium taurocholate-induced pancreatitis in rats. METHODS: Seventy-two male SD rats were randomly divided into three groups: sham operation group (control), severe acute pancreatitis (SAP) group, and severe acute pancreatitis group treated with resveratrol (RES). A SAP model was established by injecting 4%
Yong Meng; Qing-Yong Ma; Xiao-Ping Kou; Jun Xu
Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure. Fortunately, 70-80% of patients with acute pancreatitis have a benign self-limiting course. The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20-30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments.
Maher, Michael M.; Lucey, Brian C.; Gervais, Debra A.; Mueller, Peter R. [Massachusetts General Hospital, Boston, MA and Harvard Medical School Boston, MA, Division of Abdominal Imaging and Interventional Radiology (United States)], E-mail: firstname.lastname@example.org
Acute pancreatitis is an inflammatory process of the pancreas with variable involvement of regional tissues and remote organs. This review gives a comprehensive overview of the aetiology, pathophysiology, diagnosis and therapy of acute pancreatitis relevant to the intensivist. Recent international guidelines on the management of acute pancreatitis are summarised. Eighty percent of acute pancreatitis episodes are related either to gallstones or to alcohol abuse. Independent of its aetiology, the pathophysiologic hallmark of acute pancreatitis is the premature activation of trypsin, which leads to massive pancreas inflammation, systemic overproduction of pro-inflammatory mediators and ultimately remote organ dysfunction. All guidelines agree that the diagnosis of acute pancreatitis should include clinical symptoms, increased serum amylase or lipase levels and/or characteristic findings on computed tomography. Endoscopic retrograde cholangiopancreatography is recommended as a causative therapy in patients with acute cholangitis or a strong suspicion of gallstones. All guidelines underline the importance of vigorous fluid resuscitation and supplemental oxygen therapy and prefer enteral over parenteral nutrition, with the majority favouring the nasojejunal route. In view of lacking scientific evidence, antibiotic prophylaxis to prevent infection of pancreatic necroses is discouraged by most guidelines. Computed tomography-guided fine needle aspiration is the technique of choice to differentiate between sterile and infected pancreas necrosis. While sterile pancreatic necrosis should be managed conservatively, infected pancreatic necrosis requires debridement and drainage supplemented by antibiotic therapy. Surgical necrosectomy is the traditional approach, but less invasive techniques (retroperitoneal or laparoscopic necrosectomy, computed tomography-guided percutaneous catheter drainage) may be equally effective. PMID:19400483
Hasibeder, W R; Torgersen, C; Rieger, M; Dünser, M
In acute pancreatitis the mechanism involved in the auto-amplification of morbid phenomena can be suppressed in most of the cases by inhibiting the pancreatic secretion. This can also enhance the repair of pancreatic, duodenal and jejunal fistulae. On the basis of experimental studies carried out by Johnson, and on the clinical studies of Guttmann, as well as on original studies done by the authors, Ftorafur was included in the complex therapy of acute pancreatitis, and of pancreatic and duodenal fistulae. A group of 14 cases of acute pancreatitis, were treated. These included 5 necrotic-haemorrhagic pancreatitis, and 9 oedematous pancreatitis. The drug was given by continuous intravenous perfusion in doses of 1,200-1,600 mg per day, for a period of 6-12 days. In all the cases the clinical improvement of the patients as well as recovery of normal values of blood amylase were spectacular, and full recovery was achieved in all the cases. Ftorafur was also used in 3 cases of pancreatic fistulae, and in 2 cases of duodenal fistulae, and recovery was also achieved in a very short time. On the basis of this experience, although small, the authors recommend the introduction of Ftorafur in the complex therapy of acute pancreatitis, as well as in that of pancreatic and duodenal fistulae. Following administration of Ftorafur no adverse effects were noted, and in the doses mentioned above this drug did not delay the repair of surgical wounds. PMID:2149191
Georgescu, T; Naftali, Z; Varga, A; Simon, G; Pan?, C; Cr?ciun, C; Nistor, V; Ilniczky, P; Bo?ianu, A; Kovács, M
Abstract Oxidative stress has been implicated in the pathogenesis of acute pancreatitis, a severe and debilitating inflammation of the pancreas that carries a significant mortality, and which imposes a considerable financial burden on the health system due to patient care. Although extensive efforts have been directed towards the elucidation of critical underlying mechanisms and the identification of novel therapeutic targets, the disease remains without a specific therapy. In experimental animal models of acute pancreatitis, increased oxidative stress and decreased antioxidant defences have been observed, changes also detected in patients clinically. However, despite the promise of studies evaluating the effects of antioxidants in these model systems, translation to the clinic has thus far been disappointing. This may reflect many factors involved in the design of both preclinical and clinical evaluations of antioxidant therapy, not least the fact that most experimental studies have focussed on pre-treatment rather than post-injury assessment. This review has examined evidence relating to the involvement of oxidative stress in the pathophysiology of acute pancreatitis, focussing on experimental models and the clinical experience, including the experimental techniques employed and potential of antioxidant therapy. PMID:23952531
Armstrong, J A; Cash, N; Soares, P M G; Souza, M H L P; Sutton, R; Criddle, D N
Recently, endotoxaemia has been reported as a prognostic marker in acute pancreatitis. However, the role of endotoxin in inducing\\u000a or aggravating acute pancreatitis is not fully understood. We administered endotoxin 400 ?g\\/kg i.p. to rats 24 h before performing\\u000a either a closed duodenal loop (group B) or a sham operation (group D). Pancreatic damage and overall survival were compared\\u000a with
Mario Pirisi; Alessandro Cavarape; Carlo Fabris; Cathryn Scott; Edmondo Falleti; Edda Federico; Gianfranco Rizzuti; Fabio Gonano; Carlo Alberto Beltrami; Ettore Bartoli
Calcium homeostasis was studied serially in six patients admitted to the surgical intensive care unit because of acute pancreatitis. All developed ionized hypocalcemia. Serial assays of serum parathyroid hormone (PTH) revealed a prompt response to this hypocalcemia (1143 +/- 239 versus 574 +/- 24 pg/ml, P less than 0.05). Serum 1,25-dihydroxyvitamin D (1,25(OH)2D) levels rose from 26 +/- 8 to 104 +/- 17 pg/ml (P less than 0.01) in the expected time frame subsequent to the PTH peak, confirming the biologic significance of the PTH increases observed. Despite these significant elevations of PTH and 1,25(OH)2D, the expected prompt return of ionized calcium concentrations to normal levels was not seen. Also, urinary cyclic adenosine monophosphate production was not stimulated. These results suggest an acute functional resistance of bone to physiologic levels of PTH stimulation during the acute phase of pancreatitis. Fluid sequestration and hypovolemia are marked at this time. We suggest that pancreatitic hypocalcemia may occur when oligemic bone cannot respond normally to PTH and 1,25(OH)2D stimulation. As such, it may represent an end organ failure syndrome associated with shock and poor tissue perfusion. PMID:6195746
Hauser, C J; Kamrath, R O; Sparks, J; Shoemaker, W C
A case of acute necrotizing pancreatitis due to Mycoplasma pneumoniae infection was treated in an 8-year-old girl. She experienced acute pancreatitis during treatment for M. pneumoniae. Contrast-enhanced computed tomographic scan revealed necrotizing pancreatitis. The computed tomographic severity index was 8 points (grade E). A protease inhibitor, ulinastatin, was provided via intravenous infusion but was ineffective. Continuous regional arterial infusion therapy was provided with gabexate mesilate (FOY-007, a protease inhibitor) and meropenem trihydrate, and the pancreatitis improved. This case suggests that infusion therapy is safe and useful in treating necrotizing pancreatitis in children.
Nakagawa, Motoo, E-mail: email@example.com; Ogino, Hiroyuki; Shimohira, Masashi; Hara, Masaki; Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)
Objective To determine if B cell activating factor of the tumor necrosis factor family (BAFF) acts as an acute phase reactant and predicts severity of acute pancreatitis. Methods 40 patients with acute pancreatitis were included in this single center cohort pilot study. Whole blood and serum was analyzed on day of admission and nine consecutive days for BAFF, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and leucocyte numbers. Different severity Scores (Ranson, APACHE II, SAPS II, SAPS III) and the clinical course of the patient (treatment, duration of stay, duration ICU) were recorded. Results Serum BAFF correlates with CRP, an established marker of severity in acute pancreatitis at day of admission with a timecourse profil similar to IL-6 over the first nine days. Serum BAFF increases with Ranson score (Kruskal-Wallis: Chi2?=?10.8; p?=?0.03) similar to CRP (Kruskal-Wallis: Chi2?=?9.4; p?=?0.05 ). Serum BAFF, IL-6, and CRP levels are elevated in patients that need intensive care for more than seven days and in patients with complicated necrotizing pancreatitis. Discriminant analysis and receiver operator characteristics show that CRP (wilks-lambda?=?0.549; ROC: AUC 0.948) and BAFF (wilks-lambda?=?0.907; ROC: AUC 0.843) serum levels at day of admission best predict severe necrotizing pancreatitis or death, outperforming IL-6, PCT, and number of leucocytes. Conclusion This study establishes for the first time BAFF as an acute phase reactant with predictive value for the course of acute pancreatitis. BAFF outperforms established markers in acute pancreatitis, like IL-6 and PCT underscoring the important role of BAFF in the acute inflammatory response.
Pongratz, Georg; Hochrinner, Hannah; Straub, Rainer H.; Lang, Stefanie; Brunnler, Tanja
OBJECTIVE: To validate the safety of gadolinium-diethylenetriamine pentaacetic acid (GD-DTPA) by measuring its effect on pancreatic capillary perfusion and acinar injury in acute pancreatitis. BACKGROUND: Contrast-enhanced computed tomography (CECT) is proposed as a gold standard for early evaluation of acute necrotizing pancreatitis. However, iodinated contrast media used for CECT have been shown in these circumstances to reduce pancreatic capillary flow and increase necrosis and mortality. Recent reports suggest that post-GD MRI provides images comparable to CECT in the assessment of severe acute pancreatitis. METHODS: Necrotizing pancreatitis was induced in 14 Wistar rats by intraductal glycodeoxycholic acid (10 mM/L) and intravenous caerulein (5 microg/kg/h) over 6 hours. Intravital microscopic quantitation of pancreatic capillary blood flow was performed using fluorescein isothiocyanate-labeled erythrocytes after induction of pancreatitis and 30 and 60 minutes after an intravenous bolus of either Ringer's solution or GD-DTPA (0.2 mL/kg). RESULTS: The two study groups were comparable with regard to mean arterial pressure, heart rate, arterial blood gases, hematocrit, amylase, lipase, and trypsinogen activation peptide production throughout the experiment. GD-DTPA did not reduce capillary flow (1.93 +/- 0.05 nL/capillary/min) compared to animals infused with Ringer's solution (1.90 +/- 0.06 nL/capillary/min). CONCLUSIONS: Intravenous injection of GD-DTPA does not further impair pancreatic microcirculation or increase acinar injury in acute necrotizing pancreatitis. Because of this advantage over CT contrast medium, further development of MRI as a staging tool in acute pancreatitis seems desirable.
Werner, J; Schmidt, J; Warshaw, A L; Gebhard, M M; Herfarth, C; Klar, E
Acute pancreatitis is a morbid inflammatory condition of pancreas with limited specific therapy. Enhanced oxidative stress plays an important role in induction and progression of acute pancreatitis. So reducing oxidative stress may relieve this pathogenic process. Echium amoenum Fisch. and Mey has been implemented in Iranian folk medicine for several centuries. Antioxidant, analgesic, immunomodulatory, and anxiolytic properties of E. amoenum suggest that this plant may have beneficial effects in the management of acute pancreatitis. The aim of this study was to evaluate the protective effect of petals of E. amoenum extract (EAE) on a murine model of pancreatitis. Acute pancreatitis was induced by five intraperitoneal (i.p.) injection of cerulein (50??g/kg) with 1h intervals which was characterized by pancreatic inflammation and increase in the serum level of digestive enzymes, in comparison to normal mice. EAE (100, 200, and 400?mg/kg) was administered i.p., 30 minutes before induction of pancreatitis. Pretreatment with EAE (400?mg/kg) reduced significantly the inflammatory response of cerulein-induced acute pancreatitis by ameliorating pancreatic edema, amylase and lipase serum levels, proinflammatory cytokines, myeloperoxidase activity, lipid peroxidation and pathological alteration. These results show that EAE attenuates the severity of cerulein-induced acute pancreatitis with an anti-inflammatory, immunomodulatory and antioxidant effects. PMID:23008778
Abed, Alireza; Minaiyan, Mohsen; Ghannadi, Alireza; Mahzouni, Parvin; Babavalian, Mohammad Reza
Acute pancreatitis is a morbid inflammatory condition of pancreas with limited specific therapy. Enhanced oxidative stress plays an important role in induction and progression of acute pancreatitis. So reducing oxidative stress may relieve this pathogenic process. Echium amoenum Fisch. and Mey has been implemented in Iranian folk medicine for several centuries. Antioxidant, analgesic, immunomodulatory, and anxiolytic properties of E. amoenum suggest that this plant may have beneficial effects in the management of acute pancreatitis. The aim of this study was to evaluate the protective effect of petals of E. amoenum extract (EAE) on a murine model of pancreatitis. Acute pancreatitis was induced by five intraperitoneal (i.p.) injection of cerulein (50??g/kg) with 1h intervals which was characterized by pancreatic inflammation and increase in the serum level of digestive enzymes, in comparison to normal mice. EAE (100, 200, and 400?mg/kg) was administered i.p., 30 minutes before induction of pancreatitis. Pretreatment with EAE (400?mg/kg) reduced significantly the inflammatory response of cerulein-induced acute pancreatitis by ameliorating pancreatic edema, amylase and lipase serum levels, proinflammatory cytokines, myeloperoxidase activity, lipid peroxidation and pathological alteration. These results show that EAE attenuates the severity of cerulein-induced acute pancreatitis with an anti-inflammatory, immunomodulatory and antioxidant effects.
Abed, Alireza; Minaiyan, Mohsen; Ghannadi, Alireza; Mahzouni, Parvin; Babavalian, Mohammad Reza
Thirty-five patients with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy groups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, two inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen, and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including intravenous fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, four of the 18 patients (22.2%) died, while in the lavation group eight of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but one patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. However, these complications accumulated to patients who ultimately died. Also, the need for reoperation was greater in the lavation group (20 reoperations/10 patients versus 12 reoperation/eight patients). Yet, the length of overall hospital stay was equal in the two groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the nine survivors in the lavation group got this complication. The results suggest that pancreatic resection is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. However, these benefits are gained at the expense of higher incidence of postoperative diabetes. PMID:6712318
Kivilaakso, E; Lempinen, M; Mäkeläinen, A; Nikki, P; Schröder, T
Thirty-five patients with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy groups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, two inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen, and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including intravenous fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, four of the 18 patients (22.2%) died, while in the lavation group eight of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but one patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. However, these complications accumulated to patients who ultimately died. Also, the need for reoperation was greater in the lavation group (20 reoperations/10 patients versus 12 reoperation/eight patients). Yet, the length of overall hospital stay was equal in the two groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the nine survivors in the lavation group got this complication. The results suggest that pancreatic resection is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. However, these benefits are gained at the expense of higher incidence of postoperative diabetes.
Kivilaakso, E; Lempinen, M; Makelainen, A; Nikki, P; Schroder, T
The use of dermal fillers is increasingly common. Side effects associated with their use are usually limited to local reactions. Acute pancreatitis is also a common condition with a wide range of aetiologies. To date, no potential associations between acute pancreatitis and dermal filler injections have been reported. A 58-year-old lady was admitted with an acute onset of epigastric pain and vomiting. She was diagnosed with acute severe pancreatitis. No cause could be found for her pancreatitis. She did, however, have dermal filler injection 24 hours previous to her initial symptoms. Causality is difficult to prove beyond doubt in the present isolated case report. However, given the exponential rise in accessible and affordable cosmetic procedures such as dermal filler injections such case reporting is necessary to establish whether such associations truly exist and to examine underlying mechanisms.
Lucas-Herald, AK; Jamieson, NB; Roxburgh, CS
The records of 30 consecutive patients treated by pancreatic resection for acute hemorrhagic or necrotizing pancreatitis from 1974 to 1978 were reviewed. Formal subtotal or near to total resection of the pancreas was undertaken whenever vigorous nonoperative therapeutic measures did not bring rapid improvement of the condition of the patient. The rationale was that removal of the diseased pancreatic tissue would prohibit the progress of inflammation and abolish the development of complications directly associated to the inflammatory process itself. There was no intraoperative mortality, but 11 patients died after the operation. Of the 19 survivors, eight had an uncomplicated postoperative course, whereas 11 patients recovered only after severe complications, usually requiring multiple reoperations. Among the most important complications were intra-abdominal sepsis, septicemia, upper gastrointestinal tract bleeding, respiratory insufficiency, renal insufficiency and perforations of the gastrointestinal tract. After a follow-up period of one to five years, five patients have remained completely free of symptoms. In 12 patients, diabetes has developed, and four patients had recurrent mild attacks of pancreatitis. All but two patients have resumed their previous work or other activities of living. PMID:7209780
Kivilaakso, E; Fräki, O; Nikki, P; Lempinen, M
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.
Deeb, Liliane S.; Bajaj, Jasmeet; Bhargava, Sandeep; Alcid, David; Pitchumoni, C.S.
Twenty-eight consecutive patients with a first attack of acute alcohol-induced pancreatitis were examined by computed tomography (CT). After a survey scan of the abdomen a rapid contrast bolus (400 mg I/kg) was given intravenously, and the contrast enhancement of the pancreatic parenchyma was measured from a consecutive series of pancreatic scans. Nine patients with a fulminant course of the disease were operated on, and haemorrhagic necrotizing pancreatitis was found in eight. In all of these the contrast enhancement was decreased or absent. Patients recovering by conservative treatment showed normal or increased enhancement. The contrast enhancement seems to constitute a useful criterion for the early differentiation of acute fulminant pancreatitis from less severe forms of the disease. PMID:6675177
Kivisaari, L; Somer, K; Standertskjöld-Nordenstam, C G; Schröder, T; Kivilaakso, E; Lempinen, M
Acute fulminant pancreatitis is associated with significant morbidity and mortality. To examine the outcome of conservative and surgical treatment of this disorder, 36 patients who survived an initial episode were restudied after a mean of six years. Fifty three per cent had developed diabetes mellitus, half of whom required insulin therapy. Pancreatic resection was associated with a 100% frequency of diabetes, while only 26% of those treated with peritoneal lavage developed this (p less than 0.001). Insulin secretion and sensitivity were assessed using the hyperglycaemic glucose clamp technique. First phase insulin secretion was impaired in surgically treated patients (mean (SEM) 14 (5) microU/ml x 10 minutes) compared with conservatively treated patients and control subjects (144 (66) and 87 (12) microU/ml x 10 minutes, respectively; p less than 0.05). Second phase and 'maximal' insulin secretion were also impaired among the surgically treated patients compared with the conservatively treated patients and the controls. Insulin sensitivity was reduced among the surgically treated patients (2.88 (58) mg/kg.minute) when compared with conservatively treated patients and healthy control subjects (5.87 (1.02) and 6.45 (0.66) mg/kg.minute; p less than 0.05). Pancreatic resection is associated with a very high frequency of diabetes compared with peritoneal lavage, and these results favour conservative treatment of active fulminant pancreatitis whenever possible.
Eriksson, J; Doepel, M; Widen, E; Halme, L; Ekstrand, A; Groop, L; Hockerstedt, K
Objective To study alterations of serum levels of the pancreatic reg family of proteins in two models of acute pancreatitis. Summary Background Data The pancreatic reg family of proteins is expressed in the acinar pancreas. Reg I (pancreatic stone protein, PSP) and reg III (pancreatitis-associated protein, PAP) are induced after the onset of acute pancreatitis, and both have been proposed as potential markers of pancreatitis. Methods Pancreatitis was induced in rats by either retrograde infusion of sodium taurocholate or by direct trauma. Serum samples were obtained daily for 4 days after the procedure, and the animals were then killed. Twelve animals underwent sham procedure and six underwent daily analysis without surgery. Levels of reg I/PSP and reg III/PAP were estimated by enzyme-linked immunosorbent assay. Results Reg III/PAP levels increased significantly the first day after induction of both types of pancreatitis and rapidly returned to baseline in all survivors. Even animals who received retrograde infusion of saline showed a mild increase in reg III/PAP on the first day, whereas control animals that did not undergo surgery showed no variations. Reg I/PSP serum levels remained unchanged throughout all experimental periods. Postinjury reg III/PAP levels significantly correlated with severity of the pancreatic injury and animal survival;reg I/PSP levels did not. Conclusion After induction of pancreatitis, serum levels of reg I and III protein differ significantly. Reg III/PAP levels are a sensitive marker of pancreatic injury and early in the disease may be a useful prognostic indicator for disease severity.
Zenilman, Michael E.; Tuchman, David; Zheng, Qing-hu; Levine, Joshua; Delany, Harry
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BACKGROUND: In human acute pancreatitis two different types of secretory phospholipase A2 (PLA2) have been found. AIM: To analyse the specific pattern of distribution of these PLA2 activities and their pathophysiological role in experimental acute pancreatitis. SUBJECTS AND METHODS: Catalytic activities of secretory type I (pancreatic) and type II (non-pancreatic) PLA2 and the protein concentration of immunoreactive pancreatic PLA2 (IR-PLA2) in serum and pancreatic tissue of rats with cerulein (mild form) and sodium taurocholate (severe form) induced acute pancreatitis were determined. RESULTS: Cerulein infusion caused a significant increase in type I PLA2 activity (p < 0.01) and IR-PLA2 protein concentration (p < 0.01) in serum and pancreas, whereas type II PLA2 activity remained unchanged during the 12 hour observation period. Histology showed no significant tissue destruction. In sodium taurocholate induced acute pancreatitis type II PLA2 activity significantly increased, reaching values over 10-fold higher than controls (p < 0.01), whereas IR-PLA2 protein concentration and type I PLA2 activity were only marginally increased. In this severe model of acute pancreatitis significantly lower values were detected than in the control pancreas (p < 0.002) for PLA2 activity and IR-PLA2 protein concentration. Histology showed parenchymal and fat necroses with haemorrhage, oedema, and inflammatory cell infiltration. CONCLUSIONS: Type I PLA2 activity is dependent on the IR-PLA2 protein concentration in serum and pancreatic tissue. The type II PLA2 activity is not stimulated by cerulein, which indicates an extra-acinar origin of this enzyme. Type II PLA2 activity is significantly increased in sodium taurocholate induced acute pancreatitis indicating its role in the local necrotising process and involvement in the systemic effects in severe acute pancreatitis.
Uhl, W; Schrag, H J; Schmitter, N; Nevalainen, T J; Aufenanger, J; Wheatley, A M; Buchler, M W
The intestinal inflammation caused by intestinal ischemia reperfusion during acute pancreatitis (AP) often leads to multiply organ dysfunction and aggravation of acute pancreatitis. This review concerns up-date progress of the pathophysiology and molecular mechanism of the excessive production of gut-derived cytokines. The regulation effects of immuno-neuro-endocrine network for pancreatic necrosis are the basis for pharmacological therapeutic in AP. The translation from basic research to clinical trials for the prevention or treatment of severe acute pancreatitis (SAP) is of great value. Early enteral nutrition is necessary for the restitution, proliferation, and differentiation of the intestinal epithelial cells adjacent to the wounded area. Clearance of the excess intestinal bacteria and supplement of probiotics may be helpful to prevent bacterial translocation and infection of pancreas. PMID:23782148
Guo, Zhen- -Zhen; Wang, Pu; Yi, Zhi- Hui; Huang, Zhi- Yin; Tang, Cheng- Wei
OBJECTIVE: The authors' aim was to determine the requirement for an active interleukin (IL)-1 receptor during the development and progression of acute pancreatitis. SUMMARY OF BACKGROUND DATA: Interleukin-1 is a pro- inflammatory cytokine that has been shown to be produced during acute pancreatitis. Earlier animal studies of moderate and severe pancreatitis have shown that blockade of this powerful mediator is associated with attenuated pancreatic destruction and dramatic increases in survival. The exact role played by IL-1 and the requirement for activation of its receptor in the initiation and progression of pancreatitis is unknown. METHODS: Conventional and IL-1 receptor ¿knockout¿ animals were used in parallel experiments of acute pancreatitis induced by intraperitoneal injection of cerulean (50 microg/kg every 1 hour X 4). The conventional mouse strain had the IL-1 receptor blocked prophylactically by means of a recombinant IL-1 receptor antagonist (10 mg/kg injected intraperitoneally every 2 hours). The second mouse strain was genetically engineered by means of gene targeting in murine embryonic stem cells to be devoid of type 1 IL-1 receptor (IL-1 receptor knockout). Animals were killed at 0, 0.5, 1, 2, 4, and 8 hours, with the severity of pancreatitis determined by serum amylase, lipase, and IL-6 levels and blind histologic grading. Strain-specific controls were used for comparison. RESULTS: The genetic absence of the IL-1 receptor or its pharmacologic blockade resulted in significantly attenuated pancreatic vacuolization, edema, necrosis, inflammation, and enzyme release. Serum IL-6, a marker of inflammation severity, was dramatically decreased in both groups. CONCLUSIONS: Activation of the IL-1 receptor is not required for the development of pancreatitis but apparently is necessary for the maximal propagation of pancreatic injury and its associated inflammation. Images Figure 1. Figure 2. Figure 3. Figure 4.
Norman, J G; Fink, G; Franz, M; Guffey, J; Carter, G; Davison, B; Sexton, C; Glaccum, M
OBJECTIVE--To estimate the usefulness of serum concentrations of the complex of trypsin 2 and alpha 1 antitrypsin in diagnosing and assessing the severity of acute pancreatitis in comparison with serum C reactive protein, amylase, and trypsinogen 2 concentrations (reference markers). DESIGN--Markers were measured in consecutive patients admitted with acute abdominal pain that was either due to pancreatitis or to other disease unrelated to the pancreas (controls). SETTING--Department of surgery of a teaching hospital in Helsinki. SUBJECTS--110 patients with acute pancreatitis and 66 with acute abdominal diseases of extrapancreatic origin. On the basis of the clinical course, acute pancreatitis was classified as mild (82 patients) or severe (28 patients). MAIN OUTCOME MEASURES--Clinical diagnosis of acute pancreatitis and severity of the disease. RESULTS--At admission all patients with acute pancreatitis had clearly raised concentrations of trypsin 2-alpha 1 antitrypsin complex (32 micrograms/l), whereas only three of the controls had such values. Of the markers studied, trypsin 2-alpha 1 antitrypsin complex had the largest area under the receiver operating curve, both in differentiating acute pancreatitis from extrapancreatic disease and in differentiating mild from severe disease. CONCLUSIONS--Of the markers studied, trypsin 2-alpha 1 antitrypsin complex was the most accurate in differentiating between acute pancreatitis and extrapancreatic disease and in predicting a severe course for acute pancreatitis.
Hedstrom, J.; Sainio, V.; Kemppainen, E.; Haapiainen, R.; Kivilaakso, E.; Schroder, T.; Leinonen, J.; Stenman, U. H.
Changes in peritoneal morphology were examined histologically and by scanning electron microscopy during porcine acute hemorrhagic (n = 8) and edematous (n = 9) pancreatitis and after intraperitoneal installation of hemorrhagic pancreatitis-associated peritoneal exudate in healthy piglets (n = 3). In all experimental groups peritoneal inflammatory changes with mesothelial damage were evident already 1 h after the induction of the disease, and increased with time. Hemorrhagic pancreatitis caused desquamation of mesothelial cells and denudation of the basal membrane. Intraperitoneal installation of hemorrhagic pancreatitis-associated peritoneal exudate in healthy piglets caused similar changes, whereas the changes in edematous pancreatitis were much less extensive. Peritoneal exudate accumulating in the peritoneal cavity during hemorrhagic pancreatitis caused early chemical peritonitis characterized by severe inflammation of the peritoneum with destruction of the mesothelial cell layer, leading to denudation of the underlying connective tissue. The significance of these changes in the pathophysiology of acute fulminant pancreatitis remains to be further studied. PMID:3809992
Lehtola, A; Talja, M; Nuutinen, P; Nordling, S; Lempinen, M; Schröder, T
Aim: Acute pancreatitis (AP), in particular, severe acute pancreatitis (SAP), is a rare but challenging complication during pregnancy in terms of diagnosis and management. The objective of this paper is to investigate the causes and therapeutic strategies of AP in patients during the third trimester of pregnancy. Methods: We performed a retrospective analysis of the clinical features, laboratory data, and outcomes in 16 patients with acute pancreatitis during the third trimester of pregnancy. Results: Information was collected on admission, management, and outcome. A total 16 patients were diagnosed with acute pancreatitis during pregnancy. In 7 of 9 patients with mild AP, pregnancy was terminated by cesarean section and all 9 cases were cured. In 4 out of 7 patients with SAP, pregnancy was terminated by cesarean section in conjunction with peritoneal irrigation and drainage, and the mothers and infants survived. In the remaining 3 patients with SAP, there was one case of intrauterine death in which Induced labor was performed and 2 patients died of multiple organ failure. Conclusion: A high-fat diet and cholelithiasis are the triggers of AP in pregnancy. Conservative treatment is the preferred therapeutic method; in particular, for mild AP. Endoscopic surgery and peritoneal drainage are effective for acute biliary pancreatitis. Patients with hyperlipidemic pancreatitis should undergo lipid-lowering therapy, and hemofiltration should be done as soon as it becomes necessary. For patients with SAP, termination of pregnancy should be carried out as early as possible.
Sun, Yanmei; Fan, Cuifang; Wang, Suqing
Early surgery for biliary pancreatitis has resulted in a need for an accurate method of gallstone detection in acute pancreatitis. Fifty patients with acute pancreatitis were studied prospectively to assess the diagnostic value of Radionuclide Biliary Scanning (RBS) performed within 72 hours of an attack. To assess the general accuracy of RBS a further 154 patients with suspected acute cholecystitis or biliary colic were similarly studied. There were 34 patients with biliary pancreatitis and 18 (53%) had a positive scan (no gallbladder seen). There were 16 patients with non-biliary pancreatitis and 5 (31%) had a positive scan. All 51 patients with acute cholecystitis had a positive scan, as did 82% of the 51 patients with biliary colic. There were 52 patients with no biliary or pancreatic disease and none of these had a positive scan. RBS is highly accurate in confirming a diagnosis of acute cholecystitis or biliary colic. However, it cannot be relied on to differentiate between biliary and non-biliary pancreatitis and should certainly not be used as the basis for biliary surgery in these patients.
Neoptolemos, J. P.; Fossard, D. P.; Berry, J. M.
Polyamines are required for optimal growth and function of cells. Regulation of their cellular homeostasis is therefore tightly controlled. The key regulatory enzyme for polyamine catabolism is the spermidine/spermine N1-acetyltransferase (SSAT). Depletion of cellular polyamines has been associated with inhibition of growth and programmed cell death. To investigate the physiological function SSAT, we generated a transgenic rat line overexpressing the SSAT gene under the control of the inducible mouse metallothionein I promoter. Administration of zinc resulted in a marked induction of pancreatic SSAT, overaccumulation of putrescine, and appearance of N1-acetylspermidine with extensive depletion of spermidine and spermine in transgenic animals. The activation of pancreatic polyamine catabolism resulted in acute pancreatitis. In nontransgenic animals, an equal dose of zinc did not affect pancreatic polyamine pools, nor did it induce pancreatitis. Acetylated polyamines, products of the SSAT-catalyzed reaction, are metabolized further by the polyamine oxidase (PAO) generating hydrogen peroxide, which might cause or contribute to the pancreatic inflammatory process. Administration of specific PAO inhibitor, MDL72527 [N1,N2-bis(2,3-butadienyl)-1,4-butanediamine], however, did not affect the histological score of the pancreatitis. Induction of SSAT by the polyamine analogue N1,N11-diethylnorspermine reduced pancreatic polyamines levels only moderately and without signs of organ inflammation. In contrast, the combination of N1,N11-diethylnorspermine with MDL72527 dramatically activated SSAT, causing profound depletion of pancreatic polyamines and acute pancreatitis. These results demonstrate that acute induction of SSAT leads to pancreatic inflammation, suggesting that sufficient pools of higher polyamine levels are essential to maintain pancreatic integrity. This inflammatory process is independent of the production of hydrogen peroxide by PAO.
Alhonen, Leena; Parkkinen, Jyrki J.; Keinanen, Tuomo; Sinervirta, Riitta; Herzig, Karl-Heinz; Janne, Juhani
Background Meandering main pancreatic duct (MMPD), which comprises loop type and reverse-Z type main pancreatic duct (MPD), has long been discussed its relation to pancreatitis. However, no previous study has investigated its clinical significance. We aimed to determine the non-biased prevalence and the effect of MMPD on idiopathic pancreatitis using non-invasive magnetic resonance (MR) technique. Methods and Findings A cross-sectional study performed in a tertiary referral center. The study enrolled 504 subjects from the community and 30 patients with idiopathic pancreatitis (7 acute, 13 chronic, and 10 recurrent acute). All subjects underwent MR scanning and medical examination. MMPD was diagnosed when the MPD in the head of pancreas formed two or more extrema in the horizontal direction on coronal images of MR cholangiopancreatography, making a loop or a reverse-Z shaped hairpin curves and not accompanied by other pancreatic ductal anomaly. Statistical comparison was made among groups on the rate of MMPD including loop and reverse-Z subtypes, MR findings, and clinical features. The rate of MMPD was significantly higher for all idiopathic pancreatitis/idiopathic recurrent acute pancreatitis (RAP) (20%/40%; P<0.001/0.0001; odds ratio (OR), 11.1/29.0) than in the community (2.2%) but was not higher for acute/chronic pancreatitis (14%/8%; P?=?0.154/0.266). Multiple logistic regression analysis revealed MMPD to be a significant factor that induces pancreatitis/RAP (P<0.0001/0.0001; OR, 4.01/26.2). Loop/reverse-Z subtypes were found more frequently in idiopathic RAP subgroup (20%/20%; P?=?0.009/0.007; OR, 20.2/24.2) than in the community (1.2%/1.0%). The other clinical and radiographic features were shown not associated with the onset of pancreatitis. Conclusions MMPD is a common anatomical variant and might be a relevant factor to the onset of idiopathic RAP.
Gonoi, Wataru; Akai, Hiroyuki; Hagiwara, Kazuchika; Akahane, Masaaki; Hayashi, Naoto; Maeda, Eriko; Yoshikawa, Takeharu; Kiryu, Shigeru; Tada, Minoru; Uno, Kansei; Ohtsu, Hiroshi; Okura, Naoki; Koike, Kazuhiko; Ohtomo, Kuni
Purpose: We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. Materials and Methods: A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. Results: After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient's hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Conclusion: Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.
Hershberger, Richard C., E-mail: firstname.lastname@example.org; Bornak, Arash; Aulivola, Bernadette; Mannava, Krishna [Loyola University Chicago Medical Center, Division of Vascular Surgery and Endovascular Therapy (United States)
Background\\/Aims: Inflammatory events are believed to play an important role in the pathogenesis of acute pancreatitis. Interleukin 10 (IL-10) recently emerged as a major anti-inflammatory cytokine, inhibiting the secretion of proinflammatory cytokines by monocytes and\\/or macrophages. The potential protective role of IL-10 in a model of acute necrotizing pancreatitis in mice was tested. Methods: Animals received two intraperitoneal injections of
Jean-Luc Van Laethem; Arnaud Marchant; Anne Delvaux; Michel Goldman; Patrick Robberecht; Thierry Velu; Jacques Devière
We report on a patient with acute pancreatitis whose pain was resistant to simultaneous administration of morphine, procaine and Buscopan. This episode was complicated by development of hypertension, tachycardia, angina pectoris, ventricular arrhythmias and electrocardiographic modifications. Analgesia was provided by epidural administration of fentanyl and bupivacaine and brought about rapid resolution of all symptoms. The usefulness of epidural analgesia in acute pancreatitis is discussed. PMID:2305224
Borgeat, A; Nicolet, A; Chanson, C; Schwander, D
Objective To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. Summary Background Data Infection of pancreatic necrosis is the most important risk factor contributing to death in severe acute pancreatitis, and it is generally accepted that infected pancreatic necrosis should be managed surgically. In contrast, the management of sterile pancreatic necrosis accompanied by organ failure is controversial. Recent clinical experience has provided evidence that conservative management of sterile pancreatic necrosis including early antibiotic administration seems promising. Methods A prospective single-center trial evaluated the role of nonsurgical management including early antibiotic treatment in patients with necrotizing pancreatitis. Pancreatic infection, if confirmed by fine-needle aspiration, was considered an indication for surgery, whereas patients without signs of pancreatic infection were treated without surgery. Results Between January 1994 and June 1999, 204 consecutive patients with acute pancreatitis were recruited. Eighty-six (42%) had necrotizing disease, of whom 57 (66%) had sterile and 29 (34%) infected necrosis. Patients with infected necrosis had more organ failures and a greater extent of necrosis compared with those with sterile necrosis. When early antibiotic treatment was used in all patients with necrotizing pancreatitis (imipenem/cilastatin), the characteristics of pancreatic infection changed to predominantly gram-positive and fungal infections. Fine-needle aspiration showed a sensitivity of 96% for detecting pancreatic infection. The death rate was 1.8% (1/56) in patients with sterile necrosis managed without surgery versus 24% (7/29) in patients with infected necrosis (P <.01). Two patients whose infected necrosis could not be diagnosed in a timely fashion died while receiving nonsurgical treatment. Thus, an intent-to-treat analysis (nonsurgical vs. surgical treatment) revealed a death rate of 5% (3/58) with conservative management versus 21% (6/28) with surgery. Conclusions These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients with infected necrosis still represent a high-risk group in severe acute pancreatitis, and for them surgical treatment seems preferable.
Buchler, Markus W.; Gloor, Beat; Muller, Christophe A.; Friess, Helmut; Seiler, Christian A.; Uhl, Waldemar
Improving the outcome of acute pancreatitis through prognostic markers has been a matter of ample research. We evaluate the\\u000a clinical usefulness of four serum markers in comparison to Ranson’s score. Serum measurements of C-reactive protein (CRP),\\u000a interleukin-6, -10 (IL-6, IL-10), and pancreatitis-associated protein (PAP) were performed. The usefulness of each marker\\u000a for predicting severity was compared with that of Ranson’s
Andrés Duarte-Rojo; Jorge Suazo-Barahona; María Teresa Ramírez-Iglesias; Luis F. Uscanga; Guillermo Robles-Díaz
This study measured the volume and colour, as well as concentrations of trypsinogen activation peptides (TAP) in the peritoneal fluid of 22 patients with acute pancreatitis and related these findings to the presence of pancreatic necrosis. Nine patients had a severe attack with histologically confirmed pancreatic necrosis, seven a severe attack without confirmed necrosis, and six a mild attack, also without confirmed necrosis. A free fluid volume > 20 ml or free fluid colour > grade 5 on the Leeds chart, or both detected histologically confirmed pancreatic necrosis with a sensitivity of 100% and specificity of 31%. A total peritoneal fluid TAP concentration of > or = nmol detected histologically confirmed pancreatic necrosis with a sensitivity of 89% and specificity of 85%, figures comparable with contrast enhanced computed tomography. These findings suggest that the measurement of peritoneal fluid TAP concentrations can detect effectively histologically confirmed pancreatic necrosis and that such measurements may prove useful in the selection of patients for surgery.
Heath, D I; Wilson, C; Gudgeon, A M; Jehanli, A; Shenkin, A; Imrie, C W
We describe an interesting case of intramural duodenal hematoma in an otherwise healthy male who presented to emergency room with gradually progressive abdominal pain, nausea, and vomiting. This condition was missed on initial evaluation and patient was discharged from emergency room with diagnosis of acute gastritis. After 3 days, patient came back to emergency room and abdominal imaging studies were conducted which showed that patient had intramural duodenal hematoma associated with gastric outlet obstruction and pancreatitis. Hematoma was the cause of acute pancreatitis as pancreatic enzymes levels were normal at the time of first presentation, but later as the hematoma grew in size, it caused compression of pancreas and subsequent elevation of pancreatic enzymes. We experienced a case of pancreatitis which was caused by intramural duodenal hematoma. This case was missed on initial evaluation. We suggest that physicians should be more vigilant about this condition.
Goyal, Hemant; Singla, Umesh; Agrawal, Roli R.
To determine the role of magnesium deficiency in the pathogenesis of hypocalcemia in acute pancreatitis, we measured magnesium levels in serum and in peripheral blood mononuclear cells in 29 patients with acute pancreatitis, 14 of whom had hypocalcemia and 15 of whom had normal calcium levels. Only six patients had overt hypomagnesemia (serum magnesium less than 0.70 mmol per liter [1.7 mg per dl]). The mean serum magnesium concentration in hypocalcemic patients was not significantly lower than in normocalcemic patients, but the mononuclear cell magnesium content in hypocalcemic patients with pancreatitis was significantly lower than in normocalcemic patients with pancreatitis (P less than .01). The serum magnesium level did not correlate with that of serum calcium or the mononuclear cell magnesium content, but the latter did significantly correlate with the serum calcium concentration (r = .81, P less than .001). Most patients with hypocalcemia had a low intracellular magnesium content. Three normomagnesemic, hypocalcemic patients with alcoholic pancreatitis also underwent low-dose parenteral magnesium tolerance testing and showed increased retention of the magnesium load. We conclude that patients with acute pancreatitis and hypocalcemia commonly have magnesium deficiency despite normal serum magnesium concentrations. Magnesium deficiency may play a significant role in the pathogenesis of hypocalcemia in patients with acute pancreatitis.
Ryzen, E.; Rude, R. K.
Two children with acute lymphoblastic leukemia/lymphoma developed recurrent acute pancreatitis during treatment; the etiology was presumed to be secondary to 6-mercaptopurine (6MP). Both had no further attacks after discontinuation of 6MP. Acute pancreatitis secondary to 6MP is extremely rare in acute leukemia/lymphoma although it has been reported in patients with other conditions like inflammatory bowel disease; the reason for this difference is not clearly understood. PMID:23138114
Halalsheh, Hadeel; Bazzeh, Faiha; Alkayed, Khaldoun; Salami, Khadra; Madanat, Faris
ObjectiveTo report on the development and treatment of thrombotic microangiopathy, an atypical cause of acute renal failure in patients with acute pancreatitis.DesignCase reports.SettingA 21-bed medical intensive care unit at an university hospital.PatientsTwo men with acute pancreatitis presented with acute renal failure, neurological manifestations, haemolytic anaemia and thrombocytopenia. Both patients required intensive care.MeasurementsFragmented red cell count; levels of haptoglobin, amylase and
Alexandre Boyer; Karim Chadda; Amar Salah; Guy Bonmarchand
BACKGROUND AND AIMS:Computed tomography (CT), especially contrast-enhanced CT (CECT), provides important information on the severity and prognosis of acute pancreatitis (AP). Magnetic resonance imaging (MRI) has become a useful tool as an alternative to CT in the assessment of AP. The primary aim of our study was to determine the diagnostic value of nonenhanced MRI (NEMRI) to assess severity and
Davor Štimac; Damir Mileti?; Mladen Radi?; Irena Krznari?; Marzena Mazur-Grbac; Domagoj Perkovi?; Sandra Mili?; Vesna Golubovi?
Acute pancreatitis (AP) is a common clinical condition with an incidence of about 300 or more patients per million annually. About 10%-15% of patients will develop severe acute pancreatitis (SAP) and of those, 10%-30% may die due to SAP-associated complications. Despite the improvements done in the diagnosis and management of AP, the mortality rate has not significantly declined during the last decades. Toll-like receptors (TLRs) are pattern-recognition receptors that seem to play a major role in the development of numerous diseases, which make these molecules attractive as potential therapeutic targets. TLRs are involved in the development of the systemic inflammatory response syndrome, a potentially lethal complication in SAP. In the present review, we explore the current knowledge about the role of different TLRs that have been described associated with AP. The main candidate for targeting seems to be TLR4, which recognizes numerous damage-associated molecular patterns related to AP. TLR2 has also been linked with AP, but there are only limited studies that exclusively studied its role in AP. There is also data suggesting that TLR9 may play a role in AP.
Vaz, Juan; Akbarshahi, Hamid; Andersson, Roland
INTRODUCTION Gastrointestinal stromal tumours (GISTs) account for less than 3% of all gastrointestinal tract tumours and 5.7% of all sarcomas, and the majority of these tumours are gastric in origin. Patients commonly present with gastrointestinal bleeding or abdominal pain with 10–30% of patients presenting with symptoms of gastrointestinal obstruction. PRESENTATION OF A CASE We present a case of a 65-year-old gentleman who presented with symptomatic iron deficiency anaemia. Gastroscopy revealed a large submucosal lesion originating from the gastric fundus, consistent with a GIST. The patient developed acute epigastric pain, vomiting with raised inflammatory markers. A CT of the abdomen revealed the GIST to be causing gastric outlet obstruction as result of a prolapse of the tumour through the pylorus into the duodenum. This also resulted in compression of the distal common bile duct and was associated with the radiological appearance of acute pancreatitis. This responded to conservative management. The GIST was resected subsequently using a laparoscopic technique. DISCUSSION Only one similar case has previously been reported in the literature. Several surgical approached have been described in the management of gastric GISTs including open, laparoscopic, hand assisted, ultrasound assisted and a combined endoscopic and laparoscopic approach. A laparosopic ‘eversion’ techinque was preferred in our case due to the close proximity of the tumour to the gastro-oesophageal junction. CONCLUSION Pancreatitis secondary to a prolapsed gastric GIST is a rare entity. Laparoscopic wedge resection of these tumours can be safely performed with a satisfactory oncological outcome.
Jones, Owain; Monk, David; Balling, Trevor; Wright, Ann
AIM: To investigate the effect of emodin on pancreatic claudin-5 and occludin expression, and pancreatic paracellular permeability in acute pancreatitis (AP). METHODS: Experimental pancreatitis was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. Emodin was injected via the external jugular vein 0 or 6 h after induction of AP. Rats from sham operation and AP groups were injected with normal saline at the same time. Samples of pancreas were obtained 6 or 12 h after drug administration. Pancreatic morphology was examined with hematoxylin and eosin staining. Pancreatic edema was estimated by measuring tissue water content. Tumor necrosis factor (TNF)-? and interleukin (IL)-6 level were measured by enzyme-linked immunosorbent assay. Pancreatic paracellular permeability was assessed by tissue dye extravasation. Expression of pancreatic claudin-5 and occludin was examined by immunohistology, quantitative real-time reverse transcriptase polymerase chain reaction and western blotting. RESULTS: Pancreatic TNF-? and IL-6 levels, wet/dry ratio, dye extravasation, and histological score were significantly elevated at 3, 6 and 12 h following sodium taurocholate infusion; treatment with emodin prevented these changes at all time points. Immunostaining of claudin-5 and occludin was detected in rat pancreas, which was distributed in pancreatic acinar cells, ductal cells and vascular endothelial cells, respectively. Sodium taurocholate infusion significantly decreased pancreatic claudin-5 and occludin mRNA and protein levels at 3, 6 and 12 h, and that could be promoted by intravenous administration of emodin at all time points. CONCLUSION: These results demonstrate that emodin could promote pancreatic claudin-5 and occludin expression, and reduce pancreatic paracellular permeability.
Xia, Xian-Ming; Li, Bang-Ku; Xing, Shi-Mei; Ruan, Hai-Ling
The severe acute respiratory syndrome (SARS) is responsible for the first pandemic of the 21st century. Within months after its emergence in Guangdong Province in mainland China, it had affected more than 8000 patients and caused 774 deaths in 26 countries on five continents. It illustrated dramatically the potential of air travel and globalization for the dissemination of an emerging
Joseph S. M. Peiris; Kwok Y. Yuen; Albert D. M. E. Osterhaus; K. Stohr
Background\\/Aims: Polyamines are ubiquitous organic cations essential for cellular proliferation and tissue integrity. We have previously shown that pancreatic polyamine depletion in rats overexpressing the catabolic enzyme, spermidine\\/spermine N1-acetyltransferase (SSAT), results in the development of severe acute pancreatitis, and that therapeutic administration of metabolically stable ?-methylated polyamine analogs protects the animals from pancreatitis-associated mortality. Our aim was to elucidate the
M. T. Hyvönen; R. Sinervirta; T. A. Keinänen; T. Fashe; N. Grigorenko; A. R. Khomutov; J. Vepsäläinen; L. Alhonen
1. Functional alterations of the mononuclear phagocytic system (MPS) may be an important factor in the pathogenesis of infection in acute pancreatitis (AP). In the present study, MPS activity was investigated in rats and hepatic blood flow (HBF) was also determined. 2. A total of 122 male Wistar rats were divided into three groups: 1, AP group (N = 51); 2, sham-operated (SO) (N = 49); 3, intact group (IG) (N = 22). AP was induced by retrograde injection of 0.5 ml of 2.5% sodium taurocholate saline into the main biliopancreatic duct under ketamine chloride anesthesia. SO animals were submitted to the same surgical steps as AP animals except for AP induction. 3. Each experimental group was subdivided into two subgroups. The first subgroup was submitted to the study of MPS activity as follows: each group was injected with colloidal 198Au and liver clearance parameters were determined 2 h (N = 11), 12 h (N = 10) and 24 h (N = 10) later in the AP group, and 2 h (N = 9), 12 h (N = 10) and 24 h (N = 11) later in the SO group. In the second subgroup, HBF was assessed using 131I-bromosulphalein at 2 h (N = 10) and 24 h (N = 10) in the AP group and at 2 h (N = 10) and 24 h (N = 10) in the SO group. The IG was submitted to both radioactive tracer studies. Each animal was used for only one experiment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8257929
Abdo, E E; Gonçalez, Y; Machado, M C; Aguirre-Costa, P L; Gonçalez, F; Sampietri, S N; Pinotti, H W
Our purpose was to determine if cytokines are produced systemically during acute pancreatitis. Proinflammatory cytokines are elevated during acute pancreatitis and have been implicated in the progression of pancreatitis-associated multiple organ dysfunction. Whether these mediators are produced within all tissues or very few specific organs is not known. Edematous pancreatitis was induced in adult male mice by IP injection of
James G. Norman; Gregory W. Fink; Woody Denham; Jun Yang; Gay Carter; Cheryl Sexton; Julie Falkner; William R. Gower; Michael G. Franz
The most successful approach for restoring normal long-term glucose homeostasis in type I diabetes mellitus is whole-organ pancreas transplantation. Graft pancreatitis is observed in up to 20% of patients and may lead to loss of the transplanted organ. Several pathophysiological events have been implicated in this form of pancreatitis. The most important cause of early graft pancreatitis is ischemia\\/reperfusion (I\\/R)-related
Dirk Uhlmann; Heike Lauer; Frederik Serr; Helmut Witzigmann
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease that can affect most organs or systems. It most frequently involves the joints, skin, and the kidneys. It less commonly involves the central nervous system, heart, and lungs. Acute pancreatitis in SLE is rare. It is usually mild, occurring in association with more severe organ involvement elsewhere. A patient with newly diagnosed SLE is reported who developed acute fulminant pancreatitis unrelated to concomitant drug therapy and who eventually died of complications including a systemic fungal infection related to this.
Wolman, R; de Gara, C; Isenberg, D
Despite the lack of precise knowledge as to its exact mechanism of causation, acute pancreatitis continues to engage the clinician's attention. The world medical literature is replete with publications on the subject and the numerous Australian studies attest to the continuing clinical interest (Hennessy, 1965; Bennett and Jepson, 1966; Kune, 1968; Barraclough and Coupland, 1972; Battersby and Chapuis, 1977 and Reid and Kune, 1978). The majority of these reviews concentrate on the supposed aetiology and clinical features of acute pancreatitis and cover well trodden ground. It is the purpose of this paper to review the problems in the diagnosis and management of acute pancreatitis in the light of present knowledge and to relate these to 494 patients with acute pancreatitis admitted to St Vincent's Hospital, Melbourne, during the period 1968 to 1979. The diagnosis of acute pancreatitis in these 494 cases was made at operation, autopsy or by the demonstration of an elevation in the serum amylase above 1200 International units (I.U.) per litre in patients with compatible symptoms and signs. PMID:6167254
Paroulakis, M; Fischer, S; Vellar, I D; Mullany, C
Normal serum PAP levels on admission to the hospital in patiens with acute pancreatitis has been proposed to help select the\\u000a patients who are not going to develop complications. The aims of this study were, first, to assess the specificity of serum\\u000a pancreatitis - associated protein (PAP) serology test and second, to evalute the usefulness of the test for prediciting
Janja Polanec; Zlatko P Pavelic; Igor Krizman; Joe Osredkar
BACKGROUND:Much of the late morbidity and mortality of acute pancreatitis (AP) is attributed to complications of pancreatic necrosis (PNEC). Early diagnosis of PNEC in high-risk patients is critical to management. Hemoconcentration is one risk factor for PNEC, but additional risk factors are likely implicated.AIMS:(1) To evaluate a series of preselected clinical factors in a prospectively collected cohort with AP to
Georgios I. Papachristou; Dionysios J. Papachristou; Veronique D. Morinville; Adam Slivka; David C. Whitcomb
Summary Viable acinar cells were isolated from normal rat pancreas as well as from pancreata pretreatedin situ by a short-term ischemia without and with reperfusion, induction of a pancreatic juice edema, and acute pancreatitis (AP),\\u000a respectively. The isolated cells were incubated at 37 °C in an oxygenated Krebs-Henseleit bicarbonate buffer lacking any nutrient.\\u000a As an analogto in vivo acinar cell necrosis,
H.-U. Schulz; G. Letko; H. Spormann
The histological features of 24 pancreases obtained from patients who died of causes other than hepatitis, pancreatitis or pancreatic tumors, included a variable degree of autolysis, rare foci of inflammatory reaction but no hemorrhagic fat necrosis or destruction of elastic tissue in vessel walls (elastolysis). Assays of elastase in extracts of these pancreases showed no free enzyme, but varying amounts of proelastase. A review of autopsy findings in 33 patients with fatal liver necrosis attributed to halothane anesthesia, demonstrated changes of acute pancreatitis only in two. On the other hand, a review of 16 cases of fulminant viral hepatitis revealed changes characteristic of acute pancreatitis in seven – interstitial edema, hemorrhagic fat necrosis, inflammatory reaction and frequently elastolysis in vessel walls. Determination of elastase in extracts of one pancreas showed the bulk of the enzyme in free form. Furthermore, assays of urinary amylase in 44 patients with viral hepatitis showed increased levels of this enzyme (2583 ± 398 mean value ± standard error, Somogyi units per 100 ml in 13, or 29.5 percent). The evidence suggests that acute pancreatitis may at times complicate viral hepatitis. Although direct proof of viral pancreatic involvement is not feasible at present, a rational hypothesis is advanced which underlines similar mechanisms of tissue involvement in both liver and pancreas that may be brought about by the hepatitis viruses.
Geokas, Michael C.; Olsen, Harvey; Swanson, Virginia; Rinderknecht, Heinrich
AIM: To assess the clinical outcomes of pre-, pro- and synbiotics therapy in patients with acute pancreatitis. METHODS: The databases including Medline, Embase, the Cochrane Library, Web of Science and Chinese Biomedicine Database were searched for all relevant randomized controlled trials that studied the effects of pre-, pro- or synbiotics in patients with acute pancreatitis. Main outcome measures were postoperative infections, pancreatic infections, multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS), length of hospital stay, antibiotic therapy and mortality. RESULTS: Seven randomized studies with 559 acute pancreatic patients were included. Pre-, pro- or synbiotics treatment showed no influence on the incidence of postoperative infections [odds ratios (OR) 0.30, 95% confidence interval (CI): 0.09-1.02, P = 0.05], pancreatic infection (OR 0.50, 95% CI: 0.12-2.17, P = 0.36), MOF (OR 0.88, 95% CI: 0.35-2.21, P = 0.79) and SIRS (OR 0.78, 95% CI: 0.20-2.98, P = 0.71). There were also no significant differences in the length of antibiotic therapy (OR 0.75, 95% CI: 0.50-1.14, P = 0.18) and the mortality (OR 0.75, 95% CI: 0.25-2.24, P = 0.61). However, Pre-, pro- or synbiotics treatment was associated with a reduced length of hospital stay (OR -3.87, 95% CI: -6.20 to -1.54, P = 0.001). When stratifying for the severity of acute pancreatitis, the main results were similar. CONCLUSION: Pre-, pro- or synbiotics treatment shows no significant influence on patients with acute pancreatitis. There is a lack of evidence to support the use of probiotics/synbiotics in this area.
Zhang, Ming-Ming; Cheng, Jing-Qiu; Lu, Yan-Rong; Yi, Zhi-Hui; Yang, Ping; Wu, Xiao-Ting
Background. Endothelin peptides are polykines with strong vasoconstrictor properties. We have previously shown that endothelin antagonism (PD145065) reduces the local severity of acute pancreatitis. We now investigated the effect of endothelin antagonism on systemic inflammation in a model of acute hemorrhagic pancreatitis.Methods. Forty-two mice were divided into four groups. Group 1 was fed standard food plus PD145065 every 8 hours.
Karen E Todd; Michael P. N Lewis; Beat Gloor; Stanley W Ashley; Howard A Reber
Of 279 patients admitted to a specialist unit with acute pancreatitis, 210 were admitted directly and 69 were transferred for treatment of local or systemic complications. Outcome was assessed in terms of mortality and morbidity and in relation to aetiology, predicted severity of disease (modified Glasgow score), organ failure (modified Goris multiple organ failure score), and need for surgical intervention.
A C de Beaux; K R Palmer; D C Carter
BACKGROUND & AIMS: The treatment of patients with extensive pancreatic necrosis remains controversial; a subpopulation of patients with extensive acute pancreatic necrosis develop complex, organized collections. This study examined the feasibility of endoscopic drainage in patients with extensive organized pancreatic necrosis. METHODS: Eleven patients with organized pancreatic necrosis (8 sterile and 3 infected) after severe acute necrotizing pancreatitis underwent attempted
TH Baron; WG Thaggard; DE Morgan
Vancomycin-induced thrombocytopenia is a rare side effect of a commonly used drug that may cause life-threatening disease. A 51-year-old man was treated for an episode of acute severe alcohol-induced pancreatitis complicated by development of a peripancreatic fluid collection. He developed fever of unknown origin and was treated with intravenous vancomycin and piperacillin with tazobactam. On day 6 of vancomycin therapy his platelet count dropped to 46×10(9)/L (237×10(9)/L on day 1 of treatment) and by day 8 of therapy platelets had fallen to a nadir of 9×10(9)/L. The patient at this stage displayed a florid purpuric rash and haematoma formation on attempted intravenous cannulation. A clinical diagnosis of vancomycin-induced thrombocytopaenia was made and the drug withdrawn. After 3 days a significant improvement in the platelet count was noted, rising to 56?×?10(9)/L. Immunofluorescence testing (PIFT) ruled out teicoplanin and heparin as causes of drug-induced thrombocytopenia. PMID:24132444
Rowland, Simon P; Rankin, Iain; Sheth, Hemant
Background & Aims: Intercellular adhesion molecule 1 (ICAM-1) and neutrophils play important roles in many inflammatory processes, but their importance in both acute pancreatitis and pancreatitis-associated lung injury has not been defined. Methods: To address this issue, mice that do not express ICAM-1 were used and depleted of neutrophils by administration of antineutrophil serum. Pancreatitis was induced by administering either
Jean-Louis Frossard; Ashok Saluja; Lakshmi Bhagat; Hong Sik Lee; Madhav Bhatia; Bernd Hofbauer; Michael L. Steer
This work focuses on studying the early events associated with pancreatic damage after retrograde infusion through the pancreatic duct in rats. We have analyzed changes in calcium homeostasis and secretory response in pancreatic acini from rats with taurocholate-induced acute pancreatitis. Moreover, in order to test whether pancreatic duct manipulation can trigger damage inside pancreatic acinar cells, we have studied both parameters in acini from animals infused with saline. Our study demonstrates that taurocholate causes evident damage to acinar cells, impairing both calcium homeostasis and secretory response to CCK. In saline, a significant decrease in calcium cytosolic response to CCK was observed. Calcium disturbances similar to those observed in acute pancreatitis appear before secretion blockade and inflammation processes in saline treated rats. These results could be interesting since pancreatitis is associated to clinical procedures that require duct manipulation such as endoscopic retrograde cholangiopancreatography. PMID:18600455
García, Mónica; Barbáchano, Ernesto Hernández; Lorenzo, Pilar Hernández; San Román, José Ignacio; López, María A; Coveñas, Rafael; Calvo, José Julián
In acute severe asthma, the use of heliox can reduce dyspnea, when the patient is spontaneously breathing as well as in mechanical ventilation. This effect is due to a decrease in airway resistance. A better penetration of aerosolized bronchodilators has also been observed. However, the clinical benefit of these physiological measurable effects remains undetermined. Heliox could nevertheless be interesting in emergency situations in order to avoid endotracheal intubation, and in very difficult cases when mechanical ventilation is almost impossible to perform. This gas mixture could also be used with non-invasive mechanical ventilation, but this indication is presently investigated. PMID:18225843
Sridharan, Govind; Tassaux, Didier; Chevrolet, Jean-Claude
A case is reported of pancreatic ascites in a 14-year-old girl who had acute and chronic pancreatitis associated with pancreatic duct stones and a ruptured pancreatic duct. Abdominal erythema ab igne was considered to be an important physical sign of genuine severe abdominal pain. PMID:2144996
Mucklow, E S; Freeman, N V
The patient was a woman, aged 69, diagnosed with acute pancreatitis by a local physician; simultaneously, with US, a low-echo tumor was indicated in the pancreas' uncinate process. Diagnosis was made of acute pancreatitis resulting from a pancreatic IPMN, and the patient was referred. Ultrasound showed hypoechoic tumor images accompanied by posterior echo enhancement. With radiography-CT, from the pancreas parenchymal phase, the peripheral portion was densely stained, while internally, images showed densely stained dendriforms towards the equilibrium phase. With MRI T1-weighted images, there was appearance at low intensity, and with T2-weighted images, there was appearance at high intensity; with MRCP, there was depiction at relatively high intensity. In the final pathological diagnosis, there was prominent formation of mucinous nodules, and mucinous carcinoma including large quantity of mucous. PMID:19194098
Urata, Takahiro; Hifumi, Michio; Takekuma, Yoshi; Hijioka, Susumu; Gushima, Ryosuke; Hashigo, Syunpei; Nagaoka, Katsuya; Yoshinaga, Syuya; Kitada, Hideki; Kawaguchi, Tetsu; Yamanaga, Shigeyoshi; Yokomizo, Hiroshi
Introduction One of the most important requirements in treatment of acute necrotizing pancreatitis is minimized invasion. Aim We are presenting experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, comparing our results to other studies, evaluating feasibility and safety, discussing advantages and disadvantages of this method. Material and methods We performed a retrospective analysis of 13 patients who had acute necrotizing pancreatitis with large fluid collections in retroperitoneal space and underwent retroperitoneal necrosectomy. Results There were eight males and three females aged between 24 and 60 years, average age was 42.8 ±9.2 years. The most common cause of pancreatitis was alcohol, 10 patients (76.9%). Average time between diagnosis and performance of operation was 25.7 ±11.3 days. One patient underwent eight repeated interventions: two retroperitoneal necrosectomies; five laparotomies; ultrasound-guided drainage. One patient underwent four reinterventions: lumbotomy; revision; two lavages. Three patients had two reinterventions: one had laparotomy and tamponation; one had two repeated retroperitoneal necrosectomies; third had one repeated retroperitoneal necrosectomy and one had ultrasound-guided drainage. Three patients needed one additional retroperitoneal necrosectomy. Five patients did not required additional interventions. 61.5% of our patients did not require more than one reintervention. Postoperative stay varied from 9 to 94 days, average 50.8 ±32.6 days. Conclusions Minimally invasive techniques should be considered as first-choice surgical option in treating patients with acute necrotizing pancreatitis. Pancreatic necrosis occupying less than 30% and with massive fluid collections in the left retroperitoneal space can be safely managed by minimally invasive retroperitoneal necrosectomy.
Beisa, Virgilijus; Beisa, Augustas; Samuilis, Arturas; Serpytis, Mindaugas; Strupas, Kestutis
Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded
Paul Georg Lankisch; Markus M. Lerch
Between 1968 and 1979 650 patients in the Bristol clinical area suffered 737 attacks of acute pancreatitis. Sex distribution was approximately equal and mean age was 60 years. Comparison with the previous decade shows an increase in mean annual incidence of first attacks from 53.8 to 73.0 cases per million population. Case mortality was unchanged at 20%. In no less
A P Corfield; M J Cooper; R C Williamson
Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease. The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups. Two categories of pancreatic enhancement were found: "low enhancement" and "high enhancement." In all 10 patients with "low-enhancement" values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with "high-enhancement" values conservative treatment was continued, and the clinical course was nonfulminant in all of them. PMID:6724235
Kivisaari, L; Somer, K; Standertskjöld-Nordenstam, C G; Schröder, T; Kivilaakso, E; Lempinen, M
Background\\/Aims: Acute pancreatitis (AP) is characterized by premature zymogen activation, systemic inflammatory response resulting in inflammatory infiltrates, sustained intracellular calcium, neurogenic inflammation and pain. The inhibitory neurotransmitter and cytoprotective amino acid glycine exerts a direct inhibitory effect on inflammatory cells, inhibits calcium influx and neuronal activation and therefore represents a putative therapeutic agent in AP. Methods: To explore the impact
G. O. Ceyhan; A.-K. Timm; F. Bergmann; A. Günther; A. A. Aghdassi; I. E. Demir; J. Mayerle; M. Kern; M. M. Lerch; M. W. Büchler; H. Friess; P. Schemmer
Severe acute malnutrition (SAM) affects approximately 13?million children under the age of 5 and is associated with 1–2?million preventable child deaths each year. In most developing countries, case fatality rates (CFRs) in hospitals treating SAM remain at 20–30% and few of those requiring care actually access treatment. Recently, community?based therapeutic care (CTC) programmes treating most cases of SAM solely as outpatients have dramatically reduced CFRs and increased the numbers receiving care. CTC uses ready?to?use therapeutic foods and aims to increase access to services, promoting early presentation and compliance, thereby increasing coverage and recovery rates. Initial data indicate that this combination of centre?based and community?based care is cost effective and should be integrated into mainstream child survival programmes.
Mediterranean spotted fever (MSF) is an infectious disease, caused by Rickettsia conorii. It can have a serious course, even deadly, with many types of complications. Described is a case of a 70-year-old man, hospitalized for fever, abdominal pain, amylase and lipase elevation, and ultrasound hypoechoic pancreas. The working diagnosis at admission was acute pancreatitis. 2 days after admission, the patient developed signs of MSF: fever, maculopapular rash, and "tache noire". Treatment with oral doxycycline was started. After 5 days of therapy, there was complete remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with Mediterranean spotted fever. Much more rare is pancreatic involvement. PMID:21563660
Acute pancreatitis is a potentially fatal disease with no known cure. The initial events in acute pancreatitis may occur within the acinar cells. We examined the effect of sesamol on (i) a cerulein-induced pancreatic acinar cancer cell line, AR42J, and (ii) cerulein-induced experimental acute pancreatitis in rats. Sesamol inhibited amylase activity and increased cell survival. It also inhibited medium lipid peroxidation and 8-hydroxydeoxyguanosine in AR42J cells compared with the cerulein-alone groups. In addition, in cerulein-treated rats, sesamol inhibited serum amylase and lipase levels, pancreatic edema, and lipid peroxidation, but it increased pancreatic glutathione and nitric oxide levels. Thus, we hypothesize that sesamol attenuates cerulein-induced experimental acute pancreatitis by inhibiting the pancreatic acinar cell death associated with oxidative stress in rats. PMID:22076497
Chu, P-Y; Srinivasan, P; Deng, J-F; Liu, M-Y
The role of pancreatic acinar cells in initiating necro-inflammatory responses during the early onset of alcoholic acute pancreatitis (AP) has not been fully evaluated. We investigated the ability of acinar cells to generate pro- and anti-inflammatory mediators, including inflammasome-associated IL-18/caspase-1, and evaluated acinar cell necrosis in an animal model of AP and human samples. Rats were fed either an ethanol-containing or control diet for 14 weeks and killed 3 or 24?h after a single lipopolysaccharide (LPS) injection. Inflammasome components and necro-inflammation were evaluated in acinar cells by immunofluorescence (IF), histology, and biochemical approaches. Alcohol exposure enhanced acinar cell-specific production of TNF?, IL-6, MCP-1 and IL-10, as early as 3?h after LPS, whereas IL-18 and caspase-1 were evident 24?h later. Alcohol enhanced LPS-induced TNF? expression, whereas blockade of LPS signaling diminished TNF? production in vitro, indicating that the response of pancreatic acinar cells to LPS is similar to that of immune cells. Similar results were observed from acinar cells in samples from patients with acute/recurrent pancreatitis. Although morphologic examination of sub-clinical AP showed no visible signs of necrosis, early loss of pancreatic HMGB1 and increased systemic levels of HMGB1 and LDH were observed, indicating that this strong systemic inflammatory response is associated with little pancreatic necrosis. These results suggest that TLR-4-positive acinar cells respond to LPS by activating the inflammasome and producing pro- and anti-inflammatory mediators during the development of mild, sub-clinical AP, and that these effects are exacerbated by alcohol injury. PMID:24091659
Gu, H; Werner, J; Bergmann, F; Whitcomb, D C; Büchler, M W; Fortunato, F
Background—Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis.Aims—To
B Rau; G Steinbach; F Gansauge; J M Mayer; A Grünert; H G Beger
Pancreatic acinar cells are secretory cells whose main function is to synthesize, store and finally release digestive enzymes into the duodenum. However, in response to noxious stimuli, acinar cells behave like real inflammatory cells because of their ability to activate signalling transduction pathways involved in the expression of inflammatory mediators. Mediated by the kinase cascade, activation of Nuclear factor-?B, Activating factor-1 and Signal transducers and activators of transcription transcription factors has been demonstrated in acinar cells, resulting in overexpression of inflammatory genes. In turn, kinase activity is down-regulated by protein phosphatases and the final balance between kinase and phosphatase activity will determine the capability of the acinar cells to produce inflammatory factors. The kinase/phosphatase pair is a redox-sensitive system in which kinase activation overwhelms phosphatase activity under oxidant conditions. Thus, the oxidative stress developed within acinar cells at early stages of acute pancreatitis triggers the activation of signalling pathways involved in the up-regulation of cytokines, chemokines and adhesion molecules. In this way, acinar cells trigger the release of the first inflammatory signals which can mediate the activation and recruitment of circulating inflammatory cells into the injured pancreas. Accordingly, the role of acinar cells as promoters of the inflammatory response in acute pancreatitis may be considered. This concept leads to amplifying the focus from leukocyte to acinar cells themselves, to explain the local inflammation in early pancreatitis.
Dios, Isabel De
Proinflammatory cytokines, such as tumour necrosis factor ? (TNF?), play fundamental roles in the pathogenesis of acute pancreatitis (AP). The aim of this study was to determine if polymorphisms in the TNF? gene are associated with AP. Two polymorphisms located in the promoter region (positions ?308 and ?238) in TNF? gene were determined using polymerase chain reaction- (PCR-) restriction fragment length polymorphism (RFLP) methods in 103 patients with AP and 92 healthy controls. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression analysis adjusted for age, sex, BMI and smoking. The frequencies of TNF? polymorphisms were both similar in patients with mild or severe pancreatitis, so were in pancreatitis patients and in controls. We suggest that both SNPs of TNF? are not genetic risk factor for AP susceptibility (OR = 1.63; 95% CI: 1.13?4.01 for TNF??308 and OR = 0.86; 95% CI: 0.75?1.77 for TNF??238).
Ozhan, Gul; Yanar, Hakan T.; Ertekin, Cemalettin; Alpertunga, Buket
Proinflammatory cytokines, such as tumour necrosis factor alpha (TNFalpha), play fundamental roles in the pathogenesis of acute pancreatitis (AP). The aim of this study was to determine if polymorphisms in the TNFalpha gene are associated with AP. Two polymorphisms located in the promoter region (positions -308 and -238) in TNFalpha gene were determined using polymerase chain reaction- (PCR-) restriction fragment length polymorphism (RFLP) methods in 103 patients with AP and 92 healthy controls. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression analysis adjusted for age, sex, BMI and smoking. The frequencies of TNFalpha polymorphisms were both similar in patients with mild or severe pancreatitis, so were in pancreatitis patients and in controls. We suggest that both SNPs of TNFalpha are not genetic risk factor for AP susceptibility (OR = 1.63; 95% CI: 1.13-4.01 for TNFalpha(-308) and OR = 0.86; 95% CI: 0.75-1.77 for TNFalpha(-238)). PMID:20396411
Ozhan, Gül; Yanar, Hakan T; Ertekin, Cemalettin; Alpertunga, Buket
Between 1968 and 1979 650 patients in the Bristol clinical area suffered 737 attacks of acute pancreatitis. Sex distribution was approximately equal and mean age was 60 years. Comparison with the previous decade shows an increase in mean annual incidence of first attacks from 53.8 to 73.0 cases per million population. Case mortality was unchanged at 20%. In no less than 35% of fatal cases the diagnosis was first made at necropsy. Gall stones were detected in 50% of first attacks, predominantly in women. The proportion of alcoholics (8% overall) increased three-fold during the period of the study. In 23% of cases no aetiological cause was identified. Eighty patients suffered 99 recurrent attacks of acute pancreatitis, with a mortality rate (12%) that was not significantly lower than that of the first attack. Neglected gall stones accounted for 51% of these subsequent attacks.
Corfield, A P; Cooper, M J; Williamson, R C
Taeniasis is a helminthic infection endemic in southeast Asia, including Taiwan. Recent studies suggest that Asian Taenia is a new subspecies of Taenia saginata and has been renamed as Taenia saginata asiatica. It is usually asymptomatic or associated with only mild gastrointestinal symptoms. We report the case of a 52-year-old woman with acute epigastric pain and vomiting. Her levels of amylase and lipase were significantly elevated on admission. Gastrointestinal endoscopy showed proglottids of a tapeworm in the papilla of the duodenum. The epigastric pain subsided and the amylase and lipase levels decreased after removal of the tapeworm by endoscopy and anthelminthic treatment. Although parasites are not an uncommon cause of pancreatitis, especially in disease-endemic areas, it is rare for Taenia to cause acute pancreatitis. PMID:16103608
Liu, Yu-Min; Bair, Ming-Jong; Chang, Wen-Hsiung; Lin, Shee-Chan; Chan, Yu-Jan
Substance P, acting via the neurokinin 1 receptor (NK1R), plays an important role in mediating a variety of inflammatory processes. However, its role in acute pancreatitis has not been previously described. We have found that, in normal mice, substance P levels in the pancreas and pancreatic acinar cell expression of NK1R are both increased during secretagogue-induced experimental pancreatitis. To evaluate
Madhav Bhatia; Ashok K. Saluja; Bernd Hofbauer; Jean-Louis Frossard; Hong Sik Lee; Ignazio Castagliuolo; Chi-Chung Wang; Norma Gerard; Charalabos Pothoulakis; Michael L. Steer
Pancreatic acinar cells express proteinase-activated receptor-2 (PAR2) that is activated by trypsin-like serine proteases and has been shown to exert model-specific effects on the severity of experimental pancreatitis, i.e., PAR2(-/-) mice are protected from experimental acute biliary pancreatitis but develop more severe secretagogue-induced pancreatitis. P2pal-18S is a novel pepducin lipopeptide that targets and inhibits PAR2. In studies monitoring PAR2-stimulated intracellular Ca(2+) concentration changes, we show that P2pal-18S is a full PAR2 inhibitor in acinar cells. Our in vivo studies show that P2pal-18S significantly reduces the severity of experimental biliary pancreatitis induced by retrograde intraductal bile acid infusion, which mimics injury induced by endoscopic retrograde cholangiopancreatography (ERCP). This reduction in pancreatitis severity is observed when the pepducin is given before or 2 h after bile acid infusion but not when it is given 5 h after bile acid infusion. Conversely, P2pal-18S increases the severity of secretagogue-induced pancreatitis. In vitro studies indicate that P2pal-18S protects acinar cells against bile acid-induced injury/death, but it does not alter bile acid-induced intracellular zymogen activation. These studies are the first to report the effects of an effective PAR2 pharmacological inhibitor on pancreatic acinar cells and on the severity of experimental pancreatitis. They raise the possibility that a pepducin such as P2pal-18S might prove useful in the clinical management of patients at risk for developing severe biliary pancreatitis such as occurs following ERCP. PMID:23275617
Michael, E S; Kuliopulos, A; Covic, L; Steer, M L; Perides, G
Pancreatitis is not one disease but several and perhaps many. Diagnosis is imperfect in all forms and the usual lack of histologic\\u000a material has hampered attempts to understand the pathogenesis and possible interrelationships of the different forms of pancreatic\\u000a inflammation. Acute pancreatitis does not as a rule evolve into chronic pancreatitis, even after multiple recurrences. Recurrent\\u000a acute attacks can be
Andrew L. Warshaw
We report a case of typhoid rhabdomyolysis with acute renal failure and acute pancreatitis in a 23-year-old Vietnamese male who was admitted to the intensive care unit with a 15-day history of fever followed by severe abdominal pain. On examination, the patient was febrile and his abdomen was diffusely tender. Serum creatinine was 533 micromol/L, pancreatic amylase 1800 U/L and lipase 900 U/L; the myoglobin blood level was high, which is associated with significant myoglobinuria. Blood, urine and stool culture yielded Salmonella enterica serovar typhi, which was sensitive to ceftriaxon, ampicillin and ciprofloxacin. Ceftriaxon was initiated for a total of 14 days. Subsequently, the patient maintained a good urine output with improved renal parameters and accordingly was discharged. In this report, we review the literature and discuss the pathogenesis of the disease thoroughly. PMID:19147385
Khan, Fahmi Yousef; Al-Ani, Ahmed; Ali, Hamda Abdulla
BACKGROUND: Placement of prophylactic pancreatic stents (PPS) is a method proven to reduce the rate and severity of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; however, PPS do not eliminate the risk completely. Early PPS dislodgement may occur prematurely and contribute to more frequent or severe PEP. OBJECTIVE: To determine the effect of early dislodgement of PPS in patients with moderate or severe PEP. METHOD: A total of 27,176 ERCP procedures from January 1994 to September 2007 for PPS placement in high-risk patients were analyzed. Patient and procedure data were analyzed to assess risk factors for PEP, and to evaluate the severity of pancreatitis, length of hospitalization and subsequent complications. Timing of stent dislodgment was assessed radiographically. RESULTS: PPS were placed in 7661 patients. Of these, 580 patients (7.5%) developed PEP, which was graded as mild in 460 (6.0%), moderate in 87 (1.1%) and severe in 33 (0.4%). Risk factors for developing PEP were not different in patients who developed moderate PEP compared with those with severe PEP. PPS dislodged before 72 h in seven of 59 (11.9%) patients with moderate PEP and five of 27 (18.5%) patients with severe PEP (P=0.505). The mean (± SD) length of hospitalization in patients with moderate PEP with stent dislodgement before and after 72 h were 7.43±1.46 days and 8.37±1.16 days, respectively (P=0.20). The mean length of hospitalization in patients with severe PEP whose stent dislodged before and after 72 h were 21.6±6.11 and 22.23±3.13 days, respectively (P=0.96). CONCLUSION: Early PPS dislodgement was associated with moderate and severe PEP in less than 20% of cases and was not associated with a more severe course. Factors other than ductal obstruction contribute to PEP in high-risk patients undergoing ERCP and PPS placement.
Moffatt, Dana C; Kongkam, Pradermchai; Avula, Haritha; Sherman, Stuart; Fogel, Evan L; Lehman, Glen A
In an attempt to decrease the infectious complications of acute pancreatitis and its high mortality, many investigators have\\u000a conducted randomized prospective trials on the efficacy of prophylactic antibiotics. The results of these studies are conflicting,\\u000a and many have called for a large multicenter study. Because multicenter trials are costly and difficult to organize, we believe\\u000a that meta-analysis is a reasonable
Robert Golub; Faizi Siddiqi; Dieter Pohl
Background: Interleukin-18 (IL-18) production is the main mechanism of hepatic injury in several animal models via further gamma interferon (IFN-?) release. IL-18 also functions as an inducer of proinflammatory cytokines as TNF-?, which are also shown to induce organ injuries in many severe inflammatory conditions. To clarify the mechanism of hepatic injury developed in acute pancreatitis, plasma concentrations of IL-18
Muneyuki Shibata; Masahiko Hirota; Kotaro Inoue; Michio Ogawa
Treatment with asparaginase for acute lymphoblastic leukemia (ALL) can cause acute pancreatitis. Complication of pancreatitis by pancreatic pseudocyst formation can prolong the hospital stay, delay chemotherapy, and necessitate long-term parenteral nutrition. We report five children with ALL who developed acute pancreatitis complicated by pancreatic pseudocysts. They required modifications to their chemotherapy regimen and prolonged parenteral nutrition but no surgical intervention. All five patients survive in first remission and their pseudocysts resolved after 3 to 37 months or continued to decrease in size at last follow-up. These cases illustrate that non-surgical management of pancreatic pseudocyst is safe, though pseudocyst resolution may require many months. In addition, these patients demonstrate that oral feeding can be initiated after the acute episode of pancreatitis resolves even if a pseudocyst is present.
Spraker, Holly L.; Spyridis, Georgios P.; Pui, Ching-Hon; Howard, Scott C.
Neural cross talk between visceral organs may play a role in mediating inflammation and pain remote from the site of the insult. We hypothesized such a cross talk exists between the duodenum and pancreas, and further it induces pancreatitis in response to intraduodenal toxins. A dichotomous spinal innervation serving both the duodenum and pancreas was examined, and splanchnic nerve responses to mechanical stimulation of these organs were detected. This pathway was then excited on the duodenal side by exposure to ethanol followed by luminal mustard oil to activate transient receptor potential subfamily A, member 1 (TRPA1). Ninety minutes later, pancreatic inflammation was examined. Ablation of duodenal afferents by resiniferatoxin (RTX) or blocking TRPA1 by Chembridge (CHEM)-5861528 was used to further investigate the duodeno-pancreatic neural reflex via TRPA1. ~40% of dorsal root ganglia (DRG) from the spinal cord originated from both duodenum and pancreas via dichotomous peripheral branches; ~50% splanchnic nerve single units responded to mechanical stimulation of both organs. Ethanol sensitized TRPA1 currents in cultured DRG neurons. Pancreatic edema and myeloperoxidase activity significantly increased after intraduodenal ethanol followed by mustard oil (but not capsaicin) but significantly decreased after ablation of duodenal afferents by using RTX or blocking TRPA1 by CHEM-5861528. We found the existence of a neural cross talk between the duodenum and pancreas that can promote acute pancreatitis in response to intraduodenal chemicals. It also proves a previously unexamined mechanism by which alcohol can induce pancreatitis, which is novel both in terms of the site (duodenum), process (neurogenic), and receptor (TRPA1). PMID:23306082
Li, Cuiping; Zhu, Yaohui; Shenoy, Mohan; Pai, Reetesh; Liu, Liansheng; Pasricha, Pankaj Jay
Infusion of supramaximal doses of cerulein induces acute edematous pancreatitis in the rat. Cannulation of the main pancreatic duct does not prevent the formation of the edema but reveals an almost complete reduction of pancreatic flow. Using freeze-fracture techniques and thin-section electron microscopy, earliest structural alterations were observed at membranes of zymogen granules and the plasma membrane. Fusion of zymogen
Guido Adler; Gerhard Rohr; Horst F. Kern
This study indicates that a single injection of platelet activating factor (PAF, 50-500 ng) into the superior pancreaticoduodenal artery of rabbits induces dose-dependent morphologic alterations of pancreatic tissue and increases serum amylase levels, both consistent with the development of an acute pancreatitis. The main histologic findings observed by light microscopy 24-72 hours after the injection of PAF were edema, polymorphonuclear neutrophil infiltration, cell vacuolization, and acinar cell necrosis. Fat cell necrosis was present in 30% of animals. By electron microscopy an increase of the number of zymogen granules in the apical region of acinar cells was observed 3 hours after PAF challenge. At 24-72 hours, many acinar cells showed vacuoles containing myelinlike figures, zymogen granules, and cellular debris. Pancreatic lesions developed in the area supplied by the artery injected with PAF and they were completely antagonized by the pretreatment of rabbits with CV 3988, a specific antagonist of PAF. In addition, the significant protective effect of atropine suggests a potential role for cholinergic mechanisms in the pancreatic alterations induced by PAF. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5
Emanuelli, G.; Montrucchio, G.; Gaia, E.; Dughera, L.; Corvetti, G.; Gubetta, L.
Under the imbalance between generation of reactive oxygen species and inadequate antioxi- dant defense systems, oxidative stress can cause cell damage either directly or indirectly through altering signaling pathways. It is the etiopatho- genisis and also the consequence of many dis- eases. Oxidative injury plays an important role not only in the pathogenesis of acute pancreati- tis (AP) but also
Yan-Hong Wang; Zhi-Jie Feng; Xiao Hao
Recent studies have indicated that pre-induction of heat shock protein 70 (HSP70) expression in the pancreas protects against secretagogue-induced pancreatitis. In those studies, the HSP70 was mostly induced by unfeasible conditions. The aim of this current study was to investigate the effect of peritoneal lavage with hot 0.9 % saline (42 °C) on the pancreatic expression of HSP70 and its protective effect on cerulein-induced acute pancreatitis in rats. Male Wistar rats were peritoneally lavaged with 0.9 % saline at 42 °C for 30 min. HSP70 expression was evaluated by western blotting analysis. Prior peritoneal lavages with hot and warm saline were performed. Acute pancreatitis was induced by administration of intraperitoneal injection of cerulein (20 ?g/kg) four times, and its severity was assessed by measuring serum amylase, tumor necrosis factor-alpha (TNF-?), interleukin-6 (IL-6), and trypsinogen activation peptide (TAP) levels. Pancreatic sections were stained with hematoxylin and eosin for histological evaluation. Peritoneal lavage with hot 0.9 % saline increased intrapancreatic HSP70 expression and ameliorated the cerulein-induced pancreatitis in rats, judged by the significantly reduced serum amylase, TNF-?, and IL-6 concentrations; histopathological scores, and serum TAP levels. Peritoneal lavage with hot 0.9 % saline can induce HSP70 expression and prevent cerulein-induced acute pancreatitis in rats. The results suggest that HSP70 protects against cerulein-induced pancreatitis by preventing proinflammatory cytokine synthesis and trypsinogen activation during acute pancreatitis. PMID:23096089
Meng, Ke; Liu, Qingsen; Dou, Yan; Huang, Qiyang
Summary Severe hemorrhage from pancreatic pseudocysts is a rare condition that poses a diagnostic and therapeutic challenge.\\u000a \\u000a Two cases of preoperative intracystic bleeding and massive postoperative gastrointestinal hemorrhage observed during the last\\u000a year form the basis of the present report.\\u000a \\u000a \\u000a \\u000a In the first patient, transcystic suture ligation of the bleeding vessel was necessary to control this life-threatening and\\u000a dramatic condition—External drainage
Giulio Belli; Giovanni Romano; Vincenzo D’Alessandro; Mario Luigi Santangelo
Objectives To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998. Design Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates.
Michael J Goldacre; Stephen E Roberts
The catalytic activity of type II phospholipase A2 (PLA2) in blood has been reported to increase in acute pancreatitis and to reflect the severity of pancreatitis. In this study, we evaluated the effects of a new inhibitor of type II PLA2, S5920/LY315920Na, on trypsin-taurocholate-induced pancreatitis in rats. Hemorrhagic pancreatitis was induced by an infusion of a mixture of trypsin and taurocholate into the pancreatic duct. S5920/LY315920Na was administered subcutaneously at 0 h and 3 h after the induction of pancreatitis. Survival rates for 24 h in rats treated with 0.1 and 1 mg/kg of S5920/LY315920Na were significantly higher than that in untreated rats (71 and 86% vs. 14%). Serum levels of amylase and lipase in rats treated with 1 mg/kg of S5920/LY315920Na were significantly lower than those in untreated rats (amylase, 6,903 vs. 32,516 U/L; and lipase, 514 vs. 6,710 U/L) at the time of death or 24 h after the induction of pancreatitis. Plasma levels of S5920/LY315920Na were enough to inhibit catalytic activity of PLA2 in plasma for 9 h. A new inhibitor of type II PLA2, S5920/LY315920Na, inhibited catalytic activity of PLA2 and improved the survival rate in experimental hemorrhagic pancreatitis in rats. PMID:10438167
Yoshikawa, T; Naruse, S; Kitagawa, M; Ishiguro, H; Nakae, Y; Ono, T; Hayakawa, T
Objective To analyze the involvement of connective tissue growth factor (CTGF) in the transforming growth factor-? (TGF-?) pathway during acute necrotizing pancreatitis (ANP) in humans and rats. Summary Background Data Connective tissue growth factor is involved in several fibrotic diseases and has a critical role in fibrogenesis and tissue remodeling after injury. Methods Normal human pancreas tissue samples were obtained through an organ donor program from five individuals without a history of pancreatic disease. Human ANP tissues were obtained from eight persons undergoing surgery for this disease. In rats, ANP was induced by intraductal infusion of taurocholate. The expression of CTGF was studied by Northern blot analysis, in situ hybridization, and immunohistochemistry in both human and rat pancreatic tissue samples. Results Northern blot analysis revealed enhanced CTGF mRNA expression in human ANP tissue samples compared with normal controls. In addition, a concomitant increase in TGF-?1 was present. By in situ hybridization, CTGF mRNA was localized in the remaining acinar and ductal cells and in fibroblasts. In regions of intense damage adjacent to areas of necrosis, CTGF mRNA signals were most intense. Inflammatory cells were devoid of any CTGF mRNA signals. By immunohistochemistry, CTGF protein was localized at high levels in the same cell types as CTGF mRNA. In ANP in rats, concomitantly enhanced mRNA levels of CTGF, TGF-?1, and collagen type 1 were present, with a biphasic peak pattern on days 2 to 3 and day 7 after induction of ANP. Conclusions These data indicate that CTGF participates in tissue remodeling in ANP. The expression of CTGF predominantly in the remaining acinar and ductal cells indicates that extracellular matrix synthesis after necrosis is at least partly regulated by the remaining pancreatic parenchyma and only to a minor extent by inflammatory cells. Blockage of CTGF, a downstream mediator of TGF-? in fibrogenesis, might be useful as a target to influence and reduce fibrogenesis in this disorder.
di Mola, Fabio F.; Friess, Helmut; Riesle, Erick; Koliopanos, Alexander; Buchler, Peter; Zhu, Zhaowen; Brigstock, David R.; Korc, Murray; Buchler, Markus W.
We sought to determine if necrosectomy can be omitted for complicated acute necrotizing pancreatitis (ANP). Since 1996, we prospectively performed retroperitoneal drainage by introducing a sump drain to the pancreatic head area via a small left flank incision without debridement and irrigation on 19 consecutive complicated ANP patients. We purposely delayed surgery until liquefaction of retroperitoneal tissue reached the left
Yu-Chung Chang; Hong-Min Tsai; Xi-Zhang Lin; Chia-Hao Chang; Jen Pin Chuang
Bacterial translocation is an important source of pancreas infection in acute pancreatitis. The effect of platelet-activating\\u000a factor (PAF) in the pathogenesis of acute pancreatitis has been proved in various studies. The aim of this study was to determine\\u000a whether potent PAF antagonists influence bacterial translocation in acute pancreatitis. Acute pancreatitis was induced in\\u000a 62 Wistar rats by injection of 2.5%
Lourenilson José de Souza; Sandra Nassa Sampietre; Rosenilda Salvador Assis; Charles H. Knowles; Kátia Ramos Leite; Sonia Jancar; José Eduardo Monteiro Cunha; Marcel Cerqueira Cesar Machado
The case is described of a 32-year-old man suffering from alcoholism who came to the Emergency Unit with vomiting, fever, and sharp epigastric pain irradiating to the chest and upper abdomen. A diagnosis of acute pancreatitis was made after high amylase and lipase levels were observed and the results of computed tomography scan revealed images typical of acute pancreatitis. Findings
S. M. A. Campo; V. Gasparri; G. Catarinelli; M. Sepe
Respiratory complications of acute pancreatitis are well recognised and are closely related to a poor prognosis. Using an experimental model in the rat, a decrease in lung compliance and an increase in lung weight were produced in acute pancreatitis. The effects of dexamethasone, heparin, and aspirin on these changes were studied. The mean specific lung compliance was reduced by 16%
A R Berry; T V Taylor
Summary Acute pancreatitis by closed duodenal loop in two groups of rats, with or without biliary diversion, was induced to ascertain any role that bile might have in codetermining and influencing the disease. Both the histological findings and the serum amylase levels showed the presence of mild acute pancreatitis in both groups. The histological and\\/or biochemical findings and the survival
A. Infantino; G. Dodi; C. Fabris; S. Munaretto; P. Pregnolato; D. Basso; A. Fassina; G. DelFavero; A. Piccoli; M. Zaninotto; M. Lise; R. Naccarato I
The possible beneficial effect of reduced glutathione infusion on acute reflux pancreatitis was investigated in five groups of rats (8 each). In groups A, A’ and B, B’ acute pancreatitis was induced by means of a closed duodenal loop; group C was sham operated. In groups B and B’ reduced glutathione was infused at a flow rate of 0.2 ml\\/h
Daniela Basso; Maria Piera Panozzo; Carlo Fabris; Aldo Infantino; Mario Plebani; Donatello Olivato; Ambrogio Fassina; Giuseppe Del Favero
Acute pancreatitis is a sudden inflammation of the pancreas that may be life threatening disease with high mortality rates; particularly in presence of systemic inflammatory response and multiple organ failure despite of the conventional antibiotic and symptomatic treatment. Oxidative stress has been shown to be involved in the pathophysiology of acute pancreatitis. This study was designed to investigate the possible
Amany A. Abdin; Mohammed A. Abd El-Hamid; Samia H. Abou El-Seoud; Mohammed F. H. Balaha
Objective To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. Data sources Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. Study selection Randomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as
Paul E Marik; Gary P Zaloga
Background Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages. Methods and Findings We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference ?2.18; 95%CI ?3.48?(?0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05). Conclusion Enteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.
Chen, Guang-Cheng; Yuan, Yu-Hong; Zhong, Wa; Zhao, Li-Na; Chen, Qi-Kui
Tumor necrosis factor-alpha (TNF?) is postulated to be a mediator of the systemic complications associated with acute pancreatitis. Neutralization of TNF? with monoclonal antibody ameliorates the morbidity and mortality associated with acute pancreatitis in a rat model. Although high levels of TNF? are measurable in peripheral blood in acute pancreatitis, specific sites of TNF? production in this disease have not
Christopher B. Hughes; James Henry; Malak Kotb; Andrew Lobaschevsky; Omaima Sabek; A. Osama Gaber
The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy. After a month of treatment of acute pancreatitis, the clinical picture improved, the patient's vision sharpness improved and the laboratory parametres returned to normal. The finding on the ocular fundus also improved. Even though similar cases are rare, more patients with acute pancreatitis should be checked for eventual vision disorders. Ocular fundus examination should be included in the set of tests performed for acute pancreatitis, similarly to the practice in arterial hypertension or diabetes mellitus patients. PMID:18522297
Krahulec, B; Stefanicková, J; Hlinst'áková, S; Hirnerová, E; Kosmálová, V; Hasa, J; Pesko, K; Strmen, P; Dukát, A
The endocannabinoid system has been shown to mediate beneficial effects on gastrointestinal inflammation via cannabinoid receptors 1 (CB(1)) and 2 (CB(2)). These receptors have also been reported to activate the MAP kinases p38 and c-Jun NH(2)-terminal kinase (JNK), which are involved in early acinar events leading to acute pancreatitis and induction of proinflammatory cytokines. Our aim was to examine the role of cannabinoid receptor activation in an experimental model of acute pancreatitis and the potential involvement of MAP kinases. Cerulein pancreatitis was induced in wild-type, CB(1)-/-, and MK2-/- mice pretreated with selective cannabinoid receptor agonists or antagonists. Severity of pancreatitis was determined by serum amylase and IL-6 levels, intracellular activation of pancreatic trypsinogen, lung myeloperoxidase activity, pancreatic edema, and histological examinations. Pancreatic lysates were investigated by Western blotting using phospho-specific antibodies against p38 and JNK. Quantitative PCR data, Western blotting experiments, and immunohistochemistry clearly show that CB(1) and CB(2) are expressed in mouse pancreatic acini. During acute pancreatitis, an upregulation especially of CB(2) on apoptotic cells occurred. The unselective CB(1)/CB(2) agonist HU210 ameliorated pancreatitis in wild-type and CB(1)-/- mice, indicating that this effect is mediated by CB(2). Furthermore, blockade of CB(2), not CB(1), with selective antagonists engraved pathology. Stimulation with a selective CB(2) agonist attenuated acute pancreatitis and an increased activation of p38 was observed in the acini. With use of MK2-/- mice, it could be demonstrated that this attenuation is dependent on MK2. Hence, using the MK2-/- mouse model we reveal a novel CB(2)-activated and MAP kinase-dependent pathway that modulates cytokine expression and reduces pancreatic injury and affiliated complications. PMID:23139224
Michler, Thomas; Storr, Martin; Kramer, Johannes; Ochs, Stefanie; Malo, Antje; Reu, Simone; Göke, Burkhard; Schäfer, Claus
The aim of this study was to determine whether oxymatrine has a protective effect against acute pancreatitis (AP) in a rat model of L-arginine-induced AP. AP was induced by two intraperitoneal injections of L-arginine (250 mg/100 g) at a 1-h interval. Oxymatrine (50 mg/kg) was administered every 6 h after the induction of AP. Oxymatrine significantly reduced the plasma amylase, D-lactic acid and tumor necrosis factor alpha concentration, serum diamine oxidase and lipase activity, and pancreatic myeloperoxidase activity, which were increased in AP rats (P?0.05). In addition, the pancreatic CD45 expression and the expression of claudin-1, but not zonula occludens-1 (ZO-1) and occludin, in the intestinal tissues were significantly reduced after the induction of AP. However, oxymatrine increased the expression of claudin-1 and CD45, but did not alter the expression of ZO-1 and occludin. In conclusion, our results demonstrated that oxymatrine is potentially capably of protecting against L-arginine-induced AP and attenuating AP-associated intestinal barrier injury by up-regulation of claudin-1. PMID:21633783
Zhang, Zhiqiang; Wang, Yanqing; Dong, Ming; Cui, Jianchun; Rong, Daqing; Dong, Qi
BACKGROUND—It has been suggested that the incidence of acute pancreatitis in patients with end stage renal failure is increased.?AIMS—To assess the risk of acute pancreatitis in patients on long term peritoneal dialysis and long term haemodialysis compared with the general population, to evaluate its clinical course and outcome, and to identify possible aetiological factors.?PATIENTS—All patients who were maintained on long term peritoneal dialysis and/or haemodialysis (total dialysis time more than six weeks) from January 1989 to March 1998 in a large general hospital in The Netherlands.?METHODS—Retrospective cohort study. Standardised ratios (as an approximate relative risk) between the incidence of acute pancreatitis in haemodialysis or peritoneal dialysis and the general population were calculated. Possible risk factors were identified. Patients with and without acute pancreatitis were compared.?RESULTS—In 269 patients on haemodialysis (total of 614 person years), one patient developed an attack of acute pancreatitis. Patients on haemodialysis did not show an increased risk for acute pancreatitis compared with the general population (standardised ratio 11; 95% confidence interval (CI) 0.275 to 60.5). In 128 patients on peritoneal dialysis (total of 241 person years), seven patients had nine attacks of acute pancreatitis. Patients on peritoneal dialysis had a significantly and highly increased risk for acute pancreatitis (standardised ratio 249; 95% CI 114 to 473). Mortality in this series of nine attacks was 11%. No single aetiological risk factor could be identified.?CONCLUSIONS—The risk of acute pancreatitis in patients on long term peritoneal dialysis is significantly and highly increased compared with the general population. The underlying causal mechanisms remain to be elucidated.???Keywords: acute pancreatitis; epidemiology; incidence; renal insufficiency; haemodialysis; peritoneal dialysis
Bruno, M; van Westerloo, D J; van Dorp, W T; Dekker, W; Ferwerda, J; Tytgat, G; Schut, N
Objectives To assess the role of serum amylase and lipase in the diagnosis of acute pancreatitis. Secondary aims were to perform a cost analysis of these enzyme assays in patients admitted to the surgical admissions unit. Design Cohort study. Setting Secondary care. Participants Patients admitted with pancreatitis to the acute surgical admissions unit from January to December 2010 were included in the study. Methods Data collated included demographics, laboratory results and aetiology. The cost of measuring a single enzyme assay was £0.69 and both assays were £0.99. Results Of the 151 patients included, 117 patients had acute pancreatitis with gallstones (n=51) as the most common cause. The majority of patients with acute pancreatitis had raised levels of both amylase and lipase. Raised lipase levels only were observed in additional 12% and 23% of patients with gallstone-induced and alcohol-induced pancreatitis, respectively. Overall, raised lipase levels were seen in between 95% and 100% of patients depending on aetiology. Sensitivity and specificity of lipase in the diagnosis of acute pancreatitis was 96.6% and 99.4%, respectively. In contrast, the sensitivity and specificity of amylase in diagnosing acute pancreatitis were 78.6% and 99.1%, respectively. Single lipase assay in all patients presenting with abdominal pain to the surgical admission unit would result in a potential saving of £893.70/year. Conclusions Determining serum lipase level alone is sufficient to diagnose acute pancreatitis and substantial savings can be made if measured alone.
Gomez, Dhanwant; Addison, Alfred; De Rosa, Antonella; Brooks, Adam; Cameron, Iain C
The possible causal link between damage to the heart and acute pancreatitis and other pancreatic diseases has been considered in both adults and children, particularly in cases of sudden, unexpected death. However, the cardiac pathological findings so far reported in the literature are neither specific enough, nor of a kind to prove a direct pancreatic pathogenesis. We describe the occurrence of steatonecrosis developed in areas of lipomatous infiltration of the heart following acute exacerbation of latent chronic pancreatitis. The presence of mature adipocytes in the myocardium is an adequate substrate for the pancreatic lipase to give rise to the steatonecrosis, which is a well-known marker of acute pancreatitis. As far as we are aware, this is the first reported case of heart steatonecrosis in the literature. PMID:22079999
Roncati, Luca; Gualandri, Giorgio; Fortuni, Giuseppe; Barbolini, Giuseppe
Acute pancreatitis (AP) is a common emergency condition. In the majority of cases, it presents in a mild and self-limited form. However, about 20% of patients develop severe disease with local pancreatic complications (including necrosis, abscess, or pseudocysts), systemic organ dysfunction, or both. A modern classification of AP severity has recently been proposed based on the factors that are causally associated with severity of AP. These factors are both local (peripancreatic necrosis) and systemic (organ failure). In AP, inflammation is initiated by intracellular activation of pancreatic proenzymes and/or nuclear factor-?B. Activated leukocytes infiltrate into and around the pancreas and play a central role in determining AP severity. Inflammatory reaction is first local, but may amplify leading to systemic overwhelming production of inflammatory mediators and early organ failure. Concomitantly, anti-inflammatory cytokines and specific cytokine inhibitors are produced. This anti-inflammatory reaction may overcompensate and inhibit the immune response, rendering the host at risk for systemic infection. Currently, there is no specific treatment for AP. However, there are several early supportive treatments and interventions which are beneficial. Also, increasing the understanding of the pathogenesis of systemic inflammation and the development of organ dysfunction may provide us with future treatment modalities.
Kylanpaa, Leena; Rakonczay, Zoltan; O'Reilly, Derek A.
Background Asparaginase, an agent used in the treatment of acute lymphoblastic leukemia (ALL), is associated with the development of pancreatitis. The clinical course and long-term outcome of patients experiencing this complication has not been extensively detailed. Procedure We reviewed the clinical course for all children with ALL diagnosed with pancreatitis at the Dana-Farber Cancer Institute/Children’s Hospital Boston between 1987 and 2003. The outcome of these patients was compared with that of patients with ALL who did not experience pancreatitis. Results Twenty-eight of 403 children (7%) were diagnosed with pancreatitis. Patients 10–18 years old at diagnosis had 2.4 times the risk of developing pancreatitis compared with younger patients. Pancreatitis typically occurred early in the course of therapy (median 4 weeks after first dose of asparaginase). Ninety-three percent of affected patients were hospitalized and 57% received parenteral nutrition. No patient developed chronic sequelae or died as a result of pancreatitis. Sixteen (57%) patients were retreated with asparaginase, 10 of whom had another episode of pancreatitis. No significant differences in event-free survival were observed when comparing patients with and without a history of pancreatitis. Conclusion Asparaginase-associated pancreatitis was more common in older children, and caused significant acute morbidity. It tended to occur after the first few doses of asparaginase, suggesting a predisposition to this complication rather than a cumulative drug effect. Re-treatment with asparaginase after an episode of pancreatitis was associated with a high risk of recurrent pancreatitis.
Kearney, Susan L.; Dahlberg, Suzanne E.; Levy, Donna E.; Voss, Stephan D.; Sallan, Stephen E.; Silverman, Lewis B.
We report a 30-year-old woman who was confined to a wheelchair because of severe myopathy. She was first seen by a neurologist because of a convulsive syndrome of unknown etiology when she was nine. She was started on anticonvulsive drugs but the drug was stopped when her serum calcium level was found to be very low. She had a history from childhood of steatorrhea and abdominal pain after a fatty meal and became vegetarian at age five years. She worked in a hospital as a nurse and at home her living room received no direct sunlight. As a result of these conditions osteomalacia progressed. We believe an awareness of chronic pancreatitis (CP) during childhood could have prevented the consequences of the disease in this case. PMID:16374983
Kurtulmus, N; Yarman, S; Tanakol, R; Alagol, F
We report here a case of drug-induced acute pancreatitis proved by elimination and single, low dose challenge test in a child with Crohn disease. A 14-year-old boy with moderate/severe Crohn disease was admitted due to high fever and severe epigastric pain during administration of mesalazine and azathioprine. Blood test and abdominal ultrasonography revealed acute pancreatitis. After discontinuance of the medication and supportive care, the symptoms and laboratory findings improved. A single, low dose challenge test was done to confirm the relationship of the adverse drug reaction and acute pancreatitis, and to discriminate the responsible drug. Azathioprine and 6-mercaptopurine showed positive responses, and mesalazine showed a negative response. We introduce the method of single, low dose challenge test and its interpretation for drug-induced pancreatitis.
Yi, Geum-Chae-Won; Yoon, Ka-Hyun
We report here a case of drug-induced acute pancreatitis proved by elimination and single, low dose challenge test in a child with Crohn disease. A 14-year-old boy with moderate/severe Crohn disease was admitted due to high fever and severe epigastric pain during administration of mesalazine and azathioprine. Blood test and abdominal ultrasonography revealed acute pancreatitis. After discontinuance of the medication and supportive care, the symptoms and laboratory findings improved. A single, low dose challenge test was done to confirm the relationship of the adverse drug reaction and acute pancreatitis, and to discriminate the responsible drug. Azathioprine and 6-mercaptopurine showed positive responses, and mesalazine showed a negative response. We introduce the method of single, low dose challenge test and its interpretation for drug-induced pancreatitis. PMID:24010098
Yi, Geum-Chae-Won; Yoon, Ka-Hyun; Hwang, Jin-Bok
OBJECTIVE: We developed a new method to quantitate leukocyte accumulation in tissues and used it to examine the time course and severity of acute experimental pancreatitis. BACKGROUND: Leukocyte activation and infiltration are believed to be critical steps in the progression from mild to severe pancreatitis and responsible for many of its systemic complications. METHODS: Pancreatitis of graded severity was induced in Sprague-Dawley rats with a combination of caerulein and controlled intraductal infusion. Technetium-99m (99mTc)-labeled leukocytes were quantified in pancreas, lung, liver, spleen, and kidney and compared with myeloperoxidase activity. The severity of pancreatitis was ascertained by wet/dry weight ratio, plasma amylase, and trypsinogen activation peptide in the pancreas. The time course of leukocyte accumulation was determined over 24 hours. RESULTS: Pancreatic leukocyte infiltration correlated well with tissue myeloperoxidase concentrations. In mild pancreatitis, leukocytes accumulated only in the pancreas. Moderate and severe pancreatitis were characterized by much greater leukocyte infiltration in the pancreas than in mild disease (p < 0.01), and increased 99mTc radioactivity was detectable in the lung as early as 3 hours. 99mTc radioactivity correlated directly with the three levels of pancreatitis. CONCLUSIONS: Mild pancreatitis is characterized by low-level leukocyte activation and accumulation in the pancreas without recruitment of other organs; marked leukocyte accumulation was found in the pancreas and in the lung in more severe grades of pancreatitis. These findings provide a basis for the pathophysiologic production of cytokines and oxygen free radicals, which potentiate organ injury in severe pancreatitis. This study validates a new tool to study local and systemic effects of leukocytes in pancreatitis as well as new therapeutic hypotheses.
Werner, J; Dragotakes, S C; Fernandez-del Castillo, C; Rivera, J A; Ou, J; Rattner, D W; Fischman, A J; Warshaw, A L
Somatostatin was first suggested for the treatment of acute pancreatitis more than 15 years ago but despite many studies, its role in the management of this condition remains unclear. The experimental and clinical studies are reviewed and the physiological actions of somatostatin, which may influence the course of acute pancreatitis are examined. It is concluded that although some reports suggest a trend towards improved survival and lessened complication rate with somatostatin treatment, insufficient evidence of benefit exists to support the use of somatostatin or its analogue in the treatment or prophylaxis against acute pancreatitis in routine clinical practice.
McKay, C J; Imrie, C W; Baxter, J N
Understanding of the relation between the alcoholic consumption and the development of pancreatitis should help in defining the alcoholic etiology of pancreatitis. Although the association between alcohol consumption and pancreatitis has been recognized for over 100 years, it remains still unclear why some alcoholics develop pancreatitis and some do not. Surprisingly little data are available about alcohol amounts, drinking patterns,
J. Sand; P. G. Lankisch; I. Nordback
Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death.
Jung, Eul Sik; Jang, Young Rock; Kim, Sejoong; Yang, Ji Won; Lee, Kyounghoon; Ahn, Taehoon
Background In February 2008, the results of the PRObiotics in PAncreatitis TRIAl (PROPATRIA) were published. This study investigated the use of probiotics in patients suffering from severe acute pancreatitis. No differences between the groups were found for any of the primary endpoints. However, mortality in the probiotics group was significantly higher than in the placebo group. This result was unexpected in light of the results of the animal studies referred to in the trial protocol. We used the methods of systematic review and meta-analysis to take a closer look at the relation between the animal studies on probiotics and pancreatitis and the PROPATRIA-trial, focussing on indications for harmful effects and efficacy. Methods and results Both PubMed and Embase were searched for original articles concerning the effects of probiotics in experimental acute pancreatitis, yielding thirteen studies that met the inclusion criteria. Data on mortality, bacterial translocation and histological damage to the pancreas were extracted, as well as study quality indicators. Meta-analysis of the four animal studies published before PROPATRIA showed that probiotic supplementation did not diminish mortality, reduced the overall histopathological score of the pancreas and reduced bacterial translocation to pancreas and mesenteric lymph nodes. Comparable results were found when all relevant studies published so far were taken into account. Conclusions A more thorough analysis of all relevant animal studies carried out before (and after) the publication of the study protocol of the PROPATRIA trial could not have predicted the harmful effects of probiotics found in the PROPATRIA-trial. Moreover, meta-analysis of the preclinical animal studies did show evidence for efficacy. It may be suggested, however, that the most appropriate animal experiments in relation to the design of the human trial have not yet been conducted, which compromises a fair comparison between the results of the animal studies and the PROPATRIA trial.
Hooijmans, Carlijn R.; de Vries, Rob B. M.; Rovers, Maroeska M.; Gooszen, Hein G.; Ritskes-Hoitinga, Merel
Thirty-eight pregnant inpatients with acute pancreatitis (AP) were retrospectively reviewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27‰. Most (78.95%) of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% (12 cases). Primary diseases were absent in most cases (57.89%). The most common clinical presentations were abdominal pain (89.47%) and vomiting (68.42%). Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required intensive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imaging examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up. PMID:23771661
Zhang, Dong-lin; Huang, Yi; Yan, Li; Phu, Amy; Ran, Xiao; Li, Shu-sheng
Acute necrotizing pancreatitis induced by infusion of bile salt into the pancreatic duct in rats is consistently associated with acute lung injury similar to the adult respiratory distress syndrome. The role of platelet-activating factor (PAF) in this pancreatitis-associated remote organ failure (lung injury) was investigated. Pulmonary tissue levels of PAF were increased gradually and reached a level of 1345 +/- 455 pg/g (6 times the control level) at 12 hours after induction of pancreatitis, whereas pancreatic PAF levels were undetectable and blood PAF remained unchanged. This local pulmonary PAF accumulation occurred at approximately the same time as the progression of lung injury. Pulmonary responses detected (i.e., eicosanoid production, leukocytic infiltration, Evan's blue extravasation, beta-glucuronidase release) were attenuated to varying degrees by treatment of rats in which pancreatitis was initiated with the PAF receptor antagonists (WEB2170 and BN52021). Rat lung lavages were examined after a 12-hour course of pancreatitis and no changes in PAF concentration, surfactant content, and phospholipase A2 (PLA2) activity were noted. Intravenous administration of PLA2 promoted pulmonary PAF production in experimental rats with pancreatitis but not in normal rats. This observation indicates that PLA2, which was determined to be elevated in plasma during pancreatitis, may be responsible for the accumulation of PAF in the lung. In conclusion, pancreatitis-associated lung injury appears to result from an endogenous inflammatory response in which PAF may play an important role. Images Figure 1
Zhou, W.; McCollum, M. O.; Levine, B. A.; Olson, M. S.
Aims Previously, a retrospective cohort study found no increased risk of acute pancreatitis with current or recent use of exenatide twice daily compared with use of other anti-diabetic drugs. This follow-up study investigated incident acute pancreatitis, with the use of a different data source and analytic method, in patients exposed to exenatide twice daily compared with patients exposed to other anti-diabetic medications. Methods A large US health insurance claims database was used. Eligible patients had ?months continuous enrollment without a claim for pancreatitis and a claim for a new anti-diabetic medication on or after 1 June 2005 to 31 March 2009. Cases of acute pancreatitis were defined as hospitalized patients with an Internation Classification of Disease9 code of 577.0 in the primary position. A discrete time survival model was used to evaluate the relationship between exenatide twice daily and acute pancreatitis. Results Of 482034 eligible patients, 24237 initiated exenatide twice daily and 457797 initiated another anti-diabetic medication. Initiators of exenatide twice daily had more severe diabetes compared with initiators of other anti-diabetic medications. After adjustments for propensity score, insulin and use of medication potentially associated with acute pancreatitis, the odds ratio with exenatide twice daily exposure was 0.95 (95%CI 0.65–1.38). A secondary analysis that examined current, recent and past medication exposure found no increased risk of acute pancreatitis with exenatide twice daily, regardless of exposure category. Conclusion This study indicates that exposure to exenatide twice daily was not associated with an increased risk of acute pancreatitis compared with exposure to other anti-diabetic medications. These results should be interpreted in light of potential residual confounding and unknown biases.
Wenten, M; Gaebler, J A; Hussein, M; Pelletier, E M; Smith, D B; Girase, P; Noel, R A; Braun, D K; Bloomgren, G L
Background In acute pancreatitis, oxygen free radicals (OFRs) and cytokines have been shown to play a role in the failure of pancreatic microcirculation and the development of local tissue damage. We studied the effects of trimetazidine (TMZ), a potent antioxidant and anti-ischemic agent, on acute pancreatitis. Methods Rats were randomized into 3 groups: a control group (n = 15), a study group (n = 15) in which acute pancreatitis was induced with with L-arginine, and a treatment group (n = 15) in which pancreatitis was induced and treated with TMZ intraperitoneally. The rats were followed for 24 hours. At the 24th hour we determined serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lactate dehydrogenase (LDH), interleukin 1-? (IL-1?), interleukin 6 (IL-6) and tumour necrosis factor-? (TNF-?), and the pancreatic tissues were analyzed histopathologically. Results The AST (p < 0.001), ALT (p < 0.01), amylase (p < 0.001), LDH (p < 0.01), TNF-? (p < 0.01), IL-1? (p < 0.001) and IL-6 (p < 0.001) levels, and pancreatic tissue edema (p < 0.01), hemorrhage (p < 0.05), acinar cell necrosis (p < 0.001) and level of perivascular inflammation (p < 0.01), were significantly lower in the treatment group than the study group. Conclusion Trimetazidine markedly decreases biochemical and histopathologic changes during the early stages of acute pancreatitis, thus preserving the pancreas histologically.
Yenicerioglu, Akan; Cetinkaya, Ziya; Girgin, Mustafa; Ustundag, Bilal; Ozercan, Ibrahim Hanefi; Ayten, Refik; Kanat, Burhan Hakan
Data defining the optimal management of abdominal compartment syndrome resulting from acute pancreatitis are lacking. We investigated the outcomes of patients with acute pancreatitis who underwent surgery for treatment of abdominal compartment syndrome at a tertiary referral center. An electronic database was searched to identify patients with acute pancreatitis who underwent laparotomy between January 1, 2000, and December 31, 2009, for treatment of abdominal compartment syndrome. Twelve patients underwent decompressive laparotomy for abdominal compartment syndrome. The median interval between onset of pancreatitis and laparotomy was 4.5 days. Nine patients underwent a laparotomy within seven days of onset of pancreatitis. As a result of cardiopulmonary instability, four decompressive laparotomies were performed in the intensive care unit. In 11 patients, cardiopulmonary improvement was observed. Statistically significant improvements were seen across multiple physiologic parameters. Despite this initial improvement, six patients (50%) died from multisystem organ failure. Two patients survived without need for pancreatic débridement. Abdominal compartment syndrome is an uncommon but likely underrecognized and highly lethal complication of acute pancreatitis that should be considered in patients who become critically ill early in the course of their pancreatitis. Prompt recognition and decompressive laparotomy may rescue some of these patients and does not mandate future débridement. PMID:23711270
Boone, Brian; Zureikat, Amer; Hughes, Steven J; Moser, A James; Yadav, Dhiraj; Zeh, Herbert J; Lee, Kenneth K W
Diffusion-weighted imaging (DWI) is an established diagnostic method of acute stroke. The latest advances in magnetic resonance imaging (MRI) technology have greatly expanded the utility of DWI in the examination of various organs. Recent studies have revealed the usefulness of DWI for imaging of the liver, kidney, ovary, and breast. We report a patient with acute pancreatitis detected by DWI and discussed the efficacy of DWI in diagnosing acute pancreatitis. A 50-year old man presented with a primary complaint of abdominal pain. We performed both DWI and computed tomography (CT) for this patient. The signal intensity in a series of DWI was measured and the apparent diffusion coefficient (ADC) values were calculated to differentiate inflammation from normal tissue. Two experienced radiologists evaluated the grade of acute pancreatitis by comparing the CT findings. Initially, the pancreas and multiple ascites around the pancreas produced a bright signal and ADC values were reduced on DWI. As the inflammation decreased, the bright signal faded to an iso-signal and the ADC values returned to their normal level. There was no difference in the abilities of DWI and CT images to detect acute pancreatitis. However, our case indicates that DWI can evaluate the manifestations of acute pancreatitis using no enhancement material and has the potential to replace CT as a primary diagnostic strategy for acute pancreatitis.
Shinya, Satoshi; Sasaki, Takamitsu; Nakagawa, Yoshifumi; Guiquing, Zhang; Yamamoto, Fumio; Yamashita, Yuichi
Pancreatitis is a mild and self-limiting disease. Although severe forms such as acute necrotizing pancreatitis (ANP) are rare it is associated with significant mortality rate reported to be 30-70%. Probiotics are viable microbial dietary supplements when introduced in sufficient quantities can have beneficial effects. The physiological effects of probiotics include suppression of bacterial infections, production of some digestive enzymes and vitamins and reconstruction of normal intestinal microflora. In the present study, the aim was to investigate the role of probiotics on the DNA damage in the peripheral lymphocytes, in the exfoliated epithelial cells and lymphocytes of the peritoneal fluids and in the pancreatic acinar cells of ANP induced rats. DNA damage was determined by COMET assay. ANP was induced by intravenous infusion of cerulein and superimposed infusion glycodeoxycholic acid into biliopancreatic duct. Saccharomyces Boulardii was used as the probiotic agent. DNA damage in pancreatic acinar cells and exfoliated epithelial cells and the lymphocytes of the peritoneal fluids was significantly higher in pancreatitis group compared to the controls and probiotic treated groups (P<0.001). No significant difference was observed in the DNA damage between the groups in the peripheral lymphocytes. In conclusion; our results support that probiotic agent Saccharomyces Boulardii can diminish bacterial infections and offer health benefits in the therapy of pancreatitis. PMID:17884953
Sahin, Tolga; Aydin, Sevtap; Yüksel, Osman; Bostanci, Hasan; Akyürek, Nalan; Memi?, Leyla; Ba?aran, Nur?en
The purpose of this study was to compare the clinical utility of the serum concentration of feline trypsin-like immunoreactivity (fTLI), the plasma and urine concentrations of trypsinogen-activation peptide (TAP), and the ratio of the urine TAP and creatinine concentrations (TAP:Cr) in the diagnosis of feline acute pancreatitis. We used 13 healthy cats and 10 cats with a diagnosis of acute pancreatitis. The mean serum fTLI and plasma TAP concentrations were significantly higher in the cats with acute pancreatitis than in the healthy cats (P < 0.05); the mean urine TAP concentrations and the median urine TAP:Cr ratios were not significantly different. Among the cats examined in this study, there was no benefit of plasma TAP over serum fTLI in the evaluation of suspected acute pancreatitis.
Allen, Heidi S.; Steiner, Jorg; Broussard, John; Mansfield, Caroline; Williams, David A.; Jones, Boyd
Case reports have indicated an increased risk of acute pancreatitis during use of selective serotonin reuptake inhibitors (SSRIs), an association not found in a few epidemiological studies. We studied the use of SSRI in relation to risk of acute pancreatitis in a population-based case-control study of people aged 40 to 84 years between 2006 and 2008 in Sweden. The Patient Register was used to identify 6161 cases of first-episode acute pancreatitis. The Register of the Total Population was used to randomly select 61,637 control subjects from the general population using frequency-based density sampling, matched for age, sex, and calendar year. Use of SSRI was defined as "current," "recent," "past," or "former" if the drug had been dispensed 1 to 114 days, 115 to 180 days, 181 to 365 days, or 1 to 3.5 years before a given index date, respectively. Logistic regression with adjustment for potential confounding factors was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The OR for acute pancreatitis, adjusted for matching variables, was increased among present users of SSRI (OR, 1.5; 95% CI, 1.4-1.7). After adjusting for diseases or medications related to alcohol overconsumption, tobacco smoking, diabetes, ischemic heart disease, obesity, and severe pain together with educational level and marital status, the corresponding OR was 1.1 (95% CI, 1.0-1.3). After adjusting for the number of distinct medications, a proxy for comorbidity, the corresponding OR was 1.0 (95% CI, 0.9-1.1). The OR for antidepressant use other than SSRI showed a similar pattern. In conclusion, no increased risk of acute pancreatitis remained among users of SSRI after adjusting for confounding factors. PMID:22544014
Ljung, Rickard; Rück, Christian; Mattsson, Fredrik; Bexelius, Tomas Sjöberg; Lagergren, Jesper; Lindblad, Mats
Severe acute respiratory syndrome (SARS) is a highly infectious disease with a significant morbidity and mortality. Respiratory failure is the major complication, and patients may progress to acute respiratory distress syndrome. Health care workers are particularly vulnerable to SARS. SARS has the potential of being converted from droplet to airborne transmission. There is currently no proven effective treatment of SARS, so early recognition, isolation, and stringent infection control are the key to controlling this highly contagious disease. Horseshoe bats are implicated in the emergence of novel coronavirus infection in humans. Further studies are needed to examine host genetic markers that may predict clinical outcome. PMID:20674795
Hui, David S C; Chan, Paul K S
Background & Aims The functional involvement of the endocannabinoid system in modulation of pancreatic inflammation, such as acute pancreatitis, has not been studied to date. Moreover, the therapeutic potential of cannabinoids in pancreatitis has not been addressed. Methods We quantified endocannabinoid levels and expression of cannabinoid receptors 1 and 2 (CB1 and CB2) in pancreas biopsies from patients and mice with acute pancreatitis. Functional studies were performed in mice using pharmacological interventions. Histological examination, serological, and molecular analyses (lipase, myeloperoxidase, cytokines, and chemokines) were performed to assess disease pathology and inflammation. Pain resulting from pancreatitis was studied as abdominal hypersensitivity to punctate von Frey stimuli. Behavioral analyses in the open-field, light-dark, and catalepsy tests were performed to judge cannabinoid-induced central side effects. Results Patients with acute pancreatitis showed an up-regulation of cannabinoid receptors and elevated levels of endocannabinoids in the pancreas. HU210, a synthetic agonist at CB1 and CB2, abolished abdominal pain associated with pancreatitis and also reduced inflammation and decreased tissue pathology in mice without producing central, adverse effects. Antagonists at CB1- and CB2-receptors were effective in reversing HU210-induced antinociception, whereas a combination of CB1- and CB2-antagonists was required to block the anti-inflammatory effects of HU210 in pancreatitis. Conclusions In humans, acute pancreatitis is associated with up-regulation of ligands as well as receptors of the endocannabinoid system in the pancreas. Furthermore, our results suggest a therapeutic potential for cannabinoids in abolishing pain associated with acute pancreatitis and in partially reducing inflammation and disease pathology in the absence of adverse side effects.
MICHALSKI, CHRISTOPH W.; LAUKERT, TAMARA; SAULIUNAITE, DANGUOLE; PACHER, PAL; BERGMANN, FRANK; AGARWAL, NITIN; SU, YUN; GIESE, THOMAS; GIESE, NATHALIA A.; BATKAI, SANDOR; FRIESS, HELMUT; KUNER, ROHINI
OBJECTIVE. The objective of this paper was to assess the safety and efficacy of percuta- neous catheter drainage for initial treatment of infected acute necrotizing pancreatitis. MATERIALS AND METHODS. Thirty-four patients with acute necrotizing pancreatitis shown with contrast-enhanced CT were treated for sepsis with percutaneous catheter drain- age. Extent of necrosis was less than 30% in 10 cases. 3(1-50% in
Patrick C. Freeny; Ellen Hauptmann; Sandra J. Althaus; L. William Traverso; Mika Sinanan
Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.
Lee, Jun Young; Chung, Jin Soo
Objective. To evaluate risk factors - notably drugs - for developing acute pancreatitis. Methods. A population-based, case-control study, encompassing 1.4 million inhabitants aged 20-85 years from four regions in Sweden between 1 January 1995 and 31 May 1998. A total of 462 cases were hospitalised in surgical departments with their first episode of acute pancreatitis without previously known biliary stone
Kerstin B. Blomgren; Anders Sundström; Gunnar Steineck; Sven Genell; Svante Sjöstedt; Bengt-Erik Wiholm
The therapeutic effect and the mechanism of action of the synthetic trypsin inhibitor camostate were studied in a rat model of acute interstitial pancreatitis induced by four subcutaneous injections of 20 µg\\/kg body weight of cerulein at hourly intervals. Rats with acute pancreatitis were given either 100 mg\\/kg body weight camostate or volume- and pH-adjusted water via an orogastric tube
Makoto Otsuki; Satoshi Tani; Yoshinori Okabayashi; Masatoshi Fuji; Takahiko Nakamura; Takashi Fujisawa; Hiroshi Itoh
Oxidative stress plays an important role in the pathogenesis of acute pancreatitis (AP). As an ideal exterminator of poisonous free radicals, hydrogen can clearly reduce the degree of oxidative damage caused by severe acute pancreatitis (SAP) and lessen the presence of inflammatory cytokines. The aim of this study was to investigate the effects and mechanism of hydrogen-rich saline on SAP in rats. Serum TNF-?, IL-6, and IL-18 and histopathological score in the pancreas were reduced after hydrogen-rich saline treatment. Malondialdehyde (MDA) and myeloperoxidase (MPO) contents were obviously reduced, while superoxide dismutase (SOD) and glutathione (GSH) contents were increased after hydrogen-rich saline treatment. The expression of mRNA of tumor necrosis factor-? (TNF-?) and intercellular adhesion molecule-1 (ICAM-1) in the pancreas was reduced in hydrogen-rich saline treated group. In conclusion, intravenous hydrogen-rich saline injections could attenuate the severity of AP, probably via inhibiting the oxidative stress and reducing the presence of inflammatory mediators.
Zhang, De-qing; Feng, Huang; Chen, Wei-chang
Acute necrotizing pancreatitis is characterized by focal macroscopic or diffuse necrosis, hemorrhage, and vascular thrombosis of the pancreas. Current treatment options are limited to supportive and symptomatic interventions. A large amount of experimental work is ongoing to identify novel therapeutic agents for acute pancreatitis. The present study was carried out to explore the beneficial effects of Emblica officinalis, a medicinal plant of India, on acute pancreatitis. Ascorbic acid is one of the major chemical components of E. officinalis, so a vitamin C group was included for comparison. Acute pancreatitis was induced by L-arginine. Rats were divided into the following groups: control (saline), arginine?+?saline, arginine?+?E. officinalis, and arginine?+?vitamin C. Animals in each group were sacrificed at 24 hours and 3, 14, and 28 days after pancreatitis induction for determination of biochemical parameters and histological examination. For rate of DNA synthesis and immunohistochemical studies, animals were sacrificed on Day 3 and Day 7. Drug administration was started 2 hours after the last arginine injection and continued until the day of sacrifice. E. officinalis treatment was found to be beneficial for treating acute pancreatitis. Serum levels of lipase and interleukin-10 were significantly lower than in the arginine group. Nucleic acid content, rate of DNA synthesis, pancreatic proteins, and pancreatic amylase content were significantly improved. Histopathological examination showed significantly lower total scores in the Emblica group. Vitamin C was found to be less efficacious than E. officinalis for all outcome parameters. Thus E. officinalis treatment was found to be beneficial in acute necrotizing pancreatitis. PMID:21138365
Sidhu, Shabir; Pandhi, Promila; Malhotra, Samir; Vaiphei, Kim; Khanduja, Kundal Lal
In 21 female Beagle dogs an experimental pancreatitis was induced by injection of bile into the pancreatic duct system. Beside controls, dogs received 62.5 micrograms/h cyclic somatostatin (SRIF) a continuous i.v. infusion starting with a bolus of 250 micrograms 15 minutes before or 2 hours after bile injection. Following blood parameters were determined: lipase, amylase, blood count, minerals, glucose, insulin, gastrin, secretin and CCK. Two controls died within 24 hours, the others were sacrificed after 48 hours. All pancreata were examined morephologically. The controls developed all clinical signs of acute hemorrhagic pancreatitis, whereas all SRIF-treated dogs were in much better general condition. Lipase and amylase increased in all groups. In the controls insulin, gastrin and secretin remained unchanged and CCK rose slightly. SRIF-treatment diminished insulin, CCK and the test meal-induced increase of secretin. At autopsy the pancreata of the controls were nearly entirely apoplectic. The SRIF-treated dogs showed less damage of the pancreas and no severe hemorrhagic necrosis was noted. The beneficial effect of SRIF cannot only be due to an interaction with intestinal hormones. An additional direct protective effect on the exocrine parenchyma is proposed to exist. PMID:395059
Schwedes, U; Althoff, P H; Klempa, I; Leuschner, U; Mothes, L; Raptis, S; Wdowinski, J; Usadel, K H
Since hyperglycemia aggravates acute pancreatitis and also activates the receptor for advanced glycation endproducts (RAGE) in other organs, we explored if RAGE is expressed in the pancreas and if its expression is regulated during acute pancreatitis and hyperglycemia. Acute pancreatitis was induced by cerulein in untreated and streptozotocin treated diabetic mice. Expression of RAGE was analyzed by Western blot and immunohistochemistry. To evaluate signal transduction the phosphorylation of ERK1/ERK2 was assessed by Western blot and the progression of acute pancreatitis was monitored by evaluation of lipase activity and the pancreas wet to dry weight ratio. RAGE is mainly expressed by acinar as well as interstitial cells in the pancreas. During acute pancreatitis infiltrating inflammatory cells also express RAGE. Using two distinct anti-RAGE antibodies six RAGE proteins with diverse molecular weight are detected in the pancreas, whereas just three distinct RAGE proteins are detected in the lung. Hyperglycemia, which aggravates acute pancreatitis, significantly reduces the production of two RAGE proteins in the inflamed pancreas. PMID:24133579
Zechner, Dietmar; Sempert, Kai; Genz, Berit; Timm, Franziska; Bürtin, Florian; Kroemer, Tim; Butschkau, Antje; Kuhla, Angela; Vollmar, Brigitte
Since hyperglycemia aggravates acute pancreatitis and also activates the receptor for advanced glycation endproducts (RAGE) in other organs, we explored if RAGE is expressed in the pancreas and if its expression is regulated during acute pancreatitis and hyperglycemia. Acute pancreatitis was induced by cerulein in untreated and streptozotocin treated diabetic mice. Expression of RAGE was analyzed by Western blot and immunohistochemistry. To evaluate signal transduction the phosphorylation of ERK1/ERK2 was assessed by Western blot and the progression of acute pancreatitis was monitored by evaluation of lipase activity and the pancreas wet to dry weight ratio. RAGE is mainly expressed by acinar as well as interstitial cells in the pancreas. During acute pancreatitis infiltrating inflammatory cells also express RAGE. Using two distinct anti-RAGE antibodies six RAGE proteins with diverse molecular weight are detected in the pancreas, whereas just three distinct RAGE proteins are detected in the lung. Hyperglycemia, which aggravates acute pancreatitis, significantly reduces the production of two RAGE proteins in the inflamed pancreas.
Zechner, Dietmar; Sempert, Kai; Genz, Berit; Timm, Franziska; Burtin, Florian; Kroemer, Tim; Butschkau, Antje; Kuhla, Angela; Vollmar, Brigitte
This report describes a case of acute pancreatitis in a 2-year-old boy following rotavirus gastroenteritis. Its characteristics are analyzed and discussed in the light of another 4 cases of pancreatitis associated with rotavirus infection found through a systematic review of the international literature. None of the five children underwent surgery or was referred to an intensive care unit and all 5 children recovered with normalization of pancreatic enzymes within 5-10 days. The pathogenesis of this rare complication remains unsettled, and its actual incidence may be higher than reported. Although acute pancreatitis associated with rotavirus gastroenteritis seems to be a mild disease, attention must be paid by the pediatrician fearing possible complications. Rotavirus infection should be amended to the differential diagnosis panel of pancreatitis in toddlers. PMID:23435823
Giordano, Salvatore; Serra, Gregorio; Dones, Piera; Di Gangi, Maria; Failla, Maria Concetta; Iaria, Chiara; Ricciardi, Filippo; Pernice, Lucia Maria; Pantaleo, Dario; Cascio, Antonio
Serum concentrations of free fatty acids (FFA) were assayed in 20 patients with acute necrotizing pancreatitis (ANP). Pancreatic\\u000a and peripancreatic fat necrosis was verified on operation and\\/or by contrast-enhanced computed tomography. For comparison,\\u000a 20 patients with acute edematous pancreatitis (AEP) were examined. On admission, FFA serum levels were 1.14±0.12 (SEM) mmol\\/L\\u000a in ANP and, thus, significantly (p<0.03) higher than in
S. Domschke; P. Malfertheiner; W. Uhl; M. Büchler; W. Domschke
We used a vascular access system (VAS) for continuous arterial infusion (CAI) of a protease inhibitor in two patients with acute necrotizing pancreatitis. The infusion catheter was placed into the dorsal pancreatic artery in the first patient and into the gastroduodenal artery in the second, via a femoral artery approach. An implantable port was then connected to the catheter and was secured in a subcutaneous pocket prepared in the right lower abdomen. No complications related to the VAS were encountered. This system provided safe and uncontaminated vascular access for successful CAI for acute pancreatitis.
Ganaha, Fumikiyo; Yamada, Tetsuhisa; Yorozu, Naoya; Ujita, Masuo; Irie, Takeo; Fukuda, Yasushi; Fukuda, Kunihiko; Tada, Shimpei [Department of Radiology, Jikei University School of Medicine, Aoto Hospital, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506 (Japan)
Acute haemorrhagic pancreatitis was produced in the dogs by transduodenal injection of autologous bile into the main pancreatic duct. There was no significant change in the activity of three regulatory enzymes of phosphatidylcholine biosynthesis (glycerophosphate acyltransferase, cytidyltransferase and cholinephosphotransferase) in lung; however, there was a 42% decrease in the amount of dipalmitoyl phosphatidylcholine (surfactant) in lung lavage due to acute pancreatitis. The decrease in lavage phospholipid content was associated with 5-fold increase in phospholipase A2 activity of lung lavage, and massive accumulation of osmiophilic spheroid structures in the alveolar space. PMID:3036136
Das, S K; Scott, M T; McCuiston, S
Background: The end result of leakage of pancreatic juice into the peripancreatic space can be sterile necrosis, infected necrosis, or rupture into an adjacent hollow viscus or blood vessel (eg, colon, small bowel, or pseudoaneurysm). If a pancreatic duct (PD) leak is present, should treatment be aimed at minimizing the sequela of the leakage of pancreatic juice and not just
Stanley T Lau; Erik J Simchuk; Richard A Kozarek; L. William Traverso
A 46-yr-old man developed severe hypoxemia, pulmo- nary infiltrates, and an acute decrease in his leukocyte count shortly after transfusion of fresh-frozen plasma (FFP) during recovery from cardiac surgery. Cardiogenic pulmonary edema was excluded. Granulocyte-reactive and agglutinating alloantibodies were detected in the se- rum of the fresh-frozen plasma donor. The cross-match with the patient's granulocytes revealed antibodies specific for HLA
Lukas Brander; Angelika Reil; Juergen Bux; Behrouz Mansouri Taleghani; Bruno Regli; Jukka Takala
The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were\\u000a used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective\\u000a in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication.\\u000a The effectiveness of corticosteroids has only
S. T. Lai
Introduction. Several European studies have reported an increase in the incidence rate of acute pancreatitis (AP). Therefore, we studied the incidence rate of AP in the North Adriatic Region in Croatia, as well as epidemiological analysis concerning etiology, age, gender, and severity of disease. Methods. We analyzed 922 patients with confirmed diagnosis of AP (history, clinical and laboratory findings, and imaging methods) admitted to our hospital during a ten-year period (2000–2009). Epidemiological analysis was carried out focusing on incidence, demographic data, and etiology, as well as severity of the disease based on the Ranson and APACHE II scores. Results. The incidence rate varied from 24 to 35/100 000 inhabitants annually. Mean age was 60 ± 16 years. There were 53% men and 47% women among the patients. Most frequent etiologies of AP were biliary stones in 60% and alcohol abuse in 19% of patients. According to the Ranson and APACHE II scores, pancreatitis was considered to be severe in 50% and 43% of the cases, respectively. Conclusion. In our region the incidence of AP was around 30 per 100,000 population per year during the ten-year period studied. The mean age at admission was 60 years and etiology was predominantly biliary. In our region, we have shown epidemiological characteristics of AP typical for Mediterranean countries.
Stimac, Davor; Mikolasevic, Ivana; Krznaric-Zrnic, Irena; Radic, Mladen; Milic, Sandra
Background and Aim. Early assessment of severity in acute pancreatitis (AP) is a key measure to provide rational and effective management. The aim of our study is to determine the prognostic value of interleukins (IL) 6, 8, and 10, soluble receptor for tumor necrosis factor (sTNFr), pancreatic elastase (E1), and C-reactive protein (CRP) as predictors of systemic complications in AP. Patients and Methods. A hundred and fifty patients with confirmed AP were enrolled in the study. The severity of AP was defined according to Atlanta criteria. Measurements of interleukins and sTNFr were performed on the first day of admission. CRP and E1 levels were assessed on admission and after 48 hours. ROC analysis was performed for all parameters. Results. Interleukins and sTNFr significantly differentiated patients with systemic complications from those without. Elevation of IL-6 showed the highest significance as a predictor (P = 0.001). CRP and elastase levels did not differ between mild and severe cases on admission, but reached statistical significance when measured on the third day (P = 0.002 and P = 0.001, resp.). Conclusion. Our study confirmed that IL-6, IL-8, IL-10, and sTNFr measured on admission, and CRP and pancreatic elastase measured on third day of admission represent valuable prognostic factors of severity and systemic complications of AP.
Fisic, E.; Poropat, G.; Bilic-Zulle, L.; Licul, V.; Milic, S.; Stimac, D.
Twenty-three patients with acute fulminant pancreatitis were studied. The diagnosis was confirmed at laparotomy in every case. Blood samples for the assay of phospholipase A2 were collected for 14 days, and the pulmonary status of the patients was followed by monitoring the blood gases and the inspired oxygen fraction and studying a derived variable, the alveolar to arterial oxygen tension difference--the arterial oxygen tension ratio (A--aDo2/PaO2). The serum phospholipase A2 activities correlated with the changes in pulmonary function and with the outcome of the disease. Eight patients succumbed and they showed higher phospholipase A2 activities and A--aDo2/PaO2 ratios than the five patients who survived after major complications and the ten patients who survived without major complications. The results suggest that in acute fulminant pancreatitis serum phospholipase A2 activity correlates with the severity of the pulmonary changes. Furthermore, it seems to reflect the prognosis. PMID:6294771
Schröder, T; Lempinen, M; Kivilaakso, E; Nikki, P
Substance P (SP) is well known to promote inflammation in acute pancreatitis (AP) by interacting with neurokinin-1 receptor. However, mechanisms that terminate SP-mediated responses are unclear. Neutral endopeptidase (NEP) is a cell-surface enzyme that degrades SP in the extracellular fluid. In this study, we examined the expression and the role of NEP in caerulein-induced AP. Male BALB/c mice (20-25 g) subjected to 3-10 hourly injections of caerulein (50 ?g/kg) exhibited reduced NEP activity and protein expression in the pancreas and lungs. Additionally, caerulein (10(-7) M) also downregulated NEP activity and mRNA expression in isolated pancreatic acinar cells. The role of NEP in AP was examined in two opposite ways: inhibition of NEP (phosphoramidon [5 mg/kg] or thiorphan [10 mg/kg]) followed by 6 hourly caerulein injections) or supplementation with exogenous NEP (10 hourly caerulein injections, treatment of recombinant mouse NEP [1 mg/kg] during second caerulein injection). Inhibition of NEP raised SP levels and exacerbated inflammatory conditions in mice. Meanwhile, the severity of AP, determined by histological examination, tissue water content, myeloperoxidase activity, and plasma amylase activity, was markedly better in mice that received exogenous NEP treatment. Our results suggest that NEP is anti-inflammatory in caerulein-induced AP. Acute inhibition of NEP contributes to increased SP levels in caerulein-induced AP, which leads to augmented inflammatory responses in the pancreas and associated lung injury. PMID:22013111
Koh, Yung-Hua; Moochhala, Shabbir; Bhatia, Madhav
Adding either H2-receptor antagonists (cimetidine or ranitidine) or proton pump inhibitors to an adequate amount of lipolytic activity improves fat malabsorption in most cases and abolishes steatorrhoea in up to 40% of children and adults with cystic fibrosis and in adults with chronic pancreatitis. Acid suppression improves fat absorption because the resultant increase in pH within the upper gastrointestinal tract
Eugene P. DiMagno
Pancreatic panniculitis represents a rare cutaneous disorder most commonly associated with acute or chronic pancreatitis or pancreatic carcinoma. We describe a case of a 17-year-old woman who presented with a 2-day history of erythematous patches involving her bilateral knees and tender, scattered red-brown nodules involving her bilateral anterior shins. She was seen during a hospitalization for emergent cesarean section and her hospital course was complicated by HELLP syndrome (defined by the presence of hemolysis, elevated liver enzymes, low platelet count), acute fatty liver of pregnancy and pancreatitis. The characteristic histopathologic findings, including ghost cells, fat necrosis and granular basophilic material with dystrophic calcification, appear in later lesions. In early lesions, as was shown in this case, a neutrophilic subcutaneous infiltrate raises a differential diagnosis including infection, subcutaneous Sweet's syndrome or atypical erythema nodosum. To our knowledge, this represents the first report of pancreatic panniculitis in association with HELLP syndrome and acute fatty liver of pregnancy. Early recognition is critical, as skin lesions may precede the development of pancreatitis. Often, as in our case, the effects of pancreatitis may be life threatening. PMID:21752052
Kirkland, Eugene B; Sachdev, Reena; Kim, Jinah; Peng, David
To define the role of free radicals and of lipid peroxide involvement during the progress of cerulein-induced acute pancreatitis in mice, we evaluated the effect of a novel free radical scavenger, 2-octadecylascorbic acid (CV-3611), on pancreatic edema formation, and the levels of serum enzymes (amylase, lipase) and of lipid peroxide in pancreatic tissue. Mice were divided into three groups: control
Atsushi Nonaka; Tadao Manabe; Takahisa Kyogoku; Koichiro Tamura; Takayoshi Tobe
Background and Aims: In the general adaptation syndrome, gastric lesions are the first manifestation of stress. We hypothesized that acute pancreatitis (AP), an inflammatory acute disease, will be exacerbated if unchained following stress. Visceral hypersensitivity will be enhanced due to catecholaminergic discharges leading to an over-induction of the intrapancreatic cholinergic tone with increased response of the pancreocyte to cholecystokinin (CCK).
Laura Iris Cosen-Binker; Marcelo Gustavo Binker; Gustavo Negri; Osvaldo Tiscornia
Abstract Acute pancreatitis (AP) is a significant clinical problem. There have been no prospective epidemiological data on AP in Poland. The aim of this study is to estimate prevalence, etiology and severity of acute pancreatitis in the ?wi?tokrzyskie Voivodeship population, involving risk factors of this disease. Material and methods. In 2011 prospective observation was conducted in all departments of surgery of the ?wi?tokrzyskie Voivodeship. The inclusion criterion of the study, a definite diagnosis of AP, was met in 1044 hospitalized patients. According to our assumption that repeated hospitalization is considered as a new case if occurred more than 60 days after the previous one, 1004 patients were included in the further analysis. Results. The incidence rate was 99.96/100,000. Incidence rate among woman was 72/100,000 and incidence among men was 130.24/100,000 (p < 0.05). Median age of AP patients was 53 years. Median age among woman (65 years) was significantly (p < 0.005) higher than among man (47 years). Incidence rate for the first episode was 79.7/100,000 citizens. Main causes of AP included cholelithiasis (30.1%), alcohol (24.1%), coexisting cholelithiasis and alcohol abuse (2.9%), pancreatic cancer (1%), AP after ERCP (0.7%). Basing on modified Atlanta criteria, severe AP was diagnosed in 7%, moderate in 12.3%, and mild in 80.7% of patients. Mean duration of hospitalization of patients with severe AP was 14.8, moderate - 16,7, mild - 7.1 days. Mortality rate for AP was 3.9%. Mean age of deceased women was 74 years and was significantly higher than in the group of men (61 years). Mortality rate in severe AP was 52.9% and was significantly (p < 0.05) higher than mortality in moderate (no deaths) or mild AP (0.2%). Conclusions. Incidence rate of AP in the ?wi?tokrzyskie Voivodeship population is among the highest in Poland. Our study indicates that new Atlanta classification, that differentiates between moderate and severe AP, needs to be implemented to the clinical practice, since the latter carries high mortality in severe cases. PMID:23399628
G?uszek, Stanis?aw; Kozie?, Dorota
The efficacy of lawsone against L-arginine induced acute pancreatitis was determined at 24 h by determination of serum levels of amylase, lipase and proinflammatory cytokines [tumor necrosis factor (TNF)-alpha, C-reactive proteins and interleukin (IL)], pancreatic myeloperoxidase (MPO) activity, lipid peroxidation (thiobarbituric acid reactive substances (TBARS)], nitrate/nitrite levels, and the wet weight/body weight ratio. Lawsone and methylprednisolone treatments significantly attenuated the L-arginine- induced increases in pancreatic wet weight/body weight ratio, and decreased the serum levels of amylase and lipase, and TNF-alpha and IL-6 and significantly lowered pancreatic levels of MPO, TBARS, and nitrate/nitrite. The histoimmunological findings further proved the amelioration of pancreatic injury by lawsone and further proved anti-inflammatory and antioxidant agent property of lawsone. PMID:23678547
Biradar, Sandeep; Veeresh, B
Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children
Knut Øymar; Thomas Halvorsen
Autodigestion of the pancreas by its own prematurely activated digestive proteases is thought to be an important event in the onset of acute pancreatitis. The mechanism responsible for the intrapancreatic activation of digestive zymogens is unknown, but a recent hypothesis predicts that a redistribution of lysosomal cathepsin B (CTSB) into a zymogen-containing subcellular compartment triggers this event. To test this hypothesis, we used CTSB-deficient mice in which the ctsb gene had been deleted by targeted disruption. After induction of experimental secretagogue–induced pancreatitis, the trypsin activity in the pancreas of ctsb–/– animals was more than 80% lower than in ctsb+/+ animals. Pancreatic damage as indicated by serum activities of amylase and lipase, or by the extent of acinar tissue necrosis, was 50% lower in ctsb–/– animals. These experiments provide the first conclusive evidence to our knowledge that cathepsin B plays a role in intrapancreatic trypsinogen activation and the onset of acute pancreatitis.
Halangk, Walter; Lerch, Markus M.; Brandt-Nedelev, Barbara; Roth, Wera; Ruthenbuerger, Manuel; Reinheckel, Thomas; Domschke, Wolfram; Lippert, Hans; Peters, Christoph; Deussing, Jan
A variety of receptors on pancreatic acinar and duct cells regulate both pancreatic exocrine secretion and intracellular processes. These receptors are potential sites of action for therapeutic agents in the treatment of pancreatitis. Cholecystokinin (CCK) receptor antagonists, which may reduce the level of metabolic "stress" on acinar cells, have been shown to mitigate the severity of acute pancreatitis in a number of models. Not all studies have shown a benefit, however, and differences may exist between different structural classes of antagonists. Because increased pancreatic stimulation due to loss of feedback inhibition of CCK has been proposed to contribute to the pain of some patients with chronic pancreatitis, CCK receptor antagonists could also be of benefit in this setting. Somatostatin and its analogs diminish pancreatic secretion of water and electrolytes and have been effective in treating pancreatic fistulas and pseudocysts. These agents are also being evaluated for their ability to reduce pain in chronic pancreatitis (perhaps by reducing ductal pressure by diminishing secretory volume) and mitigating the severity of acute pancreatitis (possibly by reducing the metabolic load on acinar cells). Recently described secretin receptor antagonists may also have therapeutic value as a means of selectively inhibiting pancreatic secretion of water and electrolytes.
Grendell, J. H.
Utilising incomplete data supplied by the Hospital Inpatient Analysis, the annual incidence of acute pancreatitis in Northern Ireland was estimated to be about 170 cases per million population. The annual mortality rate for the years 1974-1983, using figures obtained from the Registrar-General for Northern Ireland, was 12.3 cases per million. An increase in both incidence and mortality from acute pancreatitis was demonstrated during the study. There was 191 deaths from pancreatitis during the study period and in 27 of these the diagnosis was made only at postmortem examination. Of the undiagnosed fatalities, 10 occurred in individuals with a history of alcohol abuse. Eight of the 27 undiagnosed cases had not sought medical attention, five had presented with a systemic complication of acute pancreatitis, and a further five had only minor gastrointestinal tract symptoms prior to death. The diagnosis of acute pancreatitis requires a high index of suspicion and should be considered in acutely ill patients, particularly those with a history of alcohol abuse, who fail to respond to appropriate therapy.
Heatley, M. K.; Crane, J.
Hormonal influences during pregnancy can compromise otherwise controlled lipid levels in women with familial hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity in both mother and fetus. Both cholesterol and triglyceride levels in serum increase progressively during pregnancy. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications. Experiences with plasmapheresis are limited. We report two cases of hypertriglyceridemia-induced acute pancreatitis during pregnancy, which were successfully treated by plasmapheresis. PMID:22557756
Altun, Dilek; Eren, Gulay; Cukurova, Zafer; Hergünsel, Oya; Yasar, Levent
Tacrolimus is increasingly used for graft-versus-host disease (GVHD) prophylaxis and therapy in the allogeneic stem cell transplant (allo-SCT) setting. Pancreatitis, previously described as a side-effect of cyclosporine, has not been reported in allo-SCT recipients receiving tacrolimus. We present here a case of acute pancreatitis in a 28-year-old patient with chronic myelogenous leukemia (CML) who received an unrelated umbilical cord blood
Y Nieto; P Russ; G Everson; SI Bearman; PJ Cagnoni; RB Jones; EJ Shpall
58 patients with alcohol-induced acute pancreatitis were studied by contrast enhanced computed tomography (CT). The patients were divided into groups both on the basis of the clinical course and the prognostic signs. The contrast enhancement curves were then plotted for these patients. All patients with uncomplicated pancreatitis had increased or normal contrast enhancement, whereas all those with fulminant pancreatitis had decreased contrast enhancement of the pancreas. The patients with three, or more prognostic signs had lower enhancement values than those with fewer prognostic signs, but the prognostic signs did not correlate as well with the clinical course as did the contrast enhancement. PMID:6524858
Schröder, T; Kivisaari, L; Standertskjöld-Nordenstam, C G; Somer, K; Kivilaakso, E; Lempinen, M
Acute pancreatitis is a medical emergency. Alcohol and gallstones are the most common etiologies accounting for 60%-75% cases. Other important causes include postendoscopic retrograde cholangiopancreatography procedure, abdominal trauma, drug toxicity, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown (idiopathic pancreatitis). Metabolic conditions giving rise to pancreatitis are less common, accounting for 5%-10% cases. The causes include hypertriglyceridemia, hypercalcemia, diabetes mellitus, porphyria, and Wilson's disease. The episodes of pancreatitis tend to be more severe. In cases of metabolic pancreatitis, over and above the standard routine management of pancreatitis, careful management of the underlying metabolic abnormalities is of paramount importance. If not treated properly, it leads to recurrent life-threatening bouts of acute pancreatitis. We hereby review the pathogenesis and management of various causes of metabolic pancreatitis.
Kota, Sunil Kumar; Krishna, S.V.S.; Lakhtakia, Sandeep; Modi, Kirtikumar D.
... as an ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) may be required. An ERCP consists ... How is pancreatitis diagnosed? How is pancreatitis treated? NORTH AMERICAN SOCIETY FOR PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION ...
Acute necrotizing pancreatitis is still associated with high morbidity and mortality. In this prospective clinical trial, we analyzed the effect of octreotide in patients with acute pancreatitis. Eight patients received either 3 × 100, 3 × 200 or 3 × 500 ?g octreotide subcutaneously per day over a period of 10 days. The complication rate was lower in the group
M. Binder; W. Uhl; H. Friess; P. Malfertheiner; M. W. Büchler
Hyperammonemia related to urea cycle disorders is a rare cause of potentially fatal encephalopathy that is encountered in intensive care units (ICUs). Left undiagnosed, this condition may manifest irreversible neuronal damage. However, timely diagnosis and treatment initiation can be facilitated simply by increased awareness of the ICU staff. Here, we describe a patient with acute severe pancreatitis who developed hyperammonemia and encephalopathy without liver disease. Urea cycle disorder was suspected and hemodialysis was initiated. Following reduction of ammonia levels, subsequent treatment included protein restriction and administration of arginine and sodium benzoate. The patient was discharged to home after 47 days with plasma ammonia within normal range and without neurological symptoms. In clinical care settings, patients with neurological symptoms unexplained by the present illness should be assessed for serum ammonia levels to disclose any urea cycle disorders to initiate timely treatment and improve outcome.
Machado, Marcel Cerqueira Cesar; Fonseca, Gilton Marques; Jukemura, Jose
Hyperammonemia related to urea cycle disorders is a rare cause of potentially fatal encephalopathy that is encountered in intensive care units (ICUs). Left undiagnosed, this condition may manifest irreversible neuronal damage. However, timely diagnosis and treatment initiation can be facilitated simply by increased awareness of the ICU staff. Here, we describe a patient with acute severe pancreatitis who developed hyperammonemia and encephalopathy without liver disease. Urea cycle disorder was suspected and hemodialysis was initiated. Following reduction of ammonia levels, subsequent treatment included protein restriction and administration of arginine and sodium benzoate. The patient was discharged to home after 47 days with plasma ammonia within normal range and without neurological symptoms. In clinical care settings, patients with neurological symptoms unexplained by the present illness should be assessed for serum ammonia levels to disclose any urea cycle disorders to initiate timely treatment and improve outcome. PMID:24073003
Machado, Marcel Cerqueira Cesar; Fonseca, Gilton Marques; Jukemura, José
We investigated the efficacy of a potent inhibitor of secretory phospholipase A2 (sPLA2), S-5920/LY315920Na, in an experimental model of acute pancreatitis in rats. Combined intraductal injection of sodium taurocholate (5 mg/rat) and porcine pancreatic sPLA2-IB (300 microg/rat) caused severe hemorrhagic necrotizing pancreatitis resulting in high mortality, along with rapid increases of catalytic PLA2 and lipase activities in plasma and ascites and with gradual increases of plasma amylase and aspartate aminotransferase levels over 9 h after the pancreatitis. Prophylactic intravenous treatment with S-5920/LY315920Na significantly reduced mortality at 7 days, and strongly abrogated PLA2 activities in both plasma and ascites along with significant reduction of lipase activity, amylase, aspartate aminotransferase, and hemorrhage at 6 h. It also significantly reduced histological damage such as edema and parenchymal and fat necroses of the pancreatic tissue. This sPLA2 inhibitor could become an effective agent for the treatment of severe acute pancreatitis. PMID:15467263
Tomita, Yasuhiko; Kuwabara, Kenji; Furue, Shingo; Tanaka, Kazushige; Yamada, Katsutoshi; Ueno, Masahiko; Ono, Takashi; Maruyama, Toshiyuki; Ajiki, Tetsuo; Onoyama, Hirohiko; Yamamoto, Masahiro; Hori, Yozo
Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely. PMID:23082068
Kim, Ji Hun; Chang, Jae Hyuck; Nam, Sung Min; Lee, Mi Jeong; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Park, Il Young; Han, Sok Won
Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.
Kim, Ji Hun; Chang, Jae Hyuck; Nam, Sung Min; Lee, Mi Jeong; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Park, Il Young; Han, Sok Won
This article presents the results of treatment of 54 patients with acute pancreatitis. The patients were divided into two groups according to the method of treatment. The control group (26 patients) received a conventional therapy, whereas the experimental group (28 patients) received mexidol in combination with the intravenous laser irradiation of blood. Clinical and laboratory tests confirmed a high efficiency of the combined therapy based on the administration of mexidol antioxidant and low-intensity (lambda) equals 0.63 micrometers diode laser irradiation of blood. This therapeutic technique produced an influence on the basic pathogenetic mechanisms of acute pancreatitis. The application of this method of treatment improved the course and prognosis of acute pancreatitis.
Parzyan, G. R.; Geinits, A. V.
Background The manifestation of primary hyperparathyroidism with acute pancreatitis is a rare event. Ectopic paraesophageal parathyroid adenomas account for about 5%–10% of primary hyperparathyroidism and surgical resection results in cure of the disease. Case presentation A 71-year-old woman was presented with acute pancreatitis and hypercalcaemia. During the investigation of hypercalcemia, a paraesophageal ectopic parathyroid mass was detected by computerized tomography (CT) scan and 99mTc sestamibi scintigraphy. The tumor was resected via a cervical collar incision and calcium and parathormone tumor levels returned to normal within 48 hours. Conclusions Acute pancreatitis associated with hypercalcaemia should pose the suspicion of primary hyperparathyroidism. Accurate preoperative localization of an ectopic parathyroid adenoma, by using the combination of 99mTc sestamibi scintigraphy and CT scan of the neck and chest allows successful surgical treatment.
Foroulis, Christophoros N; Rousogiannis, Sotirios; Lioupis, Christos; Koutarelos, Dimitrios; Kassi, Georgia; Lioupis, Athanassios
Objective To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP). Summary Background Data The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks. Methods From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3). Results Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3 ± 2.1 events per year before surgery in group 2 and 7.8 ± 1.8 events per year in group 3. After surgery, no acute exacerbations occurred in 42 of 64 (66%) group 2 patients and in 40 of 49 (82%) group 3 patients. The mean number of episodes of acute exacerbation after surgery was 1.6 ± 2.3 events in group 2 and 1.1 ± 1.9 events in group 3. Only four patients in group 2 and one patient in group 3 had an equal or increased frequency of attacks after surgery. Preventing attacks was most effective with LPJ (58/64, 91%) and least effective for DP (6/18, 33%). Conclusions Surgical intervention prevents recurrent acute exacerbations. The overall frequency of events was reduced in nearly all patients. Therefore, surgical intervention is indicated in patients with CP whose disease is characterized by recurrent acute exacerbations.
Nealon, William H.; Matin, Sina
1. We have measured intracellular calcium concentrations in basal conditions and in response to cholecystokinin-octapeptide and acetylcholine in pancreatic acini isolated from rats with caerulein-induced acute pancreatitis and compared them with those in control rats. 2. We also measured amylase secretion in basal conditions and in response to cholecystokinin-octapeptide in both groups. 3. In pancreatic acini from rats with pancreatitis the basal intracellular calcium concentration was significantly increased (134.9 +/- 7.1 nmol/l compared with 71.8 +/- 2.9 nmol/l, P < 0.001). Moreover, the maximum values of intracellular calcium attained during the stimulation period were equivalent in acini from control and pancreatitic rats with no statistically significant differences. 4. In acini from control rats the differences between the resting levels of intracellular calcium and the maximum intracellular calcium values (delta[Ca2+]i) in response to several concentrations of cholecystokinin-octapeptide showed a clear dose-response relationship, with a half-maximal increase at 0.1 nmol/l and a maximal difference (delta[Ca2+]i = 259 +/- 50 nmol/l) at 1 nmol/l. In contrast, a right-shifted response, with a statistically significant smaller increase, was observed in acini from pancreatitic rats. 5. Basal amylase release was significantly higher in acini from rats with pancreatitis (11.7 +/- 1.0% of total compared with 5.9 +/- 1.1% of total, P < 0.001). In contrast, cholecystokinin-octapeptide and acetyl-choline-evoked amylase secretion was reduced by more than 85% in acini from pancreatitic rats. 6. In conclusion, calcium homoeostasis in pancreatic acinar cells from rats with caerulein-induced pancreatitis seems to be impaired. These results suggest excessive release of acinar free ionized calcium, or damage to the integrity of mechanisms that restore low resting levels of intracellular free ionized calcium, and the consequent calcium toxicity could be the key trigger in caerulein-induced acute pancreatitis. PMID:8869421
Bragado, M J; San Román, J I; González, A; García, L J; López, M A; Calvo, J J
Abstract Background: Acute pancreatitis is one of the rare complications of hemorrhagic fever with renal syndrome (HFRS), which easy to be misdiagnosed as acute abdomen, usually critically ill, poor treatment effect, highly mortality. In this study, we retrospectively analyzed to explore the clinical characteristics, 12 cases of hemorrhagic fever with renal syndrome complicated with acute pancreatitis treatment methods and prognosis. Methods: We conducted a retrospective study of HFRS in patients complicated with acute pancreatitis. 12 cases were collected from Ningbo first hospital between January 2001 and December 2012. Clinical information and laboratory parameters were obtained by reviewing literature and records. Results: Twelve from 156 cases (7.69%) HFRS complicated with acute pancreatitis. Men comprised more than half (75%) of the sample population, the mean age was (38?±?19) years. Abdominal pain was the main clinical manifestations in all the patients, all of their serum amylase and serum lipase were increased, 10 patients were given the total abdomen CT examination, eight cases showed enlargement of the pancreas and surrounding leakage, two cases showed pancreatic necrosis and hemorrhage. Three cases complicated with pulmonary edema. In 12 cases, four of them received hemodialysis treatment, one gives surgical intervention. Eight cases were complete remission, three cases were partial remission and one case was death. Conclusions: Acute pancreatitis is one of rare of the serious complications of HFRS, whereas the correct diagnosis and clear the cause of disease is critical for improve the quality of life of patients and reduce the mortality, timely hemodialysis treatment is effective, early intervention can improve the prognosis. PMID:23964665
Fan, Heng; Zhao, Yu; Song, Fu-Chun
Creatine kinase (CK) activity is found in high concentrations in skeletal muscle, cardiac muscle and brain. Here, we describe a 64-year-old woman with acute pancreatitis and elevated serum CK activity. This association is extraordinarily rare. In particular, laboratory findings which were found to be abnormal were serum CK 4.150 U/l (peaked 1 day after admission) with the CK-MB fraction being less than 5%, lactate dehydrogenase (LDH) 424 U/l, serum lipase 1.265 U/I and serum amylase 1.105 U/l. Some data regarding the phenomenon of acute pancreatitis and elevated serum CK activity are given. PMID:15875618
Karachaliou, I; Papadopoulou, K; Karachalios, G; Charalabopoulos, A; Papalimneou, V; Charalabopoulos, K
OBJECTIVE: To evaluate (1) whether alveolar macrophages are activated as a consequence of acute pancreatitis (AP), (2) the implication of inflammatory factors released by these macrophages in the process of neutrophil migration into the lungs observed in lung injury induced by AP, and (3) the role of the liver in the activation of alveolar macrophages. SUMMARY BACKGROUND DATA: Acute lung injury is the extrapancreatic complication most frequently associated with death and complications in severe AP. Neutrophil infiltration into the lungs seems to be related to the release of systemic and local mediators. The liver and alveolar macrophages are sources of mediators that have been suggested to participate in the lung damage associated with AP. METHODS: Pancreatitis was induced in rats by intraductal administration of 5% sodium taurocholate. The inflammatory process in the lung and the activation of alveolar macrophages were investigated in animals with and without portocaval shunting 3 hours after AP induction. Alveolar macrophages were obtained by bronchoalveolar lavage. The generation of nitric oxide, leukotriene B4, tumor necrosis factor-alpha, and MIP-2 by alveolar macrophages and the chemotactic activity of supernatants of cultured macrophages were evaluated. RESULTS: Pancreatitis was associated with increased infiltration of neutrophils into the lungs 3 hours after induction. This effect was prevented by the portocaval shunt. Alveolar macrophages obtained after induction of pancreatitis generated increased levels of nitric oxide, tumor necrosis factor-alpha, and MIP-2, but not leukotriene B4. In addition, supernatants of these macrophages exhibited a chemotactic activity for neutrophils when instilled into the lungs of unmanipulated animals. All these effects were abolished when portocaval shunting was carried out before induction of pancreatitis. CONCLUSION: Lung damage induced by experimental AP is associated with alveolar macrophage activation. The liver mediates the alveolar macrophage activation in this experimental model. Images Figure 3.
Closa, D; Sabater, L; Fernandez-Cruz, L; Prats, N; Gelpi, E; Rosello-Catafau, J
Grapefruit seed extract (GSE) has been shown to exert antibacterial, antifungal and antioxidant activity possibly due to the presence of naringenin, the flavonoid with cytoprotective action on the gastric mucosa. No study so far has been undertaken to determine whether this GSE is also capable of preventing acute pancreatic damage induced by ischemia/reperfusion (I/R), which is known to result from reduction of anti-oxidative capability of pancreatic tissue, and whether its possible preventive effect involves an antioxidative action of this biocomponent. In this study carried out on rats with acute hemorrhagic pancreatitis induced by 30 min partial pancreatic ischemia followed by 6 h of reperfusion, the GSE or vehicle (vegetable glycerin) was applied intragastrically in gradually increasing amounts (50-500 microl) 30 min before I/R. Pretreatment with GSE decreased the extent of pancreatitis with maximal protective effect of GSE at the dose 250 microl. GSE reduced the pancreatitis-evoked increase in serum lipase and poly-C specific ribonuclease activity, and attenuated the marked fall in pancreatic blood flow and pancreatic DNA synthesis. GSE administered alone increased significantly pancreatic tissue content of lipid peroxidation products, malondialdehyde and 4-hydroxyalkens, and when administered before I/R, GSE reduced the pancreatitis-induced lipid peroxidation. We conclude that GSE exerts protective activity against I/R-induced pancreatitis probably due to the activation of antioxidative mechanisms in the pancreas and the improvement of pancreatic blood flow. PMID:15613745
Dembinski, A; Warzecha, Z; Konturek, S J; Ceranowicz, P; Dembinski, M; Pawlik, W W; Kusnierz-Cabala, B; Naskalski, J W
In various organs, including heart, kidneys, brain, liver and stomach, preconditioning by brief exposure to ischemia protects the organ against damage evoked by subsequent severe ischemia. This study has been undertaken to check whether two brief ischemic periods protect the pancreas against severe ischemia\\/reperfusion-induced pancreatitis and, if so, what is the role of sensory and vagal nerves in this phenomenon.
Artur Dembi?ski; Zygmunt Warzecha; Piotr Ceranowicz; Romana Tomaszewska; Marcin Dembi?ski; Ma Pabia?czyk; Jerzy Stachura; Stanis Konturek
Asparaginase treatment is associated with several adverse effects, including allergy, thromboembolic events, acute pancreatitis, altered liver function, and hyperglycemia. In addition, asparaginase can cause abnormalities in lipid metabolism, predominantly hypercholesterolemia and -triglyceridemia. Herein, we report on the case of a 5-year-old male presenting with acute severe hypertriglyceridemia caused by accidental pegylated asparaginase push during treatment of relapsed acute lymphoblastic leukemia. Hypertriglyceridemia did not occur after appropriate administrations of pegylated asparaginase before and after accidental drug infusions, so we speculate that the rate of pegylated asparaginase administration may have an effect on the serum triglyceride level. PMID:22149271
Malbora, Baris; Avci, Zekai; Ozbek, Namik
Spontaneous pseudoaneurysm regression is a rare event. In particular, the spontaneous regression of a splenic artery pseudoaneurysm has, to our knowledge, been previously documented in only two case reports. Furthermore, the pathophysiological mechanism of this event remains unclear. However, it is fully known that this vascular complication is potentially life-threatening and presents a high mortality rate if untreated. We report the case of a 49-year-old man affected by acute pancreatitis. Computed tomography was performed, and showed a pseudoaneurysm of the splenic artery. This patient underwent endoscopic retrograde cholangiopancreatography to treat the pancreatitis, while the vascular complication was managed with a careful and conservative treatment. On day 6 of hospitalization, a second computed tomography scan was performed and revealed complete regression of the pseudoaneurysm. This case describes the diagnosis and management of splenic artery pseudoaneurysm following acute pancreatitis and its spontaneous regression.
Castillo-Tandazo, Wilson; Ortega, Jose; Mariscal, Cesar
The severe acute respiratory syndrome (SARS) was a highly infectious pneumonia that emerged in southern China early in 2003. A large number of SARS patients experienced large joint arthralgia, although this was, for the most part, not associated with any abnormality on magnetic resonance imaging. The main musculoskeletal complications of SARS were osteonecrosis and reduced bone mass, and these arose not from the disease per se but as a sequel to treatment of SARS with high-dose steroids. SARS patients were almost universally steroid naive with no other known predisposition to osteonecrosis. Prevalence of osteonecrosis in SARS patients treated with steroids ranged from 5% to 58%. Osteonecrosis most commonly affected the proximal femur and femoral condyles and was most strongly related to cumulative steroid dose and duration of steroid therapy. Osteonecrosis risk was <1% in patients receiving <3 g and 13% in patients receiving >3 g cumulative prednisolone-equivalent dose. Most osteonecrotic lesions tended to improve with a reduction in lesion volume over a follow-up period of 5 years. The relative reduction in osteonecrotic lesion volume was greatest for smaller lesions. PMID:22081289
Griffith, James F
Purpose: This study was designed to clarify the change of the cytokine levels in acute pancreatitis (AP), and investigate the concern over the cytokine storm in AP with its course of inflammatory attack, as well as the effect of continuous arterial infusion therapy (CAI). Subjects and methods: Twenty-seven patients with AP were subjected during latest 3 years. The serum cytokines
Maki Sugimoto; Tadahiro Takada; Hideki Yasuda; Hodaka Amano; Masahiro Yoshida; Takahiro Isaka; Naoyuki Toyota; Keita Wada; Kenji Takagi
A female, mixed-breed dog was presented with signs of abdominal discomfort and vomiting of 24 h duration following an episode of dietary indiscretion. Clinical signs, previous medical history, and diagnostic tests supported a diagnosis of acute pancreatitis. Specific and supportive treatment was instituted, and clinical signs resolved 10 d after presentation.
Background & Aims: This study aimed to compare the accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing acute pancreatitis (AP) and to explore the correlation between MRI findings and clinical outcome. Methods: Patients with AP were investigated by contrast-enhanced CT and MRI on admission and 7 and 30 days thereafter. MRI was performed with intravenous secretin
Marianna Arvanitakis; Myriam Delhaye; Viviane De Maertelaere; Monia Bali; Catherine Winant; Emmanuel Coppens; Jacques Jeanmart; Marc Zalcman; Daniel Van Gansbeke; Jacques Devière; Celso Matos