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1

Severe acute pancreatitis: Clinical course and management  

Microsoft Academic Search

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

2

Drug induced acute pancreatitis: incidence and severity.  

PubMed Central

To determine the incidence and severity of drug induced acute pancreatitis, data from 45 German centres of gastroenterology were evaluated. Among 1613 patients treated for acute pancreatitis in 1993, drug induced acute pancreatitis was diagnosed in 22 patients (incidence 1.4%). Drugs held responsible were azathioprine, mesalazine/sulfasalazine, 2',3'-dideoxyinosine (ddI), oestrogens, frusemide, hydrochlorothiazide, and rifampicin. Pancreatic necrosis not exceeding 33% of the organ was found on ultrasonography or computed tomography, or both, in three patients (14%). Pancreatic pseudocysts did not occur. A decrease of arterial PO2 reflecting respiratory insufficiency, and an increase of serum creatinine, reflecting renal insufficiency as complications of acute pancreatitis were seen in two (9%) and four (18%) patients, respectively. Artificial ventilation was not needed, and dialysis was necessary in only one (5%) case. Two patients (9%) died of AIDS and tuberculosis, respectively; pancreatitis did not seem to have contributed materially to their death. In conclusion, drugs rarely cause acute pancreatitis, and drug induced acute pancreatitis usually runs a benign course. PMID:7489946

Lankisch, P G; Droge, M; Gottesleben, F

1995-01-01

3

Correlates of Organ Failure in Severe Acute Pancreatitis  

Microsoft Academic Search

Context The clinical course of severe acute pancreatitis may be complicated by organ failure. Objective We studied the incidence of organ failure and the correlation of the extent of necrosis and infective necrosis with organ failure. Methods The medical records of 161 patients with severe acute pancreatitis and persistent organ failure over a 4-year period were studied. Main outcome measures

Jai Dev Wig; Kishore Gurumoorthy; Subramanya Bharathy; Rakesh Kochhar; Thakur Deen Yadav; Ashwini Kumar Kudari; Rudra Prasad Doley; Vikas Gupta

4

Severe Acute Pancreatitis: Case-Oriented Discussion of Interdisciplinary Management  

Microsoft Academic Search

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

2005-01-01

5

Hyperbaric Oxygen Therapy Reduces Severity and Improves Survival in Severe Acute Pancreatitis  

Microsoft Academic Search

Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemic inflammation. Hyperbaric\\u000a oxygen (HBO) therapy modulates inflammation, but has not been extensively studied in pancreatitis. This study investigates\\u000a the effects of HBO in a rat model of severe acute pancreatitis. Sixty-four rats were induced with severe pancreatitis using\\u000a 4% sodium taurocholate and randomized to HBO treatment or

Mehrdad Nikfarjam; Christine M. Cuthbertson; Caterina Malcontenti-Wilson; Vijayaragavan Muralidharan; Ian Millar; Christopher Christophi

2007-01-01

6

Perioperative factors determine outcome after surgery for severe acute pancreatitis  

Microsoft Academic Search

INTRODUCTION: There is evidence that postponing surgery in critically ill patients with severe acute pancreatitis (SAP) leads to improved survival, but previous reports included patients with both sterile and infected pancreatic necrosis who were operated on for various indications and with different degrees of organ dysfunction at the moment of surgery, which might be an important bias. The objective of

Jan J De Waele; Eric Hoste; Stijn I Blot; Uwe Hesse; Piet Pattyn; Bernard de Hemptinne; Johan Decruyenaere; Dirk Vogelaers; Francis Colardyn

2004-01-01

7

Pancreatic and synovial type phospholipases A2 in serum samples from patients with severe acute pancreatitis  

Microsoft Academic Search

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

T J Nevalainen; J M Grönroos; P T Kortesuo

1993-01-01

8

Protective effects of edaravone on rats with severe acute pancreatitis  

Microsoft Academic Search

AIM: To investigate the therapeutic effects and mechanism of edaravone on rats with severe acute pancreatitis (SAP) induced by L-arginine. METHODS: A total of 60 rats were randomly and equally divided into three groups, namely control group, SAP model group and edaravone treatment group (n = 20). A SAP model was established by injecting intraperitoneally with L-arginine at a dose

Ping Gong; Yu Zhang; Zheng-Jun Song

9

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics  

Microsoft Academic Search

AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (? 60 years of age). METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007. RESULTS: In 169 patients with SAP, 94 were elderly and 16 died. Biliary and idiopathic etiologies were the first two causes

Ming-Jun Xin; Jia-Bang Sun; Changchun Jie; Chris E Forsmark

2008-01-01

10

Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications.  

PubMed

Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, laboratory data, diagnosis and treatment procedure of each patient were recorded, and the association with rhabdomyolysis was analyzed. Alcohol consumption was the most predominant cause of SAP and rhabdomyolysis in these patients. SAP-related rhabdomyolysis was primarily induced by the toxicity associated with pancreatic necrosis. The laboratory tests revealed that the concentration of serum creatine kinase (CK) and myoglobin increased and acute renal failure symptoms were present, which provided an exact diagnosis for SAP-induced rhabdomyolysis. Rhabdomyolysis and subsequent hypermyoglobinuria severely impaired kidney function and aggravated hypocalcemia. The therapy of early stage SAP complicated by rhabdomyolysis involved liquid resuscitation support. When first stage treatment fails, blood purification should be performed immediately. Both patients developed multiple organ failure (MOF) and succumbed to the disease. Considering the two cases presented, we conclude that alcohol-related SAP complicated by rhabdomyolysis may have a poor clinical prognosis. PMID:23251265

Su, Mao-Sheng; Jiang, Ying; Yan, Xiao-Yuan Hu; Zhao, Qing-Hua; Liu, Zhi-Wei; Zhang, Wen-Zhi; He, Lei

2013-01-01

11

Android Fat Distribution as Predictor of Severity in Acute Pancreatitis  

Microsoft Academic Search

Background\\/Aims: Obesity is considered an independent risk factor for the development of severe acute pancreatitis (AP). The purpose of this study was to define the type of fat distribution related to severity in AP. Methods: Eighty-eight patients with first-time AP underwent measurements of weight, height, waist and hip circumferences, and skinfold thickness on admission. Severity was defined according to Atlanta

Carlos M. Mery; Valeria Rubio; Andrés Duarte-Rojo; Jorge Suazo-Barahona; Mario Peláez-Luna; Pilar Milke; Guillermo Robles-Díaz

2002-01-01

12

Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial  

Microsoft Academic Search

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

2008-01-01

13

Acute pancreatitis.  

PubMed

Acute pancreatitis is most commonly caused by gallstones or chronic alcohol use, and accounts for more than 200,000 hospital admissions annually. Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging. It is important to distinguish mild from severe disease because severe pancreatitis has a mortality rate of up to 30%. Contrast-enhanced computed tomography is considered the diagnostic standard for radiologic evaluation of acute pancreatitis because of its success in predicting disease severity and prognosis. The BALI and computed tomography severity index scores also can aid in determining disease severity and predicting the likelihood of complications. Treatment begins with pain control, hydration, and bowel rest. In the first 48 to 72 hours of treatment, monitoring is required to prevent morbidity and mortality associated with worsening pancreatitis. When prolonged bowel rest is indicated, enteral nutrition is associated with lower rates of complications, including death, multiorgan failure, local complications, and systemic infections, than parenteral nutrition. In severe cases involving greater than 30% necrosis, antibiotic prophylaxis with imipenem/cilastatin decreases the risk of pancreatic infection. In gallstone-associated pancreatitis, early cholecystectomy and endoscopic retrograde cholangiopancreatography with sphincterotomy can decrease length of hospital stay and complication rates. A multidisciplinary approach to care is essential in cases involving pancreatic necrosis. PMID:25368923

Quinlan, Jeff D

2014-11-01

14

Erythropoietic protoporphyria with severe liver dysfunction and acute pancreatitis.  

PubMed

A case of erythropoietic protoporphyria associated with severe hepatic dysfunction and acute pancreatitis is reported. The patient, a 33-year-old man, was admitted to our hospital complaining of upper abdominal pain, nausea, and vomiting of 3 days' duration. Laboratory tests on admission demonstrated liver dysfunction, anemia, and thrombocytopenia. On the third hospital day, the intensity of the upper abdominal pain increased, concomitantly with elevated levels of serum amylase. Ultrasonography and computed tomography scanning revealed a slightly enlarged pancreas. During this episode, he also complained of various neurological symptoms, including reduced mental alertness, weakness of extremities, constipation, profound sweating, and urinary retention. Porphyrin studies demonstrated markedly elevated erythrocyte and fecal protoporphyrin levels. Laparoscopic findings obtained after the attack subsided were compatible with porphyric liver cirrhosis. We therefore concluded that neurologic disorders and acute pancreatitis could develop in patients with erythropoietic protoporphyria with severe liver dysfunction. PMID:10832676

Komatsu, K; Shimosegawa, T; Uchi, M; Maruhama, Y; Toyota, T

2000-01-01

15

Criteria for the diagnosis and severity stratification of acute pancreatitis  

PubMed Central

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. PMID:24124324

Otsuki, Makoto; Takeda, Kazunori; Matsuno, Seiki; Kihara, Yasuyuki; Koizumi, Masaru; Hirota, Masahiko; Ito, Tetsuhide; Kataoka, Keisho; Kitagawa, Motoji; Inui, Kazuo; Takeyama, Yoshifumi

2013-01-01

16

P-Selectin Inhibition Reduces Severity of Acute Experimental Pancreatitis  

Microsoft Academic Search

Background: Acute pancreatitis (AP) is characterized by disturbed pancreatic microcirculation with tissue necrosis. Platelet and leukocyte activation contributes to microcirculatory disorders and inflammatory tissue infiltration. P-selectin mediates the adhesion of both activated platelets and leukocytes to the vessel wall. The aim of this study was to investigate the effect of P-selectin inhibition by monoclonal antibodies (AB) on experimental AP. Methods:

Thilo Hackert; Rasmus Sperber; Werner Hartwig; Stefan Fritz; Lutz Schneider; Martha-Maria Gebhard; Jens Werner

2009-01-01

17

Severe acute pancreatitis: advances and insights in assessment of severity and management.  

PubMed

The patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Often, there is no correlation between the degree of structural damage to pancreas and clinical manifestation of the disease. The effectiveness of any treatment is related to the ability to predict severity accurately, but there is no ideal predictive system or biochemical marker. Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis. The use of multiparametric criteria and the evaluation of severity index permit us to select high-risk patients. Furthermore, contrast-enhanced computed tomographic scanning and contrast-enhanced MRI play an important role in severity assessment. The adoption of multiparametric criteria proposed together with morphological evaluation consents the formulation of a discreetly reliable prognosis on the evolution of the disease a few days from onset. PMID:21659951

Brisinda, Giuseppe; Vanella, Serafino; Crocco, Anna; Mazzari, Andrea; Tomaiuolo, Pasquina; Santullo, Francesco; Grossi, Ugo; Crucitti, Antonio

2011-07-01

18

Treatment of severe acute pancreatitis and its complications  

PubMed Central

Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder. PMID:25320523

Zerem, Enver

2014-01-01

19

N-Acetylcysteine Improves Pancreatic Microcirculation and Alleviates the Severity of Acute Necrotizing Pancreatitis  

PubMed Central

Background/Aims To investigate the beneficial effect of N-Acetylcysteine (NAC) on pancreatic microvascular perfusion in acute necrotizing pancreatitis (ANP). Methods Fifty-four rats were divided into a control group, an ANP group and an NAC-treated group. The ANP model was established by a retrograde injection of 3% sodium taurocholate into the pancreatic duct. The NAC-treated group received an intravenous infusion of NAC just 2 hours before and 30 minutes after the induction of ANP. The pancreatic microvascular perfusion was measured with laser Doppler flowmetry and pancreatic samples were collected for histological examination. Results The microvascular perfusion in the NAC-treated group decreased slightly and exhibited a significant increase compared to the ANP group (p<0.01). A pathological examination revealed that edema and inflammatory infiltration decreased, and the hemorrhaging and necrosis of the pancreas were significantly reduced. Conclusions NAC could improve pancreatic microvascular perfusion and alleviate the severity of sodium taurocholate-induced ANP, possibly representing a new therapeutic approach to prevent the progression of ANP. PMID:23710319

Du, Bing-Qing; Yang, Yue-Ming; Chen, Yong-Hua; Liu, Xu-Bao

2013-01-01

20

Macrophage migration inhibitory factor is a critical mediator of severe acute pancreatitis  

Microsoft Academic Search

Background & Aims: Macrophage migration inhibitory factor (MIF), originally described as an inhibitor of the random migration of macrophages, has been shown recently to be involved in the pathogenesis of several inflammatory diseases such as sepsis. The aim of this study was to clarify the role of MIF in acute pancreatitis (AP). Methods: Hemorrhagic necrotizing pancreatitis and edematous pancreatitis were

Yoshitaka Sakai; Atsushi Masamune; Akihiko Satoh; Jun Nishihira; Tetsuya Yamagiwa; Tooru Shimosegawa

2003-01-01

21

Mesenchymal stem cells improve intestinal integrity during severe acute pancreatitis.  

PubMed

Severe acute pancreatitis (SAP) is an acute inflammatory disease of the pancreas that involves various distant tissues and organs. This study aimed to investigate post-tissue injury repair by mesenchymal stem cells (MSCs) in a rat model of SAP. A total of 54 pathogen-free adult male SD rats were randomly assigned to the groups SAP, SAP + MSCs and sham-operated (SO). SAP was induced by 4% sodium taurocholate, and MSCs were injected via the dorsal penile vein 1 h later. The amylase activity, and tumor necrosis factor (TNF)-? and diamine oxidase (DAO) levels were measured with an enzyme?linked immunosorbent assay (ELISA), while the expression of aquaporin (AQP)-1 was evaluated by immunohistochemical staining. The pathological score of intestinal tissues was also compared among groups. Marked improvement in intestinal necrosis, villi shedding and infiltration of inflammatory cells was observed in the SAP + MSCs group compared to the SAP and SO groups. Amylase, TNF-?, and DAO levels were significantly increased in the SAP + MSCs group. The intestinal expression of AQP-1 was increased at 12 and 24 h post-MSC transplantation compared to the SO group. Rats of the SAP + MSCs group displayed higher pathological scores compared to the SAP group at all time points. Overall, these data showed that MSCs can inhibit systemic inflammation and reduce TNF-? release in a rat model of SAP-induced intestinal injury, suggesting that MSCs exert protective effects on the intestinal barrier during SAP. PMID:25109509

Tu, Xiao-Huang; Huang, Shao-Xiong; Li, Wen-Sheng; Song, Jing-Xiang; Yang, Xiao-Li

2014-10-01

22

Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus.  

PubMed

The side effects of tamoxifen are generally mild, including the effect on lipoprotein metabolism. However, there are few cases of severe tamoxifen induced hypertriglyceridemia. Hypertriglyceridemia is a marked risk factor for acute pancreatitis and approximately 2% to 5% of cases of acute pancreatitis are related to drugs. We report on tamoxifen-induced hypertriglyceridemia and acute pancreatitis in a 40 years old woman with type 2 diabetes mellitus occurred by dexamethasone. She was treated with insulin infusion and fenofibrate, and goserelin acetate was started instead of tamoxifen after discharge from the hospital. Also, probable pathogenic hypotheses about the correlation between tamoxifen and dexamethasone induced type 2 diabetes mellitus on severe acute pancreatitis are provided. Clinicians should take care of risks of severe acute pancreatitis on using tamoxifen, especially for patients with dexamethasone induced diabetes mellitus. These individuals should undergo pre-post tamoxifen lipid screening and careful history taking of drugs, including dexamethasone. PMID:25035662

Kim, Young Ae; Lee, Sol; Jung, Ji Woong; Kwon, Yu Jin; Lee, Gyeong Bok; Shin, Dong Gue; Park, Sang Su; Yun, Jin; Jang, Yong-Seog; Cho, Dong Hui

2014-06-01

23

Critical illness-related corticosteroid insufficiency in patients with severe acute biliary pancreatitis: a prospective cohort study  

Microsoft Academic Search

INTRODUCTION: Gallstones are the most common cause of acute pancreatitis worldwide. Patients with severe acute biliary pancreatitis (SABP) constitute a subgroup of severe acute pancreatitis (SAP) patients in whom systemic inflammation may be triggered and perpetuated by different mechanisms. The aim of this prospective investigation was to examine the adrenal response to corticotropin and the relationship between adrenal function and

Yun-Shing Peng; Cheng-Shyong Wu; Yung-Chang Chen; Jau-Min Lien; Ya-Chung Tian; Ji-Tseng Fang; Chun Yang; Yun-Yi Chu; Chien-Fu Hung; Chih-Wei Yang; Pang-Chi Chen; Ming-Hung Tsai

2009-01-01

24

Early Nasogastric Feeding in Predicted Severe Acute Pancreatitis  

PubMed Central

Objective: To compare the efficacy and safety of early, nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with predicted severe acute pancreatitis (SAP). Summary Background Data: In SAP, the magnitude of the inflammatory response as well as increased intestinal permeability correlates with outcome. Enteral feeding has been suggested superior to parenteral feeding due to a proposed beneficial effect on the gut barrier. Methods: Fifty patients who met the inclusion criteria were randomized to TPN or EN groups. The nutritional regimen was started within 24 hours from admission and EN was provided through a nasogastric tube. The observation period was 10 days. Intestinal permeability was measured by excretion of polyethylene glycol (PEG) and concentrations of antiendotoxin core antibodies (Endocab). Interleukins (IL)-6 IL-8, and C-reactive protein (CRP) were used as markers of the systemic inflammatory response. Morbidity and feasibility of the nutritional route were evaluated by the frequency of complications, gastrointestinal symptoms, and abdominal pain. Results: PEG, Endocab, CRP, IL-6, APACHE II score, severity according to the Atlanta classification (22 patients), and gastrointestinal symptoms or abdominal pain did not significantly differ between the groups. The incidence of hyperglycemia was significantly higher in TPN patients (21 of 26 vs. 7 of 23; P < 0.001). Total complications (25 vs. 52; P = 0.04) and pulmonary complications (10 vs. 21; P = 0.04) were significantly more frequent in EN patients, although complications were diagnosed dominantly within the first 3 days. Conclusion: In predicted SAP, nasogastric early EN was feasible and resulted in better control of blood glucose levels, although the overall early complication rate was higher in the EN group. No beneficial effects on intestinal permeability or the inflammatory response were seen by EN treatment. PMID:17122621

Eckerwall, Gunilla E.; Axelsson, Jakob B.; Andersson, Roland G.

2006-01-01

25

Acute Pancreatitis  

PubMed Central

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. PMID:4559467

Geokas, Michael C.

1972-01-01

26

Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage  

PubMed Central

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.

Park, Soonyoung; Lee, Seungho; Lee, Hyo Deok; Kim, Min; Kim, Kyeongmin; Jeong, Yusook

2014-01-01

27

Early increase in intestinal permeability in patients with severe acute pancreatitis: Correlation with endotoxemia, organ failure, and mortality  

Microsoft Academic Search

Sepsis accounts for 80% of deaths from acute pancreatitis. This study aimed to investigate early changes in intestinal permeability\\u000a in patients with acute pancreatitis, and to correlate these changes with subsequent disease severity and endotoxemia. The\\u000a renal excretion of enterally administered polyethylene glycol (PEG) 3350 and PEG 400 was measured within 72 hours of onset\\u000a of acute pancreatitis to determine

Basil J. Ammori; Paul C. Leeder; Roderick F. G. J. King; G. Robin Barclay; Iain G. Martin; Mike Larvin; Michael J. McMahon

1999-01-01

28

Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis  

Microsoft Academic Search

BACKGROUND: The elevated serum and peritoneal cytokine concentrations responsible for the systemic response syndrome (SIRS) and multiorgan failure in patients with severe acute pancreatitis lead to high morbidity and mortality rates. Prompted by reports underlining the importance of reducing circulating inflammatory mediators in severe acute pancreatitis, we designed this study to evaluate the efficiency of laparotomy followed by continuous perioperative

Roberto Caronna; Michele Benedetti; Andrea Morelli; Monica Rocco; Loretta Diana; Giampaolo Prezioso; Maurizio Cardi; Monica Schiratti; Gabriele Martino; Gianfranco Fanello; Federica Papini; Francesco Farelli; Roberto L Meniconi; Michele Marengo; Giuseppe Dinatale; Piero Chirletti

2009-01-01

29

Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review  

Microsoft Academic Search

AIM: To evaluate the effectiveness and safety of early nasogastric enteral nutrition (NGEN) for patients with severe acute pancreatitis (SAP). METHODS: We searched Cochrane Central Register of Controlled Trials (Issue 2, 2006), Pub-Medline (1966-2006), and references from relevant articles. We included randomized controlled trials (RCTs) only, which reported the mortality of SAP patients at least. Two reviewers assessed the quality

Kun Jiang; Xin-Zu Chen; Qing Xia; Wen-Fu Tang; Lei Wang

2007-01-01

30

Luminal lactate in acute pancreatitis - validation and relation to disease severity  

PubMed Central

Background Increased rectal luminal lactate concentration may be associated with the severity of the septic shock and high dose of vasopressors. It suggests hypoperfusion of the gut mucosa. This is potentially associated with bacterial translocation from the gut leading to local and systemic inflammation. In acute pancreatitis (AP) bacterial translocation is considered as the key event leading to infection of necrotic pancreatic tissue and high severity of illness. Methods We used rectal luminal equilibration dialysis for the measurement of gut luminal lactate in 30 consecutive patients admitted to hospital due to acute pancreatitis to test the hypothesis that a single measurement of rectal luminal lactate predicts the severity of acute pancreatitis, the length of hospital stay, the need of intensive care and ultimately, mortality. We also tested the physiological validity of luminal lactate concentration by comparing it to luminal partial tension of oxygen. Additionally, a comparison between two different L-lactate analyzers was performed. Results High rectal luminal lactate was associated with low mucosal partial tension of oxygen (R?=?0.57, p?=?0.005) thereby indicating the physiological validity of the method. Rectal luminal lactate at the hospital admission was not associated with the first day or the highest SOFA score, CRP level, hospital length of stay, length of stay in intensive care or mortality. In this cohort of unselected consecutive patients with acute pancreatitis we observed a tendency of increased rectal lactate in the severe cases. Low precision and high bias was observed between two lactate analyzers. Conclusions The association between rectal luminal lactate and oxygen tension indicates that luminal lactate is a marker mucosal anaerobiosis. Comparison between two different analyzers showed poor, non-constant precision over the range of lactate concentrations. Rectal luminal lactate concentration at the time of hospital admission did not predict the severity of pancreatitis. PMID:22545716

2012-01-01

31

Classification of acute pancreatitis.  

PubMed

Based on the Atlanta Classification, acute pancreatitis is classified according to its severity in either mild or severe acute pancreatitis. In recent years, several issues regarding acute pancreatitis have been discussed in the literature. These issues include how many categories of severity should be considered; whether or not a patient with organ failure holds similar holds severity of disease and prognosis of a patient with infected necrosis; the role of transient organ failure; and how to evaluate organ failure. The"Evidence-based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) conducted a review of the recent literature on the topic, and critically appraised its most relevant pieces of evidence.. The articles discussed suggested classifying the severity of acute pancreatitis in three or four categories, rather than mild or severe only, and addressed which is the best score to assess organ failure. The following recommendations were proposed: (1) Acute pancreatitis should be classified into four categories: mild, moderate, severe and critical, which allows a better determination of the characteristics of patients, (2) Evaluation of organ failure with a severity score that preferably evaluate directly each organ failure, such as the SOFA and MODS (Marshall). The SOFA seems to have greater accuracy, but the MODS has better applicability due to its ease of use. PMID:23752646

De Campos, Tercio; Parreira, José Gustavo; Assef, José Cesar; Rizoli, Sandro; Nascimento, Barto; Fraga, Gustavo Pereira

2013-01-01

32

Timing of mortality in severe acute pancreatitis: Experience from 643 patients  

PubMed Central

AIM: To determine the timing of mortality after onset of severe acute pancreatitis (SAP) and the course of the disease in a large series of patients. METHODS: From July 1996 to June 2005, all patients diagnosed with acute pancreatitis at Chang Gung Memorial Hospital, Taipei, Taiwan were retrospectively studied. Three thousand two hundred and fifty episodes of acute pancreatitis were recorded in 2248 patients (1431 males and 817 females; median age, 55.6 years; range, 18-97 years). Mortality was divided into two groups: early death (? 14 d after admission), and late death (> 14 d after admission). The clinical features of patients in these two groups were compared. RESULTS: Although the overall mortality rate of acute pancreatitis was 3.8% (123/3250), mortality rate of SAP was as high as 16.3% (105/643). Of those 105 SAP mortalities, 44 (41.9%) deaths occurred within the first 14 d after admission and 61 (58.1%) occurred after14 d. Incidence of early death did not significantly differ from that of late death. The co-morbidities did not contribute to the timing of death. Early deaths mainly resulted from multiple organ failure. Late deaths were mainly caused by secondary complication of infected necrosis. Intra-abdominal bleeding significantly caused higher mortality in late death. CONCLUSION: Approximately half (42%) of SAP deaths occur within 14 d and most were due to multiple organ failure. The late deaths of SAP were mostly due to infected necrosis. PMID:17461498

Fu, Chih-Yuan; Yeh, Chun-Nan; Hsu, Jun-Te; Jan, Yi-Yin; Hwang, Tsann-Long

2007-01-01

33

Nutritional strategies in severe acute pancreatitis: a systematic review of the evidence.  

PubMed

Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. This review aims to systematically review the evidence available to inform the use of nutritional support in severe acute pancreatitis. High quality (level 1) evidence supports naso-jejunal enteral nutrition (NJ-EN) over parenteral nutrition (PN) reducing infectious morbidity and showing a trend towards reduced organ failure although there is no detectable difference in mortality. Trial data may underestimate benefit as patients are often recruited with predicted rather than proven severe disease. NJ-EN is safe when started immediately (level 3 evidence). NJ-EN is often impractical and naso-gastric (NG) feeding seems to be equivalent in terms of safety and outcomes whilst being more practical (level 2 evidence). Regarding feed supplementation, probiotic feed supplementation is not beneficial (level 1 evidence) the and may cause harm with excess mortality (level 2 evidence). No evidence exists to confirm benefit of the addition of prokinetics in severe acute pancreatitis (SAP) although their use is proven in other critically ill patients. Level 2 evidence does not currently support the use of combination immuno-nutrition though further work on individual agents may provide differing results. Level 2 evidence does not support intravenous supplementation of anti-oxidants and has demonstrated that these too may cause harm. PMID:20303893

Al Samaraee, Ahmad; McCallum, Iain J D; Coyne, Peter E; Seymour, Keith

2010-04-01

34

Serum Proteomic Patterns as a Predictor of Severity in Acute Pancreatitis  

Microsoft Academic Search

Background: Approximately 20% of patients with acute pancreatitis (AP) develop a severe and potentially life-threatening course. Serum proteomic pattern analysis for disease diagnosis is a promising novel and rapidly expanding field based on the hypothesis that serum patterns of low molecular mass biomarkers can specifically reflect an underlying organ-specific pathologic state. Aim: To evaluate the potential differences in proteomic profiles

Georgios I. Papachristou; David E. Malehorn; Janette Lamb; Adam Slivka; William L. Bigbee; David C. Whitcomb

2007-01-01

35

Correlation of fibrinogen-like protein 2 with disease progression in patients with severe acute pancreatitis  

PubMed Central

It has recently been demonstrated that fibrinogen-like protein 2 (fgl2) is expressed on the surface of macrophages, T cells and endothelial cells and directly cleaves prothrombin to thrombin. The present study was designed to examine fgl2 expression in patients with severe acute pancreatitis (SAP) and its correlation with disease progression. Peripheral blood mononuclear cells (PBMCs) were isolated from 25 patients with SAP, 37 patients with mild acute pancreatitis (MAP) and 20 healthy volunteers as controls. Paraffin sections of pancreas were obtained from 18 postoperative patients with SAP between 2003 and 2012. Human fgl2 (hfgl2) gene expression was determined in the PBMCs by real-time PCR. A monoclonal antibody against hfgl2 was applied to detect hfgl2 protein expression in the pancreatic tissues as well as in the PBMCs by immunohistochemical staining. The levels of hfgl2 expression in the PBMCs from the 25 patients with SAP were markedly upregulated compared with the other groups, whereas no significant difference between the MAP group and healthy controls was observed. hfgl2 expression in the PBMCs and pancreatic tissues was detectable through using immunohistochemistry and was demonstrated to be specifically localized to the endothelium of microvessels and inflammatory infiltrative cells in the areas of acute focal, confluent necrosis. There were positive correlations between hfgl2 expression in the PBMCs and the severity of SAP, as indicated by scores of Ranson and Acute Physiology and Chronic Health Evaluation II. The results suggest that hfgl2 is involved in the pathogenesis of SAP and hfgl2 levels may serve as a biomarker during disease progression. PMID:24348769

YE, XIAOHUA; HUAI, JIAPING; CHEN, RENPIN; DING, JIN; CHEN, YANPING; CAI, ZHENZHAI

2014-01-01

36

Metformin induced acute pancreatitis.  

PubMed

Acute pancreatitis frequently presents with abdomen pain but may presents with various skin manifestations as rash and rarely, pancreatic panniculitis. Metformin, one of the most effective and valuable oral hypoglycemic agents in the biguanide class was linked to acute pancreatitis in few cases. Here, we report a case of metformin induce acute pancreatitis in young healthy man with normal renal function. PMID:24194972

Alsubaie, Sadeem; Almalki, Mussa H

2013-04-01

37

Metformin induced acute pancreatitis  

PubMed Central

Acute pancreatitis frequently presents with abdomen pain but may presents with various skin manifestations as rash and rarely, pancreatic panniculitis. Metformin, one of the most effective and valuable oral hypoglycemic agents in the biguanide class was linked to acute pancreatitis in few cases. Here, we report a case of metformin induce acute pancreatitis in young healthy man with normal renal function. PMID:24194972

Alsubaie, Sadeem; Almalki, Mussa H.

2013-01-01

38

Severe lactic acidosis and acute pancreatitis associated with cimetidine in a patient with type 2 diabetes mellitus taking metformin.  

PubMed

An 82-year-old woman with type 2 diabetes mellitus, hypertension, and unstable angina presented with severe lactic acidosis and acute kidney injury (AKI) accompanied by acute pancreatitis. Her medical history revealed that she had taken cimetidine for two weeks while taking other medications, including metformin. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated under diagnosis of lactic acidosis due to metformin and AKI caused by cimetidine-induced acute pancreatitis. In three days of CVVHDF, the levels of serum biochemical markers of lactic acidosis and AKI improved and the patient's urine output reached over 1 L/day. The pancreatitis improved over time. PMID:24088760

Seo, Ji Ho; Lee, Da Young; Hong, Chang Woo; Lee, In Hee; Ahn, Ki Sung; Kang, Gun Woo

2013-01-01

39

Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis  

PubMed Central

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. PMID:23506945

2013-01-01

40

Improved outcome of severe acute pancreatitis in the intensive care unit.  

PubMed

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. PMID:23662207

Pavlidis, Polychronis; Crichton, Siobhan; Lemmich Smith, Joanna; Morrison, David; Atkinson, Simon; Wyncoll, Duncan; Ostermann, Marlies

2013-01-01

41

Improved Outcome of Severe Acute Pancreatitis in the Intensive Care Unit  

PubMed Central

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. PMID:23662207

Pavlidis, Polychronis; Crichton, Siobhan; Lemmich Smith, Joanna; Morrison, David; Atkinson, Simon; Wyncoll, Duncan; Ostermann, Marlies

2013-01-01

42

Clinical significance of melatonin concentrations in predicting the severity of acute pancreatitis  

PubMed Central

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. PMID:23840154

Jin, Yin; Lin, Chun-Jing; Dong, Le-Mei; Chen, Meng-Jun; Zhou, Qiong; Wu, Jian-Sheng

2013-01-01

43

Ultrasound-guided percutaneous catheter drainage in early treatment of severe acute pancreatitis  

PubMed Central

BACKGROUND: Percutaneous catheter drainage (PCD) is a minimally invasive intervation for severe acute pancreatitis (SAP). This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP. METHODS: In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography (CT) and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD. RESULTS: The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group (0%). There was a significant difference between the two groups (P=0.044). The mean time for recovery of the serum C-reactive protein (CRP) level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group (23.8 days) (P=0.034). CONCLUSION: Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.

Ai, Xin-bo; Qian, Xiao-ping; Pan, Wen-sheng; Xu, Jun; Wu, Liang-qing; Zhang, Wan-jun; Wang, An

2010-01-01

44

Inhibition of glycogen synthase kinase-3? attenuates acute kidney injury in sodium taurocholate?induced severe acute pancreatitis in rats.  

PubMed

The aim of the present study was to investigate the efficacy of 4?benzyl?2?methyl?1,2,4?thiadiazolidine?3,5?dione (TDZD?8), the selective inhibitor of glycogen synthase kinase?3? (GSK?3?), on the development of acute kidney injury in an experimental model of sodium taurocholate?induced severe acute pancreatitis (SAP) in rats. The serum amylase, lipase, interleukin?1? and interleukin?6 levels, and the pancreatic pathological score were examined to determine the magnitude of pancreatitis injury. The serum creatinine and blood urea nitrogen levels, myeloperoxidase (MPO) activity and renal histological grading were measured to assess the magnitude of SAP?induced acute kidney injury. The activation of nuclear factor??B (NF??B) was examined using an immunohistochemistry assay. The expression of GSK?3?, phospho?GSK?3? (Ser9), tumour necrosis factor?? (TNF??), intercellular adhesion molecule?1 (ICAM?1) and inducible nitric oxide synthase (iNOS) protein in the kidney was characterised using western blot analysis. TDZD?8 attenuated (i) serum amylase, lipase and renal dysfunction; (ii) the serum concentrations of proinflammatory cytokines; (iii) pancreatic and renal pathological injury; (iv) renal MPO activity and (v) NF??B activation and TNF??, ICAM?1 and iNOS protein expression in the kidney. The results obtained in the present study suggest that the inhibition of GSK?3? attenuates renal disorders associated with SAP through the inhibition of NF??B activation and the downregulation of the expression of proinflammatory cytokines, TNF??, ICAM?1 and iNOS in rats. Blocking GSK?3? protein kinase activity may be a novel approach to the treatment of this in?ammatory condition. PMID:25323773

Zhao, Kailiang; Chen, Chen; Shi, Qiao; Deng, Wenhong; Zuo, Teng; He, Xiaobo; Liu, Tianyi; Zhao, Liang; Wang, Weixing

2014-12-01

45

Hydrogen-rich saline ameliorates the severity of L-arginine-induced acute pancreatitis in rats  

SciTech Connect

Molecular hydrogen, which reacts with the hydroxyl radical, has been considered as a novel antioxidant. Here, we evaluated the protective effects of hydrogen-rich saline on the L-arginine (L-Arg)-induced acute pancreatitis (AP). AP was induced in Sprague-Dawley rats by giving two intraperitoneal injections of L-Arg, each at concentrations of 250 mg/100 g body weight, with an interval of 1 h. Hydrogen-rich saline (>0.6 mM, 6 ml/kg) or saline (6 ml/kg) was administered, respectively, via tail vein 15 min after each L-Arg administration. Severity of AP was assessed by analysis of serum amylase activity, pancreatic water content and histology. Samples of pancreas were taken for measuring malondialdehyde and myeloperoxidase. Apoptosis in pancreatic acinar cell was determined with terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling technique (TUNEL). Expression of proliferating cell nuclear antigen (PCNA) and nuclear factor kappa B (NF-{kappa}B) were detected with immunohistochemistry. Hydrogen-rich saline treatment significantly attenuated the severity of L-Arg-induced AP by ameliorating the increased serum amylase activity, inhibiting neutrophil infiltration, lipid oxidation and pancreatic tissue edema. Moreover, hydrogen-rich saline treatment could promote acinar cell proliferation, inhibit apoptosis and NF-{kappa}B activation. These results indicate that hydrogen treatment has a protective effect against AP, and the effect is possibly due to its ability to inhibit oxidative stress, apoptosis, NF-{kappa}B activation and to promote acinar cell proliferation.

Chen, Han; Sun, Yan Ping; Li, Yang [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)] [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Liu, Wen Wu [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China)] [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Xiang, Hong Gang [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)] [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Fan, Lie Ying [Department of Clinical Laboratory, Shanghai East Hospital, Tong Ji University, Shanghai 200120 (China)] [Department of Clinical Laboratory, Shanghai East Hospital, Tong Ji University, Shanghai 200120 (China); Sun, Qiang [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China)] [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Xu, Xin Yun [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)] [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Cai, Jian Mei [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China)] [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Ruan, Can Ping; Su, Ning; Yan, Rong Lin [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)] [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Sun, Xue Jun, E-mail: sunxjk@hotmail.com [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Wang, Qiang, E-mail: wang2929@hotmail.com [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)] [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)

2010-03-05

46

Updated imaging nomenclature for acute pancreatitis.  

PubMed

KEY POINTS 1. CT is used to confirm the diagnosis of acute pancreatitis when the diagnosis is in doubt and to differentiate acute interstitial pancreatitis from necrotizing pancreatitis, which is a key element of the updated Atlanta nomenclature. The acute interstitial variety accounts for 90-95% of cases, with acute necrotizing pancreatitis accounting for the remaining cases. 2. Necrosis due to acute pancreatitis is best assessed on IV contrast-enhanced CT performed 40 seconds after injection. Peripancreatic necrosis is a subtype of necrotizing pancreatitis in which tissue death occurs in peripancreatic tissues. This is seen in isolation in 20% of patients with necrotizing pancreatitis. 3. Simple fluid collections associated with acute interstitial pancreatitis are subdivided chronologically. A collection observed within approximately 4 weeks of acute pancreatitis onset is termed an "acute peripancreatic fluid collection (APFC)." A collection older than 4 weeks should have a thin wall and is termed a "pseudocyst." Both APFCs and pseudocysts can be infected or sterile. 4. Fluid collections associated with necrotizing pancreatitis are labeled on the basis of age and the presence of a capsule. Within 4 weeks of acute pancreatitis onset, a fluid collection associated with necrotizing pancreatitis is termed an "acute necrotic collection (ANC)" whereas an older collection is termed an area of "walled-off necrosis (WON)" if it has a perceptible wall on CT. The term "pseudocyst" is not used in the setting of necrotizing pancreatitis collections. Although an ANC and a (WON can be infected or sterile, infection is far more likely compared with acute interstitial pancreatitis collections. 5. The severity of acute pancreatitis is graded on the basis of the presence of acute complications or organ failure. Mild acute pancreatitis has neither acute complications nor organ failure. Moderate-severity acute pancreatitis is associated with acute complications or organ failure lasting fewer than 48 hours. Severe acute pancreatitis is characterized by single- or multiorgan failure persisting for greater than 48 hours. PMID:25341160

Murphy, Kevin P; O'Connor, Owen J; Maher, Michael M

2014-11-01

47

Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: A prospective study  

PubMed Central

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 patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis. RESULTS: UTDT was positive in 87 (94.6%) of the AP patients and in two (8%) controls (P < 0.05). Positive UTDT was found in 61 (92.4%) of 66 (71.7%) patients with mild pancreatitis and in all (100%) of the 26 (28.3%) with severe pancreatitis (P > 0.05). UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis (6.2 ± 2.5 d vs 2.0 ± 1.43 d, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively. CONCLUSION: UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement. PMID:18069761

Kamer, Erdinc; Unalp, Haluk Recai; Derici, Hayrullah; Tansug, Tugrul; Onal, Mehmet Ali

2007-01-01

48

Acute pancreatitis: The stress factor  

PubMed Central

Acute pancreatitis is an inflammatory disorder of the pancreas that may cause life-threatening complications. Etiologies of pancreatitis vary, with gallstones accounting for the majority of all cases, followed by alcohol. Other causes of pancreatitis include trauma, ischemia, mechanical obstruction, infections, autoimmune, hereditary, and drugs. The main events occurring in the pancreatic acinar cell that initiate and propagate acute pancreatitis include inhibition of secretion, intracellular activation of proteases, and generation of inflammatory mediators. Small cytokines known as chemokines are released from damaged pancreatic cells and attract inflammatory cells, whose systemic action ultimately determined the severity of the disease. Indeed, severe forms of pancreatitis may result in systemic inflammatory response syndrome and multiorgan dysfunction syndrome, characterized by a progressive physiologic failure of several interdependent organ systems. Stress occurs when homeostasis is threatened, and stressors can include physical or mental forces, or combinations of both. Depending on the timing and duration, stress can result in beneficial or harmful consequences. While it is well established that a previous acute-short-term stress decreases the severity of experimentally-induced pancreatitis, the worsening effects of chronic stress on the exocrine pancreas have received relatively little attention. This review will focus on the influence of both prior acute-short-term and chronic stress in acute pancreatitis. PMID:24914340

Binker, Marcelo G; Cosen-Binker, Laura I

2014-01-01

49

Resistin is not an appropriate biochemical marker to predict severity of acute pancreatitis: A case-controlled study  

PubMed Central

AIM: To assess levels of serum resistin upon hospital admission as a predictor of acute pancreatitis (AP) severity. METHODS: AP is both a common and serious disease, with severe cases resulting in a high mortality rate. Several predictive inflammatory markers have been used clinically to assess severity. This prospective study collected data from 102 patients who were diagnosed with an initial acute biliary pancreatitis between March 2010 and February 2013. Measurements of body mass index (BMI) and waist circumference (WC) were obtained and serum resistin levels were analyzed at the time of hospital admission using enzyme-linked immunosorbent assay. Additionally, resistin levels were measured from a control group after matching gender, BMI and age. RESULTS: A total of 102 patients (60 females and 42 males) were diagnosed with acute gallstone-induced pancreatitis. The mean age was 45 years, and mean BMI value was 30.5 kg/m2 (Obese, class?I). Twenty-two patients (21.6%) had severe AP, while eighty-eight patients had mild pancreatitis (78.4%). Our results showed that BMI significantly correlated with pancreatitis severity (P = 0.007). Serum resistin did not correlate with BMI, weight or WC. Furthermore, serum resistin was significantly higher in patients with AP compared to control subjects (P < 0.0001). The mean resistin values upon admission were 17.5 ng/mL in the severe acute biliary pancreatitis group and 16.82 ng/mL in the mild AP group (P = 0.188), indicating that resistin is not an appropriate predictive marker of clinical severity. CONCLUSION: We demonstrate that obesity is a risk factor for developing severe AP. Further, although there is a correlation between serum resistin levels and AP at the time of hospital admission, resistin does not adequately serve as a predictive marker of clinical severity. PMID:25386084

Al-Maramhy, Hamdi; Abdelrahman, Abdelrahman I; Sawalhi, Samer

2014-01-01

50

[Surgical treatment in severe acute pancreatitis. Last 15 years of experience in Emergency County Hospital of Baia Mare].  

PubMed

The aim of this study is to investigate the particular course of the patients operated for severe acute pancreatitis in a period of 15 years in surgical department of Emergency County Hospital of Baia Mare. Medical records of 202 patients admitted and operated for severe acute pancreatitis, were studied. Follow-up parameters were: age, gender, etiology, moment of operation, the type of operations and postoperative evolution of this patients. In the group of deceased patients alcoholic etiology of pancreatitis was prevailing. Almost a half of patients were operated in the first day of admission. A high number of patients were operated for diagnosis of acute abdomen with intention of exploratory laparotomy. In the last years, besides the usual closed drainage, open drainage and planning drainage were performed. Postoperative mortality is still high. The diagnose of severe acute pancreatitis is difficult in emergency. Global mortality in pancreatitis remains high, especially in the period of enzymatic shock, and is correlated with masculine gender, alcoholic etiology and somewhat with precocity of operation. PMID:16372670

Le?e, Mihaela; T?m??an, Anca; Stoicescu, B; Brându?e, M; Puia, Ioana; Mare, C; Laz?r, C

2005-01-01

51

Regional Arterial Infusion with Lipoxin A4 Attenuates Experimental Severe Acute Pancreatitis  

PubMed Central

Objective Investigate the therapeutic effect of regional arterial infusion (RAI) with Aspirin-Triggered Lipoxin A4 (ATL) in experimental severe acute pancreatitis (SAP) in rats. Materials and Methods SAP was induced by injection of 5% sodium taurocholate into the pancreatic duct. Rats with SAP were treated with ATL (the ATL group) or physiological saline (the SAP group) infused via the left gastric artery 30 min after injection of sodium taurocholate. The sham group was subjected to the same surgical procedure, though without induction of SAP. Serum levels of amylase, phospholipase A2 (PLA2), interleukin-1? (IL-1?), IL-6 and tumor necrosis factor-? (TNF-?) were measured at 12 and 24 h after induction of SAP. Ascitic fluid, the pancreatic index (wet weight ratio) and myeloperoxidase (MPO) levels in the pancreas were determined and histopathological findings were evaluated. The expression of intercellular adhesion molecule-1 (ICAM-1), platelet endothelial cell adhesion molecule-1 (PECAM-1), NF-?B p65, and heme oxygenase-1 (HO-1) in the pancreas were estimated by immunofluorescence and western blot, respectively. Results ATL rats had lower serum levels of TNF-?, IL-1?, and IL-6 (P<0.01), PLA2 (P<0.05), and amylase levels (P<0.05) studied as compared with the SAP group. The pancreatic index in the ATL group decreased only at 24 h as compared with the SAP group (P<0.05). The histopathological findings and MPO levels in the pancreas significantly decreased in the ATL group as compared to the SAP group (P<0.05 and P<0.01, respectively). Immunofluorescence and western blot showed that ATL attenuated the expression of NF-?B p65, ICAM-1 and PECAM-1 in the pancreas, and increased the expression of HO-1 in SAP animals. Conclusions We demonstrated that RAI with ATL attenuated the severity of experimental SAP, maybe achieved by improving the expression of HO-1, and down-regulating the NF-?B signaling pathway, with decreased expression of ICAM-1 and PECAM-1 and reduced generation of pro-inflammatory cytokines. PMID:25265022

Yang, Fajing; Xie, Jianming; Wang, Weiming; Xie, Yangyun; Sun, Hongwei; Jin, Yuepeng; Xu, Dan; Chen, Bicheng; Andersson, Roland; Zhou, Mengtao

2014-01-01

52

Inhibition of geranylgeranyltransferase attenuates neutrophil accumulation and tissue injury in severe acute pancreatitis.  

PubMed

Leukocyte infiltration and acinar cell necrosis are hallmarks of severe AP, but the signaling pathways regulating inflammation and organ injury in the pancreas remain elusive. In the present study, we investigated the role of geranylgeranyltransferase in AP. Male C57BL/6 mice were treated with a geranylgeranyltransferase inhibitor GGTI-2133 (20 mg/kg) prior to induction of pancreatitis by infusion of taurocholate into the pancreatic duct. Pretreatment with GGTI-2133 reduced plasma amylase levels, pancreatic neutrophil recruitment, hemorrhage, and edema formation in taurocholate-evoked pancreatitis. Moreover, administration of GGTI-2133 decreased the taurocholate-induced increase of MPO activity in the pancreas and lung. Treatment with GGTI-2133 markedly reduced levels of CXCL2 in the pancreas and IL-6 in the plasma in response to taurocholate challenge. Notably, geranylgeranyltransferase inhibition abolished neutrophil expression of Mac-1 in mice with pancreatitis. Finally, inhibition of geranylgeranyltransferase had no direct effect on secretagogue-induced activation of trypsinogen in pancreatic acinar cells in vitro. A significant role of geranylgeranyltransferase was confirmed in an alternate model of AP induced by L-arginine challenge. Our findings show that geranylgeranyltransferase regulates neutrophil accumulation and tissue damage via expression of Mac-1 on neutrophils and CXCL2 formation in AP. Thus, these results reveal new signaling mechanisms in pancreatitis and indicate that targeting geranylgeranyltransferase might be an effective way to ameliorate severe AP. PMID:23744643

Merza, Mohammed; Wetterholm, Erik; Zhang, Su; Regner, Sara; Thorlacius, Henrik

2013-09-01

53

Effects of early enteral nutrition on immune function of severe acute pancreatitis patients  

PubMed Central

AIM: To investigate the effects of early enteral nutrition (EEN) on the immune function and clinical outcome of patients with severe acute pancreatitis (SAP). METHODS: Patients were randomly allocated to receive EEN or delayed enteral nutrition (DEN). Enteral nutrition was started within 48 h after admission in EEN group, whereas from the 8th day in DEN group. All the immunologic parameters and C-reactive protein (CRP) levels were collected on days 1, 3, 7 and 14 after admission. The clinical outcome variables were also recorded. RESULTS: Sixty SAP patients were enrolled to this study. The CD4+ T-lymphocyte percentage, CD4+/CD8+ ratio, and the CRP levels in EEN group became significantly lower than in DEN group from the 7th day after admission. In contrast, the immunoglobulin G (IgG) levels and human leukocyte antigen-DR expression in EEN group became significantly higher than in DEN group from the 7th day after admission. No difference of CD8+ T-lymphocyte percentage, IgM and IgA levels was found between the two groups. The incidences of multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection as well as the duration of intensive care unit stay were significantly lower in EEN group than in DEN group. However, there was no difference of hospital mortality between the two groups. CONCLUSION: EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent immunosuppression. EEN can improve the clinical outcome, but not decrease the hospital mortality of SAP patients. PMID:23431120

Sun, Jia-Kui; Mu, Xin-Wei; Li, Wei-Qin; Tong, Zhi-Hui; Li, Jing; Zheng, Shu-Yun

2013-01-01

54

[Prolonged acute pancreatitis after bone marrow transplantation].  

PubMed

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

2008-04-01

55

Effect of resveratrol on microcirculation disorder and lung injury following severe acute pancreatitis in rats  

PubMed Central

AIM: To investigate the mechanism of resveratrol underlying the microcirculation disorder and lung injury following severe acute pancreatitis (SAP). METHODS: Twenty-four rats were divided into 3 groups (SAP, sham and resveratrol groups) randomly. SAP model was established by injecting 4% sodium taurocholate 1 mL/kg through puncturing pancreatic ducts. Sham (control) group (8 rats) was established by turning over the duodenum. Resveratrol was given at 0.1 mg/kg b.m. intraperitoneally. Rats were sacrificed 9 h after SAP was induced. Blood samples were obtained for hemorrheological examination. Lung tissues were used for pathological observation, and examination of microvascular permeability, dry/wet ratio and myeloperoxidase (MPO) activity. Gene expression of intercellular adhesion molecule-1 (ICAM-1) was detected by RT-PCR. RESULTS: Compared with SAP group, resveratrol relieved the edema and infiltration of leukocytes in the lungs. Resveratrol improved markers of hemorrheology: high VTB (5.77±1.18 mPas vs 9.49±1.34 mPas), low VTB (16.12±3.20 mPas vs 30.91±7.28 mPas), PV (4.69±1.68 mPas vs 8.00±1.34 mPas), BSR (1.25±0.42 mm/h vs 0.03±0.03 mm/h), VPC (54.67±3.08% vs 62.17±3.39%), fibrinogen (203.2±87.8 g/ L vs 51.3±19.1 g/L), original hemolysis (0.45±0.02 vs 0.49±0.02), and complete hemolysis (0.41±0.02 vs 0.43±0.02) (P<0.05). Resveratrol decreased the OD ratio of ICAM-1 gene (0.800±0.03 vs 1.188±0.10), dry/wet ratio (0.74±0.02 vs 0.77±0.03), microvascular permeability (0.079±0.006 vs 0.112±0.004) and MPO activity (4.42±0.32 vs 5.03±0.51) significantly (P<0.05). CONCLUSION: Resveratrol can improve the microcirculation disorder of the lung by decreasing leukocyte-endothelial interaction, reducing blood viscosity, improving the decrease of blood flow, and stabilizing erythrocytes in SAP rats. It may be a potential candidate to treat SAP and its severe complications (ALI). PMID:15637762

Meng, Yong; Zhang, Mei; Xu, Jun; Liu, Xue-Min; Ma, Qing-Yong

2005-01-01

56

From Moderately Severe to Severe Hypertriglyceridemia Induced Acute Pancreatitis: Circulating MiRNAs Play Role as Potential Biomarkers  

PubMed Central

The incidence of hypertriglyceridemia induced acute pancreatitis (HTAP) continues to rise in China. It has systemic complications and high mortality, making the early assessment of the severity of this disease even more important. Circulating microRNAs (miRNAs) could be novel, non-invasive biomarkers for disease progression judgment. This study aimed to identify the potential role of serum miRNAs as novel biomarkers of HTAP progression. HTAP patients were divided into two groups: moderately severe (HTMSAP) and severe (HTSAP), healthy people were used as control group. The serum miRNA expression profiles of these three groups were determined by microarray and verified by qRT-PCR. The functions and pathways of the targeted genes of deregulated miRNAs were predicted, using bioinformatics analysis; miRNA-mRNA network was generated. Moreover, the correlation between miR-181a-5p and pancreatitis metabolism related substances were studied and the serum concentration of inflammatory cytokines and miRNAs at different time points during the MSAP and SAP were investigated, respectively. Finally, the receiver operating characteristic (ROC) curve of miRNAs was studied. Significant changes in the serum concentration of the following miRNAs of HTAP patients (P<0.05) were discovered: miR24-3p, 361-5p, 1246, and 222-3p (constantly upregulated), and 181a-5p (constantly downregulated) (P<0.05). Bioinformatics analysis predicted that 13 GOs and 36 pathways regulated by overlap miRNAs were involved in glucose, fat, calcium (Ca++), and insulin metabolism (P<0.001). miRNA-mRNA network revealed that the overlap miRNAs targeted genes participating in pancreas metabolism and miR-181a-5p, the only downregulated miRNA, had good negative correlation with triglyceride (TG), total cholesterol (TC), and fast blood glucose (FBG), but a positive correlation with Ca++. When compared with inflammatory cytokines, the changes of all five overlap miRNAs were more stable. It was found that when used for evaluating the progression of HTAP, miRNAs showed good AUC. These data suggested that serum miRNAs have the potential to be excellent HTAP biomarkers. PMID:25365448

Xia, Min; Jiang, Lisha; Lu, Guoming; Huang, Mindan; Guo, Jizhong; Liu, Side

2014-01-01

57

Acute pancreatitis in children and adolescents  

PubMed Central

In this Topic Highlight, the causes, diagnosis, and treatment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the differential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often different than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms (such as abdominal pain and vomiting), serum pancreatic enzyme levels, and imaging studies. Several scoring systems have been proposed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly differ between adults and children, and the treatments for adults and children are similar. In large part, our understanding of the pathology, optimal treatment, assessment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pancreatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severe acute pancreatitis in children is becoming better understood and more controllable.

Suzuki, Mitsuyoshi; Sai, Jin Kan; Shimizu, Toshiaki

2014-01-01

58

Acute pancreatitis in children and adolescents.  

PubMed

In this Topic Highlight, the causes, diagnosis, and treatment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the differential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often different than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms (such as abdominal pain and vomiting), serum pancreatic enzyme levels, and imaging studies. Several scoring systems have been proposed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly differ between adults and children, and the treatments for adults and children are similar. In large part, our understanding of the pathology, optimal treatment, assessment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pancreatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severe acute pancreatitis in children is becoming better understood and more controllable. PMID:25400985

Suzuki, Mitsuyoshi; Sai, Jin Kan; Shimizu, Toshiaki

2014-11-15

59

Pancreatic-duct reflux and acute gallstone pancreatitis.  

PubMed Central

A consecutive series of 614 operative cholangiograms was studied prospectively to determine the relationship of pancreatic-duct reflux to a previous history of acute gallstone pancreatitis. Of 53 patients who had previously had pancreatitis, 33 had pancreatic-duct reflux on their cholangiogram (62.3%), whereas, of 561 patients with no history of pancreatic disease, pancreatic-duct reflux was seen in only 82 (14.6%). In patients with a history of pancreatitis, reflux occurred into a wider pancreatic duct, at a greater angle between the bile and pancreatic ducts, and was associated with a longer functioning common channel. The wider cystic duct, wider common bile duct, and multiple small stones seen in patients with previous pancreatitis and pancreatic-duct reflux were suggestive of gallstone migration being associated with reflux. There was no correlation between pancreatic-duct reflux and the presence of choledochal calculi. Two patients developed recurrent severe pancreatitis after pancreatic-duct reflux of infected bile. Patients with gallstone pancreatitis appear to have an increased tendency for pancreatic-duct reflux that is mechanically facilitated by differences in the choledocho-pancreatic duct anatomy. Images FIG. 2. FIG. 3. FIG. 4. PMID:3729584

Armstrong, C P; Taylor, T V

1986-01-01

60

Acute Pancreatitis (Beyond the Basics)  

MedlinePLUS

... hospitalization for at least a few days. (See "Management of acute pancreatitis" .) Mild pancreatitis — Mild pancreatitis usually resolves with simple supportive care, which entails monitoring, drugs to control pain, and intravenous fluids. You may not be allowed ...

61

Traditional Chinese medicine, Qing Ying Tang, ameliorates the severity of acute lung injury induced by severe acute pancreatitis in rats via the upregulation of aquaporin-1  

PubMed Central

Aquaporin-1 (AQP-1) is expressed in lung endothelial cells and regulates water transport; thus, AQP-1 plays an important role in a number of edema-associated lung diseases. Qing Yin Tang (QYT), a traditional Chinese medicine, has been shown to effectively reduce the mortality rate of acute lung injury (ALI) induced by severe acute pancreatitis (SAP). The current study aimed to investigate the detailed mechanisms underlying the effects of QYT on ALI induced by SAP, particularly the effects on the expression levels of AQP-1 in the lung tissue. ALI was established in Wister rats who were subsequently divided into four groups: SHAM, ALI, dexamethasone (DEX) and QYT groups (n=8 per group). In the QYT group, 20 ml/kg QYT was administered by gavage immediately following the induction of SAP. Blood and lung tissues were collected 8 h following the induction of pancreatitis. The lung wet/dry ratio, as well as the levels of blood gases, serum amylase and tumor necrosis factor-? (TNF-?), were measured at 4, 8 and 12 h following SAP-associated ALI induction surgery. The expression levels of AQP-1 in the lung tissue were detected by quantitative polymerase chain reaction, immunohistochemistry and western blot analysis. No statistically significant differences were observed with regard to the levels of serum amylase, wet/dry ratio, partial pressure of oxygen, serum TNF-? and pathological changes in the pulmonary tissue between the QYT and DEX groups; however, a statistically significant difference was observed when compared with the ALI group. The expression levels of AQP-1 significantly increased (P<0.05) and lung edema was alleviated in the QYT and DEX groups, when compared with ALI group. Therefore, the expression level of AQP-1 is associated with pulmonary edema. QYT protects the lungs from injury induced by SAP via the upregulation of AQP-1, which suppresses TNF-? expression. PMID:25371738

GAO, ZHENMING; XU, JUNFENG; SUN, DEGUANG; ZHANG, RIXIN; LIANG, RUI; WANG, LIMING; FAN, RONG

2014-01-01

62

Nutrition, Inflammation, and Acute Pancreatitis  

PubMed Central

Acute pancreatitis is acute inflammatory disease of the pancreas. Nutrition has a number of anti-inflammatory effects that could affect outcomes of patients with pancreatitis. Further, it is the most promising nonspecific treatment modality in acute pancreatitis to date. This paper summarizes the best available evidence regarding the use of nutrition with a view of optimising clinical management of patients with acute pancreatitis. PMID:24490104

Petrov, Max

2013-01-01

63

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy  

PubMed Central

Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis. PMID:24995138

Ahmed, Seema; Shaffer, Lemuel; Cavens, Paula; Blankstein, Josef

2014-01-01

64

Diagnostic Value of Surfactant Protein-A in Severe Acute Pancreatitis-Induced Acute Respiratory Distress Syndrome  

PubMed Central

Background The complexity of multiple-item criteria in acute respiratory distress syndrome (ARDS) often causes inconvenience for physicians in the management of patients with severe acute pancreatitis (SAP). We evaluated whether serum SP-A levels in the presence of diffuse alveolar damage (DAD) can be qualitatively assessed for diagnosis of SAP-induced ARDS. Material/Methods Eighty rats were randomly divided into 2 groups (n=40 each) – the sham-operated (SO) group and the SAP group – and then randomly subdivided into 4 subgroups in a time-course manner. Furthermore, rats in the SAP group were subdivided into the SAP induced-ARDS group (ARDS group) and the SAP without ARDS group (non-ARDS group) according to the diagnostic standard of ARDS. The diagnostic cut-off values of SP-A for SAP-induced ARDS were determined by the receiver operating characteristic curve (ROC). Results Serum SP-A levels in Baseline, SO group, SAP group, ARDS group, and non-ARDS group were 43.15±14.29, 51.91±16.99, 193.4±35.37, 198.0+29.73, and 185.7±43.21 ug/ml, respectively. The best cut-off value for the serum SP-A level for the diagnosis of SAP-induced ARDS was 150 ug/ml and the area under the ROC curve of SP-A was 0.88. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SP-A in the diagnosis of SAP-induced ARDS were 100.0%, 81.8%, 71.4%, 100.0%, and 87.5%, respectively. Conclusions Serum SP-A levels may allow the detection of SAP-induced ARDS and may help to support the clinical diagnosis of ARDS. The optimal serum SP-A cut-off value to discriminate SAP-induced ARDS and other groups (SO group and non-ARDS group) is around 150 ug/ml. PMID:25256693

Zhu, Bin; Zheng, Feng; Liu, Ning; Zhu, Ming-Hui; Xie, Jun; Ye, Ji-Ru; Zhang, Jun; Jiang, Dan-Qian; Yang, Chun; Jiang, Yong

2014-01-01

65

Determinants of Pancreatic Microcirculation in Acute Pancreatitis in Rats  

Microsoft Academic Search

The aim of the study was to evaluate the effects of arterial hypotension, high-volume crystalloid resuscitation, and isovolemic hemodilution on pancreatic microvascular perfusion during acute pancreatitis. Using intravital microscopy, pancreatic functional capillary density was analyzed in rats 1 and 2 hr after onset of acute pancreatitis. Pancreatic microvascular perfusion in acute pancreatitis was characterized by a (?62%) significant reduction of

Thomas Kerner; Brigitte Vollmar; Michael D. Menger; Helmut Waldner; Konrad Messmer

1996-01-01

66

[Acute pancreatitis: An overview of the management].  

PubMed

Over the past decades, the incidence and the number of hospital admissions for acute pancreatitis have increased in the Western countries. The two most common etiological factors of acute pancreatitis are gallstones (including small gallstones or microlithiasis) and alcohol abuse. Acute pancreatitis is associated with a significant mortality (4-10%) and 25% in case of pancreatic necrosis, especially. Edematous pancreatitis is benign and oral feeding can be restarted once abdominal pain is decreasing and inflammatory markers are improving. Enteral tube feeding should be the primary therapy in patients with predicted severe acute pancreatitis who require nutritional support. Enteral nutrition in acute pancreatitis can be administered via either the nasojejunal or nasogastric route. In case of necrosis, preventive antibiotics are not recommended. The single indication is infected necrosis confirmed by fine needle aspiration. The incidence trends of acute pancreatitis possibly reflect a change in the prevalence of main etiological factors (e.g. gallstones and alcohol consumption) and cofactors such as tobacco, obesity and genetic susceptibility. Priority is to search for associated causes, especially in cases with atypical symptoms. In case of first acute pancreatitis in patients older than 50years, the presence of a tumor (benign or malignant) has to be specifically ruled out, using CT-scan, MRI and endoscopic ultrasound. PMID:24837648

Rebours, V

2014-10-01

67

Effects and mechanisms of alveolar type II epithelial cell apoptosis in severe pancreatitis-induced acute lung injury  

PubMed Central

This study aimed to examine the role of alveolar type II epithelial cell (AEC II) apoptosis in severe pancreatitis-induced acute lung injury (ALI) and the intervening role of Qingyi decoction (QYT). An SAP model was established in male Sprague-Dawley rats. Immunohistochemical analysis was conducted to observe the pathological changes in the pancreas and lung tissue. AEC II apoptosis was detected by flow cytometry and the free Ca2+ concentration in AECs II was determined by laser scanning confocal microscopy. A radioimmunoassay was performed to determine serum TNF-? content. Quantitative polymerase chain reaction (qPCR) and immunohistochemical analysis were performed to detect the mRNA and protein expression levels of Bax and caspase-8 in the lung tissue. Hematoxylin and eosin staining of lung tissue sections in the severe acute pancreatitis (SAP) group showed pathological changes from control tissue, consistent with acute lung injury (ALI). Flow cytometry showed that the level of AEC II apoptosis in the SAP group was significantly increased compared with that in the control group (P<0.01). Laser scanning confocal microscopy indicated that the free Ca2+ concentration in the AECs II of the SAP group was also significantly increased compared with that in the control (P<0.01). Radioimmunoassay demonstrated that the TNF-? levels were significantly increased in the SAP group compared with those in the control group (P<0.01), and qPCR results showed that the levels of Bax and caspase-8 apoptotic gene expression in the AECs II of the SAP group were significantly elevated (P<0.01). The aforementioned indicators were significantly lower following drug treatment compared with the levels observed in the SAP model group. These results suggest that AEC II apoptosis is involved in the ALI procedure associated with SAP. The mitochondrial pathway and death receptor pathway may have key regulatory roles in AEC II apoptosis. The use of QYT may significantly reduce the extent of lung injury. PMID:24520246

LIU, GELIANG; ZHANG, JINGWEN; CHEN, HAILONG; WANG, CHAO; QIU, YANG; LIU, YUEJIAN; WAN, JIAJIA; GUO, HUISHU

2014-01-01

68

Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis  

PubMed Central

Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24?hrs of admission, whereas Ranson and Glasgow scores after 48?hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study. PMID:24204087

Khanna, Ajay K.; Meher, Susanta; Prakash, Shashi; Tiwary, Satyendra Kumar; Singh, Usha; Srivastava, Arvind; Dixit, V. K.

2013-01-01

69

Toll-like receptor 4 polymorphisms to determine acute pancreatitis susceptibility and severity: A meta-analysis  

PubMed Central

AIM: To investigate the correlation of toll-like receptor 4 (TLR4) gene Asp299Gly and Thr399Ile polymorphisms and acute pancreatitis (AP) risk and severity. METHODS: To get a more precise estimation of the relationship, a comprehensive search was performed to examine all the eligible studies of TLR4 Asp299Gly and Thr399Ile polymorphisms and AP risk. The odds ratios with 95% confidence intervals were used to assess the strength of the association. Publication bias was analyzed by Begg’s funnel plots. RESULTS: In total, six studies with 1255 cases and 998 controls were included in this meta-analysis. Totally, no significant associations were found between TLR4 Asp299Gly or Thr399Ile polymorphisms and AP risk using five models with high homogeneity (P > 0.05). Furthermore, stratification analysis by ethnicity or assay also found no significant association in these two polymorphisms (P > 0.05), and TLR4 Asp299Gly was not associated with AP severity (P > 0.05). In addition, no publication bias was found in these studies (P > 0.05). CONCLUSION: Our current meta-analysis suggests that TLR4 Asp299Gly and Thr399Ile polymorphisms may not be risk factors to AP susceptibility. PMID:24914392

Zhou, Xiao-Jin; Cui, Yan; Cai, Li-Yi; Xiang, Jing-Ying; Zhang, Yan

2014-01-01

70

Study on protecting effects of Baicalin and Octreotide on hepatic injury in rats with severe acute pancreatitis  

PubMed Central

AIM: To investigate the protective effects and mechanisms of Baicalin and Octreotide on hepatic injury in rats with severe acute pancreatitis (SAP). METHODS: The SAP rat models were prepared and randomly assigned to the model control group, Baicalin treated group, and Octreotide treated group while other healthy rats were assigned to the sham-operated group. Rat mortality, levels of ALT, AST, liver and pancreas pathological changes in all groups were observed at 3, 6 and 12 h after operation. Tissue microarray (TMA) sections of hepatic tissue were prepared to observe expression levels of Bax, Bcl-2 protein and Caspase-3, and changes of apoptotic indexes. RESULTS: Rat survival at 12 h, expression levels of Bax, Caspase-3 protein and apoptotic indexes of liver were all significantly higher in treated groups than in model control group. While the liver and pancreas pathological scores, contents of ALT, AST, and expression levels of Bcl-2 protein were all lower in treated groups than in the model control group. CONCLUSION: Both Baicalin and Octreotide can protect rats with SAP by decreasing the contents of ALT, AST and expression levels of Bcl-2 protein, and improving the expression levels of Bax protein, Caspase-3 protein, and inducing apoptosis. PMID:19030211

Zhang, Xi-Ping; Zhang, Jie; Ren, Zheng; Feng, Guang-Hua; Zhu, Wei; Cai, Yang; Yang, Qi-Jun; Ju, Tong-Fa; Xie, Qi; Yuan, Wen-Qin

2008-01-01

71

[Resuscitation principles in severe acute pancreatitis complicated by multiple organ dysfunctions].  

PubMed

The first part renders very synthetically a few of the principal pathogenetical mechanisms implicated in PA, as well as general data about MODS, and then tackles therapeutical principles of great organic disfunction, the therapy of septic states and nutrition in PA. Hemodynamics dysfunction--the therapeutical objectives are correlated with the principal mechanisms implicated in cardio-vascular disfunction (the grown level of some myocardial depressive factors, the shortcoming of peripheral vascular resistance, a.s.o.). The therapeutical principles covets the volemic restoration, inotropic therapy, the correction of hydro-ionic and acido-basic disorders, the vasomotor therapy, the CID's correction, the myocardium protection against the free radicals of oxygen. The therapy is recommended to be individualized depending on the clinical data and the monitoring of some parameters (T.A, P.V.C., intrapulmonary pressure, EKG, hematocrit value, a.s.o.). Pulmonary disfunction--includes the therapy of some clinical forms of pulmonary complications, the restrictive syndrome, infections, the pulmonary shunt, the atelectasis and insists on ARDS which is a complication with vital implications. The therapy of curdling disorders--recommends blood, derivatives, antiprotease, the substitution of the consumed curdling factors, as well as the removal of the pathogenic factors which disturb the coagulation-coagulolysis equilibrium. Purge proceedings--covet the elimination from the organism of the toxic agents which generate cell-organic lesions. That's why it is moot the elimination of the pancreatic toxins before reaching the circulation (the thoracic tube draining and peritoneal lavage) as well as extrarenal purge proceedings (hemodialysis, hemofiltration and hemodiafiltration) with their benefits and limits. The sepsis and the immunotherapy--are tackled based on recent data from literature which besides antibiotherapy insists on the neutralization of various toxins and mediators by means of monoclonal and polyclonal antibodies, anti TFL antibodies, IL, a.s.o. Nutrition--is different presented, parenterally and enterally, each of them with their benefits and limits and with the recommendation to be used by means of the clinical form. There are mentioned some other additional treatments (pain removing, antagonisms of H2 receptors, inflammation and cytotoxicity inhibition, gastric decompression, a.s.o.). PMID:9462949

Purcaru, F; Ghelase, F; Gugil?, I; Curc?, T; Neme?, R; Georgescu, I; Chiu?u, L; Surlin, V

1997-01-01

72

Early antibiotic treatment in acute necrotising pancreatitis  

Microsoft Academic Search

SummaryDespite improvements in surgical treatment and intensive care, mortality from severe acute pancreatitis remains high. We have carried out a randomised study of 60 consecutive patients with alcohol-induced necrotising pancreatitis to find out whether early antibiotic treatment can improve outcome.30 patients were assigned cefuroxime (4·5 g\\/day intravenously) from admission. In the second group, no antibiotic treatment was given until clinical

V Sainio; E Kemppainen; P Puolakkainen; R Haapiainen; T Schröder; E Kivilaakso; V Valtonen; M Taavitsainen; L Kivisaarl

1995-01-01

73

Therapy for microcirculatory disorders in severe acute pancreatitis: Comparison of delayed therapy with ICAM-1 antibodies and a specific endothelin a receptor antagonist  

Microsoft Academic Search

Many of the complications in severe acute pancreatitis result from the amplifying effects of microcirculatory disruption.\\u000a The pathogenesis of these microcirculatory disorders is multifactorial and involves various vasoactive mediators. Thus questions\\u000a arise as to which vasoactive mediators are most important and how long after the onset of disease vasoactive mediator blockade\\u000a may be effective. The present study compares the effect

Thomas Foitzik; Guido Eibl; Heinz J. Buhr

2000-01-01

74

Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949  

PubMed Central

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. PMID:15456517

Besselink, Marc GH; Timmerman, Harro M; Buskens, Erik; Nieuwenhuijs, Vincent B; Akkermans, Louis MA; Gooszen, Hein G

2004-01-01

75

Mild acute pancreatitis with vildagliptin use.  

PubMed

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

2012-12-01

76

Role of high mobility group box-1 and protection of growth hormone and somatostatin in severe acute pancreatitis.  

PubMed

In this study, we investigated the potential role of high-mobility group box 1 (HMGB1) in severe acute pancreatitis (SAP) and the effects of growth hormone (G) and somatostatin (S) in SAP rats. The rats were randomly divided into 6 groups of 20 each: sham-operated, SAP, SAP+saline, SAP+G, SAP+S and SAP+G+S. Ileum and pancreas tissues of rats in each group were evaluated histologically. HMGB1 mRNA expression was measured by reverse transcription-PCR. Levels of circulating TNF-?, IL-1, IL-6, and endotoxin were also measured. In the SAP group, interstitial congestion and edema, inflammatory cell infiltration, and interstitial hemorrhage occurred in ileum and pancreas tissues. The levels of HMGB1, TNF-?, IL-1, IL-6 and endotoxin were significantly up-regulated in the SAP group compared with those in the sham-operated group, and the 7-day survival rate was 0%. In the SAP+G and SAP+S groups, the inflammatory response of the morphological structures was alleviated, the levels of HMGB1, TNF-?, IL-1, IL-6, and endotoxin were significantly decreased compared with those in the SAP group, and the survival rate was increased. Moreover, in the SAP+G+S group, all histological scores were significantly improved and the survival rate was significantly higher compared with the SAP group. In conclusion, HMGB1 might participate in pancreas and ileum injury in SAP. Growth hormone and somatostatin might play a therapeutic role in the inflammatory response of SAP. PMID:25387675

Wang, Y F; Wu, M; Ma, B J; Cai, D A; Yin, B B

2014-12-01

77

[Therapeutic attitude in acute necrotizing pancreatitis].  

PubMed

The necrosectomy, celiostomy and pancreatic drainage represent the surgical treatment of choice in necrotizing pancreatitis. We present the clinical observation of a patient 59 years old operated in surgical service of Baia Mare for acute necrotizing pancreatitis, discussing the moment of operation, tips of operations, postoperative complications as well as our experience in acute grave pancreatitis treatment. PMID:12731268

Le?e, Mihaela; Pop, C; Naghi, Ildiko; Mure?an, Lavinia

2002-01-01

78

Clodronate-superparamagnetic iron oxide-containing liposomes attenuate renal injury in rats with severe acute pancreatitis*  

PubMed Central

Background and objective: It has been shown that macrophages play an important role in the development of severe acute pancreatitis (SAP), and eventually lead to multiple organ failure (MOF). Clodronate-liposome selectively depleted macrophages. This study was to investigate the role of renal macrophage infiltration in acute renal injury in rats with SAP and to evaluate the potential of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) for diagnosis. Methods: Superparamagnetic Fe3O4 nanoparticles were prepared by chemical coprecipitation. SPIO-liposomes and SPIO-clodronate-liposomes were prepared by the thin film method. SAP models were prepared by injection of sodium taurocholate into the subcapsular space of rat pancreas. Sprague-Dawley rats were randomly divided into a control group, SAP plus SPIO-liposome (P) group, and SAP plus SPIO-clodronate-containing liposome (T) group. Kidney injury was evaluated by T2-weighted MRI scan. The levels of serum amylase (SAM), blood urea nitrogen (BUN), and serum creatinine (SCr) were measured by an automated enzymatic method. Serum tumor necrosis factor-? (TNF-?) was measured by enzyme-linked immunosorbent assay (ELISA). Pathological changes in the pancreas and kidney were observed using hematoxylin and eosin (H&E) staining, while cell apoptosis was detected with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. In addition, the macrophage markers (CD68) of the renal tissue were detected with immunohistochemistry. Results: The pathological changes in the pancreas and kidneys of rats in the T group were milder than those in the P group. The MRI signal intensity of the kidneys in the P and T groups was significantly lower than that in the control group. There were significant changes in the two experimental groups (P<0.01). The levels of SAM, Bun, SCr, and TNF-? in rats in the P group were higher than those in the control group (P<0.01) and in the T group (P<0.01). The apoptosis of the kidney in the T group was higher than that in the P group at 2 and 6 h (P<0.01). Conclusions: Clodronate-containing liposomes protected against renal injury in SAP rats, and SPIO can be used as a tracer for MRI examination to detect renal injury in SAP rats. SPIO-aided MRI provided an efficient non-invasive way to monitor the migration of macrophages after renal injury in rats with SAP. PMID:24903993

Dang, Sheng-chun; Zeng, Yan-hua; Wang, Ping-jiang; Chen, Bao-ding; Chen, Rong-fang; Kumar Singh, Arun; Kumar, Pankaj; Feng, Shu; Cui, Lei; Wang, Hao; Zhang, Jian-xin

2014-01-01

79

Influence of dexamethasone on inflammatory mediators and NF-?B expression in multiple organs of rats with severe acute pancreatitis  

PubMed Central

AIM: To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-?B expression in multiple organs of SAP rats as well as the mechanisms involved. METHODS: Ninety Sprague-Dawley (SD) rats with SAP were randomly divided into the model group (n = 45) and dexamethasone treatment group (n = 45), and another 45 rats were selected for the sham operation group. All groups were randomly subdivided into the 3 h, 6 h and 12 h groups, each group containing 15 rats. The survival of all groups and pathological changes of multiple organs (liver, kidney and lung) were observed at different time points after the operation. The pathological score of multiple organs was carried out, followed by the determination of amylase, endotoxin and TNF-? contents in blood. The tissue microarray was used to detect the expression levels of NF-?B p65 protein in multiple organs. RESULTS: There was no marked difference between the model group and treatment group in the survival rate. The amylase content of the treatment group was significantly lower compared to the model group at 12 h (P < 0.01, 7791.00 vs 9195.00). Moreover, the endotoxin and TNF-? levels of the treatment group were significantly lower than that of the model group at 6 h and 12 h (P < 0.01, 0.040 vs 0.055, 0.042 vs 0.059 and P < 0.05, 58.30 vs 77.54, 38.70 vs 67.30, respectively). Regarding the changes in liver NF-?B expression, the model group significantly exceeded the sham operation group at 3 h (P < 0.01, 1.00 vs 0.00), and the treatment group significantly exceeded the sham operation group at 12 h (P < 0.01, 1.00 vs 0.00), whereas no marked difference was observed between the model group and treatment group at all time points. The kidney NF-?B expression level in the treatment group significantly exceeded the model group (P < 0.05, 2.00 vs 0.00) and the sham operation group (P < 0.01, 2.00 vs 0.00) at 12 h. No NF-?B expression in the lung was found in any group. CONCLUSION: Dexamethasone can lower the amylase, endotoxin and TNF-? levels as well as mortality of SAP rats. NF-?B plays an important role in multiple organ injury. Further studies should be conducted to determine whether dexamethasone can ameliorate the pathological changes of multiple organs by reducing the NF-?B expression in the liver and kidney. The advantages of tissue microarrays in pancreatitis pathological examination include time- and energy- saving, and are highly efficient and representative. The restriction of tissue microarrays on the representation of tissues to various extents due to small diameter may lead to the deviation of analysis. PMID:17278220

Zhang, Xi-Ping; Zhang, Ling; Chen, Lin-Jie; Cheng, Qi-Hui; Wang, Jian-Mei; Cai, Wei; Shen, Hai-Ping; Cai, Jun

2007-01-01

80

[Artificial nutrition in acute pancreatitis].  

PubMed

Nutritional support in acute pancreatitis. Despite increasing knowledge and available guidelines in the fields of nutritional support in pancreatic diseases there do still exist a lot of controversies, aversions, delusions in the clinical work. Hungarian Society of Clinical Nutrition has already published it's own guideline on nutrition in pancreatic diseases in 2002. European Society of Parenteral and Enteral Nutrition (ESPEN) also published a Consensus Statement based on the proposals of an international Consensus Conference with active Hungarian participation. The aim of this article is to clear up habitual considerations of some physicians and to share current knowledge from physiology/pathophysiology to quality control upon these guidelines, meta-analyses, and, the daily practice of Hungarian pioneers of nutrition support in pancreatic diseases. PMID:15997665

Harsányi, László

2005-05-29

81

Vascular Mechanisms to Induce Acute Pancreatitis  

Microsoft Academic Search

Vascular mechanisms are not standard tools to induce acute pancreatitis. They are used for special purposes to investigate the pathophysiologic significance of circulatory changes in acute pancreatitis. Because of the rich collateral network, occlusion of the main pancreatic arteries induces no pathological change. Complete occlusion of the venous outflow induces hemorrhagic necrosis of the pancreas, disturbances of the microcirculation, edema

H. Waldner

1992-01-01

82

[Extracorporeal hemocorrection in acute pancreatitis].  

PubMed

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

2000-01-01

83

Diosmetin ameliorates the severity of cerulein-induced acute pancreatitis in mice by inhibiting the activation of the nuclear factor-?B  

PubMed Central

Diosmetin (3’, 5, 7-trihydroxy-4’-methoxyflavone), the aglycone part of the flavonoid glycosides diosmin occurs naturally in citrus fruit, was considered to exhibit anti-inflammatory and antioxidant properties. Our study aimed to investigate the effect of diosmetin in a murine model of cerulein-induced acute pancreatitis (AP). Experimental AP was induced in mice by seven intraperitoneal injection of cerulein (50 ug/kg) at hourly intervals. Diosmetin (100 mg/kg) or vehicle was pretreated 2 h before the first cerulein injection. After 6 h, 9 h, 12 h of the first cerulein injection, the severity of acute pancreatitis was evaluated biochemically and morphologically. Pretreatment with diosmetin significantly reduced serum levels of amylase and lipase; the histological injury; the secretion of tumor necrosis factor (TNF)-?, interleukin (IL)-1?, and IL-6; myeloperoxidase (MPO) activity, trypsinogen activation peptide (TAP) level, the expression of inducible nitric oxide synthase (iNOS); and the nuclear factor (NF)-?B activation in cerulein-induced AP. This study showed that administration of diosmetin demonstrated a beneficial effect on the course of cerulein-induced AP in mice. Therefore, diosmetin may become a new therapeutic agent in future clinical trials for treatment of AP. PMID:24966921

Yu, Ge; Wan, Rong; Yin, Guojian; Xiong, Jie; Hu, Yanling; Xing, Miao; Cang, Xiaofeng; Fan, Yuting; Xiao, Wenqin; Qiu, Lei; Wang, Xingpeng; Hu, Guoyong

2014-01-01

84

Questions about the use of antibiotics in acute pancreatitis  

PubMed Central

Background and objective The use of antibiotics in acute pancreatitis despite recent clinical trials remains controversial. The aim of this study is to review the latest clinical trials and guidelines about antibiotics in acute pancreatitis and determine its proper use. Methods Through a Medline search, we selected and analyzed pertinent randomized clinical trials and guidelines that evaluated the use of antibiotics in acute pancreatitis. We answered the most frequent questions about this topic. Results and conclusion Based on these clinical trials and guidelines, we conclude that the best treatment currently is the use of antibiotics in patients with severe acute pancreatitis with more than 30% of pancreatic necrosis. The best option for the treatment is Imipenem 3 × 500 mg/day i.v. for 14 days. Alternatively, Ciprofloxacin 2 × 400 mg/day i.v. associated with Metronidazole 3 × 500 mg for 14 days can also be considered as an option. PMID:16820058

De Campos, Tercio; Assef, Jose Cesar; Rasslan, Samir

2006-01-01

85

Dendritic Cells Promote Pancreatic Viability in Mice with Acute Pancreatitis  

PubMed Central

Background & Aims Acute pancreatitis increases morbidity and mortality from organ necrosis by mechanisms that are incompletely understood. Dendritic cells (DCs) can promote or suppress inflammation, depending on their subtype and context. We investigated the roles of DC in development of acute pancreatitis. Methods Acute pancreatitis was induced in CD11c.DTR mice using caerulein or L-arginine; DCs were depleted by administration of diphtheria toxin. Survival was analyzed using Kaplan-Meier analysis. Results Numbers of MHC II+CD11c+DC increased 100-fold in pancreas of mice with acute pancreatitis, to account for nearly 15% of intra-pancreatic leukocytes. Intra-pancreatic DC acquired an immune phenotype in mice with acute pancreatitis; they expressed higher levels of MHC II and CD86 and increased production of interleukin-6, membrane cofactor protein (MCP)-1, and tumor necrosis factor (TNF)-?. However, rather than inducing an organ-destructive inflammatory process, DC were required for pancreatic viability; the exocrine pancreas died in mice that were depleted of DC and challenged with caerulein or L-arginine. All mice with pancreatitis that were depleted of DC died from acinar cell death within 4 days. Depletion of DC from mice with pancreatitis resulted in neutrophil infiltration and increased levels of systemic markers of inflammation. However, the organ necrosis associated with depletion of DC did not require infiltrating neutrophils, activation of NF-?B, or signaling by mitogen-activated protein kinase or TNF-?. Conclusions DC are required for pancreatic viability in mice with acute pancreatitis and might protect organs against cell stress. PMID:21801698

Bedrosian, Andrea S.; Nguyen, Andrew H.; Hackman, Michael; Connolly, Michael K.; Malhotra, Ashim; Ibrahim, Junaid; Cieza-Rubio, Napoleon E.; Henning, Justin R.; Barilla, Rocky; Rehman, Adeel; Pachter, H. Leon; Medina-Zea, Marco V.; Cohen, Steven M.; Frey, Alan B.; Acehan, Devrim; Miller, George

2011-01-01

86

A novel approach to severe acute pancreatitis in sequential liver-kidney transplantation: the first report on the application of VAC therapy.  

PubMed

This work is the first report of vacuum-assisted closure (VAC) therapy applied as a life-saving surgical treatment for severe acute pancreatitis occurring in a sequential liver- and kidney-transplanted patient who had percutaneous biliary drainage for obstructive "late-onset" jaundice. Surgical exploration with necrosectomy and sequential laparotomies was performed because of increasing intra-abdominal pressure with hemodynamic instability and intra-abdominal multidrug-resistant sepsis, with increasingly difficult abdominal closure. Repeated laparotomies with VAC therapy (applying a continuous negative abdominal pressure) enabled a progressive, successful abdominal decompression, with the clearance of infection and definitive abdominal wound closure. The application of a negative pressure is a novel approach to severe abdominal sepsis and laparostomy management with a view to preventing compartment syndrome and fatal sepsis, and it can lead to complete abdominal wound closure. PMID:21129043

Zanus, Giacomo; Boetto, Riccardo; D'Amico, Francesco; Gringeri, Enrico; Vitale, Alessandro; Carraro, Amedeo; Bassi, Domenico; Scopelliti, Michele; Bonsignore, Pasquale; Burra, Patrizia; Angeli, Paolo; Feltracco, Paolo; Cillo, Umberto

2011-03-01

87

Evidence for early oxidative stress in acute pancreatitis  

Microsoft Academic Search

Summary  Pancreatic oxidative stress with depletion of pancreatic glutathione is an early feature in all tested models of acute pancreatitis,\\u000a and sooner or later the problem extends to the lung, irrespective of disease severity, whether toward spontaneous recovery\\u000a or death from multisystem organ failure. We, therefore, sought evidence of oxidative stress in the human disease by analyzing\\u000a admission blood samples. We

Joan M. Braganza; Patrick Scott; Diana Bilton; David Schofield; Christopher Chaloner; Neil Shiel; Linda P. Hunt; Teodoro Bottiglieri

1995-01-01

88

Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts  

Microsoft Academic Search

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

2002-01-01

89

[The management of acute pancreatitis according to the modern guidelines].  

PubMed

Severe acute pancreatitis is a critical illness as the organism that produces a significant mortality despite diagnostic and therapeutic acquisitions. While new mechanisms have been identified for production and were crystallized management principles, a number of controversies remain awaiting resolution in the near future. Aim is to establish, based on their experience and literature data, place the current means of diagnosis and treatment in close correlation with the pathophysiological events of acute pancreatitis. PMID:21698859

Botoi, G; Andercou, O; Andercou, A; Marian, D; Tamasan, A; Span, M

2011-01-01

90

Enteral Nutrition and Acute Pancreatitis: A Review  

PubMed Central

Introduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP. Methods. A MEDLINE search of the English language literature between 1999–2009. Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of pancreatic rest less probable. Enteral nutrition has a beneficial influence on the outcome of AP and should probably be initiated as early as possible (within 48 hours). Supplementation of enteral formulas with glutamine or prebiotics and probiotics cannot routinely be recommended. Conclusions. Nutrition therapy in patients with AP emerged from supportive adjunctive therapy to a proactive primary intervention. Large multicentre studies are needed to confirm the safety and effectiveness of nasogastric feeding and to investigate the role of early nutrition support. PMID:20811543

Spanier, B. W. M.; Bruno, M. J.; Mathus-Vliegen, E. M. H.

2011-01-01

91

[Clinico-tomographic correlations in acute pancreatitis].  

PubMed

In the surgery ward from Baia Mare, in the period 1989-1997 have been operated yearly, on an average, 16-17 acute pancreatitis, out of which 8-9 were necrotic-haemorrhagic acute pancreatitis. The possibility of carrying out the computerized tomography allowed a more precise pre-surgery diagnosis and after surgery was improved observation of evolution of the inflammatory phenomena from the pancreatic zone so that the volume, the structure and the outline of the pancreas, the abdominal or pleural liquid collections and the aspect of the neighboring tissues have been correlated in dynamics, with the clinic aspect of the acute pancreatitis and the prognostic indexes. Even if the computerized tomography allowed a more correct evaluation of the patients suffering of acute pancreatitis, there have been 4-6 decreases due to this affection and its complications, the post-surgery death rate remaining at 17-21%. PMID:10422361

Lese, M; Pop, C; Brându?e, M; Achim, V; Grigorescu, D; Neme?, S

1998-01-01

92

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis  

PubMed Central

Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection. Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis. The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia, while rare complications include thoracic conditions, such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum. There have been no reports of acute mediastinitis originating from pancreatitis in South Korea. In this report, we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.

Choe, In Soo; Kim, Yong Seok; Lee, Tae Hee; Kim, Sun Moon; Song, Kyung Ho; Koo, Hoon Sup; Park, Jung Ho; Pyo, Jin Sil; Kim, Ji Yeong; Choi, In Seok

2014-01-01

93

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis.  

PubMed

Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection. Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis. The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia, while rare complications include thoracic conditions, such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum. There have been no reports of acute mediastinitis originating from pancreatitis in South Korea. In this report, we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention. PMID:25356062

Choe, In Soo; Kim, Yong Seok; Lee, Tae Hee; Kim, Sun Moon; Song, Kyung Ho; Koo, Hoon Sup; Park, Jung Ho; Pyo, Jin Sil; Kim, Ji Yeong; Choi, In Seok

2014-10-28

94

Can early endoscopic ultrasound predict pancreatic necrosis in acute pancreatitis?  

PubMed Central

Background Presence of pancreatic/extrapancreatic necroses (PN/EPN) is an important prognostic indicator in acute pancreatitis (AP) and their early detection is a challenge. Endoscopic ultrasound (EUS) provides high resolution images of pancreas but there is paucity of data on its role in AP. Methods Consecutive patients with AP seen at our center from December 2012-November 2013 and presenting within 5 days of onset of symptoms were prospectively enrolled. EUS was done on the day of admission with a radial echoendoscope and pancreatic/peripancreatic findings were compared with the abdominal computed tomography (CT) findings performed on day 7. Results Of the 46 patients evaluated, 14 were excluded, and 32 patients (22 male; age 40.68±12.46 years) underwent EUS at admission. The etiology of AP was alcohol in 16, gallstones in 13, and idiopathic in 3 patients. Necrotizing pancreatitis was present in 20 (62%) patients, and mean CT severity index was 6.45±2.96. In patients without PN (n=12), EUS revealed normal echo pattern in 6 patients and diffusely hyperechoic and enlarged pancreas in 6 patients. In patients with PN/EPN, EUS revealed multiple hypoechoic areas (>5 mm) in 5 patients, multiple hyperechoic areas (>5 mm) in 7 patients and mixed hypo and hyperechoic areas in 8 patients. Also, 13 of these patients had peripancreatic hypoechoic areas that correlated with EPN. Moreover, EUS detected common bile duct (CBD) stones in two patients, pleural effusion in 17 patients, and ascites in 15 patients. Conclusion EUS done at admission can reliably detect PN and co-existent disorders like CBD stones. PMID:25331790

Rana, Surinder S.; Bhasin, Deepak K.; Sharma, Vishal; Sharma, Ravi; Chaudhary, Vinita; Chhabra, Puneet

2014-01-01

95

The classification of acute pancreatitis: Current status  

PubMed Central

Summary The Atlanta Classification of acute pancreatitis (AP) is widely accepted and has been used by physicians and radiologists since 1992. However, advances in knowledge of the disease process, improved imaging, and ever-changing treatment options have rendered some of its definitions ambiguous and highlighted the inadequacy of its classification of severity. This review discusses revision of the Atlanta Classification (2008) and it describes a new determinant-based classification (2012). In contrast to the Atlanta Classification, the revised version and new classification are based on evidence but still need to be developed through systematic review of new data and further international consultation.

Mao, Liang; Qiu, Yudong

2012-01-01

96

Review of experimental animal models of acute pancreatitis  

PubMed Central

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. PMID:18333137

Hue Su, Kim; Cuthbertson, Christine

2006-01-01

97

Metformin induced acute pancreatitis precipitated by renal failure.  

PubMed

Metformin is a biguanide commonly used in type 2 diabetes and considered to be a safe drug with minimal side effects. Approximately 2% of cases of acute pancreatitis may be caused by drugs, but it is not a known complication of metformin therapy. To date only one case of pancreatitis has been reported in association with metformin, but that was secondary to metformin poisoning (overdose). This is the first reported case of pancreatitis caused by a therapeutic dose of metformin (although in this case renal failure precipitated the metformin toxicity). Severe lactic acidosis is a rare but life threatening complication of metformin, which occurs particularly in patients with renal failure. PMID:15082849

Mallick, S

2004-04-01

98

Surgical and interventional management of complications caused by acute pancreatitis  

PubMed Central

Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience.

Karakayali, Feza Y

2014-01-01

99

Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials  

PubMed Central

Introduction Necrotic tissue infection can worsen the prognosis of severe acute pancreatitis (SAP), and probiotics have been shown to be beneficial in reducing the infection rate in animal experiments and primary clinical trials. However, the results of multicenter randomized clinical trials have been contradictory. Our aim in this study was to systematically review and quantitatively analyze all randomized controlled trials with regard to important outcomes in patients with predicted SAP who received probiotics. Methods A systematic literature search of the PubMed, Embase and Cochrane Library databases was conducted using specific search terms. Eligible studies were randomized controlled trials that compared the effects of probiotic with placebo treatment in patients with predicted SAP. Mean difference (MD), risk ratio (RR) and 95% confidence interval (95% CI) were calculated using the Mantel-Haenszel fixed- and random-effects models. A meta-analysis on the use of probiotics in the treatment of critically ill patients was also performed to serve as a reference. Results In this study, 6 trials comprising an aggregate total of 536 patients were analyzed. Significant heterogeneities were observed in the type, dose, treatment duration and clinical effects of probiotics in these trials. Systematic analysis showed that probiotics did not significantly affect the pancreatic infection rate (RR?=?1.19, 95% CI?=?0.74 to 1.93; P?=?0.47), total infections (RR?=?1.09, 95% CI?=?0.80 to 1.48; P?=?0.57), operation rate (RR?=?1.42, 95% CI?=?0.43 to 3.47; P?=?0.71), length of hospital stay (MD?=?2.45, 95% CI?=??2.71 to 7.60; P?=?0.35) or mortality (RR?=?0.72, 95% CI?=?0.42 to 1.45; P?=?0.25). Conclusions Probiotics showed neither beneficial nor adverse effects on the clinical outcomes of patients with predicted SAP. However, significant heterogeneity was noted between the trials reviewed with regard to the type, dose and treatment duration of probiotics, which may have contributed to the heterogeneity of the clinical outcomes. The current data are not sufficient to draw a conclusion regarding the effects of probiotics on patients with predicted SAP. Carefully designed clinical trials are needed to validate the effects of particular probiotics given at specific dosages and for specific treatment durations. PMID:24684832

2014-01-01

100

Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: Case report and review of literature  

Microsoft Academic Search

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

2008-01-01

101

Acute Pancreatitis Induced by Methimazole Therapy  

PubMed Central

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. PMID:22679409

Abraham, Albin; Raghavan, Pooja; Patel, Rajshree; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul

2012-01-01

102

Acute pancreatitis at the beginning of the 21st century: The state of the art  

PubMed Central

Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century. PMID:19554647

Tonsi, Alfredo F; Bacchion, Matilde; Crippa, Stefano; Malleo, Giuseppe; Bassi, Claudio

2009-01-01

103

Endoscopic therapy in acute recurrent pancreatitis  

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), and less invasive endoscopy, especially endoscopic ultrasound (EUS), have largely taken over from ERCP for diagnosis. However, ERCP remains the “first line” therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis, including bile duct stones (choledocholithiasis), ampullary masses (benign and malignant), congenital variants of biliary and pancreatic anatomy (e.g. pancreas divisum, choledochoceles), sphincter of Oddi dysfunction (SOD), pancreatic stones and strictures, and parasitic disorders involving the biliary tree and/or pancreatic duct (e.g Ascariasis, Clonorchiasis). PMID:18286684

Baillie, John

2008-01-01

104

Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis  

PubMed Central

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. PMID:19824123

Smith, Emily K; Ek, Edmund; Croagh, Daniel; Spain, Lavinia A; Farrell, Stephen

2009-01-01

105

Duodenal web presenting with acute pancreatitis.  

PubMed

An 8-year-old boy presented with acute pancreatitis and was found to have a fenestrated duodenal web (windsock) and associated anomalies. After partial excision of the web and duodenoplasty, he has remained well with no further symptoms. PMID:9269984

Alizai, N K; Puntis, J W; Stringer, M D

1997-08-01

106

The Atlanta Classification of acute pancreatitis revisited  

Microsoft Academic Search

Background: In a complex disease such as acute pancreatitis, correct terminology and clear definitions are important. The clinically based Atlanta Classification was formulated in 1992, but in recent years it has been increasingly criticized. No formal evaluation of the use of the Atlanta definitions in the literature has ever been performed. Methods: A Medline literature search sought studies published after

T. L. Bollen; H. C. van Santvoort; M. G. H. Besselink; M. S. van Leeuwen; K. D. Horvath; P. C. Freeny; H. G. Gooszen

2008-01-01

107

Pattern of Acute Pancreatitis in a Tertiary Care Center in Oman  

PubMed Central

Objective To describe the epidemiology of acute pancreatitis in a tertiary care center in Oman. Methods A retrospective study evaluated all adults (>18 yrs) who presented with first attack of acute pancreatitis to SQUH from 1st of January 2006 to 31st of December 2012. Results One hundred seventy-four patients were found. The mean age of the cohort was 44 ± 11 years. 54% (n=95) were male and 45% (n=79) were female. Majority of the cases were mild (n=131) compared to moderate (n=29) and severe (n=14). Sixty six percent (n=116) of the cases were secondary to alcohol and biliary tract diseases. Alcoholic pancreatitis occurred in 53% of the males whereas biliary pancreatitis occurred in 51% of the females. Pancreatitis recurred in 40% (n=71) of the cases, especially in alcoholic pancreatitis. 56 patients (32%) had complications, especially in the severe cases. Conclusion The data about acute pancreatitis in Oman was similar to the Western countries. Pancreatitis occurred in males more than females. Alcoholic pancreatitis was more common in males, whereas biliary pancreatitis was more common in females. Alcoholic pancreatitis re-occurred in nearly half of the cases. Severe cases were associated with more complications and recurrence. PMID:25337313

Albulushi, Arif; Siddiqi, Aftab; Alqarshoubi, Issa; Aladawi, Moza; Alkhadhouri, Ghalib; Farhan, Hatem

2014-01-01

108

Inhibition of the nucleotide-binding domain, leucine-rich containing family, pyrin-domain containing 3 inflammasome reduces the severity of experimentally induced acute pancreatitis in obese mice.  

PubMed

Acute pancreatitis (AP), although most often a mild and self-limiting inflammatory disease, worsens to a characteristically necrotic severe acute pancreatitis (SAP) in about 20% of cases. Obesity, affecting more than one-third of American adults, is a risk factor for the development of SAP, but the exact mechanism of this association has not been identified. Coincidental with chronic low-grade inflammation, activation of the nucleotide-binding domain, leucine-rich containing family, pyrin-domain containing 3 (NLRP3) inflammasome increases with obesity. Lean mice genetically deficient in specific components of the NLRP3 inflammasome are protected from experimentally induced AP, indicating a direct involvement of this pathway in AP pathophysiology. We hypothesized that inhibition of the NLRP3 inflammasome with the sulfonylurea drug glyburide would reduce disease severity in obese mice with cerulein-induced SAP. Treatment with glyburide led to significantly reduced relative pancreatic mass and water content and less pancreatic damage and cell death in genetically obese ob/ob mice with SAP compared with vehicle-treated obese SAP mice. Glyburide administration in ob/ob mice with cerulein-induced SAP also resulted in significantly reduced serum levels of interleukin 6, lipase, and amylase and led to lower production of lipopolysaccharide-stimulated interleukin 1? release in cultured peritoneal cells, compared with vehicle-treated ob/ob mice with SAP. Together, these data indicate involvement of the NLRP3 inflammasome in obesity-associated SAP and expose the possible utility of its inhibition in prevention or treatment of SAP in obese individuals. PMID:25152324

York, Jason M; Castellanos, Karla J; Cabay, Robert J; Fantuzzi, Giamila

2014-10-01

109

Role of interleukin-6 in acute pancreatitis. Comparison with C-reactive protein and phospholipase A  

Microsoft Academic Search

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

1992-01-01

110

Continuous Intravenous Octreotide Treatment for Acute Experimental Pancreatitis  

Microsoft Academic Search

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

1999-01-01

111

Pancreatogastrostomy in experimental acute necrotizing pancreatitis  

Microsoft Academic Search

Summary  Experimental acute necrotizing pancreatitis was induced retrogradely in dogs with sunflower oil injected intraductally. Then,\\u000a a zipper was sutured into the abdominal wound. From the first postoperative day, three different treatments were started:\\u000a first group: only conservative therapy was used; second group: removal of necrotized tissue and single peritoneal lavage were\\u000a aplied; and third group: the necrotic part of the

Dezsö Kelemen; Béla Török

1990-01-01

112

Effects of gabexate mesilate on serum inflammatory cytokines in rats with acute necrotizing pancreatitis.  

PubMed

Gabexate mesilate is a synthetic protease inhibitor. The effectiveness of gabexate mesilate in patients with acute pancreatitis is controversial. Proinflammatory cytokines are associated with systemic inflammatory response syndrome (SIRS) in acute pancreatitis. A compensatory anti-inflammatory response occurs in parallel with SIRS. We investigated the effects of gabexate mesilate on acute necrotizing pancreatitis in rats, emphasizing the changes in serum levels of proinflammatory and anti-inflammatory cytokines. Acute necrotizing pancreatitis was induced by retrograde infusion of sodium taurodeoxycholate into the pancreatobiliary duct in rats. The rats were divided into three groups. Group I was given gabexate mesilate 2 mg/kg/h i.v. continuously 1 h before the induction of acute pancreatitis. Group II was given gabexate mesilate the same dose immediately after the induction of acute pancreatitis. Group III was given normal saline as the controls. Serum levels of amylase, lipase, tumor necrosis factor alpha, interleukin-6, and interleukin-10, pancreatic histopathology and hemodynamics were examined at 5h after the induction of acute pancreatitis. Gabexate mesilate significantly reduced serum levels of amylase, lipase, tumor necrosis factor alpha and interleukin-6 at 5 h. Serum levels of interleukin-10 significantly increased in Group I, as compared with Groups II and III. The severity of pancreatic histopathology, the reduction of mean arterial pressure, the volume of ascites and pancreatic wet weight/body weight ratios were also significantly improved by the administration of gabexate mesilate. The beneficial effects of gabexate mesilate on acute pancreatitis may be, in part, due to the modulation of inflammatory cytokine responses. PMID:16473521

Chen, Chun-Chia; Wang, Sun-Sang; Tsay, Shyh-Haw; Lee, Fa-Yauh; Lu, Rei-Hwa; Chang, Full-Young; Lee, Shou-Dong

2006-01-21

113

A prospective study to determine the efficacy of antibiotics in acute pancreatitis.  

PubMed Central

This study is a double "blind" prospective evaluation of the efficacy of antibiotics (Ampicillin) in the treatment of acute alcohol-induced and idiopathic pancreatitis. Fifty-eight patients with acute pancreatitis were randomly divided into antibiotic and non-antibiotic treatment groups. The two groups were comparable clinically at the onset of the study and other than for antibiotics received identical therapy. The patients without antibiotics had a clinical course equal or slightly more favorable than the antibiotic treatment group in all parameters examined. These data indicate that prophylactic use of Ampicillin is not indicated in patients with routine acute alcohol-induced or idiopathic pancreatitis. The role of prophylactic antibiotics in patients with pancreatitis related to biliary calculi and those with more severe varieties of acute hemorrhagic or necrotizing pancreatitis remains to be more clearly defined. PMID:788655

Finch, W T; Sawyers, J L; Schenker, S

1976-01-01

114

Mutations in the cationic trypsinogen gene are associated with recurrent acute and chronic pancreatitis  

Microsoft Academic Search

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

1997-01-01

115

Gene Expression Profiles in Cells of Peripheral Blood Identify New Molecular Markers of Acute Pancreatitis  

PubMed Central

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. PMID:18347268

Bluth, Martin; Lin, Yin-yao; Zhang, Hong; Viterbo, Dominick; Zenilman, Michael

2009-01-01

116

Effects of hypoxia-inducible factor-1? and matrix metalloproteinase-9 on alveolar-capillary barrier disruption and lung edema in rat models of severe acute pancreatitis-associated lung injury  

PubMed Central

The aim of this study was to investigate the effects of hypoxia-inducible factor-1? (HIF-1?) and matrix metalloproteinase-9 (MMP-9) on alveolar-capillary barrier disruption and lung edema in rat models of severe acute pancreatitis-associated lung injury (PALI). A total of 40 male Sprague-Dawley rats were randomly divided into a sham surgery group (n=10) and three PALI groups, in which acute pancreatitis was induced by the retrograde infusion of 5% sodium taurocholate (1 ml/kg). The PALI groups were as follows: i) Untreated PALI group (n=10); ii) 2-methoxyestradiol (2ME2) group (5 mg/kg body mass; n=10); and iii) 2ME2 group (15 mg/kg body mass; n=10). In the two 2ME2 groups, the HIF-1? inhibitor 2ME2 was administered intraperitoneally 1 h after the induction of AP. The severity of the pancreatitis was evaluated by the serum amylase levels and pathology. The severity of the lung injury was evaluated by the wet/dry ratio, blood gas analysis and pathology. The alveolar-capillary barrier disruption was assessed by Evans blue dye extravasation. The protein and mRNA expression levels of HIF-1? and MMP-9 were studied using enzyme-linked immunosorbent assays (ELISAs), western blot analysis and reverse transcription-polymerase chain reaction. The active tumor necrosis factor-? levels were measured using an ELISA. The HIF-1? inhibitor 2ME2 attenuated the severity of the pancreatitis and PALI, while the lung edema and alveolar-capillary barrier disruption were significantly ameliorated compared with those in the untreated PALI group. Administration of the higher dose of 2ME2 significantly suppressed the protein expression of MMP-9 in the lung tissues. The results indicate that HIF-1? has a major function in alveolar-capillary barrier disruption and lung edema in PALI via a molecular pathway cascade involving MMP-9. Inhibition of HIF-1? by 2ME2 attenuates alveolar-capillary barrier disruption and lung edema. Pharmacological blockade of this pathway in patients with PALI may provide a novel therapeutic strategy. PMID:25120621

QI, BING; CHEN, HAI-LONG; SHANG, DONG; DONG, YING; ZHANG, GUI-XIN; YU, LEI

2014-01-01

117

Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience  

PubMed Central

CONTEXT: Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management. AIMS: Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date. Herein, we present our experience with laparoscopic management of pancreatic necrosis in 28 patients. MATERIALS AND METHODS: A retrospective study of 28 cases [20 men, 8 women] was carried out in our institution. The medical record of these patients including history, clinical examination, investigations, and operative notes were reviewed. The mean age was 47.8 years [range, 23-70 years]. Twenty-one patients were managed by transgastrocolic, four patients by transgastric, two patients by intra-cavitary, and one patient by transmesocolic approach. RESULTS: The mean operating time was 100.8 min [range, 60-120 min]. The duration of hospital stay after the procedure was 10-18 days. Two cases were converted to open (7.1%) because of extensive dense adhesions. Pancreatic fistula was the most common complication (n = 8; 28.6%) followed by recollection (n = 3; 10.7%) and wound infection (n = 3; 10.7%). One patient [3.6%] died in postoperative period. CONCLUSIONS: Laparoscopic pancreatic necrosectomy is a promising and safe approach with all the benefits of minimally invasive surgery and is found to have reduced incidence of major complications and mortality. PMID:25013328

Mathew, Mittu John; Parmar, Amit Kumar; Sahu, Diwakar; Reddy, Prasanna Kumar

2014-01-01

118

Increased activity of group II phospholipase A2 in plasma in rat sodium deoxycholate induced acute pancreatitis  

PubMed Central

Background—Two different types of secretory phospholipase A2 (PLA2), pancreatic group I (PLA2-I) and non-pancreatic group II (PLA2-II), have been identified and postulated to be associated with the pathogenesis of various diseases, such as acute pancreatitis, septic shock, and multiple organ failure. ?Aims—To investigate the type of secretory PLA2 responsible for its catalytic activity found in plasma and ascites of experimental acute pancreatitis. ?Methods—Acute pancreatitis of differing severity was induced by the injection of different concentrations (1% or 10%) of sodium deoxycholate (DCA) into the common biliopancreatic duct in rats, and catalytic PLA2 activity in plasma and ascites were differentiated by anti-PLA2-I antibody and specific inhibitor of PLA2-II. Survival rate and plasma amylase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were also measured.?Results—In 1% and 10% DCA induced acute pancreatitis, plasma amylase values as well as PLA2 activity in ascites were greatly increased. PLA2 activity in plasma was also notably increased in 10% DCA induced acute pancreatitis, but not in 1% DCA induced acute pancreatitis. PLA2-I specific polyclonal antibody significantly inhibited PLA2 activity in ascites but not that in plasma. In contrast, plasma PLA2 activity was completely suppressed by PLA2-II specific inhibitor. In addition, a high mortality (93% at five hours) and a significant increase in plasma AST and ALT were noted in 10% DCA induced pancreatitis. ?Conclusion—Ascites PLA2 activity is mainly derived from PLA2-I, whereas plasma PLA2 activity is mostly derived from PLA2-II in severe acute pancreatitis, suggesting that increased plasma PLA2-II activity might be implicated in hepatic failure arising after severe acute pancreatitis. ?? Keywords: acute pancreatitis; phospholipase A2; sodium deoxycholate pancreatitis; hepatic failure PMID:9462218

Furue, S; Hori, Y; Kuwabara, K; Ikeuchi, J; Onoyama, H; Yamamoto, M; Tanaka, K

1997-01-01

119

Histopathologic correlates of serum amylase activity in acute experimental pancreatitis  

Microsoft Academic Search

The association of serum amylase activity with the extent of pancreatic injury in acute pancreatitis is unclear. To clarify this relationship, we induced acute pancreatitis ranging from mild to lethal in 118 Sprague-Dawley rats (350–450 g). This was achieved by controlled intraductal infusion of low- or high-dose bile salt, with or without enterokinase, followed by intravenous cerulein or saline for

J. Schmidt; K. Lewandrowski; C. Fernandez-Del Castillo; U. Mandavilli; C. C. Compton; A. L. Warshaw; D. W. Rattner

1992-01-01

120

Acute Pancreatitis: The Role of Imaging and Interventional Radiology  

Microsoft Academic Search

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 [1, 2]. Fortunately, 70–80% of patients with acute pancreatitis have a benign self-limiting course (Figs. 1, 2, 4). The initial 24-48 hours after

Michael M. Maher; Brian C. Lucey; Debra A. Gervais; Peter R. Mueller

2004-01-01

121

Acute Pancreatitis: The Role of Imaging and Interventional Radiology  

Microsoft Academic Search

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

Michael M. Maher; Brian C. Lucey; Debra A. Gervais; Peter R. Mueller

2004-01-01

122

Acute pancreatitis due to pancreatic hydatid cyst: a case report and review of the literature  

PubMed Central

Hydatid disease is a major health problem worldwide. Primary hydatid disease of the pancreas is very rare and acute pancreatitis secondary to hydatid cyst has rarely been reported. We report the case of a 38-year-old man who presented acute pancreatitis. A diagnosis of hydatid cyst of the pancreas, measuring 10 cm, was established by abdominal computed tomography before surgery. The treatment consisted of a distal pancreatectomy. The postoperative period was uneventful. Additionally, a review of the literature regarding case reports of acute pancreatitis due to pancreatic hydatid cyst is presented. PMID:22445170

2012-01-01

123

Towards a Novel Treatment Strategy for Acute Pancreatitis  

Microsoft Academic Search

Despite more than a century of research endeavour, there is no specific medical treatment for acute pancreatitis and early mortality is high – 20% of fatalities by the day after admission. I do not see any realistic prospect that today’s focus on immunomodulation will provide a breakthrough either. The signs are that the outcome of acute pancreatitis is determined almost

Joan M. Braganza

2001-01-01

124

Pancreatitis  

MedlinePLUS

... the pancreas itself. Pancreatitis can be acute or chronic. Either form is serious and can lead to ... IV) fluids, antibiotics, and medicines to relieve pain. Chronic pancreatitis does not heal or improve. It gets ...

125

Pancreatitis  

MedlinePLUS

... or more of the tests used to diagnose acute pancreatitis—abdominal ultrasound, CT scan, EUS, and MRCP. Treatment Treatment for chronic pancreatitis may require hospitalization for pain management, IV hydration, and nutritional support. Nasogastric feedings may ...

126

Evidence-Based Treatment of Acute Pancreatitis  

PubMed Central

Background: The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment. Methods: A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A = large randomized; B = small randomized; C = prospective trial). Results: None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over “open-packing” because of fewer complications with comparable mortality rates (level C). Conclusions: While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery. PMID:16432347

Heinrich, Stefan; Schafer, Markus; Rousson, Valentin; Clavien, Pierre-Alain

2006-01-01

127

Continuous Regional Arterial Infusion Therapy for Acute Necrotizing Pancreatitis Due to Mycoplasma pneumoniae Infection in a Child  

SciTech Connect

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: lmloltlolol@gmail.com; Ogino, Hiroyuki; Shimohira, Masashi; Hara, Masaki; Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

2009-05-15

128

Effect of Echium amoenum Fisch. et Mey a Traditional Iranian Herbal Remedy in an Experimental Model of Acute Pancreatitis  

PubMed Central

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

2012-01-01

129

Aggravation of Hypertriglyceridemia and Acute Pancreatitis in a Bipolar Patient Treated with Quetiapine  

PubMed Central

Pancreatitis is a very rare adverse effect of quetiapine treatment, with only 5 cases of quetiapine-associated pancreatitis reported in the English literature to date. Herein, we report one patient who developed severe hypertriglyceridemia (>1000 mg/dL) after quetiapine administration, resulting in acute pancreatitis. An analysis of the underlying pathogenic mechanisms and a review of relevant literature are also presented. Clinicians should be aware of the potentially life-threatening metabolic disturbances and/or pancreatitis associated with quetiapine therapy. PMID:24719155

Liou, Li-Syue; Hung, Yi-Jen; Hsieh, Chang-Hsun

2014-01-01

130

Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis  

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool in the evaluation and management of acute pancreatitis. This review will focus on the role of ERCP in specific causes of acute pancreatitis, including microlithiasis and gallstone disease, pancreas divisum, Sphincter of Oddi dysfunction, tumors of the pancreaticobiliary tract, pancreatic pseudocysts, and pancreatic duct injury. Indications for endoscopic techniques such as biliary and pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections and stone extraction will also be discussed in this review. With the advent of less invasive and safer diagnostic modalities including endoscopic ultrasound (EUS) and magnetic retrograde cholangiopancreatography (MRCP), ERCP is appropriately becoming a therapeutic rather than diagnostic tool in the management of acute pancreatitis and its complications. PMID:18081218

Canlas, Karen R; Branch, Malcolm S

2007-01-01

131

NF-kappaB activation is detrimental in arginine-induced acute pancreatitis.  

PubMed

The transcription factor nuclear factor kappaB (NF-kappaB) has been shown to have a critical role in the pathogenesis of sodium taurocholate- and cerulein-induced acute pancreatitis by regulating the expression of many proinflammatory genes in the pancreas. Heat shock proteins (HSPs), on the other hand, protect the pancreas against cellular damage. The aims of the present study were: (i) to investigate pancreatic NF-kappaB activation, proinflammatory cytokine synthesis, and cytoprotective HSP induction during L-arginine- (Arg-) induced acute pancreatitis in rats, and (ii) to establish whether pretreatment with pyrrolidine dithiocarbamate (PDTC) or methylprednisolone (MP) can block the activation of pancreatic NF-kappaB and determine their effects on the severity of Arg-induced acute pancreatitis. The dose-response (3 or 4 g/kg) and time-effect (0.5-96 h) curves relating to the action of Arg on pancreatic NF-kappaB activation and IL-1beta, TNF-alpha, HSP60, and HSP72 synthesis were evaluated. Various doses of PDTC or MP were administered 1 h before the induction of pancreatitis. We demonstrated that Arg specifically and dose-dependently induces pancreatitis, activates NF-kappaB (only the 3 g/kg dose) and proinflammatory cytokine synthesis, and increases the expressions of HSP60 and HSP72 in the pancreas of rats. The lower dose of Arg induced a less severe pancreatitis, but larger increases in the levels of HSPs. The present work supports and extends earlier observations that NF-kappaB activation is a common mechanism in acute pancreatitis, although it is dose dependent and occurs at a later stage in Arg-induced pancreatitis as compared with other models. PDTC and MP pretreatment dose-dependently blocked NF-kappaB activation and proinflammatory cytokine expression and ameliorated many of the examined laboratory (the pancreatic weight/body weight ratio, the pancreatic myeloperoxidase activity, the pancreatic contents of protein, amylase and trypsinogen, the degrees of lipid peroxidation and protein oxidation, and the nonprotein sulfhydryl group content) and morphological parameters of the disease. These findings suggest that pretreatment with PDTC or MP has an anti-inflammatory effect during Arg-induced pancreatitis, which is at least partly mediated by the inhibition of NF-kappaB activation and proinflammatory cytokine synthesis. The increased levels of HSPs most probably act to limit the severity of the disease. PMID:12633747

Rakonczay, Zoltán; Jármay, Katalin; Kaszaki, József; Mándi, Yvette; Duda, Ernö; Hegyi, Péter; Boros, Imre; Lonovics, János; Takács, Tamás

2003-03-15

132

Nutritional Support in Acute Pancreatitis and Pancreatic Cancer  

Microsoft Academic Search

\\u000a All pancreatic diseases, whether inflammatory or neoplastic, cause a change in the function of the organ that translates into\\u000a a digestive impairment. Furthermore, pancreatic cancer is frequently responsible for cachexia, due to its late diagnosis and\\u000a the peculiar characteristics of this type of tumor. It is also known that food consumption by pancreatic patients can frequently\\u000a trigger or exacerbate pain

Simona Irma Rocchetti; Aldo Alberto Beneduce; Marco Braga

133

Saline Infusion Through the Pancreatic Duct Leads to Changes in Calcium Homeostasis Similar to Those Observed in Acute Pancreatitis  

Microsoft Academic Search

This work focuses on studying the early events associated with pancreatic damage after retrograde infusion through the pancreatic\\u000a duct in rats. We have analyzed changes in calcium homeostasis and secretory response in pancreatic acini from rats with taurocholate-induced\\u000a acute pancreatitis. Moreover, in order to test whether pancreatic duct manipulation can trigger damage inside pancreatic acinar\\u000a cells, we have studied both

Mónica García; Ernesto Hernández Barbáchano; Pilar Hernández Lorenzo; José Ignacio San Román; María A. López; Rafael Coveńas; José Julián Calvo

2009-01-01

134

Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction.  

PubMed

Polypharmacy may lead to synergistic complications from the different medications. We report the case of a 50-year-old woman who was prescribed 11 drugs, including a diuretic, celecoxib, metformin, and candesartan, and who developed acute kidney dysfunction while on these drugs, manifesting as severe proteinuria, acute azotemia, hyperkalemia. The kidney injury caused the accumulation of metformin, leading to lactic acidosis and acute pancreatitis. Sodium bicarbonate hemodialysis not only improved the metabolic abnormalities but also hastened the removal of metformin. PMID:18259965

Audia, Pat; Feinfeld, Donald A; Dubrow, Alan; Winchester, James F

2008-02-01

135

Axitinib-induced acute pancreatitis: a case report.  

PubMed

Axitinib is an oral second-generation selective inhibitor of vascular endothelial growth factor receptors recently approved for the treatment of advanced renal cell carcinoma. Numerous cases of acute pancreatitis have been reported after treatment with nonselective tyrosine kinase inhibitors such as sorafenib and sunitinib. We present the first report of a patient under axitinib treatment presenting with acute pancreatitis for which no other etiology has been found. The patient was a 29-year-old woman treated for renal cell carcinoma. The patient had no history of chronic illness, gallstone-related disease, or alcohol consumption. She had been previously treated with sunitinib and everolimus. Four months after the onset of axitinib treatment she was hospitalized for acute pancreatitis. Symptoms and blood lipase levels normalized within a few days after axitinib was withheld. We believe that acute pancreatitis should be recognized as a potential axitinib-related adverse event. PMID:24398664

Péron, Julien; Khenifer, Safia; Potier, Valérie; Vitry, Thierry; Pasquet, Florian; Rassat, Robin; Pavic, Michel

2014-04-01

136

Immune-modulating therapy in acute pancreatitis: Fact or fiction  

PubMed Central

Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, bearing significant morbidity and mortality worldwide. Current treatment of AP remains unspecific and supportive and is mainly targeted to aggressively prevent systemic complications and organ failure by intensive care. As acute pancreatitis shares an indistinguishable profile of inflammation with sepsis, therapeutic approaches have turned towards modulating the systemic inflammatory response. Targets, among others, have included pro- and anti-inflammatory modulators, cytokines, chemokines, immune cells, adhesive molecules and platelets. Even though, initial results in experimental models have been encouraging, clinical implementation of immune-regulating therapies in acute pancreatitis has had a slow progress. Main reasons include difficulty in clinical translation of experimental data, poor understanding of inflammatory response time-course, flaws in experimental designs, need for multimodal approaches and commercial drawbacks. Whether immune-modulation in acute pancreatitis remains a fact or just fiction remains to be seen in the future. PMID:25386069

Akinosoglou, Karolina; Gogos, Charalambos

2014-01-01

137

A prospective study of radionuclide biliary scanning in acute pancreatitis.  

PubMed Central

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. PMID:6859781

Neoptolemos, J. P.; Fossard, D. P.; Berry, J. M.

1983-01-01

138

Alterations of platelet function and coagulation parameters during acute pancreatitis.  

PubMed

Vascular thrombosis and systemic hypercoagulable states are known complications of pancreatitis. Higher levels of mean platelet volume (MPV) have been associated with thrombotic diseases. However, a few studies have investigated the association between acute pancreatitis and MPV. We aimed to investigate whether there is a difference of MPV and coagulation parameters in patients with active and remission in acute pancreatitis. We included 24 consecutive patients with biliary acute pancreatitis and 24 consecutive healthy age-matched and sex-matched controls. Full blood counts and other laboratory tests were collected at onset and remission. The MPV was significantly higher in patients with acute pancreatitis at admission 8.6±1.4 fl than controls 7.6±0.7 fl (P=0.005). We detected positive correlation between, aspartate aminotransferase, alanine aminotransferase, ?-glutamyltransferase, amylase, lipase, and glucose, BMI, D-dimer and MPV. However, there was negative correlation between progression, thrombocyte counts, hemoglobin and MPV. As a result higher MPV levels in acute pancreatitis may reflect hypercoagulation associated with pancreatitis. PMID:23425662

Akbal, Erdem; Demirci, Selim; Koçak, Erdem; Köklü, Seyfettin; Ba?ar, Omer; Tuna, Ya?ar

2013-04-01

139

Clinical analysis of 16 patients with acute pancreatitis in the third trimester of pregnancy  

PubMed Central

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. PMID:23923092

Sun, Yanmei; Fan, Cuifang; Wang, Suqing

2013-01-01

140

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

141

Oxygen free radicals in acute pancreatitis of the rat  

Microsoft Academic Search

This study aimed to assess the role of oxygen free radicals in acute pancreatitis. Acute pancreatitis was induced in rats by infusion of the CCK-analogue cerulein (5 micrograms\\/kg per hour) for 30 minutes, 3.5 hours, and 12 hours. After the infusion, serum enzymes and conjugated tissue dienes and malondialdehyde were measured and tissue samples were subjected to electron and light

M H Schoenberg; M Büchler; M Gaspar; A Stinner; M Younes; I Melzner; B Bültmann; H G Beger

1990-01-01

142

Acute Pancreatitis after Percutaneous Mechanical Thrombectomy: Case Report and Review of the Literature  

SciTech Connect

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: rihershberger@lumc.edu; Bornak, Arash; Aulivola, Bernadette; Mannava, Krishna [Loyola University Chicago Medical Center, Division of Vascular Surgery and Endovascular Therapy (United States)

2011-02-15

143

Differential Upregulation of Cellular Adhesion Molecules at the Sites of Oxidative Stress in Experimental Acute Pancreatitis  

Microsoft Academic Search

Background. Severe acute pancreatitis (AP)2 is associated with exaggerated leukocyte adherence and activation. Endothelial cellular adhesion molecules (CAMs) can be induced by cytokines, but also directly by oxygen free radicals (OFRs), mediated by nuclear factor kappa-B (NF-?B). We investigated the behavior of inducible CAMs in relation to pancreatic oxidative stress. Our novel modification of cerium capture histochemistry (reaction of OFRs

Géza Telek; Robert Ducroc; Jean-Yves Scoazec; Catherine Pasquier; Gérard Feldmann; Claude Rozé

2001-01-01

144

Acute pancreatitis associated with boceprevir: a case report.  

PubMed

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir. PMID:24833196

Bilar, Juliana Miguel; Carvalho-Filho, Roberto José; Mota, Carolina Frade Magalhăes Girardin Pimentel; Fucuta, Patricia da Silva; Ferraz, Maria Lucia Cardoso Gomes

2014-01-01

145

Update on pathogenesis and clinical management of acute pancreatitis.  

PubMed

Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce. PMID:22737590

Cruz-Santamaría, Dulce M; Taxonera, Carlos; Giner, Manuel

2012-06-15

146

Update on pathogenesis and clinical management of acute pancreatitis  

PubMed Central

Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce. PMID:22737590

Cruz-Santamaria, Dulce M; Taxonera, Carlos; Giner, Manuel

2012-01-01

147

Intense adrenal enhancement in patients with acute pancreatitis and early organ failure.  

PubMed

Intense adrenal enhancement has previously been reported in patients with hypovolemic and septic shock. The purpose of this study was to assess whether this computed tomography (CT) finding is also observed in patients presenting with severe acute pancreatitis and early organ failure. A retrospective analysis of a prospectively collected database was performed. Out of 38 consecutive patients with predicted severe acute pancreatitis, 3 patients showed intense bilateral adrenal enhancement on early CT. All patients had early multiple organ failure and subsequently died. In two cases, pathologic correlation was obtained. Intense adrenal enhancement may be a new prognostic indicator in patients with acute pancreatitis, particularly when organ failure is present at the time of CT examination. Further studies are necessary to confirm this observation. PMID:17594117

Bollen, T L; van Santvoort, H C; Besselink, M G H; van Ramshorst, B; van Es, H W; Gooszen, H G

2007-10-01

148

Controversial role of toll-like receptors in acute pancreatitis  

PubMed Central

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. PMID:23431068

Vaz, Juan; Akbarshahi, Hamid; Andersson, Roland

2013-01-01

149

Induction of M2 Polarization in Primary Culture Liver Macrophages from Rats with Acute Pancreatitis  

PubMed Central

Background and Aims Systemic inflammatory response syndrome (SIRS), a major process of severe acute pancreatitis (SAP), usually occurs after various activated proinflammatory cytokines, which are produced by macrophages such as liver macrophages. Macrophages can secrete not only proinflammatory mediators but also inhibitory inflammatory cytokines such as IL-10, leading to two different functional states defined as “polarization”. The main purpose of this study was to demonstrate the polarization of liver macrophages during severe acute pancreatitis and to explore whether the polarization of these activated Liver macrophages could be reversed in vitro. Methods Liver macrophages were isolated from rats with acute pancreatitis. These primary culture macrophages were treated with IL-4 or regulatory T cells in vitro to reverse their polarization and was evaluated by measuring M1/M2 marker expression using real time PCR and immunofluorescence staining. Results Acute pancreatitis was induced successfully by intra-pancreatic ductal injection of 5% sodium taurocholate. The liver macrophages demonstrated M1 polarization from 4 h to 16 h after the onset of acute pancreatitis. However, after IL-4 or Treg treatment, the polarization of the liver macrophages was reversed as indicated by increased expression of M2 markers and reduced expression of M1 markers. Furthermore, the effect of Treg on modulating macrophage polarization was slightly better than that of IL-4 in vitro. Conclusion Liver macrophages, a pivotal cell type in the pathogenesis of SAP, become M1 polarized during pancreatic inflammation. Treatment of these cells with IL-4 and Treg can reverse this activation in vitro. This method of altering macrophage polarization could be a prospective therapy for SAP. PMID:25259888

Lin, Rong; Han, Chaoqun; Liu, Jun; Ding, Zhen

2014-01-01

150

Degradation and Inactivation of Plasma Tumor Necrosis Factor-Alpha by Pancreatic Proteases in Experimental Acute Pancreatitis  

PubMed Central

Background Release of TNF? is thought to play an important role in mediating systemic effects in acute pancreatitis (AP). We have been unable to find an elevation of plasma TNF? in AP and hypothesize that it is susceptible to catabolism by circulating pancreatic proteases. Methods (1) AP was induced in Sprague-Dawley rats by cerulein hyperstimulation preceded by intraductal infusion of saline (mild) or glycodeoxycholic acid (severe). Healthy and sham-operated animals served as controls. Severity of pancreatitis was confirmed by histology. Plasma TNF? levels were measured at various time points after induction of AP with competitive ELISA. (2) Recombinant rat TNF? (rrTNF?) was incubated with trypsin, elastase, chymotrypsin and pepsin. Western Blot was performed to visualize TNF degradation. (3) RrTNF? was incubated in a concentration and time-dependant manner with proteases and TNF bioactivity was evaluated with a cytotoxicity assay. Results (1) Plasma TNF? levels in severe pancreatitis were significantly lower than in sham-operated controls after 0.5 and 6 h. (2) Incubation with proteases showed degradation in the presence of trypsin, elastase and chymotrypsin and no effect of pepsin. (3) There was a concentration dependent inactivation of rrTNF? in the presence of pancreatic proteases and a complete time-dependent inactivation in the presence of trypsin. Conclusion Plasma TNF? does not rise in experimental AP, and levels are significantly lower in severe pancreatitis compared to sham-operated controls. Our study demonstrates degradation and inactivation of TNF? by pancreatic proteases, suggesting that it is unlikely it plays an important role in the development of distant organ failure. PMID:15775698

Alsfasser, G.; Antoniu, B.; Thayer, S.P.; Warshaw, A.L.; Fernandez-del Castillo, C.

2013-01-01

151

Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi.  

PubMed

An elderly woman with a history of cholecystectomy and a re-operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct. PMID:10710251

Abe, H; Nisimura, T; Osawa, S; Miura, T; Oka, F

2000-02-01

152

An Impacted Pancreatic Stone in the Papilla Induced Acute Obstructive Cholangitis in a Patient with Chronic Pancreatitis  

PubMed Central

Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well. PMID:22741140

Yoo, Kwang-Ho; Yoon, Sang-Wook; Kim, Won Hee; Lee, Jung Min; Ko, Kwang Hyun; Hong, Sung Pyo; Park, Pil Won

2012-01-01

153

Chronic Alcohol Consumption Is a Major Risk Factor for Pancreatic Necrosis in Acute Pancreatitis  

Microsoft Academic Search

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

2006-01-01

154

Serine proteases mediate inflammatory pain in acute pancreatitis.  

PubMed

Acute pancreatitis is a life-threatening inflammatory disease characterized by abdominal pain of unknown etiology. Trypsin, a key mediator of pancreatitis, causes inflammation and pain by activating protease-activated receptor 2 (PAR(2)), but the isoforms of trypsin that cause pancreatitis and pancreatic pain are unknown. We hypothesized that human trypsin IV and rat P23, which activate PAR(2) and are resistant to pancreatic trypsin inhibitors, contribute to pancreatic inflammation and pain. Injections of a subinflammatory dose of exogenous trypsin increased c-Fos immunoreactivity, indicative of spinal nociceptive activation, but did not cause inflammation, as assessed by measuring serum amylase and myeloperoxidase activity and by histology. The same dose of trypsin IV and P23 increased some inflammatory end points and caused a more robust effect on nociception, which was blocked by melagatran, a trypsin inhibitor that also inhibits polypeptide-resistant trypsin isoforms. To determine the contribution of endogenous activation of trypsin and its minor isoforms, recombinant enterokinase (ENK), which activates trypsins in the duodenum, was administered into the pancreas. Intraductal ENK caused nociception and inflammation that were diminished by polypeptide inhibitors, including soybean trypsin inhibitor and a specific trypsin inhibitor (type I-P), and by melagatran. Finally, the secretagogue cerulein induced pancreatic nociceptive activation and nocifensive behavior that were reversed by melagatran. Thus trypsin and its minor isoforms mediate pancreatic pain and inflammation. In particular, the inhibitor-resistant isoforms trypsin IV and P23 may be important in mediating prolonged pancreatic inflammatory pain in pancreatitis. Our results suggest that inhibitors of these isoforms could be novel therapies for pancreatitis pain. PMID:21436316

Ceppa, Eugene P; Lyo, Victoria; Grady, Eileen F; Knecht, Wolfgang; Grahn, Sarah; Peterson, Anders; Bunnett, Nigel W; Kirkwood, Kimberly S; Cattaruzza, Fiore

2011-06-01

155

Prevalence of normal serum amylase levels in patients with acute alcoholic pancreatitis  

Microsoft Academic Search

Acute alcoholic pancreatitis is uncommonly diagnosed when the serum amylase level is normal. We defined acute alcoholic pancreatitis as a clinical syndrome in which hyperamylasemia was not a necessary component and sought support for the diagnosis by ultrasonography and computed tomography of the pancreas. In 68 episodes of acute alcoholic pancreatitis identified in a one-year period, the serum amylase level

Stuart Jon Spechler; John W. Dalton; Alan H. Robbins; Stephen G. Gerzof; Jerry S. Stern; Willard C. Johnson; Donald C. Nabseth; Elihu M. Schimmel

1983-01-01

156

Ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis.  

PubMed

Parathyroid carcinoma is a rare cause of hyperparathyroidism, accounting for fewer than 1% of cases. The incidence of acute pancreatitis in patients with hyperparathyroidism was reported to be only 1.5%. We report a very rare case of ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis. A 72-year-old man presented with acute pancreatitis and hypercalcemia. During the work-up for hypercalcemia, a mediastinal parathyroid tumor was identified by (99m)Tc-sestamibi scintigraphy and magnetic resonance imaging. The tumor was completely removed via a lower cervical collar incision. The histopathology revealed parathyroid carcinoma. There was no tumor recurrence or abdominal symptoms at 3-year follow-up. PMID:23351422

Tseng, Chih-Wei; Lin, Shan-Zu; Sun, Chih-Hao; Chen, Chun-Chia; Yang, An-Hang; Chang, Full-Young; Lin, Han-Chieh; Lee, Shou-Dong

2013-02-01

157

Pancreatitis  

MedlinePLUS Videos and Cool Tools

... level of sugar in the body. Hormones are substances in the blood stream that control our body ... After the pancreas recovers, blood levels of these substances usually return to normal. Treatment for acute pancreatitis ...

158

The impact of obesity on the course and outcome of acute pancreatitis.  

PubMed

Obesity has reached epidemic proportions in many countries and is an established risk factor in many chronic illnesses, but its role in acute illness is less clear. Pancreatologists have long recognized obesity as a risk factor for a poor outcome in severe acute pancreatitis. There are now several studies that have identified obesity as a primary risk factor for developing local complications (abscess, pseudocyst, necrosis), organ failure, and death. Indeed, meta-analysis of these studies gives a relative risk of 4.3 for local complications, 2.0 for systemic complications, and 2.1 for death. This has led to proposed modifications of acute pancreatitis scoring systems to include obesity as an independent primary predictive factor of severe disease. Obesity is associated with a low-grade inflammatory state, which may predispose obese patients to such complications. Furthermore, visceral obesity and visceral adipose tissue may be particularly important in underlying the pathophysiology of these observations. PMID:18202895

Abu Hilal, Mohammed; Armstrong, Thomas

2008-03-01

159

[Pancreatic phlegmon].  

PubMed

Seven patients with severe pancreatic inflamation secondary to acute pancreatitis are reported. Symptoms, laboratory data and radiologia findings suggested the diagnosis of phlegmon of the pancreas. The ultrasonography of the pancreas was useful for discriminating pancreatic pseudocyst from this entity. Clinical evolution of the pancreatic phlegmon could be long, up to 4 months, but it has tendency to expontaneous resolution. Relevant clinical findings of the disease are mentioned. PMID:7403765

Segovia, E; Bautista, J; Stoopen, M

1980-01-01

160

Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis  

PubMed Central

AIM: To assess the value of contrast-enhanced ultrasound (CEUS) in diagnosing splenic artery complications (SACs) after acute pancreatitis (AP). METHODS: One hundred and eighteen patients with AP were enrolled in the study. All patients were examined by CEUS and contrast-enhanced computed tomography (CECT). CECT was accepted as a gold standard for the diagnosis of SACs in AP. The diagnostic accuracy of splenic CEUS and pancreatic CEUS was compared with that of CECT. Splenic infarction was the diagnostic criterion for splenic artery embolism and local dysperfusion of the splenic parenchyma was the diagnostic criterion for splenic arterial stenosis. The incidence of splenic sub-capsular hemorrhage, splenic artery aneurysms, and splenic rupture was all lower than that of SACs. RESULTS: Nine patients were diagnosed as having SACs after AP by CECT among the 118 patients. The patients with SACs were diagnosed with severe acute pancreatitis (SAP). Among them, 6 lesions were diagnosed as splenic artery embolism, 5 as splenic artery aneurysms, and 1 as splenic arterial stenosis. No lesion was diagnosed by pancreatic CEUS and 5 lesions were diagnosed by splenic CEUS. By splenic CEUS, 4 cases were diagnosed as splenic artery embolism and 1 as splenic arterial stenosis. The accuracy of splenic CEUS in diagnosis of SACs in SAP was 41.7% (5/12), which was higher than that of pancreatic CEUS (0%). CONCLUSION: Splenic CEUS is a supplementary method for pancreatic CEUS in AP patients, which can decrease missed diagnosis of SACs. PMID:24574783

Cai, Di-Ming; Parajuly, Shyam Sundar; Ling, Wen-Wu; Li, Yong-Zhong; Luo, Yan

2014-01-01

161

Therapeutic plasma exchange for acute hyperlipidemic pancreatitis: a case series.  

PubMed

Therapeutic plasma exchange (TPE) has been used for the treatment of hyperlipidemic pancreatitis (HLP) with variable results. Eight patients with acute HLP were studied and treated with TPE, in addition to dietary fat restriction and lipid lowering agents. TPE lowered plasma levels of amylase (723.63 +/- 391.70-189.25 +/- 71.26 IU/L, P = 0.002), triglycerides (110.28 +/- 146.39-38.47 +/- 48.79 mmol/L, P = 0.048) and cholesterol (13.37 +/- 7.97-3.84 +/- 1.34 mmol/L, P < 0.001). Clinical symptoms improved in all patients with no resultant complications, and follow up of the patients for 12 months revealed no recurrence of pancreatitis. Thus, TPE is effective in lowering amylase, triglycerides and cholesterol levels, improves the acute attack of hyperlipidemic pancreatitis, and aids in preventing recurrent attacks. PMID:18503696

Al-Humoud, Hani; Alhumoud, Ekhlas; Al-Hilali, Nabieh

2008-06-01

162

Percutaneous Drainage of Suppurative Pylephlebitis Complicating Acute Pancreatitis  

SciTech Connect

Suppurative pylephlebitis is a rare condition with a significant mortality rate, ranging from 50% to 80%. We report a case of suppurative pylephlebitis complicating acute pancreatitis treated by percutaneous drainage in a 40-year-old woman. The patient had an uneventful recovery.

Nouira, Kais [La Rabta Hospital, Department of Radiology (Tunisia)], E-mail: nouira.kais@gnet.tn; Bedioui, Haykel [La Rabta Hospital, Department of Surgery (Tunisia); Azaiez, Olfa; Belhiba, Hend; Messaoud, Monia Ben [La Rabta Hospital, Department of Radiology (Tunisia); Ksantini, Rachid; Jouini, Mohamed [La Rabta Hospital, Department of Surgery (Tunisia); Menif, Emna [La Rabta Hospital, Department of Radiology (Tunisia)

2007-11-15

163

Towards a Novel Treatment Strategy for Acute Pancreatitis  

Microsoft Academic Search

In part 1 it was argued that a ‘free radical-mast cell’ template for the aetiogenesis of acute pancreatitis accommodates the evidence, whereas the prevailing ‘trypsin-cytokine’ template does not. In this sequel I examine the ramifications of the new philosophy in relation to speedier diagnosis, prognostic aids and, above all, a programme of active treatment which – once validated in experimental

Joan M. Braganza

2001-01-01

164

Current therapeutic strategies in severe acute pancreatitis  

Microsoft Academic Search

Conclusion Further improvement in the outcome of the patient with SAP can be expected in the future by the timely application of a series of therapeutic means during the course of the disease. Therefore a better understanding of the pathogenesis of the initial event, knowledge of the natural history of SAP and its complications, accurate and early recognition of the

M. S. Reynaert; Th. Dugernier; P. J. Kestens

1990-01-01

165

Increased Risk of Acute Pancreatitis in Patients with Type 2 Diabetes: An Observational Study Using a Japanese Hospital Database  

PubMed Central

Background Increased risks of acute pancreatitis in patients with type 2 diabetes mellitus have been reported recently in several countries. We aimed to estimate the risks of acute pancreatitis in Japanese patients with diabetes mellitus. Methods/Findings We examined a large-scale hospital administrative database consisting of one million patients in 16 secondary medical care hospitals, from 2003 to 2010. The incidence rates of acute pancreatitis were estimated with cohort design; the odds ratios associated with diabetes mellitus and other comorbid risk factors were estimated with separate case-control analyses. In cohort analysis, the incidence of acute pancreatitis was higher in 14,707 diabetic patients than in 186,032 non-diabetic patients (4.75 vs. 1.65 per 1,000 patient-years) and increased in male patients and as age advanced. The adjusted odds ratio of acute pancreatitis in patients with diabetes mellitus was 1.86 (P<0.001) compared with non-diabetic patients in case-control analysis from 1,372 cases and 5,469 matched controls, which is consistent with the ones reported in previous studies. Alcoholism and gallstones were associated with a large increase in the risk of acute pancreatitis (adjusted odds ratio 13.40 and 14.29, respectively, P<0.001), although dyslipidemia was associated with significant risk reduction (adjusted odds ratio 0.62, P<0.001). Conclusions This observational study ascertained the elevated incidence rates and risk of acute pancreatitis in Japanese patients with diabetes. The risk estimates in Japanese patients with diabetes were in agreement with the ones reported in previous studies, and the elevated risk of acute pancreatitis in patients with diabetes would be generalized in different locations/populations. PMID:23300896

Urushihara, Hisashi; Taketsuna, Masanori; Liu, Ying; Oda, Eisei; Nakamura, Masaki; Nishiuma, Shinichi; Maeda, Rei

2012-01-01

166

Cystathionine-gamma-lyase inhibitor attenuates acute lung injury induced by acute pancreatitis in rats  

PubMed Central

Introduction Acute pancreatitis (AP) is known to induce injuries to extrapancreatic organs. Because respiratory dysfunction is the main cause of death in patients with severe AP, acute pancreatitis-associated lung injury (APALI) is a great challenge for clinicians. This study aimed to investigate the potential role of hydrogen sulfide (H2S) in the pathogenesis of APALI. Material and methods Fifty-four SD rats were randomly divided into three groups: the AP group of rats that received injection of sodium deoxycholate into the common bile duct, the control group that underwent a sham operation, and the treatment group made by intraperitoneal injection of propargylglycine (PAG), an inhibitor of cystathionine-?-lyase (CSE), into rats with AP. Histopathology of the lung was examined and the expression of CSE and TNF-? mRNA in lung tissue was detected by real-time polymerase chain reaction. The H2S level in the serum was detected spectrophotometrically. Results The serum concentration of H2S and CSE and TNF-? expression in the lung were increased in AP rats modeled after 3 h and 6 h than in control rats (p < 0.05). Intraperitoneal injection of PAG could reduce the serum concentration of H2S, reduce CSE and TNF-? expression, and alleviate the lung pathology (p < 0.05). Conclusions Taken together, our findings suggest that the H2S/CSE system is crucially involved in the pathological process of APALI and represents a novel target for the therapy of APALI.

Qu, Zhen; Wu, Bao-Qiang; Duan, Yun-Fei; Sun, Zhen-Di; Luo, Guang-Hua

2014-01-01

167

Genetics of acute and chronic pancreatitis: An update  

PubMed Central

Progress made in identifying the genetic susceptibility underlying acute and chronic pancreatitis has benefitted the clinicians in understanding the pathogenesis of the disease in a better way. The identification of mutations in cationic trypsinogen gene (PRSS1 gene; functional gain mutations) and serine protease inhibitor kazal type 1 (SPINK1 gene; functional loss mutations) and other potential susceptibility factors in genes that play an important role in the pancreatic secretory functions or response to inflammation during pancreatic injury has changed the current concepts and understanding of a complex multifactorial disease like pancreatitis. An individual’s susceptibility to the disease is governed by genetic factors in combination with environmental factors. Candidate gene and genetic linkage studies have identified polymorphisms in cationic trypsinogen (PRSS1), SPINK1, cystic fibrosis trans-membrane conductance regulator (CFTR), Chymotrypsinogen C (CTRC), Cathepsin B (CTSB) and calcium sensing receptor (CASR). Individuals with polymorphisms in the mentioned genes and other as yet identified genes are at an enhanced risk for the disease. Recently, polymorphisms in genes other than those involved in “intra-pancreatic trypsin regulatory mechanism” namely Claudin-2 (CLDN2) and Carboxypeptidase A1 (CPA1) gene have also been identified for their association with pancreatitis. With ever growing number of studies trying to identify the genetic susceptibility in the form of single nucleotide polymorphisms, this review is an attempt to compile the available information on the topic.

Ravi Kanth, VV; Nageshwar Reddy, D

2014-01-01

168

Genetics of acute and chronic pancreatitis: An update.  

PubMed

Progress made in identifying the genetic susceptibility underlying acute and chronic pancreatitis has benefitted the clinicians in understanding the pathogenesis of the disease in a better way. The identification of mutations in cationic trypsinogen gene (PRSS1 gene; functional gain mutations) and serine protease inhibitor kazal type 1 (SPINK1 gene; functional loss mutations) and other potential susceptibility factors in genes that play an important role in the pancreatic secretory functions or response to inflammation during pancreatic injury has changed the current concepts and understanding of a complex multifactorial disease like pancreatitis. An individual's susceptibility to the disease is governed by genetic factors in combination with environmental factors. Candidate gene and genetic linkage studies have identified polymorphisms in cationic trypsinogen (PRSS1), SPINK1, cystic fibrosis trans-membrane conductance regulator (CFTR), Chymotrypsinogen C (CTRC), Cathepsin B (CTSB) and calcium sensing receptor (CASR). Individuals with polymorphisms in the mentioned genes and other as yet identified genes are at an enhanced risk for the disease. Recently, polymorphisms in genes other than those involved in "intra-pancreatic trypsin regulatory mechanism" namely Claudin-2 (CLDN2) and Carboxypeptidase A1 (CPA1) gene have also been identified for their association with pancreatitis. With ever growing number of studies trying to identify the genetic susceptibility in the form of single nucleotide polymorphisms, this review is an attempt to compile the available information on the topic. PMID:25400986

Ravi Kanth, Vv; Nageshwar Reddy, D

2014-11-15

169

Differences in the Inflammatory Response Induced by Acute Pancreatitis in Different White Adipose Tissue Sites in the Rat  

PubMed Central

Background There is increasing evidence of the role of adipose tissue on the systemic effects of acute pancreatitis. Patients with higher body mass index have increased risk of local and systemic complications and patients with android fat distribution and higher waist circumference are at greater risk for developing the severe form of the disease. Here we evaluated the changes on different areas of adipose tissue and its involvement on the inflammatory response in an experimental model of acute pancreatitis. Methods Pancreatitis was induced in male Wistar rats by intraductal administration of sodium taurocholate. Orlistat was administered to inhibit lipase activity. Activation of peritoneal macrophages was evaluated by measuring IL1? and TNF? expression. Inflammation was evaluated by measuring myeloperoxidase activity in mesenteric, epididymal and retroperitoneal areas of adipose tissue. Changes in the expression of inflammatory mediator in these areas of adipose tissue were also evaluated by RT-PCR. Results Pancreatitis induces the activation of peritoneal macrophages and a strong inflammatory response in mesenteric and epididymal sites of adipose tissue. By contrast, no changes were found in retroperitoneal adipose tissue. Inhibition of lipase prevented the activation of macrophages and the local inflammation in adipose tissue. Conclusions Our results confirm the involvement of adipose tissue on the progression of systemic inflammatory response during acute pancreatitis. However, there is a considerable diversity in different adipose tissue sites. These differences need to be taken into account in order to understand the progression from local pancreatic damage to systemic inflammation during acute pancreatitis. PMID:22870264

Gea-Sorli, Sabrina; Bonjoch, Laia; Closa, Daniel

2012-01-01

170

Minimally invasive intervention for infected necrosis in acute pancreatitis.  

PubMed

Infected necrosis is the main indication for invasive intervention in acute necrotizing pancreatitis. The 2013 IAP/APA guidelines state that percutaneous catheter drainage should be the first step in the treatment of infected necrosis. In 50-65% of patients, additional necrosectomy is required after catheter drainage, which was traditionally done by open necrosectomy. Driven by the perceived lower complication rate, there is an increasing trend toward minimally invasive percutaneous and endoscopic transluminal necrosectomy. The authors present an overview of current minimally invasive treatment options for necrotizing pancreatitis and review recent developments in clinical studies. PMID:25122506

Hollemans, Robbert A; van Brunschot, Sandra; Bakker, Olaf J; Bollen, Thomas L; Timmer, Robin; Besselink, Marc G H; van Santvoort, Hjalmar C

2014-11-01

171

Role of phosphoinositide 3-kinase in the pathogenesis of acute pancreatitis  

PubMed Central

A large body of experimental and clinical data supports the notion that inflammation in acute pancreatitis has a crucial role in the pathogenesis of local and systemic damage and is a major determinant of clinical severity. Thus, research has recently focused on molecules that can regulate the inflammatory processes, such as phosphoinositide 3-kinases (PI3Ks), a family of lipid and protein kinases involved in intracellular signal transduction. Studies using genetic ablation or pharmacologic inhibitors of different PI3K isoforms, in particular the class I PI3K? and PI3K?, have contributed to a greater understanding of the roles of these kinases in the modulation of inflammatory and immune responses. Recent data suggest that PI3Ks are also involved in the pathogenesis of acute pancreatitis. Activation of the PI3K signaling pathway, and in particular of the class IB PI3K? isoform, has a significant role in those events which are necessary for the initiation of acute pancreatic injury, namely calcium signaling alteration, trypsinogen activation, and nuclear factor-?B transcription. Moreover, PI3K? is instrumental in modulating acinar cell apoptosis, and regulating local neutrophil infiltration and systemic inflammatory responses during the course of experimental acute pancreatitis. The availability of PI3K inhibitors selective for specific isoforms may provide new valuable therapeutic strategies to improve the clinical course of this disease. This article presents a brief summary of PI3K structure and function, and highlights recent advances that implicate PI3Ks in the pathogenesis of acute pancreatitis. PMID:25386068

Lupia, Enrico; Pigozzi, Luca; Goffi, Alberto; Hirsch, Emilio; Montrucchio, Giuseppe

2014-01-01

172

Acute pancreatitis - from cellular signalling to complicated clinical course  

PubMed Central

Acute pancreatitis (AP) is a common disease that has a mild to moderate course in most cases. During the last decade, a change in diagnostic facilities as well as improved intensive care have influenced both morbidity and mortality in AP. Still, however, a number of controversies and unresolved questions remain regarding AP. These include prognostic factors and how these may be used to improve outcome, diagnostic possibilities, their indications and optimal timing, and the systemic inflammatory reaction (systemic inflammatory response syndrome – SIRS) and its effect on the concomitant course of the disease and potential development of organ failure. The role of the gut has been suggested to be important in severe AP, but has recently been somewhat questioned. Despite extensive research, pharmacological and medical intervention of proven clinical value is scarce. Various aspects on surgical interventions, including endoscopic sphincterotomy, cholecystectomy and necrosectomy, as regards indications and timing, will be reviewed. Last, but not least, are the management of late complications and long-term outcome for patients with especially severe AP. PMID:18345287

Andersson, Bodil; Andersson, Ellen; Axelsson, Jakob; Eckerwall, Gunilla; Tingstedt, Bobby

2007-01-01

173

A systematic review of acute pancreatitis as an adverse event of type 2 diabetes drugs: from hard facts to a balanced position.  

PubMed

The question whether antidiabetes drugs can cause acute pancreatitis dates back to the 1970s. Recently, old concerns have re-emerged following claims that use of incretins, a new class of drugs for type 2 diabetes, might increase the relative risk of acute pancreatitis up to 30-fold. Given that diabetes is per se a potent risk factor for acute pancreatitis and that drug-related acute pancreatitis is rare and difficult to diagnose, we searched the medical databases for information linking acute pancreatitis and type 2 diabetes drugs. Among the biguanides, both phenformin and metformin (the latter in patients with renal insufficiency) have been cited in case reports as a potential cause of acute pancreatitis. Sulphonylureas, as both entire class and single compound (glibenclamide), have also been found in cohort studies to increase its risk. No direct link was found between pancreatic damage and therapy with metaglinide, acarbose, pramlintide or SGLT-2 inhibitors. In animal models, thiazolinediones have demonstrated proprieties to attenuate pancreatic damage, opening perspectives for their use in treating acute pancreatitis in humans. Several case reports and the US Food and Drug Administration pharmacovigilance database indicate an association between acute pancreatitis and incretins, dipeptidyl peptidase-4 (DPP-4) inhibitors, and GLP-1 receptor agonists. To date, however, a clear-cut odds ratio for this association has been reported in only one of eight pharmacoepidemiological studies. Finally, none of the intervention trials investigating these compounds, including two large randomized controlled trials with cardiovascular endpoints, confirmed the purportedly increased risk of acute pancreatitis with incretin use. PMID:24702687

Giorda, C B; Nada, E; Tartaglino, B; Marafetti, L; Gnavi, R

2014-11-01

174

Necro-inflammatory response of pancreatic acinar cells in the pathogenesis of acute alcoholic pancreatitis  

PubMed Central

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; Buchler, M W; Fortunato, F

2013-01-01

175

Carbon dioxide transport in rats with acute pancreatitis  

Microsoft Academic Search

Summary\\u000a Conclusion  The production, release, and transport of carbon dioxide from tissues to blood are facilitated both systemically and in the\\u000a gastrointestinal tract in acute pancreatitis. Red blood cells are responsible for the major exchange and transport of this\\u000a increase in CO2. The existence of arteriovenous shunting within the intestine is associated with tissue ischemia, which may be involved in\\u000a the

Xiangdong Wang; Roland Andersson; Peter Kruse; Ingemar Ihse

1996-01-01

176

[Acute pancreatitis: use of a new prognostic stage system].  

PubMed

The spectrum of clinical severity of acute pancreatitis varies widely, but the most important is to predict high risk patients, so that, a number of classification systems have been proposed with the main focus is on laboratory findings. The purpose of this paper was to validate the Rabeneck Clinical prognostic staging system (using clinical features and comorbid illness) which classified in three stages: I, II and III. We conducted a retrospective study in 51 patients admitted to Hospital Arzobispo Loayza, from 1988 to 1994. 42 (82.4%) were female and 9 (17.6%) male. The average age was 40.3 years. The range hospital stay was 3 to 41 days. Ultrasonographically we found some alterations in pancreas texture about 84.4% and gallbladder stones in 57.7%. The mortality rates according to Rabeneck system were stage I: O of 44 (0%); stage II: 1 of 4 (25%); stage III 2 of 3 (66.7%) In conclusion the new prognostic staging system is easy to use, simple and require no additional laboratory test, so that utility to our institutional situation. PMID:12165785

Chavez, M; Nago, A

1996-01-01

177

Pancreatitis aguda grave, manejo quirúrgico en un hospital de tercer nivel  

Microsoft Academic Search

Summary Background: Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation. Methods: We studied patients diagnosed with pancreatitis from January 1, 000 to December 31, 2007. Results: We analyzed

Erick Servín-Torres; José Arturo Velázquez-García; Germán Delgadillo-Teyer; Luis Galindo-Mendoza; Francisco Bevia-Pérez; Fausto Rivera-Bennet

178

Anatomical and functional characterization of a duodeno-pancreatic neural reflex that can induce acute pancreatitis.  

PubMed

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

2013-03-01

179

Diabetic Ketoacidosis-induced Hypertriglyceridemic Acute Pancreatitis Treated with Plasmapheresis-Recipe for Biochemical Disaster Management.  

PubMed

Diabetic ketoacidosis (DKA)-induced hypertriglyceridemia causing pancreatitis is an interesting phenomenon that has rarely been reported in literature. Plasmapharesis is a well known treatment modality for hypertriglyceridemia-induced pancreatitis. We report a patient with DKA-induced hypertriglyceridemic acute pancreatitis treated successfully with plasmapharesis. PMID:25342924

Seth, Abhishek; Rajpal, Saurabh; Saigal, Taru; Bienvenu, John; Sheth, Ankur; Alexander, Jonathan S; Boktor, Moheb; Manas, Kenneth; Morris, James D; Jordan, Paul A

2014-01-01

180

Diabetic Ketoacidosis-induced Hypertriglyceridemic Acute Pancreatitis Treated with Plasmapheresis--Recipe for Biochemical Disaster Management  

PubMed Central

Diabetic ketoacidosis (DKA)-induced hypertriglyceridemia causing pancreatitis is an interesting phenomenon that has rarely been reported in literature. Plasmapharesis is a well known treatment modality for hypertriglyceridemia-induced pancreatitis. We report a patient with DKA-induced hypertriglyceridemic acute pancreatitis treated successfully with plasmapharesis. PMID:25342924

Seth, Abhishek; Rajpal, Saurabh; Saigal, Taru; Bienvenu, John; Sheth, Ankur; Alexander, Jonathan S; Boktor, Moheb; Manas, Kenneth; Morris, James D; Jordan, Paul A

2014-01-01

181

The role of endogenous glucocorticoids in rat experimental models of acute pancreatitis  

Microsoft Academic Search

Background & Aims: Cytokines activate the hypothalamic-pituitary-adrenal axis and suppress inflammation by stimulating glucocorticoid secretion. The state of adrenocortical function during acute pancreatitis and its role in this disease were determined. Methods: Cerulein-induced pancreatitis or closed duodenal loop pancreatitis was produced in rats that had undergone adrenalectomy or sham adrenalectomy, and the serum corticosterone and interleukin 8 levels and the

Reishi Abe; Tooru Shimosegawa; Kenji Kimura; Takashi Abe; Junya Kashimura; Masaru Koizumi; Takayoshi Toyota

1995-01-01

182

Gene Polymorphisms of the Macrophage Migration Inhibitory Factor and Acute Pancreatitis  

Microsoft Academic Search

Context Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that is released by macrophages and lymphocytes and plays an important pathogenetic role in acute pancreatitis. It is present in large amounts in the serum and ascitic fluid in rats with experimental pancreatitis and its levels are elevated in humans with pancreatitis. Polymorphisms associated with inflammatory joint diseases exist in

Rohit Makhija; Andrew Kingsnorth; Andrew Demaine

183

Fatty acids of erythrocyte membrane in acute pancreatitis patients  

PubMed Central

AIM: To evaluate changes in the fatty acid composition of erythrocyte membrane phospholipids during severe and mild acute pancreatitis (AP) of alcoholic and nonalcoholic etiology. METHODS: All consecutive patients with a diagnosis of AP and onset of the disease within the last 72 h admitted to the Hospital of Lithuanian University of Health Sciences between June and December 2007 were included. According to the Acute Physiology and Chronic Health Evaluation (APACHE II) scale, the patients were subdivided into the mild (APACHE II score < 7, n = 22) and severe (APACHE II score ? 7, n = 17) AP groups. Healthy individuals (n = 26) were enrolled as controls. Blood samples were collected from patients on admission to the hospital. Fatty acids (FAs) were extracted from erythrocyte phospholipids and expressed as percentages of the total FAs present in the chromatogram. The concentrations of superoxide dismutase and glutathione peroxidase were measured in erythrocytes. RESULTS: We found an increase in the percentages of saturated and monounsaturated FAs, a decrease in the percentages of total polyunsaturated FAs (PUFAs) and n-3 PUFAs in erythrocyte membrane phospholipids of AP patients compared with healthy controls. Palmitic (C16:0), palmitoleic (C16:1n7cis), arachidonic (C20:4n6), docosahexaenoic (DHA, C22:6n3), and docosapentaenoic (DPA, C22:5n3) acids were the major contributing factors. A decrease in the peroxidation and unsaturation indexes in AP patients as well as the severe and mild AP groups as compared with controls was observed. The concentrations of antioxidant enzymes in the mild AP group were lower than in the control group. In severe AP of nonalcoholic etiology, the percentages of arachidic (C20:0) and arachidonic (C20:4n6) acids were decreased as compared with the control group. The patients with mild AP of nonalcoholic etiology had the increased percentages of total saturated FAs and gama linoleic acid (C18:3n6) and the decreased percentages of elaidic (C18:1n9t), eicosapentaenoic acid (EPA, C20:5n3), DPA (C22:5n3), DHA (C22:6n3) as well as total and n-3 PUFAs in erythrocyte membrane phospholipids. CONCLUSION: The composition of FAs in erythrocyte membranes is altered during AP. These changes are likely to be associated with alcohol consumption, inflammatory processes, and oxidative stress. PMID:24039361

Kuliaviene, Irma; Gulbinas, Antanas; Cremers, Johannes; Pundzius, Juozas; Kupcinskas, Limas; Dambrauskas, Zilvinas; Jansen, Eugene

2013-01-01

184

Decreased Inflammation and Improved Survival With Recombinant Human Activated Protein C Treatment in Experimental Acute Pancreatitis  

PubMed Central

Hypothesis Drotrecogin alfa (activated), the pharmacologic form of activated protein C and the first Food and Drug Administration–approved drug for treatment of severe sepsis, is beneficial in experimental acute pancreatitis (AP). Design Animal study. Setting Laboratory. Subjects Male Sprague-Dawley rats. Interventions Mild (intravenous cerulein) or severe (intravenous cerulein plus intraductal glycodeoxycholic acid) AP was induced in 72 rats, and coagulation evaluated. Rats with severe AP were randomized to treatment with drotrecogin alfa (activated), 100 ?g/kg per hour, or isotonic sodium chloride. Main Outcome Measures Histologic scoring of pancreatic necrosis, inflammation of the pancreas and lung (measured by myeloperoxidase concentration), coagulation measures, and 24-hour survival. Results Severe consumptive coagulopathy, hemoconcentration, and leukocytosis were observed 6 hours after induction of severe AP, but not in mild AP. Treatment of AP with drotrecogin did not worsen coagulation measures. Although the degree of pancreatic necrosis was comparable in treated and untreated animals with severe AP, drotrecogin significantly reduced myeloperoxidase levels in the pancreas (P=.009) and lungs (P=.03). The 24-hour survival in severe AP was markedly improved in animals treated with drotrecogin (86% vs 38%; P=.05). Conclusions Animals with severe AP have severe consumptive coagulopathy, but administration of drotrecogin alfa (activated), 100 ?g/kg per hour, does not worsen coagulation abnormalities. Drotrecogin treatment reduces inflammation in the pancreas and lungs and significantly improves survival. These results encourage clinical investigation of drotrecogin in the treatment of severe AP. PMID:16847238

Alsfasser, Guido; Warshaw, Andrew L.; Thayer, Sarah P.; Antoniu, Bozena; Laposata, Michael; Lewandrowski, Kent B.; Castillo, Carlos Fernandez-del

2014-01-01

185

Acute pancreatitis: pancreas divisum with ventral duct intraductal papillary mucinous neoplasms.  

PubMed

Acute recurrent pancreatitis occurs rarely in individuals with pancreas divisum. A 39-year-old woman with no significant history presented with pancreatitis. CT scan and MRI suggested acute on chronic pancreatitis with calcifications and pancreatic divisum. An endoscopic ultrasound demonstrated complete pancreas divisum. A large calcification measuring 12?mm × 6?mm was seen in the head of the pancreas with associated dilation of the ventral pancreatic duct. Fine-needle aspiration of the dilated ventral pancreatic duct showed an amylase level of 36?923?U/L and a carcinoembryonic antigen of 194. A ventral duct intraductal papillary mucinous neoplasm was suspected and a pancreaticoduodenectomy procedure was recommended. After the procedure, pathology demonstrated an intraductal papillary lesion in the main duct with moderate dysplasia. A pancreatic intraepithelial neoplasia, grade 2 was also present. Margins of resection were clear. This case represents the importance of assessing for secondary causes of pancreatitis in pancreas divisum. PMID:25293684

Gurram, Krishna C; Czapla, Agata; Thakkar, Shyam

2014-01-01

186

Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review  

PubMed Central

Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the extent of pancreatic necrosis, and for diagnosing local complications. Magnetic resonance imaging (MRI) might be indicated in acute pancreatitis for detecting and characterizing local complications of acute pancreatitis that involve necrotic, hemorrhagic, infectious, vascular, and pseudocyst disorders. The general MRI sequences for pancreatitis require the combined use of T1-weighted, T2-weighted sequences, and magnetic resonance cholangiopancreatography. For imaging of pancreatic necrosis, the combination of T1-weighted and T2-weighted findings with dynamic contrast-enhanced imaging gives a comprehensive evaluation of the extent of necrosis and full range of inflammatory extension. For imaging of infectious complications, dynamic contrast-enhanced examinations might help differentiate pancreatic cellulitis or abscesses, from pancreatic fluid collection or simple pseudocysts. For vascular abnormalities, the combination of cross-sectional pancreatic parenchyma imaging with MRA represents a single diagnostic modality for the full evaluation of peripancreatic artery and vein involvement, such as arterial pseudoaneurysms and venous thromboses. The purpose of this pictorial review is to examine the MRI appearances of various local complications of acute pancreatitis and to discuss the practical setup of MRI in local complications of acute pancreatitis. PMID:20533593

Xiao, Bo; Zhang, Xiao-Ming; Tang, Wei; Zeng, Nan-Lin; Zhai, Zhao-Hua

2010-01-01

187

Fisetin attenuates cerulein-induced acute pancreatitis through down regulation of JNK and NF-?B signaling pathways.  

PubMed

Acute pancreatitis (AP) is a complicated disease which is largely undiscovered. Fisetin, a natural flavonoid from fruits and vegetables, has been shown to have anti-inflammatory, antioxidant, and anti-cancer activities in various disease models. However, the effects of fisetin on AP have not been determined. Pre- and post- treatment of mice with fisetin reduced the severity of AP and pancreatitis-associated lung injury and inhibited several biochemical parameters (pancreatic weight to body weight ratio, amylase, lipase, and myeloperoxidase activity) and production of inflammatory cytokines. In pancreatic acinar cells, fisetin also inhibited cell death and production of inflammatory cytokines. In addition, fisetin inhibited activation of c-Jun NH2-terminal kinase (JNK) and nuclear factor (NF)-?B in vivo and in vitro. In conclusion, these results suggest that fisetin exhibits anti-inflammatory effect on AP and could be a beneficial agent in the treatment of AP and its pulmonary complications. PMID:24861022

Jo, Il-Joo; Bae, Gi-Sang; Choi, Sun Bok; Kim, Dong-Goo; Shin, Joon-Yeon; Seo, Seung-Hee; Choi, Mee-Ok; Kim, Tae-Hyeon; Song, Ho-Joon; Park, Sung-Joo

2014-08-15

188

Severe chorea after acute carbon monoxide poisoning  

Microsoft Academic Search

Ten days after an acute exposure to carbon monoxide, a 33-year-old woman exhibited severe chorea. CT scan revealed bilateral lucencies of the pallidum and anterior arm of the internal capsule. Chorea was successfully treated by chlorpromazine and did not relapse after treatment withdrawal. The mechanism of chorea in acute carbon monoxide poisoning is discussed.

P Davous; P Rondot; M H Marion; B Gueguen

1986-01-01

189

Involvement of Oxygen-Derived Free Radicals in L-Arginine-Induced Acute Pancreatitis  

Microsoft Academic Search

This study was aimed at an assessment of the role of oxygen-derived free radicals in the pathogenesis of L-arginine (Arg)-induced acute pancreatitis in rat, by measuring the levels of malonyl dialdehyde (MDA), glutathione peroxidase (GPx), catalase, and superoxide dismutase (Mn- and Cu,Zn-SOD) in the pancreatic tissue, and evaluating the protective effect of the xanthine oxidase inhibitor allopurinol. Acute pancreatitis was

Laszlo Czako; Tamas Takacs; Ilona Sz. Varga; Laszlo Tiszlavicz; Do Quy Hai; Peter Hegyi; Bela Matkovics; Janos Lonovics

1998-01-01

190

Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology  

Microsoft Academic Search

BACKGROUNDIt has been suggested that the incidence of acute pancreatitis in patients with end stage renal failure is increased.AIMSTo 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.PATIENTSAll patients who were maintained on long

M. J. Bruno; D J van Westerloo; W T van Dorp; W. Dekker; J. Ferwerda; G. N. J. Tytgat; N. H. Schut

2000-01-01

191

Sterile Fluid Collections in Acute Pancreatitis: Catheter Drainage Versus Simple Aspiration  

Microsoft Academic Search

Purpose. To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in patients with acute pancreatitis. Methods. We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages

Eric M. Walser; William H. Nealon; Santiago Marroquin; Syed Raza; J. Alberto Hernandez; James Vasek

2006-01-01

192

Association Analysis of Genetic Variants in the Myosin IXB Gene in Acute Pancreatitis  

PubMed Central

Introduction Impairment of the mucosal barrier plays an important role in the pathophysiology of acute pancreatitis. The myosin IXB (MYO9B) gene and the two tight-junction adaptor genes, PARD3 and MAGI2, have been linked to gastrointestinal permeability. Common variants of these genes are associated with celiac disease and inflammatory bowel disease, two other conditions in which intestinal permeability plays a role. We investigated genetic variation in MYO9B, PARD3 and MAGI2 for association with acute pancreatitis. Methods Five single nucleotide polymorphisms (SNPs) in MYO9B, two SNPs in PARD3, and three SNPs in MAGI2 were studied in a Dutch cohort of 387 patients with acute pancreatitis and over 800 controls, and in a German cohort of 235 patients and 250 controls. Results Association to MYO9B and PARD3 was observed in the Dutch cohort, but only one SNP in MYO9B and one in MAGI2 showed association in the German cohort (p < 0.05). Joint analysis of the combined cohorts showed that, after correcting for multiple testing, only two SNPs in MYO9B remained associated (rs7259292, p = 0.0031, odds ratio (OR) 1.94, 95% confidence interval (95% CI) 1.35-2.78; rs1545620, p = 0.0006, OR 1.33, 95% CI 1.16-1.53). SNP rs1545620 is a non-synonymous SNP previously suspected to impact on ulcerative colitis. None of the SNPs showed association to disease severity or etiology. Conclusion Variants in MYO9B may be involved in acute pancreatitis, but we found no evidence for involvement of PARD3 or MAGI2. PMID:24386489

Nijmeijer, Rian M.; van Santvoort, Hjalmar C.; Zhernakova, Alexandra; Teller, Steffen; Scheiber, Jonas A.; de Kovel, Carolien G.; Besselink, Marc G. H.; Visser, Jeroen T. J.; Lutgendorff, Femke; Bollen, Thomas L.; Boermeester, Marja A.; Rijkers, Ger T.; Weiss, Frank U.; Mayerle, Julia; Lerch, Markus M.; Gooszen, Hein G.; Akkermans, Louis M. A.; Wijmenga, Cisca

2013-01-01

193

Effect of 5FU on modulation of disarrangement of immune-associated cytokines in experimental acute pancreatitis  

Microsoft Academic Search

AIM: To investigate the effects of 5-Fluorouracil (5-FU) on modulation of pro-inflammatory and anti-inflamma - tory cytokines in acute pancreatitis and the mechanism of it in the treatment of acute pancreatitis. METHODS: Male Sprague Dawley rats were assigned to 3 Groups: Group A, sham operated rats as controls (n = 7); Group B, acute pancreatitis induced by duc- tal injection

Xiao-Li Chen; Sang-Zhu Ciren; Hui Zhang; Li-Geng Duan; Alexander J Wesley

2009-01-01

194

Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis  

PubMed Central

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. PMID:23762266

Chen, Guang-Cheng; Yuan, Yu-Hong; Zhong, Wa; Zhao, Li-Na; Chen, Qi-Kui

2013-01-01

195

Correlation of fibrinogen-like protein 2 with progression of acute pancreatitis in rats  

PubMed Central

AIM: To examine fibrinogen-like protein 2 (fgl2) expression during taurocholate-induced acute pancreatitis progression in rats and its correlation with pancreatic injury severity. METHODS: Forty-eight male Sprague-Dawley rats were randomly divided into the severe acute pancreatitis (SAP) group (n = 24) and the sham operation (SO) group (n = 24). Sodium taurocholate (4% at doses of 1 mL/kg body weight) was retrogradely injected into the biliopancreatic ducts of the rats to induce SAP. Pancreatic tissues were prepared immediately after sacrifice. At the time of sacrifice, blood was obtained for determination of serum amylase activity and isolation of peripheral blood mononuclear cells (PBMCs). Pancreatic tissue specimens were obtained for routine light microscopy including hematoxylin and eosin staining, and the severity of pancreatic injury was evaluated 1, 4 and 8 h after induction. Expression of fgl2 mRNA was measured in the pancreas and PBMCs using reverse transcription polymerase chain reaction. Expression of fgl2 protein was evaluated in pancreatic tissues using Western blotting and immunohistochemical staining. Masson staining was also performed to observe microthrombosis. RESULTS: At each time point, levels of fgl2 mRNAs in pancreatic tissues and PBMCs were higher (P < 0.05) in the SAP group than in the SO group. For pancreatic tissue in SAP vs SO, the levels were: after 1 h, 3.911 ± 1.277 vs 1.000 ± 0.673; after 4 h, 9.850 ± 3.095 vs 1.136 ± 0.609; and after 8 h, 12.870 ± 3.046 vs 1.177 ± 0.458. For PBMCs in SAP vs SO, the levels were: after 1 h, 2.678 ± 1.509 vs 1.000 ± 0.965; after 4 h, 6.922 ± 1.984 vs 1.051 ± 0.781; and after 8 h, 13.533 ± 6.575 vs 1.306 ± 1.179. Levels of fgl2 protein expression as determined by Western blotting and immunohistochemical staining were markedly up-regulated (P < 0.001) in the SAP group compared with those in the SO group. For Western blotting in SAP vs SO, the results were: after 1 h, 2.183 ± 0.115 vs 1.110 ± 0.158; after 4 h, 2.697 ± 0.090 vs 0.947 ± 0.361; and after 8 h, 3.258 ± 0.094 vs 1.208 ± 0.082. For immunohistochemical staining in SAP vs SO, the results were: after 1 h, 1.793 ± 0.463 vs 0.808 ± 0.252; after 4 h, 4.535 ± 0.550 vs 0.871 ± 0.318; and after 8 h, 6.071 ± 0.941 vs 1.020 ± 0.406. Moreover, we observed a positive correlation in the pancreas (r = 0.852, P < 0.001) and PBMCs (r = 0.735, P < 0.001) between fgl2 expression and the severity of pancreatic injury. Masson staining showed that microthrombosis (%) in rats with SAP was increased (P < 0.001) compared with that in the SO group and it was closely correlated with fgl2 expression in the pancreas (r = 0.842, P < 0.001). For Masson staining in SAP vs SO, the results were: after 1 h, 26.880 ± 9.031 vs 8.630 ± 3.739; after 4 h, 53.750 ± 19.039 vs 8.500 ± 4.472; and after 8 h, 80.250 ± 12.915 vs 10.630 ± 7.003. CONCLUSION: Microthrombosis due to fgl2 overexpression contributes to pancreatic impairment in rats with SAP, and fgl2 level may serve as a biomarker during early stages of disease. PMID:23674850

Ye, Xiao-Hua; Chen, Tan-Zhou; Huai, Jia-Ping; Lu, Guang-Rong; Zhuge, Xiao-Ju; Chen, Ren-Pin; Chen, Wu-Jie; Wang, Chen; Huang, Zhi-Ming

2013-01-01

196

Diagnostic challenges of Wilson's disease presenting as acute pancreatitis, cholangitis, and jaundice  

PubMed Central

Wilson’s disease is a rare disorder of copper transport in hepatic cells, and may present as cholestatic liver disease; pancreatitis and cholangitis are rarely associated with Wilsons’s disease. Moreover, cases of Wilson’s disease presenting as pigmented gallstone pancreatitis have not been reported in the literature. In the present report, we describe a case of a 37-year-old man who was admitted with jaundice and abdominal pain. The patient was diagnosed with acute pancreatitis, cholangitis, and obstructive jaundice caused by pigmented gallstones that were detected during retrograde cholangiopancreatography. However, because of his long-term jaundice and the presence of pigmented gallstones, the patient underwent further evaluation for Wilson’s disease, which was subsequently confirmed. This patient’s unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson’s disease and cholestasis, and the difficulties associated with their differentiation. It suggests that Wilson’s disease should be considered in patients with pancreatitis, cholangitis, and severe protracted jaundice caused by pigmented gallstones. PMID:24303094

Nussinson, Elchanan; Shahbari, Azmi; Shibli, Fahmi; Chervinsky, Elena; Trougouboff, Philippe; Markel, Arie

2013-01-01

197

Acute Pancreatitis with Rapid Clinical Improvement in a Child with Isovaleric Acidemia  

PubMed Central

Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin. PMID:23431490

Mantadakis, Elpis; Chrysafis, Ioannis; Tsouvala, Emmanouela; Evangeliou, Athanassios; Chatzimichael, Athanassios

2013-01-01

198

Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology  

PubMed Central

AIM To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. MATERIAL AND METHODS In the period 2011–2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. RESULTS Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. CONCLUSION The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy. PMID:24833943

Neri, Vincenzo; Lapolla, Francesco; Di Lascia, Alessandra; Giambavicchio, Libero Luca

2014-01-01

199

Acute Pancreatitis Secondary to Ciprofloxacin Therapy in Patients with Infectious Colitis  

PubMed Central

Background/Aims Ciprofloxacin is considered to be a safe and effective treatment for acute infectious colitis. However, this drug may cause drug-induced pancreatitis, albeit rarely. Methods From March 2007 to February 2012, we studied 227 patients who were hospitalized for infectious colitis at St. Mary's Hospital. All of the patients received ciprofloxacin therapy for the treatment of infectious colitis. We observed a few cases of rare adverse events, including ciprofloxacin-induced acute pancreatitis diagnosed based on the Naranjo algorithm. Results During ciprofloxacin therapy, seven of 227 patients (3.1%) developed rare pancreatitis as defined by the Naranjo algorithm; pancreatic enzyme activity was sporadically elevated with ciprofloxacin use. After ciprofloxacin administration, the average interval until the development of pancreatitis was 5.5 days (range, 4 to 7 days). On abdominal computed tomography, pancreatic swelling and homogenous enhancement was noted in three of seven patients. Complicating acute pancreatitis was gradually but completely resolved after cessation of ciprofloxacin administration. The mean recovery time was 11.3 days (range, 8 to 15 days). Conclusions We observed that ciprofloxacin-induced pancreatitis may occur with an incidence of approximately 3%. Ciprofloxacin-induced pancreatitis presents a short latency, suggesting an idiosyncratic hypersensitivity reaction. Practitioners should be aware that drug-induced pancreatitis can occur during ciprofloxacin therapy. PMID:24827622

Sung, Hye Young; Lee, Hyun Jeong; Cho, Hyung Jun; Cheung, Dae Young; Kim, Sung Soo; Cho, Se Hyun; Kim, Jae Kwang

2014-01-01

200

Technetium-99m-labeled white blood cells: a new method to define the local and systemic role of leukocytes in acute experimental pancreatitis.  

PubMed Central

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. PMID:9445115

Werner, J; Dragotakes, S C; Fernandez-del Castillo, C; Rivera, J A; Ou, J; Rattner, D W; Fischman, A J; Warshaw, A L

1998-01-01

201

[Severe acute liver and pancreas damage in anorexia nervosa].  

PubMed

Anorexia nervosa, a syndrome most commonly affecting young women, is characterized by weight less than 85% of weight that is considered normal for that persons age and height, distorted body image, and fear of becoming obese, and its mortality is up to 9%. We present a case of a 33-year-old woman with a 9-year history of anorexia nervosa. She admitted to our institution with decreased mentality, and her body mass index was 11.5 kg/m2 of the time admission. Initial aminotransferase level was severely elevated, but it was normalized solely with improved nutrition and weight gain. Five and sixteen days after the admission urinary tract infection and elevation of pancreatic enzymes occurred. They were successfully treated with antibiotics and nutritional support. Fifty seven days after the admission, she discharged. We report a case of acute hepatitis and pancreatitis treated with nutritional rehabilitation in a patient with severe anorexia nervosa for the first time in Korea. PMID:19844147

Park, Jung Ho; Lee, Tae Hee; Cheon, Sang Lyeol; Sun, Jae Hyung; Choi, In Key; Kim, Yong Seok; Choi, Young Woo; Kang, Young Woo

2009-10-01

202

Effect of biologically active fraction of Nardostachys jatamansi on cerulein-induced acute pancreatitis  

PubMed Central

AIM: To determine if the fraction of Nardostachys jatamansi (NJ) has the potential to ameliorate the severity of acute pancreatitis (AP). METHODS: Mice were administered the biologically active fraction of NJ, i.e., the 4th fraction (NJ4), intraperitoneally, and then injected with the stable cholecystokinin analogue cerulein hourly for 6 h. Six hours after the last cerulein injection, the pancreas, lung, and blood were harvested for morphological examination, measurement of cytokine expression, and examination of neutrophil infiltration. RESULTS: NJ4 administration attenuated the severity of AP and lung injury associated with AP. It also reduced cytokine production and neutrophil infiltration and resulted in the in vivo up-regulation of heme oxygenase-1 (HO-1). Furthermore, NJ4 and its biologically active fraction, NJ4-2 inhibited the cerulein-induced death of acinar cells by inducing HO-1 in isolated pancreatic acinar cells. CONCLUSION: These results suggest that NJ4 may be a candidate fraction offering protection in AP and NJ4 might ameliorate the severity of pancreatitis by inducing HO-1 expression. PMID:22783046

Bae, Gi-Sang; Kim, Min-Sun; Park, Kyoung-Chel; Koo, Bon Soon; Jo, Il-Joo; Choi, Sun Bok; Lee, Dong-Sung; Kim, Youn-Chul; Kim, Tae-Hyeon; Seo, Sang-Wan; Shin, Yong Kook; Song, Ho-Joon; Park, Sung-Joo

2012-01-01

203

The Role of Somatostatin and Octreotide in Pancreatic Surgery and in Acute and Chronic Pancreatitis  

Microsoft Academic Search

Major pancreatic resection is still accompanied by considerable morbidity (35%) and even mortality (10%). Typical complications such as pancreatic fistula and abscess are chiefly associated with exocrine pancreatic secretion. Therefore, the perioperative inhibition of exocrine pancreatic secretion is a promising concept in the prevention of complications. The hormone somatostatin and its analogue octreotide is well known as a potent inhibitor

H. Friess; B. Hofbauer; M. W. Büchler

1994-01-01

204

Transient nonvisualization of the gallbladder by Tc-99m HIDA cholescintigraphy in acute pancreatitis: concise communication  

SciTech Connect

In five of seven patients with acute pancreatitis, Tc-99m HIDA scintigraphy failed to visualize the gallbladder. In all five patients the gallbladder was later found to be normal and in three of them normal filling was obtained at a repeat examination performed after the attack had subsided. Transient nonvisualization of the gallbladder in acute pancreatitis is probably due to disturbed motility of the biliary tree.

Edlund, G.; Kempi, V.; van der Linden, W.

1982-02-01

205

Percutaneous CT-Guided Catheter Drainage of Infected Acute Necrotizing Pancreatitis:Techniques and Results  

Microsoft Academic Search

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

1998-01-01

206

Acute biliary pancreatitis: an experience in a tertiary level hospital of Nepal.  

PubMed

Acute Biliary Pancreatitis is one of the commonest forms of pancreatitis in Nepal. Controversies exist as to the most appropriate way of management of these cases. The present study was carried out to evaluate the management and outcome of Acute Biliary Pancreatitis cases in a tertiary level hospital of Nepal. A retrospective analysis of the patients managed with Acute Biliary Pancreatits was done. All patients admitted with the diagnosis of Acute Biliary Pancreatitis over a period of 2 years were included in the study. The variables measured were age, sex, clinical presentation, laboratory investigations, mode of treatment and outcome. A total of 45 cases had Acute Biliary Pancreatitis suggesting a prevalence of 28 %. The mean age was 45?±?10 year. 39 patients (86.6 %) were treated with conservative management. 23 patients (54 %) had an uneventful recovery without any complications. 21 patients (46 %) developed some form of complications but recovered successfully. Mortality was seen in only one patient in the conservatively treated group. In a resource poor setting such as Nepal, definitive management is not always possible. Conservative management of Acute Biliary Pancreatitis has a favorable outcome in the majority of our patients with acceptable morbidity and mortality. Definitive management can be safely performed during index admission where possible. PMID:24465101

Manandhar, Sujan; Giri, Smith; Poudel, Prakash; Bhandari, Ramesh Singh; Lakhey, Paleswan Joshi; Vaidya, Pradeep

2013-12-01

207

Vascular Access System for Continuous Arterial Infusion of a Protease Inhibitor in Acute Necrotizing Pancreatitis  

SciTech Connect

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)

1999-09-15

208

Recurrent Acute Pancreatitis and Cholangitis in a Patient with Autosomal Dominant Polycystic Kidney Disease  

PubMed Central

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis. PMID:23543834

Yazdanpanah, Kambiz; Manouchehri, Navid; Hosseinzadeh, Elinaz; Emami, Mohammad Hassan; Karami, Mehdi; Sarrami, Amir Hossein

2013-01-01

209

Changing Referral Trends of Acute Pancreatitis in Children: A 12-year Single-center Analysis  

PubMed Central

Background Acute pancreatitis is a painful inflammatory disorder known to occur in children. Recent reports, primarily on the basis of adult data, have suggested an increasing incidence. However, pediatric studies are limited. Objective The study was performed to examine the frequency of acute pancreatitis in a pediatric population from 1994 to 2007 and to characterize etiologies by age subsets. Patients and Methods In this retrospective study, cases of pancreatitis were identified by ICD-9 codes and subjected to inclusion criteria. Results Two hundred and seventy-one cases of pancreatitis met inclusion criteria. Mean age of the subjects was 13.1 ± 5.6 years. The recurrence rate was 15.3%. Biliary disease was the most common etiology (32.6%). Acute pancreatitis cases evaluated at a single tertiary care center increased 53% between 1995 to 2000 and 2001 to 2006 (P <0.02). However, when cases were normalized by all annual pediatric emergency department visits for all medical reasons, the increase was reduced to 22% and lost statistical significance (P = 0.16). The rise was not associated with a change in etiologies or body mass index (BMI). Conclusions This is the first report demonstrating that an increase in pediatric pancreatitis may in part be due to growing referrals to tertiary care centers. The data on etiologies, particularly with regard to differing ages, may be helpful in managing children who present with acute pancreatitis. PMID:19503003

Park, Alexander; Latif, Sahibzada Usman; Shah, Ahsan U.; Tian, Jianmin; Werlin, Steven; Hsiao, Allen; Pashankar, Dinesh; Bhandari, Vineet; Nagar, Anil; Husain, Sohail Zakiuddin

2011-01-01

210

Treatment of severe acute respiratory syndrome  

Microsoft Academic Search

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

2005-01-01

211

New PRSS1 and common CFTR mutations in a child with acute recurrent pancreatitis, could be considered an "Hereditary" form of pancreatitis ?  

PubMed Central

Background acute recurrent pancreatitis is a complex multigenic disease, the diagnosis is even more difficult when this disease develops in a child. Case Presentation a 6-years old boy, hospitalized with epigastric pain radiating to the back showed high serum levels of serum amylase, lipase, CRP and erythrosedimentation rate. Several similar milder episodes of pain, followed by quick recovery and complete disappearance of symptoms were reported during the previous 13 months. The child was medically treated and after 7 days with normal clinic and laboratory tests was discharged with a hypolipidic diet. All the known aetiologic hypotheses were excluded by anamnestic investigation, clinical observation and biochemical evaluation, whereas, anatomic abnormality were excluded by a secretin stimulated magnetic resonance (MRI). At the last follow-up visit, (11 months later), the child showed a normal body weight and anthropometric profile, without further abdominal pain. Mutation screening for coding regions of PRSS1, SPINK1, CFTR and the new hereditary pancreatitis-associated chymotrypsin C (CTRC) genes showed a novel variation, c.541A > G (p.S181G), in the exon 4 of PRSS1 gene and the classical CF p.F508del mutation in the CFTR. Both mutations were present in his clinically normal mother and absent in the patient's father. Conclusions this report extend the spectrum of PRSS1 mutations, however, the absence of family history of pancreatitis leaves the present case without the hallmark of the hereditary origin of pancreatitis. At the present knowledge it can be only stated that the combined genotype CFTR (F508del)/PRSS1 (S181G) is associated to a mild phenotype of acute recurrent pancreatitis in this child without any further conclusion on its pathogenetic role or prediction on the course of the disease. PMID:20950468

2010-01-01

212

Bile-pancreatic juice exclusion promotes Akt/NF-kappaB activation and chemokine production in ligation-induced acute pancreatitis.  

PubMed

Using a unique surgical model (the donor rat model), we showed previously that duodenal replacement of bile-pancreatic juice, obtained fresh from a donor rat, ameliorates ligation-induced acute pancreatitis. We hypothesize that bile-pancreatic juice exclusion from gut exacerbates Akt/nuclear factor-kappaB (NF-kappaB) pathway activation and induces chemokine production in ligation-induced acute pancreatitis. We compared rats with bile-pancreatic duct ligation to those with duodenal bile-pancreatic juice replacement fresh from a donor rat beginning immediately before duct ligation. Sham control rats had ducts dissected but not ligated. Rats were killed 1 or 3 hours after operation (n = 7/group). Akt activation (immunoblotting, immune-complex kinase assay, and ELISA), inhibitory protein I-kappaB (IkappaB) activation (immunoblotting), and production of chemokines MCP-1 and RANTES (ELISA) were measured in pancreatic homogenates. NF-kappaB was quantitated in nuclear fractions using electrophoretic mobility shift assay. Duct ligation produced significant increases in pancreatic Akt, IkappaB, and NF-kappaB activation and production of MCP-1 and RANTES. Activation of the Akt/NF-kappaB pathway and increased MCP-1 and RANTES production in response to duct ligation were significantly reduced by bile-pancreatic juice replacement (ANOVA, P < 0.05). Bile-pancreatic juice exclusion stimulates Akt/NF-kappaB pathway activation and increases chemokine production in ligation-induced acute pancreatitis. PMID:16843865

Samuel, Isaac; Yorek, Mark A; Zaheer, Asgar; Fisher, Rory A

2006-01-01

213

Scolopendra subspinipes mutilans protected the cerulein-induced acute pancreatitis by inhibiting high-mobility group box protein-1  

PubMed Central

AIM: To evaluate the inhibitory effects of Scolopendra subspinipes mutilans (SSM) on cerulein-induced acute pancreatitis (AP) in a mouse model. METHODS: SSM water extract (0.1, 0.5, or 1 g/kg) was administrated intraperitoneally 1 h prior to the first injection of cerulein. Once AP developed, the stable cholecystokinin analogue, cerulein was injected hourly, over a 6 h period. Blood samples were taken 6 h later to determine serum amylase, lipase, and cytokine levels. The pancreas and lungs were rapidly removed for morphological examination, myeloperoxidase assay, and real-time reverse transcription polymerase chain reaction. To specify the role of SSM in pancreatitis, the pancreatic acinar cells were isolated using collagenase method. Then the cells were pre-treated with SSM, then stimulated with cerulein. The cell viability, cytokine productions and high-mobility group box protein-1 (HMGB-1) were measured. Furthermore, the regulating mechanisms of SSM action were evaluated. RESULTS: The administration of SSM significantly attenuated the severity of pancreatitis and pancreatitis associated lung injury, as was shown by the reduction in pancreatic edema, neutrophil infiltration, vacuolization and necrosis. SSM treatment also reduced pancreatic weight/body weight ratio, serum amylase, lipase and cytokine levels, and mRNA expression of multiple inflammatory mediators such as tumor necrosis factor-? and interleukin-1?. In addition, treatment with SSM inhibited HMGB-1 expression in the pancreas during AP. In accordance with in vivo data, SSM inhibited the cerulein-induced acinar cell death, cytokine, and HMGB-1 release. SSM also inhibited the activation of c-Jun NH2-terminal kinase, p38 and nuclear factor (NF)-?B. CONCLUSION: These results suggest that SSM plays a protective role during the development of AP and pancreatitis associated lung injury via deactivating c-Jun NH2-terminal kinase, p38 and NF-?B. PMID:23539679

Jo, Il-Joo; Bae, Gi-Sang; Park, Kyoung-Chel; Choi, Sun Bok; Jung, Won-Seok; Jung, Su-Young; Cho, Jung-Hee; Choi, Mee-Ok; Song, Ho-Joon; Park, Sung-Joo

2013-01-01

214

Open approach in pancreatic and infected pancreatic necrosis: Laparostomies and preplanned revisions  

Microsoft Academic Search

One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations. The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission). Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis. Overall,

Reinhold Ffigger; Franz Schulz; Michael Rogy; Friedrich Herbst; Darius Mirza; Arnulf Fritsch

1991-01-01

215

Angiopoietin-1 gene-modified human mesenchymal stem cells promote angiogenesis and reduce acute pancreatitis in rats  

PubMed Central

Mesenchymal stem cells (MSCs) can serve as a vehicle for gene therapy. Angiopoietin-1 (ANGPT1) plays an important role in the regulation of endothelial cell survival, vascular stabilization, and angiogenesis. We hypothesized that ANGPT1 gene-modified MSCs might be a potential therapeutic approach for severe acute pancreatitis (SAP) in rats. Human umbilical cord-derived MSCs with or without transfection with lentiviral vectors containing the ANGPT1 gene were delivered through the tail vein of rats 12 h after induction of SAP. Administration of MSCs alone significantly reduced pancreatic injury and inflammation, as reflected by reductions in pancreatitis severity scores and serum amylase and lipase levels as well as reducing the serum levels of proinflammatory cytokines (TNF-?, IFN-?, IL-1?, and IL-6). Furthermore, administration of ANGPT1-transfected MSCs resulted in not only further reductions in pancreatic injury and serum levels of proinflammatory cytokines, but also promotion of pancreatic angiogenesis. These results suggest that MSCs and ANGPT1 have a synergistic role in the treatment of SAP. ANGPT1 gene-modified MSCs may be developed as a potential novel therapy strategy for the treatment of SAP. PMID:25120736

Hua, Jie; He, Zhi-Gang; Qian, Dao-Hai; Lin, Sheng-Ping; Gong, Jian; Meng, Hong-Bo; Yang, Ting-Song; Sun, Wei; Xu, Bin; Zhou, Bo; Song, Zhen-Shun

2014-01-01

216

Extracellular Cleavage of E-Cadherin by Leukocyte Elastase During Acute Experimental Pancreatitis in Rats  

Microsoft Academic Search

Background & Aims: Cadherins play an important role in cell-cell contact formation at adherens junctions. During the course of acute pancreatitis, adherens junctions are known to dissociate—a requirement for the interstitial accumulation of fluid and inflammatory cells— but the underlying mechanism is unknown. Methods: Acute pan- creatitis was induced in rats by supramaximal cerulein infusion. The pancreas and lungs were

JULIA MAYERLE; JÜRGEN SCHNEKENBURGER; BURKHARD KRÜGER; JOSEF KELLERMANN; MANUEL RUTHENBÜRGER; F. ULRICH WEISS; ANGEL NALLI; WOLFRAM DOMSCHKE; MARKUS M. LERCH

2005-01-01

217

Experimental and clinical evidence of antioxidant therapy in acute pancreatitis  

PubMed Central

Oxidative stress has been shown to play an important role in the pathogenesis of acute pancreatitis (AP). Antioxidants, alone or in combination with conventional therapy, should improve oxidative-stress-induced organ damage and therefore accelerate the rate of recovery. In recent years, substantial amounts of data about the efficiency of antioxidants against oxidative damage have been obtained from experiments with rodents. Some of these antioxidants have been found beneficial in the treatment of AP in humans; however, at present there is insufficient clinical data to support the benefits of antioxidants, alone or in combination with conventional therapy, in the management of AP in humans. Conflicting results obtained from experimental animals and humans may represent distinct pathophysiological mechanisms mediating tissue injury in different species. Further detailed studies should be done to clarify the exact mechanisms of tissue injury in human AP. Herein I tried to review the existing experimental and clinical studies on AP in order to determine the efficiency of antioxidants. The use of antioxidant enriched nutrition is a potential direction of clinical research in AP given the lack of clues about the efficiency and safety of antioxidant usage in patients with AP. PMID:23112545

Esrefoglu, Mukaddes

2012-01-01

218

Severe Acute Respiratory Syndrome, Beijing, 2003  

PubMed Central

The largest outbreak of severe acute respiratory syndrome (SARS) struck Beijing in spring 2003. Multiple importations of SARS to Beijing initiated transmission in several healthcare facilities. Beijing’s outbreak began March 5; by late April, daily hospital admissions for SARS exceeded 100 for several days; 2,521 cases of probable SARS occurred. Attack rates were highest in those 20–39 years of age; 1% of cases occurred in children <10 years. The case-fatality rate was highest among patients >65 years (27.7% vs. 4.8% for those 20–64 years, p < 0.001). Healthcare workers accounted for 16% of probable cases. The proportion of case-patients without known contact to a SARS patient increased significantly in May. Implementation of early detection, isolation, contact tracing, quarantine, triage of case-patients to designated SARS hospitals, and community mobilization ended the outbreak. PMID:15078593

Liang, Wannian; Zhu, Zonghan; Guo, Jiyong; Liu, Zejun; He, Xiong; Zhou, Weigong; Chin, Daniel P.

2004-01-01

219

Incretin based drugs and risk of acute pancreatitis in patients with type 2 diabetes: cohort study  

PubMed Central

Objectives To determine whether the use of incretin based drugs, compared with sulfonylureas, is associated with an increased risk of acute pancreatitis. Design Population based cohort study. Setting 680 general practices in the United Kingdom contributing to the Clinical Practice Research Datalink. Participants From 1 January 2007 to 31 March 2012, 20?748 new users of incretin based drugs were compared with 51?712 users of sulfonylureas and followed up until 31 March 2013. Main outcome measures Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for acute pancreatitis in users of incretin based drugs compared with users of sulfonylureas. Models were adjusted for tenths of high dimensional propensity score (hdPS). Results The crude incidence rate for acute pancreatitis was 1.45 per 1000 patients per year (95% confidence interval 0.99 to 2.11) for incretin based drug users and 1.47 (1.23 to 1.76) for sulfonylurea users. The rate of acute pancreatitis associated with the use of incretin based drugs was not increased (hdPS adjusted hazard ratio: 1.00, 95% confidence interval 0.59 to 1.70) relative to sulfonylurea use. Conclusions Compared with use of sulfonylureas, the use of incretin based drugs is not associated with an increased risk of acute pancreatitis. While this study is reassuring, it does not preclude a modest increased risk, and thus additional studies are needed to confirm these findings. PMID:24764569

2014-01-01

220

Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature.  

PubMed

Extracorporeal shock wave lithotripsy (SWL) is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus. PMID:24497695

Mylarappa, Prasad; Javali, Tarun; Prathvi; Ramesh, D

2014-01-01

221

The pathogenesis of L-arginine-induced acute necrotizing pancreatitis: Inflammatory mediators and endogenous cholecystokinin  

Microsoft Academic Search

This study was aimed at an assessment of the role of oxygen-derived free radicals, cytokines and endogenous cholecystokinin (CCK) in the pathogenesis of L-arginine (Arg)-induced acute pancreatitis in rat. We measured the levels of malonyl dialdehyde (MDA), glutathione peroxidase (GPx), catalase and superoxide dismutase (Mn- and Cu, Zn-SOD) in pancreatic tissue, the serum levels of tumor necrosis factor-? (TNF-?), interleukin-6

László Czakó; Tamás Takács; Ilona Sz Varga; Do Quy Hai; László Tiszlavicz; Péter Hegyi; Yvette Mándi; Béla Matkovics; János Lonovics

2000-01-01

222

Pancreatic Cancer as a Model: Inflammatory Mediators, Acute-phase Response, and Cancer Cachexia  

Microsoft Academic Search

.   Patients with pancreatic cancer frequently develop the syndrome of cancer cachexia. Pro-inflammatory cytokines have been\\u000a strongly implicated in the pathogenesis of this syndrome. In patients with pancreatic cancer an acute-phase response (an index\\u000a of pro-inflammatory cytokine activity) is associated with accelerated weight loss, hypermetabolism, anorexia, and a shortened\\u000a duration of survival. However, little is known about the primary significance

Kenneth C. H. Fearon; Matthew D. Barber; J. S. Falconer; Donald C. McMillan; James A. Ross; Tom Preston

1999-01-01

223

Serum lipase and amylase ratio in acute alcoholic and nonalcoholic pancreatitis by using Dupont ACA discrete clinical analyzer  

Microsoft Academic Search

This work involves a retrospective analysis of serum amylase, lipase, and lipase\\/amylase ratio in alcoholic and nonalcoholic patients diagnosed with acute pancreatitis. The purpose of this study was to test the reliability of the Dupont ACA method with respect to the lipase\\/amylase ratio as a discriminator, for the etiology of pancreatitis. Thirty-six consecutive patients with the diagnosis of acute pancreatitis

Ehsan Ansari; David A. Talenti; Joseph A. Scopelliti; Jawad M. Saadat; Bradley D. Zehr

1996-01-01

224

Treatment of acute pancreatitis with mexidol and low-intensity laser radiation  

NASA Astrophysics Data System (ADS)

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.

2001-04-01

225

Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review.  

PubMed

In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis should always be considered in the diagnosis of patients with abdominal pain and elevated pancreatic enzymes. PMID:24728257

Oliveira, Natalia Mejias; Ferreira, Felipe Augusto Yamauti; Yonamine, Raquel Yumi; Chehter, Ethel Zimberg

2014-01-01

226

Oxidative stress in distant organs and the effects of allopurinol during experimental acute pancreatitis  

Microsoft Academic Search

Summary  \\u000a Background. The present study was aimed at an assessment of the role of oxygen-derived free radicals in the development of local and\\u000a systemic manifestations of l-arginine (Arg)-induced acute pancreatitis and at an evaluation of the protective effect of the xanthine oxidase inhibitor\\u000a allopurinol.\\u000a \\u000a \\u000a Methods. Acute pancreatitis was induced in male Wistar rats by injecting 2×250 mg\\/100 g body weight

László Czakó; Tamás Takács; Ilona Sz. Varga; László Tiszlavicz; Do Quy Hai; Péter Hegyi; Béla Matkovics; János Lonovics

2000-01-01

227

Sterile Fluid Collections in Acute Pancreatitis: Catheter Drainage Versus Simple Aspiration  

Microsoft Academic Search

Purpose  To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in\\u000a patients with acute pancreatitis.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral\\u000a for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages\\u000a or needle

Eric M. Walser; William H. Nealon; Santiago Marroquin; Syed Raza; J. Alberto Hernandez; James Vasek

2006-01-01

228

CCK-A receptor induction and P38 and NF-kappaB activation in acute pancreatitis.  

PubMed

Bile-pancreatic duct ligation in rats excludes bile-pancreatic juice from the gut and induces acute pancreatitis. Bile-pancreatic juice exclusion from the gut results in increased plasma cholecystokinin (CCK) levels. CCK-A receptor-mediated exocrine pancreatic hyperstimulation is implicated in disease pathogenesis. In the present study, we show for the first time a progressive rise in CCK-A receptor protein expression in ligation-induced acute pancreatitis in rats. As CCK-A receptor induction could amplify CCK-mediated acinar hyperstimulation and exacerbate acinar cell stress with activation of the p38(MAPK) stress kinase pathway, we studied CCK-A receptor protein expression and p38(MAPK) activation in duct ligation-induced acute pancreatitis in rats. Compared to sham-operated controls, acute pancreatitis induced by bile-pancreatic duct ligation associates with a temporal increase in pancreatic CCK-A receptor protein expression, p38(MAPK) expression and activation, and NF-kappaB activation. These findings may have significance in the mechanism of disease pathogenesis in this experimental model. PMID:14988658

Samuel, Isaac; Zaheer, Smita; Nelson, Jeffrey J; Yorek, Mark A; Zaheer, Asgar

2004-01-01

229

Severe Recurrent Pancreatitis in a Child with ADHD after Starting Treatment with Methylphenidate (Ritalin)  

PubMed Central

We present a case of a 10-year-old boy, who had severe relapsing pancreatitis, three times in two months within 3 weeks after starting treatment with methylphenidate (Ritalin) due to attention deficit hyperactivity disorder (ADHD). Pancreatitis due to the use of (methylphenidate) Ritalin was never published before. Attention must be made by the physicians regarding this possible complication, and this complication should be taken into consideration in every patient with abdominal pain who was newly treated with Ritalin. PMID:24711932

Bisharat, Bishara; Nijim, Yousif

2014-01-01

230

A Meta-Analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis  

PubMed Central

Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software. Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR = 0.556, 95% CI 0.436?0.709, P = .000), MOF (RR = 0.395, 95% CI 0.272?0.573, P = .003), surgical interventions (RR = 0.556, 95% CI 0.436?0.709, P = .000), and mortality (RR = 0.426, 95% CI 0.238?0.764, P = .167). There was no statistic significance in non-pancreatitis-related complications (RR = 0.853, 95% CI 0.490?1.483, P = .017). However, EN had a significantly higher incidence of non-infection-related complications (RR = 2.697, 95% CI 1.947?3.735, P = .994). Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis. PMID:21687619

Quan, Heming; Wang, Xingpeng; Guo, Chuanyong

2011-01-01

231

Salutary and prophylactic effect of pentadecapeptide BPC 157 on acute pancreatitis and concomitant gastroduodenal lesions in rats.  

PubMed

The superior effectiveness of a new pentadecapeptide, BPC 157, on gastrointestinal and liver lesions, in conjunction with an antiinflammatory and analgetic activity was recently noted. In the present study, BPC 157 was tested as either a protective or healing agent in bile duct ligation-induced acute pancreatitis in rats. In addition, the positive influence of BPC 157 on concomitantly developed gastric and duodenal lesions was simultaneously investigated. BPC 157 (10 microg, 10 ng/kg body wt, intraperitoneally or intragastrically) was given prophylactically 1 hr before ligation, whereas the therapy was given once daily beginning with the 24 hr following ligation (last application 24 hr before killing). The effect was investigated at daily intervals until the end of the fifth day after ligation. In the pretreatment regimen, a strong pancreas protection was obtained. When applied in the condition of already established severe acute pancreatitis, an obvious salutory effect was consistently noted. Assessing the appearance of the necrosis, edema, neutrophils, and mononuclears, consistently less necrosis, edema, and neutrophils, but more mononuclears, were found in BPC-treated rats. Likewise, in studies of the serum amylase values, relative to control data, a markedly lower rise (BPC pretreatment regimen) as well as a worsening of the already raised values (BPC therapy regimen) was noted. Along with its beneficial effect on pancreatitis, a positive influence of BPC 157 on the gastric and duodenal lesion course in bile duct-ligated rats was noted in both the pre- and posttreatment regimen. Taken together, in further studies of acute pancreatitis therapy, BPC could be an interesting and useful agent with an additional positive impact on concomitant gastroduodenal pathology. PMID:8689934

Sikiri?, P; Seiwerth, S; Grabarevi?, Z; Rucman, R; Petek, M; Jagi?, V; Turkovi?, B; Rotkvi?, I; Mise, S; Zorici?, I; Jurina, L; Konjevoda, P; Hanzevacki, M; Ljubanovi?, D; Separovi?, J; Gjurasin, M; Bratuli?, M; Artukovi?, B; Jelovac, N; Buljat, G

1996-07-01

232

Early Enteral Nutrition within 24 Hours or between 24 and 72 Hours for Acute Pancreatitis: Evidence Based on 12 RCTs  

PubMed Central

Background Although (EEN) is a relatively safer route by which to feed patients with severe acute pancreatitis (SAP) or predicted SAP (pSAP) compared to total parental nutrition (TPN), the appropriate starting time for EEN administration after admission is still controversial. This study pooled all relevant studies to assess the complications associated with EEN by stratifying relevant RCTs into subgroups according to the starting time (<24 h or between 24 and 72 h after admission). Material/Methods Relevant studies were searched for among 5 databases. The association between intervention and complications, including pancreatic infection, mortality, hyperglycemia, organ failure, and catheter-related septic complications, were assessed by using pooled risk ratio (RR) and the corresponding 95% confidential interval (CI). Results Twelve RCTs were identified through our literature search. Pooled analysis showed that EEN, but not TPN or delayed enteral nutrition (DEN), is associated with reduced risk of pancreatic infection, mortality, organ failure, hyperglycemia, and catheter-related septic complications. EEN within 24 h of admission presented significantly better outcome in morality than EEN between 24 and 72 h. However, no significant heterogeneity was observed in the risk of pancreatic infection, organ failure, hyperglycemia, and catheter-related septic complications between the 2 subgroups. Conclusions If the patients are reasonably expected to have high compliance to EN therapy, it could be considered as early as possible. PMID:25399541

Li, Xueping; Ma, Fengbo; Jia, Kezhi

2014-01-01

233

Management of acute severe ulcerative colitis  

PubMed Central

The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine naďve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patients not responding to infliximab or cyclosporin should be considered for colectomy.

Kedia, Saurabh; Ahuja, Vineet; Tandon, Rakesh

2014-01-01

234

Management of acute severe ulcerative colitis.  

PubMed

The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine naďve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patients not responding to infliximab or cyclosporin should be considered for colectomy. PMID:25401001

Kedia, Saurabh; Ahuja, Vineet; Tandon, Rakesh

2014-11-15

235

Electroacupuncture Ameliorates Acute Lung Injury through Promoting Gastrointestinal Motility in Rats with Acute Pancreatitis.  

PubMed

Objective. Gastrointestinal disfunction and acute lung injury (ALI) were common in acute pancreatitis (AP). The effect of electro-acupuncture (EA) on gastrointestinal motility and ALI in rats with AP was investigated to verify the theory of "lung and large intestine are interior exteriorly related" in traditional Chinese medicine. Methods. Male Sprague-Dawley rats were randomly divided into the normal group, model group, and EA group. AP model was established by three injections of 20% L-arginine at 1?h intervals. EA were applied to bilateral ST-25 and ST-36 for 30 minutes twice a day after modeling for 3 days. Arterial blood, pancreas, lung, and intestinal tissues were collected for detecting the inflammatory factors and histopathology. Intestinal propulsion rate (IPR) was also measured at 72?h. Results. EA treatment improved IPR and increased CCK-8 level compared with model group (P < 0.05). It lowered the serum levels of TNF- ? and IL-6 and increased the level of IL-4 with no effect on IL-10. EA treatment reduced serum vasoactive intestinal peptide (VIP) and myeloperoxidase (MPO) level in the lung and the pathologic scores of pancreas, lung and intestine were decreased (P < 0.05). Conclusion. EA treatment could promote gastrointestinal motility through inhibiting VIP, and promoting CCK expression and regulate pro- and anti-inflammatory mediators to ameliorate ALI in AP. PMID:24876883

Guo, Hui; Zhu, Shi-Feng; Zhang, Rong-Rong; Zhao, Xian-Lin; Wan, Mei-Hua; Tang, Wen-Fu

2014-01-01

236

Electroacupuncture Ameliorates Acute Lung Injury through Promoting Gastrointestinal Motility in Rats with Acute Pancreatitis  

PubMed Central

Objective. Gastrointestinal disfunction and acute lung injury (ALI) were common in acute pancreatitis (AP). The effect of electro-acupuncture (EA) on gastrointestinal motility and ALI in rats with AP was investigated to verify the theory of “lung and large intestine are interior exteriorly related” in traditional Chinese medicine. Methods. Male Sprague-Dawley rats were randomly divided into the normal group, model group, and EA group. AP model was established by three injections of 20% L-arginine at 1?h intervals. EA were applied to bilateral ST-25 and ST-36 for 30 minutes twice a day after modeling for 3 days. Arterial blood, pancreas, lung, and intestinal tissues were collected for detecting the inflammatory factors and histopathology. Intestinal propulsion rate (IPR) was also measured at 72?h. Results. EA treatment improved IPR and increased CCK-8 level compared with model group (P < 0.05). It lowered the serum levels of TNF-? and IL-6 and increased the level of IL-4 with no effect on IL-10. EA treatment reduced serum vasoactive intestinal peptide (VIP) and myeloperoxidase (MPO) level in the lung and the pathologic scores of pancreas, lung and intestine were decreased (P < 0.05). Conclusion. EA treatment could promote gastrointestinal motility through inhibiting VIP, and promoting CCK expression and regulate pro- and anti-inflammatory mediators to ameliorate ALI in AP. PMID:24876883

Guo, Hui; Zhu, Shi-Feng; Zhang, Rong-Rong; Zhao, Xian-Lin; Wan, Mei-Hua; Tang, Wen-Fu

2014-01-01

237

Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum.  

PubMed

Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis (PGAP) is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His post-operative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis. PMID:19777622

Kuo, I-Ming; Wang, Frank; Liu, Keng-Hao; Jan, Yi-Yin

2009-09-28

238

The Antioxidant Profiles, Lysosomal and Membrane Enzymes Activity in Patients with Acute Pancreatitis  

PubMed Central

Oxidative stress and inflammatory mediators, such as IL-6, play an important role in the pathophysiology of acute pancreatitis. The study was aimed to assess the degree of the pro/antioxidative imbalance and estimate which antioxidant plays a role in the maintenance of pro/antioxidative balance during acute pancreatitis. The study was investigated in the blood of 32 patients with acute pancreatitis and 37 healthy subjects. IL-6 concentration as early marker of inflammation was determinated. The intensity of oxidative stress was assessed by TBARS concentration. To investigate antioxidative status, the GPx and Cu/Zn SOD activities and the levels of GSH, MT, SH groups, and TRAP were measured. The concentrations of Cu and Zn as ions participating in the maintenance of antioxidant enzymes stability and playing a role in the course of disease were determinated. The activities of GGT, AAP, NAG, and ?-GD as markers of tissue damage were also measured. An increase in IL-6 concentration, which correlated with Ranson criteria, and an increase in GPx activity, levels of MT, TBARS, or GGT, and NAG activities in patients group compared to healthy subjects were demonstrated. A decrease in GSH level in patients group compared to control group was noted. The studies suggest that GPx/GSH and MT play the role of the first line of defence against oxidative stress and pro/antioxidant imbalance in the course of acute pancreatitis. PMID:25298618

Milnerowicz, Halina; Bukowski, Radoslaw; Jablonowska, Monika; Sciskalska, Milena; Milnerowicz, Stanislaw

2014-01-01

239

PGC-1? expression is increased in leukocytes in experimental acute pancreatitis.  

PubMed

Severe acute pancreatitis (AP) induces a systemic inflammatory disease that is responsible for high mortality rates, particularly when it is complicated by infection. Therefore, differentiating sepsis from the systemic inflammation caused by AP is a serious clinical challenge. Considering the high metabolic rates of leukocytes in response to stress induced by infection, we hypothesized that the transcription coactivator peroxisome proliferator-activated receptor gamma coactivator 1 (PGC-1?), a master regulator of mitochondrial biogenesis and function, would be distinctly expressed during inflammation or infection and, therefore, could constitute a useful marker to differentiate between these two conditions. Rats were subjected to injection of taurocholate into the main pancreatic duct, which caused a severe AP with high amylase levels and white blood cell counts. In these animals, a marked increase in PGC-1? mRNA levels in circulating leukocytes was observed 48 h after the surgical procedure, a time when bacteremia is present. Antibiotic treatment abolished PGC-1? up-regulation. Moreover, PGC-1? expression was higher in peritoneal macrophages from animals subjected to a bacterial insult (cecal ligation and puncture) than in animals with AP. In isolated macrophages, we also observed that PGC-1? expression is more prominent in the presence of a phagocytic stimulus (zymosan) when compared to lipopolysaccharide-induced aseptic inflammation. Moreover, abolishing PGC-1? expression with antisense oligos impaired zymosan phagocytosis. Together, these findings suggest that PGC-1? is differentially expressed during aseptic inflammation and infection and that it is necessary for adequate phagocytosis. These results could be useful in developing new tests for differentiating infection from inflammation for clinical purposes in patients with AP. PMID:24562467

Llimona, Flávia; de Lima, Thais Martins; Moretti, Ana Iochabel; Theobaldo, Mariana; Jukemura, Jose; Velasco, Irineu Tadeu; Machado, Marcel C C; Souza, Heraldo Possolo

2014-08-01

240

Estimation of plasma esterolytic activity and it's in vitro inhibition by proteinase inhibitors during acute pancreatitis in the human.  

PubMed Central

The plasma esterolytic activity was measured using benzyol arginine ethyl ester (BAEe) in the peripheral venous blood of patients with acute pancreatitis, normal healthy volunteers and a contrast group of patients with acute intrabdominal inflammations other than acute pancreatitis. The plasma esterolytic activity was significantly elevated in the pancreatitis group. This activity was maximal during the first 48 hours of the illness and remained elevated for a further 8 days thereafter. Aprotinin in a dose of 2000 K.I. u/0-3 ml plasma did not completely inhibit this esterolytic activity, although it resulted in a more substantial inhibition than either ovomucoid or soy bean inhibitor. It is concluded that pancreatic enzymes are released into the circulation during acute pancreatitis and that Aprotinin does not completely inhibit this proteolytic activity. This polyvalent proteinase inhibitor should therefore be administered in much higher dosage than that used hitherto in acute pancreatitis. The plasma esterolytic activity seems to be of diagnostic value in acute pancreatitis. PMID:1083738

Worthington, K. J.; Cuschieri, A.

1976-01-01

241

Sterile Fluid Collections in Acute Pancreatitis: Catheter Drainage Versus Simple Aspiration  

SciTech Connect

Purpose. To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in patients with acute pancreatitis. Methods. We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages or needle aspirations were included in the study. Fifteen patients had aspiration of 10-20 ml fluid only (group A) and 22 patients had catheter placement for chronic evacuation of fluid (group C). We excluded patients with grossly purulent collections and chronic pseudocysts. We also recorded the number of sinograms and catheter changes and duration of catheter drainage. The CT severity index, Ranson scores, and maximum diameter of abdominal fluid collections were calculated for all patients at presentation. The total length of hospital stay (LOS), length of hospital stay after the drainage or aspiration procedure (LOS-P), and conversions to percutaneous and/or surgical drainage were recorded as well as survival. Results. The CT severity index and acute Ransom scores were not different between the two groups (p = 0.15 and p = 0.6, respectively). When 3 crossover patients from group A to group C were accounted for, the duration of hospitalization did not differ significantly, with a mean LOS and LOS-P of 33.8 days and 27.9 days in group A and 41.5 days and 27.6 days in group C, respectively (p = 0.57 and 0.98, respectively). The 60-day mortality was 2 of 15 (13%) in group A and 2 of 22 (9.1%) in group C. Kaplan-Meier survival curves for the two groups were not significantly different (p 0.3). Surgical or percutaneous conversions occurred significantly more often in group A (7/15, 47%) than surgical conversions in group C (4/22, 18%) (p 0.03). Patients undergoing catheter drainage required an average of 2.2 sinograms/tube changes and kept catheters in for an average of 52 days. Aspirates turned culture-positive in 13 of 22 patients (59%) who had chronic catheterization. In group A, 3 of the 7 patients converted to percutaneous or surgical drainage had infected fluid at the time of conversion (total positive culture rate in group A 3/15 or 20%). Conclusions. There is no apparent clinical benefit for catheter drainage of sterile fluid collections arising in acute pancreatitis as the length of hospital stay and mortality were similar between patients undergoing aspiration versus catheter drainage. However, almost half of patients treated with simple aspiration will require surgical or percutaneous drainage at some point. Disadvantages of chronic catheter drainage include a greater than 50% rate of bacterial colonization and the need for multiple sinograms and tube changes over an average duration of about 2 months.

Walser, Eric M. [University of Texas Medical Branch, Department of Radiology (United States)], E-mail: walser.eric@mayo.edu; Nealon, William H. [University of Texas Medical Branch, Department of Surgery (United States); Marroquin, Santiago; Raza, Syed; Hernandez, J. Alberto; Vasek, James [University of Texas Medical Branch, Department of Radiology (United States)

2006-02-15

242

Proteases and protease inhibitors in taurocholate-induced acute pancreatitis in rats  

Microsoft Academic Search

Summary  \\u000a Background. Proteases and protease inhibitors have been indicated to play an important role in both human and experimental acute pancreatitis,\\u000a although little is known about them in rats.\\u000a \\u000a \\u000a Methods. Three percent sodium taurocholate was infused into the bilio-pancreatic duct to induce AP, and over 0–72 h we measured lipase,\\u000a amylase, albumin, prekallikrein, factor X, ?-1-macroglobulin, ?-2-antiplasmin, antithrombin III, ?-1-protease

Peter Kruse; Esther Hage; Ĺke Lasson

1999-01-01

243

Drug-induced acute pancreatitis: A rare manifestation of an incomplete "dapsone syndrome"  

PubMed Central

Drug-induced acute pancreatitis (AP) is under-reported, and a large number of drugs are listed as offenders, but are often overlooked. Knowledge about the possible association of medications in causing AP is important, and needs a high index of suspicion, especially with drugs that have been reported to be the etiology only rarely. Dapsone, a commonly used drug, can cause various hypersensitivity reactions including AP collectively called “dapsone syndrome.” Here, we report dapsone-induced AP in a young man. Our case shows certain dissimilarities like associated acute renal failure and acute hemolysis not previously described. PMID:25097293

Das, Anup K.; Jawed, Qaiser

2014-01-01

244

Pancreatitis in cats.  

PubMed

Pancreatitis was considered a rare disease in the cat until a couple of decades ago when several retrospective studies of severe acute pancreatitis were published. It was apparent that few of the diagnostic tests of value in the dog were helpful in cats. With increasing clinical suspicion, availability of abdominal ultrasonography, and introduction of pancreas-specific blood tests of increasing utility, it is now accepted that acute pancreatitis is probably almost as common in cats as it is in dogs, although the etiology(s) remain more obscure. Pancreatitis in cats often co-exists with inflammatory bowel disease, less commonly with cholangitis, and sometimes with both. Additionally, pancreatitis may trigger hepatic lipidosis, while other diseases, such as diabetes mellitus, may be complicated by pancreatitis. Therapy is similar to that used in dogs, with added emphasis on early nutritional support to prevent hepatic lipidosis. Less is known about chronic pancreatitis than the acute form, but chronic pancreatitis is more common in cats than it is in dogs and may respond positively to treatment with corticosteroids. PMID:23148855

Armstrong, P Jane; Williams, David A

2012-08-01

245

Chylomicronemia Syndrome in Pregnancy: a Case Report of an Acute Necrotizing Pancreatitis  

PubMed Central

Introduction: Chylomicronemia syndrome (CS) is a rare disorder characterized by a high level of triglycerides in plasma. We present a case of a pregnant woman with a severe acute pancreatitis (AP) affected by a CS. Case: A 38-year-old gravida 2, para 0 with an uneventful course of pregnancy was referred with an AP at 37 0/7 weeks of gestation. This diagnosis was made from a nearby hospital where the chemical analysis showed elevated pancreatic enzymes with significant hypertriglyceridemia. Because of a pathological fetal heart tracing a caesarean delivery was performed. The APGAR score of the female newborn was 5/8/8 at 1, 5 and 10 minutes, respectively. The pH from the umbilical cord were 7.26 (artery) and 7.59 (vein). Once transferred to our intensive care unit a computer tomography scan confirmed an onset of a necrotizing AP. A conservative treatment was tried without success. For this reason a surgical debridement of the infected and necrosic parts was performed. After a long hospitalisation the patient could be dismissed after 2.5 months in good general condition. Discussion: Lipid profile changes in normal pregnancy are characterized by an elevation of total plasma cholesterol and triglyceride levels. This is normally caused by an increased liver synthesis of triglycerides in response to elevated estrogen levels. When a CS is diagnosed the main goal is to maintain fasting triglyceride levels at less than 500?mg/dL to reduce the risk for AP. Conclusion: Practitioners have an important role in evaluating chylomicronemic patients and implementing therapeutic lifestyle and pharmaceutic interventions aimed to reduce the risk for AP.

Bolla, D.; Schyrba, V.; Drack, G.; Schoning, A.; Stage, A.; Hornung, R.

2012-01-01

246

A case of recurrent arrhythmia in an acute pancreatitis patient--pathophysiological explanation using shortage of 'repolarization reserve'.  

PubMed

We report a case of a patient with acute pancreatitis who developed serious heart rhythm abnormalities on three occasions, two of which were associated with administration of the first generation antihistamine chloropyramine, and the third one with hypomagnesemia and hypokalemia. Dysrhythmic events consisted of bigeminy, multifocal ventricular extrasystoles and torsades de pointes-like ventricular tachycardia. Electrocardiographic changes in acute pancreatitis in the absence of previous heart disease can occur in more than half of the cases. Antihistamines are medications that are known to produce heart rhythm disturbances, especially the second generation drugs astemizole and terfenadine. This is the first report of chloropyramine causing dysrhythmia. It seems that acute pancreatitis patients are especially prone to heart dysrhythmia caused by different factors such as electrolyte disturbances and pronounced vagal tone. Acute pancreatitis may be added to the list of risk factors with altered 'repolarization reserve', predisposing to drug-induced QT interval prolongation and possible torsades de pointes occurrence. PMID:24697004

Uvelin, Arsen; Hajdukovi?, Danica; Vrsajkov, Vladimir; Kolak, Radmila; Lazuki?, Aleksandra; Vickovi?, Sanja; Gojkovi?, Zoran

2013-12-01

247

Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methandrostenolone: a case report  

PubMed Central

Introduction Over the last few years the use of anabolic steroids has become increasingly common amongst amateur athletes and for aesthetic purposes. As a result, the adverse events related to their use are being seen more frequently. Methandrostenolone is an anabolic steroid which is widely available and has been used for both performance enhancement and aesthetic purposes. This drug has also been reported to cause cholestasis of the intra-hepatic bile ducts resulting in elevated aminotransferases, hyperbilirubinemia and clinical jaundice. However, to the best of our knowledge this agent has not been previously reported to cause pancreatitis or acute kidney injury. Case presentation In this paper, we report the case of a 50-year-old man of Indian descent who presented with a six week history of diffuse abdominal pain, anorexia and weight loss following an eight week cycle of methandrostenolone use. At initial presentation, his lipase level was 785 U/L, bilirubin was 922 ?mol/L and creatinine was 200 U/L while his aspartate aminotransferase and alanine aminotransferase levels were only mildly elevated at 61 U/L and 56 U/L respectively. His lipase peaked on day nine at >3000 U/L whilst his creatinine level was 299 U/L. Imaging was consistent with acute pancreatitis while a liver biopsy was consistent with intra-hepatic cholestasis and a kidney biopsy revealed evidence of acute tubular necrosis. Conclusion Both acute pancreatitis and acute kidney injury have rarely been reported with anabolic steroid use and they have not been previously reported to occur in the same patient. This case demonstrates some potentially new and serious adverse consequences occurring with the use of anabolic steroids, of which physicians need to be aware. PMID:21470406

2011-01-01

248

The effect of heparin on lysosomes of the dog pancreas during acute experimental pancreatitis.  

PubMed

In 12 dogs with acute experimental pancreatitis (AEP) and 6 control animals the "free", "latent" and "total" activity of acid phosphatase, beta-glucuronidase and cathepsins in whole homogenates of the pancreas, in a lysosomal-enriched subfraction and the supernatant of pancreatic tissue was estimated. AEP was induced by injection of bile salts and thrombin solution into the pancreatic duct. In 6 dogs the protection with heparin (1.5 mg/kg/body weight) immediately after producing AEP was applied. In AEP without any protection the free activity of hydrolases in the whole homogenate (80--90%) and in the lysosomal enriched subfraction (75--90%) was higher than in the controls (60--70% and 55--75% respectively), suggesting an augmented lysosomal fragility during the course of AEP. Heparin depressed the free activity of hydrolases to 60--80% in whole homogenates, and 64--75% in the lysosomal enriched subfraction. The release of cathepsins during incubation of the lysosomal-enriched subfraction in acidic medium was lower in the group with heparin treatment. The data obtained suggest the stabilising effect of heparin on the lysosomes of the pancreas during acute experimental pancreatitis in dogs. PMID:477825

D?ugosz, J; Bajko, K; Gabryelewicz, A

1979-01-01

249

Biochemical identification of patients with gallstones associated with acute pancreatitis on the day of admission to hospital.  

PubMed Central

Current trends in the treatment of gallstone pancreatitis require rapid diagnosis of cholelithiasis. This study evaluates the diagnostic potential of plasma aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin on the day of admission to hospital in 215 attacks of acute pancreatitis. The optimal diagnostic cut-off level for AST was 60 IU/1. A transient elevation above 60 IU/1 was recorded in 111 (84.1%) of 132 attacks associated with gallstones, but in only 12 (14.5%) of 83 attacks without stones, and was unrelated to the severity of the attack. Elevated levels of alkaline phosphatase and bilirubin were also more common in attacks associated with gallstones but were less reliable for the identification of cholelithiasis than AST. As a sensitive indicator of hepatocyte disruption, the early and transient rise in plasma AST is consistent with the concept of transient ampullary obstruction in gallstone pancreatitis, and may be useful in identifying patients who require urgent surgical or endoscopic disimpaction. PMID:2578276

Mayer, A D; McMahon, M J

1985-01-01

250

Catalpol Ameliorates Sodium Taurocholate-Induced Acute Pancreatitis in Rats via Inhibiting Activation of Nuclear Factor Kappa B  

PubMed Central

Catalpol, an iridoid glucoside extracted from the traditional Chinese herbal medicine, Rehmannia glutinosa, is reported to exert neuroprotective, anti-inflammatory, anti-tumor and anti-apoptotic effects. The main aim of the present study was to investigate whether catalpol ameliorates experimental acute pancreatitis (AP) induced by sodium taurocholate (STC). AP was induced in rats via retrograde injection of 4% STC (0.1 mL/100 g) into the biliopancreatic duct. Rats were pre-treated with saline or catalpol (50 mg/kg) 2 h before STC injection. At 12, 24 and 48 h after injection, the severity of AP was evaluated using biochemical and morphological analyses. Pretreatment with catalpol led to a significant reduction in serum amylase and lipase activities, pancreatic histological damage, myeloperoxidase (MPO) activity, interleukin (IL)-1?, IL-6 and TNF-? levels, and activation of nuclear factor kappa B (NF-?B). Moreover, administration of catalpol increased the viability of pancreatic acinar cells and inhibited NF-?B expression in vitro. Our results collectively support the potential of catalpol as a highly effective therapeutic agent for treatment of AP. PMID:25000266

Xiao, Wen Qin; Yin, Guo Jian; Fan, Yu Ting; Qiu, Lei; Cang, Xiao Feng; Yu, Ge; Hu, Yan Ling; Xing, Miao; Wu, De Qing; Wang, Xing Peng; Hu, Guo Yong; Wan, Rong

2014-01-01

251

Histopathology and pathogenesis of caerulein-, duct ligation-, and arginine-induced acute pancreatitis in Sprague-Dawley rats and C57BL6 mice.  

PubMed

Three classical rodent models of acute pancreatitis were created in an effort to identify potential pre-clinical models of drug-induced pancreatitis (DIP) and candidate non-invasive biomarkers for improved detection of DIP. Study objectives included designing a lexicon to minimize bias by capturing normal variation and spontaneous and injury-induced changes while maintaining the ability to statistically differentiate degrees of change, defining morphologic anchors for novel pancreatic injury biomarkers, and improved understanding of mechanisms responsible for pancreatitis. Models were created in male Sprague-Dawley rats and C57BL6 mice through: 1) administration of the cholecystokinin analog, caerulein; 2) administration of arginine; 3) surgical ligation of the pancreatic duct. Nine morphologically detectable processes were used in the lexicon; acinar cell hypertrophy; acinar cell autophagy; acinar cell apoptosis; acinar cell necrosis; vascular injury; interstitial edema, inflammation and hemorrhage; fat necrosis; ductal changes; acinar cell atrophy. Criteria were defined for scoring levels (0 = absent, 1 = mild, 2 = moderate, 3 = severe) for each lexicon component. Consistent with previous studies, histopathology scores were significant greater in rats compared to mice at baseline and after treatment. The histopathology scores in caerulein and ligation-treated rats and mice were significantly greater than those of arginine-treated rats and mice. The present study supports a multifaceted pathogenesis for acute pancreatitis in which intra-acinar trypsinogen activation, damage to acinar cells, fat cells, and vascular cells as well as activation/degranulation of mast cells and activated macrophages all contribute to the initiation and/or progression of acute inflammation of the exocrine pancreas. PMID:24585404

Zhang, Jun; Rouse, Rodney L

2014-09-01

252

Induction of acute ectopic pancreatitis by endoscopic ultrasound with fine-needle aspiration.  

PubMed

Ectopic pancreas rarely causes symptoms or complications. We analyzed 2 atypical cases of ectopic pancreas associated with acute ectopic pancreatitis, 1 of which was induced by endoscopic ultrasound with fine-needle aspiration (EUS-FNA). The patients were seen at a tertiary medical center where they had undergone computed tomography, esophagogastroduodenoscopy, and EUS-FNA analyses. They initially received conservative medical treatment and were later treated by surgery. Both patients were diagnosed with ectopic pancreas of the stomach on the basis of computed tomography, esophagogastroduodenoscopy, or EUS-FNA. Surgical resection cured both patients and confirmed the diagnosis of ectopic pancreas. Acute ectopic pancreatitis is an unusual complication of ectopic pancreas that can be induced by EUS-FNA and diagnosed and cured with surgery. PMID:24361413

Attwell, Augustin; Sams, Sharon; Fukami, Norio

2014-07-01

253

[Apropos of a case of acute pancreatitis revealing cystic dilatation of the common bile duct].  

PubMed

Dilatation of the common bile duct is rarely caused by cystic formations. Though the pathogenesis is uncertain, congenital disorders have been suggested. Most cases are observed in small children (80% female predominance) with only 20% of the cases reported in adults. Clinical signs vary. Recurrent acute pancreatitis has been reported but is rare. New imaging techniques using CT-scan cholangiography and sometimes MR cholangiography have greatly improved the diagnostic approach. MR of the bile ducts is a recent noninvasive technique enabling an analysis of the biliopancreatic ducts without contrast injection into the bile. To our knowledge, cystic dilatation of the common bile duct has not been previously reported in the literature. We report an interesting case in a 25-year-old woman who developed an episode of acute pancreatitis during the post partum period. We describe the clinical aspects and the different imaging findings, including magnetic resonance cholangiography results. PMID:9846293

Kabbaj, N; Ababou, A; el Fakir, Y; Amarouch, N; Dafiri, R; Sbihi, A; Imani, F

1998-11-01

254

Is there a relationship between beginning time and efficiency of octreotide in the treatment of experimental acute pancreatitis?  

PubMed Central

Purpose The efficacy of octreotide in the treatment of acute pancreatitis is controversial. Octreotide treatment for acute pancreatitis often shows poor correlation between results obtained in experimental studies and results of clinical trials. In a clinical setting, there is always a delay between the onset of the disease and initiation of the octreotide treatment. The aim of this study is to investigate the relationship between the beginning of treatment and alteration in effectiveness of octreotide. Methods Acute pancreatitis was induced by pancreatic duct ligation in 50 rats. The rats were randomly divided into five groups. Octreotide was not used in group 1 (control group). Only single dose (4 µg/kg) octreotide was administered subcutaneously to rats in group 2, having induced pancreatitis. Octreotide treatment was begun at different times (8th, 24th, 48th hour) in three other groups and continued treatment at a dosage of 4 µg/kg t.i.d. The animals were sacrificed at the end of the 72nd hour and blood and tissue samples were collected. Results Leukocyte count and plasma amylase values were less in groups 2 and 3. Hemorrhagic focuses were encountered less at pancreas tissues in group 3. Pancreatic necrosis and alveolar capillary basal membrane damage were lower in groups 3 and 4. No difference was found in fasting blood glucose, calcium and hematocrit. Conclusion Octreotide had benefical effects in acute pancreatitis when octreotide treatment was begun in the first 24 hours. PMID:22563536

Kafali, M. Ertugrul; Gul, Mehmet; Sahin, Mustafa; Toy, Hatice; Akoz, Mehmet

2012-01-01

255

Research status of the mechanism and treatment for acute pancreatitis complicated with hepatic injury  

Microsoft Academic Search

Acute pancreatitis (AP) is characterized by its sudden onset and rapid progression and is often complicated by liver injury. AP-induced liver injury may develop into hepatic failure and even result in death. Thus, it is of importance to protect liver function and block injury-related pathways. In the pathogenesis of liver injury in AP, inflammatory cytokines, nuclear factor-kappa B (NF-?B) and

Xiping Zhang; Jie Zhang; Ping Yang

2008-01-01

256

Migrated endoclip and stone formation after cholecystectomy: A new danger of acute pancreatitis  

PubMed Central

Endoclip migration into the common bile duct following laparoscopic cholecystectomy (LC) is an extremely rare complication. Migrated endoclip into the common bile duct can cause obstruction, serve as a nidus for stone formation, and cause cholangitis. We report a case of obstructive jaundice and acute biliary pancreatitis due to choledocholithiasis caused by a migrated endoclip 6 mo after LC. The patient underwent early endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and stone extraction. PMID:18081240

Dolay, Kemal; Alis, Halil; Soylu, Aliye; Altaca, Gulum; Aygun, Ersan

2007-01-01

257

Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas  

Microsoft Academic Search

Two-hundred Wistar rats were allocated to 4 groups. The groups, 3 representing our acute pancreatitis model induced by intrabiliary injection of a trypsin\\/enterokinase mixture, were studied as follows: (A) no treatment; (B) given a daily 30-ml enema with 20 mg\\/kg rifaximin; (C) given a daily 30-ml enema with 20 mg\\/kg rifaximin plus lactitol 0.5 g\\/kg, and (D) given a daily

F. Marotta; T. C. Geng; C. C. Wu; G. Barbi

1996-01-01

258

Disulfide stress: a novel type of oxidative stress in acute pancreatitis.  

PubMed

Glutathione oxidation and protein glutathionylation are considered hallmarks of oxidative stress in cells because they reflect thiol redox status in proteins. Our aims were to analyze the redox status of thiols and to identify mixed disulfides and targets of redox signaling in pancreas in experimental acute pancreatitis as a model of acute inflammation associated with glutathione depletion. Glutathione depletion in pancreas in acute pancreatitis is not associated with any increase in oxidized glutathione levels or protein glutathionylation. Cystine and homocystine levels as well as protein cysteinylation and ?-glutamyl cysteinylation markedly rose in pancreas after induction of pancreatitis. Protein cysteinylation was undetectable in pancreas under basal conditions. Targets of disulfide stress were identified by Western blotting, diagonal electrophoresis, and proteomic methods. Cysteinylated albumin was detected. Redox-sensitive PP2A and tyrosine protein phosphatase activities diminished in pancreatitis and this loss was abrogated by N-acetylcysteine. According to our findings, disulfide stress may be considered a specific type of oxidative stress in acute inflammation associated with protein cysteinylation and ?-glutamylcysteinylation and oxidation of the pair cysteine/cystine, but without glutathione oxidation or changes in protein glutathionylation. Two types of targets of disulfide stress were identified: redox buffers, such as ribonuclease inhibitor or albumin, and redox-signaling thiols, which include thioredoxin 1, APE1/Ref1, Keap1, tyrosine and serine/threonine phosphatases, and protein disulfide isomerase. These targets exhibit great relevance in DNA repair, cell proliferation, apoptosis, endoplasmic reticulum stress, and inflammatory response. Disulfide stress would be a specific mechanism of redox signaling independent of glutathione redox status involved in inflammation. PMID:24456905

Moreno, Mari-Luz; Escobar, Javier; Izquierdo-Álvarez, Alicia; Gil, Anabel; Pérez, Salvador; Pereda, Javier; Zapico, Inés; Vento, Máximo; Sabater, Luis; Marina, Anabel; Martínez-Ruiz, Antonio; Sastre, Juan

2014-05-01

259

Ischemia reperfusion of the pancreas: A new in vivo model for acute pancreatitis in rats  

Microsoft Academic Search

Based on the concept that ischemia is an important factor in the pathogenesis of acute pancreatitis, we developed a new model\\u000a of complete ischemia\\/reperfusion of the pancreas in the rat. The aim of this study was to investigate the microcirculation\\u000a of the pancreas after complete and reversible ischemia at different times after reperfusion by using intravital fluorescence\\u000a microscopy. In addition,

T. F. Hoffmann; R. Leiderer; H. Waldner; S. Arbogast; K. Messmer

1995-01-01

260

Multicenter Approach to Recurrent Acute and Chronic Pancreatitis in the United States: The North American Pancreatitis Study 2 (NAPS2)  

PubMed Central

Background Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are complex syndromes associated with numerous etiologies, clinical variables and complications. We developed the North American Pancreatitis Study 2 (NAPS2) to be sufficiently powered to understand the complex environmental, metabolic and genetic mechanisms underlying RAP and CP. Methods Between August 2000 and September 2006, a consortium of 20 expert academic and private sites prospectively ascertained 1,000 human subjects with RAP or CP, plus 695 controls (spouse, family, friend or unrelated). Standardized questionnaires were completed by both the physicians and study subjects and blood was drawn for genomic DNA and biomarker studies. All data were double-entered into a database and systematically reviewed to minimize errors and include missing data. Results A total of 1,000 subjects (460 RAP, 540 CP) and 695 controls who completed consent forms and questionnaires and donated blood samples comprised the final dataset. Data were organized according to diagnosis, supporting documentation, etiological classification, clinical signs and symptoms (including pain patterns and duration, and quality of life), past medical history, family history, environmental exposures (including alcohol and tobacco use), medication use and therapeutic interventions. Upon achieving the target enrollment, data were organized and classified to facilitate future analysis. The approaches, rationale and datasets are described, along with final demographic results. Conclusion The NAPS2 consortium has successfully completed a prospective ascertainment of 1,000 subjects with RAP and CP from the USA. These data will be useful in elucidating the environmental, metabolic and genetic conditions, and to investigate the complex interactions that underlie RAP and CP. PMID:18765957

Whitcomb, David C.; Yadav, Dhiraj; Adam, Slivka; Hawes, Robert H.; Brand, Randall E.; Anderson, Michelle A.; Money, Mary E.; Banks, Peter A.; Bishop, Michele D.; Baillie, John; Sherman, Stuart; DiSario, James; Burton, Frank R.; Gardner, Timothy B.; Amann, Stephen T.; Gelrud, Andres; Lo, Simon K.; DeMeo, Mark T.; Steinberg, William M.; Kochman, Michael L.; Etemad, Babak; Forsmark, Christopher E.; Elinoff, Beth; Greer, Julia B.; O'Connell, Michael; Lamb, Janette; Barmada, M. Michael

2008-01-01

261

Red cell distribution width to platelet ratio: New and promising prognostic marker in acute pancreatitis  

PubMed Central

AIM: To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP). METHODS: Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, co-morbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality. RESULTS: The male-female ratio (59/43) was 1.37 with a median age of 56.5 years (17-89 years). In both univariate and multivariate analyses, RDW and RPR were presented as independent and significant variables on admission to predict mortality. The RPR obtained on hospital admission was persistently higher among non-survivors than among survivors (P < 0.0001). The median RPR was 0.000087 in the non-survivor group and 0.000058 in the survivor group. RPR with a cutoff value of 0.000067 presented an area under the curve of 0.783 (95%CI: 0.688-0.878) in receiver operating characteristic curves and could predict the mortality of approximately 80% of the patients. CONCLUSION: We identified RPR as a valuable, novel laboratory test to predict mortality in AP. PMID:25339831

Cetinkaya, Erdinc; Senol, Kaz?m; Saylam, Bar?s; Tez, Mesut

2014-01-01

262

Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines.  

PubMed

The Tokyo Guidelines formulate clinical guidance for healthcare providers regarding the diagnosis, severity assessment, and treatment of acute cholangitis and acute cholecystitis. The Guidelines were developed through a comprehensive literature search and selection of evidence. Recommendations were based on the strength and quality of evidence. Expert consensus opinion was used to enhance or formulate important areas where data were insufficient. A working group, composed of gastroenterologists and surgeons with expertise in biliary tract surgery, supplemented with physicians in critical care medicine, epidemiology, and laboratory medicine, was selected to formulate draft guidelines. Several other groups (including members of the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery) have reviewed and revised the draft guidelines. To build a global consensus on the management of acute biliary infection, an international expert panel, representing experts in this area, was established. Between April 1 and 2, 2006, an International Consensus Meeting on acute biliary infections was held in Tokyo. A consensus was determined based on best available scientific evidence and discussion by the panel of experts. This report describes the highlights of the Tokyo International Consensus Meeting in 2006. Some important areas focused on at the meeting include proposals for internationally accepted diagnostic criteria and severity assessment for both clinical and research purposes. PMID:17252292

Sekimoto, Miho; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Yoshida, Masahiro; Mayumi, Toshihiko; Miura, Fumihiko; Wada, Keita; Hirota, Masahiko; Yamashita, Yuichi; Strasberg, Steven; Pitt, Henry A; Belghiti, Jacques; de Santibanes, Eduardo; Gadacz, Thomas R; Hilvano, Serafin C; Kim, Sun-Whe; Liau, Kui-Hin; Fan, Sheung-Tat; Belli, Giulio; Sachakul, Vibul

2007-01-01

263

Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines.  

PubMed

The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction. PMID:17252300

Hirota, Masahiko; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Miura, Fumihiko; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Strasberg, Steven; Pitt, Henry; Gadacz, Thomas R; de Santibanes, Eduardo; Gouma, Dirk J; Solomkin, Joseph S; Belghiti, Jacques; Neuhaus, Horst; Büchler, Markus W; Fan, Sheung-Tat; Ker, Chen-Guo; Padbury, Robert T; Liau, Kui-Hin; Hilvano, Serafin C; Belli, Giulio; Windsor, John A; Dervenis, Christos

2007-01-01

264

Gallstone Pancreatitis  

Microsoft Academic Search

Acute pancreatitis (AP) is a disease of great social impact with an incidence of approximately 20\\/100,000 population per year.\\u000a The mild form, which accounts for 75–80% of cases, has virtually no mortality and benefits from simple symptomatic treatment.\\u000a In contrast, the severe form is characterized by local and systemic complications, may lead to multiorgan failure, and is\\u000a burdened by a

Matthias Kraft; Markus M. Lerch

265

Hepatic abnormal perfusion visible by magnetic resonance imaging in acute pancreatitis  

PubMed Central

AIM: To study the prevalence and patterns of hepatic abnormal perfusion (HAP) visible by magnetic resonance imaging (MRI) in acute pancreatitis (AP). METHODS: Enhanced abdominal MRI was performed on 51 patients with AP. These patients were divided into two groups according to the MRI results: those with signs of gallstones, cholecystitis, common bile duct (CBD) stones or dilatation of the CBD on MRI and those without. The prevalence, shape and distribution of HAP in the two groups were analyzed and compared. The severity of AP was graded using the MR severity index (MRSI). The correlation between the MRSI and HAP was then analyzed. RESULTS: Of the 51 patients with AP, 32 (63%) showed at least one sign of gallbladder and CBD abnormalities on the MR images, while 19 (37%) showed no sign of gallbladder or CBD abnormalities. Nineteen patients (37%) had HAP visible in the enhanced images, including strip-, wedge- or patch-shaped HAP distributed in the hepatic tissue adjacent to the gallbladder and left and right liver lobes. There were no significant differences in the prevalence of HAP (?2 = 0.305, P = 0.581 > 0.05) or HAP distribution in the liver (?2 = 2.181, P = 0.536 > 0.05) between patients with and without gallbladder and CBD abnormalities. There were no significant differences in the MRSI score between patients with and without HAP (t = 0.559, P = 0.552 > 0.05). HAP was not correlated with the MRSI score. CONCLUSION: HAP is common in patients with AP and appears strip-, patch- or wedge-shaped on MRI. HAP on MRI cannot be used to indicate the severity of AP. PMID:24379936

Tang, Wei; Zhang, Xiao-Ming; Zhai, Zhao-Hua; Zeng, Nan-Lin

2013-01-01

266

The simultaneous incidence of acute pancreatitis and autoimmune hemolytic anemia: a rare duo in a patient with SLE  

PubMed Central

A young female presented with acute abdominal pain of two days duration consistent with acute pancreatitis. During her stay in the hospital she had a sudden drop in hemoglobin to 6 g/dl without any overt blood loss. On evaluation, it was evident that she had acute pancreatitis, in addition to displaying features of autoimmune hemolytic anemia. She had been a known case of systemic lupus erythematosus (SLE) and had discontinued her treatment. She was managed with methylprednisolone pulse therapy. Her clinical condition improved, and she has been regularly attending our clinic for the last 2 years. According to a literature search in Medline, it would appear that this is the first report of a case in which SLE with autoimmune hemolytic anemia has been associated with acute pancreatitis in a single case. PMID:25276114

Masoodi, Ibrahim

2014-01-01

267

Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas  

PubMed Central

Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy. PMID:25325008

Lee, Seong Jun; Park, Do Youn; Choi, Sang A; Lee, Sang Hee; Choi, Yu Yi; Jeon, Moo Song; Song, Geun Am

2014-01-01

268

Elevated Deoxycholic Acid and Idiopathic Recurrent Acute Pancreatitis: A Case Report With 48 Months of Follow-up  

PubMed Central

Recurrent pancreatitis is a potentially life-threatening condition with a well-established differential diagnosis. In a significant number of cases, no explanation exists. This case report documents one patient with a clear pattern of recurrent acute pancreatitis and no identifiable cause despite great effort. After 7 years of recurrent symptoms, she was found to have marked elevation of fecal deoxycholic acid (DCA), a secondary bile acid used to precipitate pancreatitis in animal models. This report documents cessation of symptoms/hospitalizations with normalization of her fecal DCA levels. This secondary bile acid is easily measured in stool. Needed now is an observational study of fecal DCA levels in patients with recurrent acute pancreatitis. PMID:24891995

2014-01-01

269

Antibiotics as Part of the Management of Severe Acute Malnutrition  

PubMed Central

BACKGROUND Severe acute malnutrition contributes to 1 million deaths among children annually. Adding routine antibiotic agents to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition treated in the community. METHODS In this randomized, double-blind, placebo-controlled trial, we randomly assigned Malawian children, 6 to 59 months of age, with severe acute malnutrition to receive amoxicillin, cefdinir, or placebo for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition. The primary outcomes were the rate of nutritional recovery and the mortality rate. RESULTS A total of 2767 children with severe acute malnutrition were enrolled. In the amoxicillin, cefdinir, and placebo groups, 88.7%, 90.9%, and 85.1% of the children recovered, respectively (relative risk of treatment failure with placebo vs. amoxicillin, 1.32; 95% confidence interval [CI], 1.04 to 1.68; relative risk with placebo vs. cefdinir, 1.64; 95% CI, 1.27 to 2.11). The mortality rates for the three groups were 4.8%, 4.1%, and 7.4%, respectively (relative risk of death with placebo vs. amoxicillin, 1.55; 95% CI, 1.07 to 2.24; relative risk with placebo vs. cefdinir, 1.80; 95% CI, 1.22 to 2.64). Among children who recovered, the rate of weight gain was increased among those who received antibiotics. No interaction between type of severe acute malnutrition and intervention group was observed for either the rate of nutritional recovery or the mortality rate. CONCLUSIONS The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. (Funded by the Hickey Family Foundation and others; ClinicalTrials.gov number, NCT01000298.) PMID:23363496

Trehan, Indi; Goldbach, Hayley S.; LaGrone, Lacey N.; Meuli, Guthrie J.; Wang, Richard J.; Maleta, Kenneth M.; Manary, Mark J.

2013-01-01

270

Can a polymorphism in the thalassemia gene and a heterozygote CFTR mutation cause acute pancreatitis?  

PubMed Central

The case of a 32-year-old black woman of African descent who suffered from repeated episodes of acute pancreatitis, initially triggered when flying on airplanes, is reported. She did not drink alcohol or smoke. Genetic analysis was negative for cationic trypsinogen, serine protease inhibitor Kazal type 1 and chymotrypsin C. However, hemoglobin F was elevated. Sequencing of the thalassemia gene revealed a novel alteration in the 5’ region indicative of a functional abnormality of the molecule. Sequencing the cystic fibrosis transmembrane conductance regulator (CFTR) gene revealed a heterozygote sequence variant. The combination of a hemoglobin gene mutation known for thalassemia in conjunction with the hitherto undescribed CFTR mutation is suggested to pave the road for initial and repetitive pancreatitis attacks. This will be discussed. PMID:24653987

Lohr, J-Matthias; Haas, Stephan

2014-01-01

271

Acinar inflammatory response to lipid derivatives generated in necrotic fat during acute pancreatitis.  

PubMed

Lipids play a role in acute pancreatitis (AP) progression. We investigate the ability of pancreatic acinar cells to trigger inflammatory response in the presence of lipid compounds generated in necrotic areas of peripancreatic adipose tissue (AT) during AP induced in rats by 5% sodium taurocholate. Lipid composition of AT was analyzed by HPLC-mass spectrometry. Acinar inflammatory response to total lipids as well as to either the free fatty acid (FFA) fraction or their chlorinated products (Cl-FFAs) was evaluated. For this, mRNA expression of chemokine (C-C motif) ligand 2 (CCL2) and P-selectin as well as the activation of MAPKs, NF-?B and STAT-3 were analyzed in pancreatic acini. Myeloperoxidase (MPO) activity, as an inducer of Cl-FFA generation, was also analyzed in AT. MPO activity significantly increased in necrotic (AT-N) induced changes in lipid composition of necrotic fat, such as increase in FFA and phospholipid (PL) content, generation of Cl-FFAs and increases in saturated FFAs and in the poly-:mono-unsaturated FFA ratio. Total lipids from AT-N induced overexpression of CCL2 and P-selectin in pancreatic acini as well as MAPKs phosphorylation and activation of NF-?B and STAT3. FFAs, but not Cl-FFAs, up-regulated CCL2 and P-selectin in acinar cells. We conclude that FFAs are capable of up-regulating inflammatory mediators in pancreatic acini and given that they are highly produced during AP, mainly may contribute to the inflammatory response triggered in acinar cells by fat necrosis. No role is played by Cl-FFAs generated as a result of neutrophil infiltration. PMID:24959971

Mateu, A; Ramudo, L; Manso, M A; Closa, D; De Dios, I

2014-09-01

272

Analyses of Hospital Administrative Data That Use Diagnosis Codes Overestimate the Cases of Acute Pancreatitis  

PubMed Central

BACKGROUND & AIMS Although widely used, little information exists on the validity of using hospital administrative data to code acute pancreatitis (AP). We sought to determine if discharge diagnosis codes accurately identify patients whose clinical course met the standard for AP diagnosis. METHODS We analyzed data from 401 unique patients admitted through the emergency department who received a primary inpatient discharge diagnosis of AP at 2 University of Pittsburgh Medical Center hospitals in the years 2000, 2002, and 2005. Each patient was matched with a control patient who was admitted with abdominal pain and then discharged without a diagnosis of AP. Patients were matched based on demographics, testing for serum levels of pancreatic enzymes, year of visit to the emergency department, admission to the intensive care unit, and performance of abdominal computed tomography scan. The standard used to diagnose AP was the presence of 2 of 3 features (abdominal pain, ?3-fold increase in serum levels of pancreatic enzymes, and positive results from imaging analysis). RESULTS The median age of AP cases was 53 years (interquartile range, 41.5–67 years); 47.1% were male, 85% were white. The most common etiologies were biliary (33.4%), alcohol-associated (16.2%), and idiopathic (24.2%). Serum levels of pancreatic enzymes were increased by any amount, and by ?3-fold, in 95.3% and 68.6% of patients diagnosed with AP and in 16.2% and 2.2% of controls, respectively. The standard for diagnosis of AP was met in 80% of cases diagnosed with this disorder; they had no history of pancreatitis. The sensitivity, specificity, and positive and negative predictive values of the AP diagnosis code were 96%, 85%, 80%, and 98%, respectively. CONCLUSIONS Approximately 1 of 5 patients diagnosed with AP upon discharge from the hospital do not meet the guidelines for diagnosis of this disorder. Efforts should be made to more consistently use guidelines for AP diagnosis. PMID:22504004

SALIGRAM, SHREYAS; LO, DAVID; SAUL, MELISSA; YADAV, DHIRAJ

2013-01-01

273

Severe Thrombocytopenia Associated with Acute Hepatitis E Virus Infection ?  

PubMed Central

We describe here what is, to the best of our knowledge, the third reported case of severe thrombocytopenia associated with acute hepatitis E virus infection. The patient was a 72-year-old French woman. It seems likely that the cause of the thrombocytopenia was acute hepatitis E virus infection, possibly occurring via an immune mechanism. No complications were noted, in contrast to the two previous reports. PMID:18480231

Colson, P.; Payraudeau, E.; Leonnet, C.; De Montigny, S.; Villeneuve, L.; Motte, A.; Tamalet, C.

2008-01-01

274

Ecstasy: A common cause of severe acute hepatotoxicity  

Microsoft Academic Search

Background\\/Aims: Ecstasy is a synthetic amphetamine recently identified as a possible cause of acute liver injury. This drug is consumed by young people and has a marked effect on improving sociability. The extent of ecstasy-associated severe hepatic damage is unknown to date.Methods: The clinical histories of 62 patients with acute liver failure admitted to the Intensive Care Liver Unit between

Victoria Andreu; Antoni Mas; Miquel Bruguera; Joan Manuel Salmerón; Vicente Moreno; Santiago Nogué; Joan Rodés

1998-01-01

275

Diagnostic Criteria in Predicting a Biliary Origin of Acute Pancreatitis in the Era of Endoscopic Ultrasound: Multicentre Prospective Evaluation of 213 Patients  

Microsoft Academic Search

Background: No study on bioclinical criteria predicting a biliary origin for acute pancreatitis has included endosonography as a reference examination. Re-examination of bioclinical parameters deserves consideration in the era where other causes are known (e.g. hereditary, autoimmune). Aim and Methods: To determine the performance of bioclinical markers in predicting a biliary origin of acute pancreatitis where the diagnosis of biliary

Philippe Lévy; Arnaud Boruchowicz; Patrick Hastier; Alexandre Pariente; Thierry Thévenot; Jean Louis Frossard; Louis Buscail; François Mauvais; Jean Claude Duchmann; Alain Courrier; Philippe Bulois; Jean Louis Gineston; Marc Barthet; Henri Licht; Dermot O’Toole; Philippe Ruszniewski

2005-01-01

276

Inverted Meckel’s Diverticulum with Ectopic Pancreatic Tissue as a Source of Severe Gastrointestinal Bleeding  

Microsoft Academic Search

Introduction  Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Authors present a 67-year-old woman\\u000a treated for iron deficiency anemia for the past 5 years. Suddenly, her disease was presented with painless severe gastrointestinal\\u000a bleeding (fresh melena). Inverted Meckel’s diverticulum with ectopic pancreatic tissue as a source of severe gastrointestinal\\u000a bleeding was diagnosed by intraoperative enteroscopy.\\u000a \\u000a \\u000a \\u000a Conclusion  A combination of

Marcela Kopá?ová; Ladislav Vykou?il; Zden?k Vacek; V?ra Ty?ová; Jolana Bártová; Stanislav Rejchrt; Jan Bureš

2010-01-01

277

The Impact of Hospital-Acquired Infection on Outcome in Acute Pancreatitis  

PubMed Central

Background & Aims Little is known regarding the impact of hospital-acquired infection (HAI) in acute pancreatitis (AP). We conducted a population-based assessment of the impact of HAI on outcome in AP. Methods Patient data was obtained from the Cardinal Health Clinical Outcomes Research Database, a large population-based dataset. Cases with principal diagnosis ICD9-CM 577.0 (AP) between Jan 2004 and Jan 2005 were identified. These cases were linked with recently reported HAI data collected by the Pennsylvania Health Care Cost Containment Council. Identification of HAI was based upon definitions set forth by the National Nosocomial Infection Surveillance System. We conducted a 5:1 multivariate propensity matched cohort study in order to determine the independent contribution of HAI to in-hospital mortality, length-of-stay and hospital charges. Results From 177 participating hospitals, there were 11,046 AP cases identified. Eighty-two (0.7%) patients developed an HAI. Mortality in the overall AP population was 1.2% vs. 11.4% among 405 matched non-HAI controls vs. 28.4% among patients that developed HAI (X2 p<0.0001). Fifteen percent of all deaths were associated with an HAI. Both average LOS and hospital charges were significantly increased among patients with HAI compared to matched non-HAI controls. Conclusions We determined that HAI had a major impact on mortality in AP. Patients that developed HAI also had significantly increased LOS and hospital charges. These differences were not explained by increased disease severity alone. Reducing HAI is an important step to improving outcome in AP. PMID:18616944

Wu, Bechien U; Johannes, Richard S.; Kurtz, Stephen; Banks, Peter A.

2008-01-01

278

Extravascular lung water as an indicator of pulmonary dysfunction in acute hemorrhagic pancreatitis.  

PubMed Central

This study quantifies lung water in acute hemorrhagic pancreatitis to determine the degree to which pulmonary dysfunction occurs subclinically, before alterations in the arterial blood gases can be measured. Pancreatitis was induced in ten dogs by injecting 0.5 ml/kg of bile into the pancreatic ducts, which had been surgically cannulated. Pulmonary and systemic blood gases and blood pressures, heart rate, extravascular lung water, and lung blood flows were studied over 5 hours while cardiac output and mean arterial pressure were maintained at control values by Ringer's lactate infusion. The percentage of water in lung tissue was determined at the time of sacrifice using gravimetric measurements. Mean arterial pressure, cardiac output, and pulmonary capillary wedge pressure, reflecting intravascular volume status, did not change through at the experiment. By contrast, major disturbances were measured in the pulmonary bed with pulmonary artery pressures rising from 15.6 +/- 1.8/8.1 +/- 1.3 mmHg to 22.0 +/- 1.2/15.6 +/- 1.7 mmHg over 5 hours (p less than 0.01). Peripheral vascular resistance rose from 3.6 +/- 0.6 units to 6.6 +/- 0.4 units (p less than 0.05), whereas bronchial blood flow to the lung fell significantly. These changes in pulmonary hemodynamics were not reflected by changes in the arterial blood gases. Arterial oxygenation was maintained during 5 hours of pancreatitis. The partial pressure of carbon dioxide and the serum pH did not change significantly. There was, however, a progressive rise in extravascular lung water measured by the double-dilution technique from 10.2 +/- 0.8 ml/kg at control to 18.1 +/- 2.8 ml/kg (p less than 0.01) at 5 hours. This was confirmed by direct gravimetric measurements, which revealed an increase in the water content of the lung from 78.1 +/- 0.3% to 86.4 +/- 2.4% over the course of the experiment. Arterial blood gases, therefore, do not necessarily reflect the pulmonary deterioration in acute pancreatitis. These data supported a mechanism of lung dysfunction independent of the circulatory compromise, which often accompanies the disease in the clinical setting. PMID:2447844

Burnweit, C A; Horton, J W

1988-01-01

279

Acute pancreatitis after viperid snake cerastes cerastes envenoming: a case report.  

PubMed

Snakebites by the viper snake Cerastes cerastes are quite common across the world but rarely published with regard to their mostly benign course. The reported case study depicts the envenoming of a 36-year-old Czech man, a private herpetologist, who suffered snakebite to his finger. He developed a painful local reaction with hemorrhagic oedema. Subsequently, consumption coagulopathy with thrombocytopenia and haemolysis, colicky pain in the epigastrium and acute renal failure developed. Acute exudative pancreatitis was diagnosed on the third day after envenoming. Hemorrhagic oedema of the arm was complicated by a phlegmon. Symptomatic treatment including haemodialysis, fresh frozen plasma and thrombocytes was administered. Antivenom was not administered due to the delay in referral to the specialized unit. The patient recovered within one month, only postnecrotic defects of the finger persisted. PMID:20359440

Valenta, J; Stach, Z; Svítek, M

2010-01-01

280

Effects of S-Propargyl-Cysteine (SPRC) in Caerulein-Induced Acute Pancreatitis in Mice  

PubMed Central

Hydrogen sulfide (H2S), a novel gaseous messenger, is synthesized endogenously from L-cysteine by two pyridoxal-5?-phosphate-dependent enzymes, cystathionine ?-synthase (CBS) and cystathionine ?-lyase (CSE). S-propargyl-cysteine (SPRC) is a slow H2S releasing drug that provides cysteine, a substrate of CSE. The present study was aimed to investigate the effects of SPRC in an in vivo model of acute pancreatitis (AP) in mice. AP was induced in mice by hourly caerulein injections (50 µg/kg) for 10 hours. Mice were treated with SPRC (10 mg/kg) or vehicle (distilled water). SPRC was administered either 12 h before or 3 h before the induction of pancreatitis. Mice were sacrificed 1 h after the last caerulein injection. Blood, pancreas and lung tissues were collected and processed to measure the plasma amylase, plasma H2S, myeloperoxidase (MPO) activities and cytokine levels in pancreas and lung. The results revealed that significant reduction of inflammation, both in pancreas and lung was associated with SPRC given 3 h prior to the induction of AP. Furthermore, the beneficial effects of SPRC were associated with reduction of pancreatic and pulmonary pro-inflammatory cytokines and increase of anti-inflammatory cytokine. SPRC administered 12 h before AP induction did not cause significant improvement in pancreatic and lung inflammation. Plasma H2S concentration showed significant difference in H2S levels between control, vehicle and SPRC (administered 3 h before AP) treatment groups. In conclusion, these data provide evidence for protective effects of SPRC in AP possibly by virtue of its slow release of endogenous H2S. PMID:22396778

Ang, Abel D.; Zhu, Yi Zhun; Bhatia, Madhav

2012-01-01

281

Decreased serum platelet derived growth factor BB levels in acute and increased in chronic pancreatitis  

PubMed Central

AIM: To examine circulating growth factor concentrations in patients with acute pancreatitis (AP) and chronic pancreatitis (CP), and walled-off pancreatic necrosis (WOPN). METHODS: Forty patients with mild AP, 40 patients with alcoholic CP, 33 patients with WOPN and 40 healthy subjects were examined. Serum concentrations of platelet derived growth factor BB (PDGF-BB), transforming growth factor ?-1 (TGF?-1), chemerin and high-mobility group box chromosomal protein 1 (HMBG1) were assayed by enzyme linked immunosorbent assay. RESULTS: Patients with mild AP and those with WOPN had significantly lower serum levels of PDGF-BB compared to healthy subjects (4.0 ± 0.61 ng/mL vs 6.2 ± 0.76 ng/mL, P = 0.027, and 1.60 ± 0.31 ng/mL vs 6.2 ± 0.76 ng/mL, P < 0.001, respectively), while CP was associated with higher serum levels of PDGF-BB (12 ± 1.3 ng/mL vs 6.2 ± 0.76 ng/mL, P < 0.001). Circulating TGF?-1 and chemerin levels were elevated in CP patients (57 ± 3.6 ng/mL vs 39 ± 3.6 ng/mL, P < 0.001 and 73 ± 7.2 ng/mL vs 48 ± 2.3 ng/mL, P < 0.001, respectively), but not in patients with AP and WOPN. No significant changes in serum HMBG1 levels were found either in patients with AP, WOPN or CP. CONCLUSION: The serum levels of some growth factors and cytokines differ significantly in AP, WOPN and CP. These data suggest that selected growth factors and cytokines may be considered as potential diagnostic biomarkers in patients with pancreatic diseases.

Stojek, Magdalena; Adrych, Krystian; Rojek, Lukasz; Smoczynski, Marian; Sledzinski, Tomasz; Szrok, Sylwia; Swierczynski, Julian

2014-01-01

282

Severe Acute Respiratory Syndrome (SARS) and Healthcare Workers  

Microsoft Academic Search

The recent outbreak of severe acute respiratory syn- drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection

MOIRA CHAN-YEUNG

283

A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome  

Microsoft Academic Search

background A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Prov- ince, China. We conducted studies to identify the etiologic agent of this outbreak. methods We received clinical specimens from patients in six countries and tested them, using virus isolation techniques, electron-microscopical and histologic studies,

Thomas G. Ksiazek; Dean Erdman; Cynthia Goldsmith; Sherif R. Zaki; Teresa Peret; Shannon Emery; Suxiang Tong; Carlo Urbani; James A. Comer; Pierre E. Rollin; Scott Dowell; Ai-Ee Ling; Charles Humphrey; Wun-Ju Shieh; Jeannette Guarner; Christopher D. Paddock; Paul Rota; Joseph DeRisi; Jyh-Yuan Yang; Nancy Cox; James Hughes; James W. LeDuc; William Bellini; Larry J. Anderson

2010-01-01

284

Lung pathology of fatal severe acute respiratory syndrome  

Microsoft Academic Search

1 Summary Background Severe acute respiratory syndrome (SARS) is a novel infectious disease with global impact. A virus from the family Coronaviridae has been identified as the cause, but the pathogenesis is still unclear. Methods Post-mortem tissue samples from six patients who died from SARS in February and March, 2003, and an open lung biopsy from one of these patients

John M Nicholls; Leo L M Poon; Kam C Lee; Wai F Ng; Sik T Lai; Chung Y Leung; Chung M Chu; Pak K Hui; Kong L Mak; Wilina Lim; Kin W Yan; Kwok H Chan; Ngai C Tsang; Yi Guan; Kwok Y Yuen; J S Malik Peiris

2003-01-01

285

Intensity-Modulated Radiation Therapy Significantly Improves Acute Gastrointestinal Toxicity in Pancreatic and Ampullary Cancers  

SciTech Connect

Purpose: Among patients with upper abdominal malignancies, intensity-modulated radiation therapy (IMRT) can improve dose distributions to critical dose-limiting structures near the target. Whether these improved dose distributions are associated with decreased toxicity when compared with conventional three-dimensional treatment remains a subject of investigation. Methods and Materials: 46 patients with pancreatic/ampullary cancer were treated with concurrent chemoradiation (CRT) using inverse-planned IMRT. All patients received CRT based on 5-fluorouracil in a schema similar to Radiation Therapy Oncology Group (RTOG) 97-04. Rates of acute gastrointestinal (GI) toxicity for this series of IMRT-treated patients were compared with those from RTOG 97-04, where all patients were treated with three-dimensional conformal techniques. Chi-square analysis was used to determine if there was a statistically different incidence in acute GI toxicity between these two groups of patients. Results: The overall incidence of Grade 3-4 acute GI toxicity was low in patients receiving IMRT-based CRT. When compared with patients who had three-dimensional treatment planning (RTOG 97-04), IMRT significantly reduced the incidence of Grade 3-4 nausea and vomiting (0% vs. 11%, p = 0.024) and diarrhea (3% vs. 18%, p = 0.017). There was no significant difference in the incidence of Grade 3-4 weight loss between the two groups of patients. Conclusions: IMRT is associated with a statistically significant decrease in acute upper and lower GI toxicity among patients treated with CRT for pancreatic/ampullary cancers. Future clinical trials plan to incorporate the use of IMRT, given that it remains a subject of active investigation.

Yovino, Susannah [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Poppe, Matthew; Jabbour, Salma [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (United States); David, Vera; Garofalo, Michael [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Pandya, Naimesh [Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Alexander, Richard; Hanna, Nader [Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); Regine, William F., E-mail: wregine@umm.ed [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States)

2011-01-01

286

Combination of allopurinol and hyperbaric oxygen therapy: A new treatment in experimental acute necrotizing pancreatitis?  

PubMed Central

AIM: To investigate the individual and combined effects of allopurinol and hyperbaric oxygen (HBO) therapy on biochemical and histopathological changes, oxidative stress, and bacterial translocation (BT) in the experimental rat acute pancreatitis (AP). METHODS: Eighty-five Sprague-Dawley rats were included in the study. Fifteen of the eighty-five rats were used as controls (sham, GroupI). AP was induced via intraductal taurocholate infusion in the remaining seventy rats. Rats that survived to induction of acute necrotizing pancreatitis were randomized into four groups. Group II received saline, Group III allopurinol, Group IV allopurinol plus HBO and Group V HBO alone. Serum amylase levels, oxidative stress parameters, BT and histopathologic scores were determined. RESULTS: Serum amylase levels were lower in Groups III, IV and V compared to Group II (974 ± 110, 384 ± 40, 851 ± 56, and 1664 ± 234 U/L, respectively, P < 0.05, for all). Combining the two treatment options revealed significantly lower median [25-75 percentiles] histopathological scores when compared to individual administrations (13 [12.5-15] in allopurinol group, 9.5 [7-11.75] in HBO group, and 6 [4.5-7.5] in combined group, P < 0.01). Oxidative stress markers were significantly better in all treatment groups compared to the controls. Bacterial translocation into the pancreas and mesenteric lymph nodes was lower in Groups III, IV and V compared to Group II (54%, 23%, 50% vs 100% for translocation to pancreas, and 62%, 46%, 58% vs 100% for translocation to mesenteric lymph nodes, respectively, P < 0.05 for all). CONCLUSION: The present study confirms the benefit of HBO and allopurinol treatment when administered separately in experimental rat AP. Combination of these treatment options appears to prevent progression of pancreatic injury parameters more effectively. PMID:18069760

Comert, Bilgin; Isik, Ahmet Turan; Aydin, Sezai; Bozoglu, Ergun; Unal, Bulent; Deveci, Salih; Mas, Nuket; Cinar, Esref; Mas, Mehmet Refik

2007-01-01

287

/sup 111/In-platelet and /sup 125/I-fibrinogen deposition in the lungs in experimental acute pancreatitis  

SciTech Connect

An experimental model of acute pancreatitis in rats has been used to study intrapulmonary /sup 125/I-fibrinogen and /sup 111/In-platelet deposition. Pancreatitis caused a significant increase in wet lung weight compared to normal, and this could be abolished by heparin or aspirin pretreatment. /sup 125/I-fibrinogen was deposited in the lungs of animals to a significantly greater degree than in controls (P less than 0.01). /sup 125/I-fibrinogen deposition was reduced to control levels by pretreatment with aspirin or heparin (P less than 0.05). The uptake of radiolabeled platelets was greater in pancreatitis than in controls (P less than 0.001). Pancreatitis appears to be responsible for platelet entrapment in the lungs. Platelet uptake was reduced by heparin treatment but unaffected by aspirin therapy.

Goulbourne, I.A.; Watson, H.; Davies, G.C.

1987-12-01

288

Inhibition of acinar apoptosis occurs during acute pancreatitis in the human homologue ?F508 cystic fibrosis mouse  

PubMed Central

Previously, we found that the University of North Carolina cystic fibrosis (UNC-CF) mouse had more severe experimental acute pancreatitis (AP) than wild-type (WT) mice characterized by exuberant pancreatic inflammation and impaired acinar apoptosis. Because exon 10 CFTR gene mutations exhibit different phenotypes in tissues such as the mouse lung, we tested the hypothesis that ?F508-CF mice also develop severe AP associated with an antiapoptotic acinar phenotype, which requires indirect effects of the extracellular milieu. We used cerulein hyperstimulation models of AP. More severe pancreatitis occurred in cerulein-injected ?F508-CF vs. WT mice based on histological severity (P < 0.01) and greater neutrophil sequestration [P < 0.0001; confirmed by myeloperoxidase activity (P < 0.005)]. In dispersed acini cerulein-evoked necrosis was greater in ?F508-CF acini compared with WT (P < 0.05) and in WT acini pretreated with CFTRinh-172 compared with vehicle (P < 0.05). Cerulein-injected ?F508-CF vs. WT mice had less apoptosis based on poly(ADP-ribose) polymerase (PARP) cleavage (P < 0.005), absent DNA laddering, and reduced terminal deoxynucleotidyltransferase biotin-dUTP nick end labeling (TUNEL) staining (P < 0.005). Unexpectedly, caspase-3 activation was greater in ?F508-CF vs. WT acini at baseline (P < 0.05) and during AP (P < 0.0001). Downstream, ?F508-CF pancreas overexpressed the X-linked inhibitor of apoptosis compared with WT (P < 0.005). In summary, the ?F508-CF mutation, similar to the UNC-CF “null” mutation, causes severe AP characterized by an exuberant inflammatory response and impaired acinar apoptosis. Enhanced acinar necrosis in ?F508-CF occurs independently of extracellular milieu and correlates with loss of CFTR-Cl conductance. Although both exon 10 models of CF inhibit acinar apoptosis execution, the ?F508-CF mouse differs by increasing apoptosis signaling. Impaired transduction of increased apoptosis signaling in ?F508-CF acini may be biologically relevant to the pathogenesis of AP associated with CFTR mutations. PMID:20522641

Lee, Sae-Hong; Owyang, Chung; Zhou, Shi-yi

2010-01-01

289

The antagonist of the JAK-1/STAT-1 signaling pathway improves the severity of cerulein-stimulated pancreatic injury via inhibition of NF-?B activity.  

PubMed

The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway is widely involved in cell migration, apoptosis and inflammation. However, its exact mechanisms in severe acute pancreatitis (SAP) remain unclear. The aim of this study was to explore the activity of the JAK/STAT signaling pathway in pancreatic injury, investigate the functional mechanisms of SAP in vitro, and thus elucidate the underlying therapeutic effects for SAP in vivo. The activation of the JAK-1/STAT-1 signaling pathway and the expessions of TNF-?, IL-1? and IL-6 proteins were investigated in AR42J cells induced with cerulein and treated with either PBS, RPM, or AG490. One group of cells was left untreated as a control group. Subsequently the activity of NF-?B was evaluated. Rats were given RPM or AG490 just before the induction of SAP, the severity of which was assessed at 24 h. The findings revealed that the up-regulated expressions of JAK-1/STAT-1, STAT-3 protein were closely correlated with the transcription of TNF-?, IL-1?, and IL-6 in cerulein-stimulated cells. Administration of RPM or AG490 decreased the activity of NF-?B and inhibited the release of TNF-?, IL-1?, and IL-6. The reflective markers of severity of SAP were also decreased by RPM or AG490 treatment compared to SAP rats. This study indicates that the JAK-1/STAT-1 signaling pathway activity is an early event in pancreatic inflammatory injury. Therefore, early treatment with its inhibitors might be beneficial for attenuation of pancreatic injury in SAP. PMID:21369693

Chen, Ping; Huang, Liya; Zhang, Yongping; Qiao, Minmin; Yao, Weiyan; Yuan, Yaozong

2011-05-01

290

Salutary and prophylactic effect of pentadecapeptide BPC 157 on acute pancreatitis and concomitant gastroduodenal lesions in rats  

Microsoft Academic Search

The superior effectiveness of a new pentadecapeptide, BPC 157, on gastrointestinal and liver lesions, in conjunction with an antiinflammatory and analgetic activity was recently noted. In the present study, BPC 157 was tested as either a protective or healing agent in bile duct ligation-induced acute pancreatitis in rats. In addition, the positive influence of BPC 157 on concomitantly developed gastric

Predrag Sikiri?; Sven Seiwerth; Željko Grabarevi?; Rudolf Ru?man; Marijan Petek; Vjekoslav Jagi?; Branko Turkovi?; IVO Rotkvi?; Stjepan Miše; Ivan Zori?i?; Ljubica Jurina; Paško Konjevoda; Miro Hanževa?ki; Danica Ljubanovi?; Jadranka Šeparovi?; Miroslav Gjurašin; Mirna Bratuli?; Branka Artukovi?; Nikola Jelovac; Gojko Buljat

1996-01-01

291

Use of famotidine in severe exocrine pancreatic insufficiency with persistent maldigestion on enzymatic replacement therapy  

Microsoft Academic Search

In patients with pancreatic exocrine insufficiency, the use of pancreatic enzyme does not abolish steatorrhea in some cases. We carried out a long-term prospective study in an attempt to clarify the effectiveness of the associated use of famotidine to enzymatic supplementation on fat absorption and nutritional parameters of patients with pancreatic insufficiency due to cystic fibrosis. We studied 10 patients,

Antonio Carroccio; Francesca Pardo; Giuseppe Montalto; Luciana Iapichino; Maurizio Soresi; Maurizio R. Averna; Giuseppe Iacono; Alberto Notarbartolo

1992-01-01

292

Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer  

PubMed Central

AIM: To allow the identification of high-risk postoperative pancreatic fistula (POPF) patients with special reference to the International Study Group on Pancreatic Fistula (ISGPF) classification. METHODS: Between 1997 and 2010, 1341 consecutive patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Based on the preoperative diagnosis, total or distal gastrectomy and sufficient lymphadenectomy was performed, mainly according to the Japanese guidelines for the treatment of gastric cancer. Of these, 35 patients (2.6%) were diagnosed with Grade B or C POPF according to the ISGPF classification and were treated intensively. The hospital records of these patients were reviewed retrospectively. RESULTS: Of 35 patients with severe POPF, 17 (49%) and 18 (51%) patients were classified as Grade B and C POPF, respectively. From several clinical factors, the severity of POPF according to the ISGPF classification was significantly correlated with the duration of intensive POPF treatments (P = 0.035). Regarding the clinical factors to distinguish extremely severe POPF, older patients (P = 0.035, 65 years ? vs < 65 years old) and those with lower lymphocyte counts at the diagnosis of POPF (P = 0.007, < 1400/mm3 vs 1400/mm3 ?) were significantly correlated with Grade C POPF, and a low lymphocyte count was an independent risk factor by multivariate analysis [P = 0.045, OR = 10.45 (95%CI: 1.050-104.1)]. CONCLUSION: Caution and intensive care are required for older POPF patients and those with lower lymphocyte counts at the diagnosis of POPF. PMID:24379588

Komatsu, Shuhei; Ichikawa, Daisuke; Kashimoto, Kingo; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

2013-01-01

293

Hepatitis E virus in patients with acute severe liver injury  

PubMed Central

AIM: To examine the incidence of hepatitis E (HepE) in individuals with acute liver injury severe enough to warrant treatment at a transplant unit. METHODS: Hepatitis E virus (HEV) is an emerging pathogen in developed countries causing severe illness, particularly in immunocompromised patients or those with underlying chronic liver disease. HepE infection is often under diagnosed, as clinicians can be reluctant to test patients who have not travelled to regions traditionally considered hyperendemic for HepE. There are few data regarding the significance of HEV in patients with very severe acute liver injury in developed countries. Eighty patients with acute severe liver injury attending the Scottish Liver Transplant unit were tested for HEV and anti-HEV IgG and IgM. Severe acute liver injury was defined as a sudden deterioration in liver function confirmed by abnormal liver function tests and coagulopathy or presence of hepatic encephalopathy. Eighty percent of these patients were diagnosed with paracetomol overdose. No patients had a history of chronic or decompensated chronic liver disease at time of sampling. IgG positive samples were quantified against the World Health Organization anti-HEV IgG standard. Samples were screened for HEV viral RNA by quantitative reverse transcription polymerase chain reaction. RESULTS: Four cases of hepatitis E were identified. Three of the four cases were only diagnosed on retrospective testing and were initially erroneously ascribed to drug-induced liver injury and decompensated chronic liver disease, with the cause of the decompensation uncertain. One case was caused by HEV genotype 1 in a traveller returning from Asia, the other three were autochthonous and diagnosed on retrospective testing. In two of these cases (where RNA was detected) HEV was found to be genotype 3, the most prevalent genotype in developed countries. Three patients survived, two of whom had been misdiagnosed as having drug induced liver injury. The fourth patient died from sepsis and liver failure precipitated as a result of hepatitis E infection and previously undiagnosed cirrhosis. Histopathology data to date is limited to mainly that seen for endemic HepE. All patients, with the exception of patient 1, demonstrated characteristics of HepE infection, as seen in previously described locally acquired cases. CONCLUSION: In patients with acute severe liver injury, HEV testing should be part of the initial diagnostic investigation algorithm irrespective of suspected initial diagnosis, age or travel history. PMID:25018853

Crossan, Claire Louise; Simpson, Kenneth J; Craig, Darren G; Bellamy, Christopher; Davidson, Janice; Dalton, Harry R; Scobie, Linda

2014-01-01

294

Prostacyclin (PGI2) stabilises hepatic lysosomes during acute experimental pancreatitis in dogs.  

PubMed

In 15 mongrel dogs acute experimental pancreatitis (AEP) was induced by injection of bile and trypsin into the pancreatic duct. After 12 hrs in lysosomal enriched subfraction of the liver in untreated group (N = 5) relative free activity of cathepsins (Cs), acid phosphatase (AP) and beta-glucuronidase (beta G) increased to 50,62, and 53% respectively in comparison to the healthy dogs (N = 6) : 19,43 and 20%. In dogs with AEP treated with prostacyclin (PGI2) in the dose of 20 ng/kg X min for 12 hrs these activities of Cs, AP and beta G were lowered to 30,55 and 41% in comparison with the untreated group. In dogs with AEP (N = 5) additionally pretreated during 1 hr before the induction of AEP with the same rate of PGI2 i.v. infusion, the relative free activity of enzymes was similar to the treated group. After two hrs incubation of lysosomal enriched subfraction in acidic medium (pH = 5,0), the highest values of relative free activity were observed in untreated group, the difference being more pronounced in comparison with control group than before incubation. In those animals treated and pretreated with PGI2, postincubation activities were much lower than in untreated dogs. These results suggest the stabilising effect of PGI2 on hepatic lysosomes, damaged during the course of AEP in dogs. PMID:6753374

Dlugosz, J; Gabryelewicz, A; Andrzejewska, A; Triebling, A; Brzozowski, J; Wereszczynska, U

1982-07-01

295

Effects of Soluble Epoxide Hydrolase Deficiency on Acute Pancreatitis in Mice  

PubMed Central

Background Acute pancreatitis (AP) is a frequent gastrointestinal disorder that causes significant morbidity, and its incidence has been progressively increasing. AP starts as a local inflammation in the pancreas that often leads to systemic inflammatory response and complications. Soluble epoxide hydrolase (sEH) is a cytosolic enzyme whose inhibition in murine models has beneficial effects in inflammatory diseases, but its significance in AP remains unexplored. Methodology/Principal Findings To investigate whether sEH may have a causal role in AP we utilized Ephx2 knockout (KO) mice to determine the effects of sEH deficiency on cerulein- and arginine-induced AP. sEH expression increased at the protein and messenger RNA levels, as well as enzymatic activity in the early phase of cerulein- and arginine-induced AP in mice. In addition, amylase and lipase levels were lower in cerulein-treated Ephx2 KO mice compared with controls. Moreover, pancreatic mRNA and serum concentrations of the inflammatory cytokines IL-1B and IL-6 were lower in cerulein-treated Ephx2 KO mice compared with controls. Further, Ephx2 KO mice exhibited decreased cerulein- and arginine-induced NF-?B inflammatory response, MAPKs activation and decreased cell death. Conclusions -These findings demonstrate a novel role for sEH in the progression of cerulein- and arginine-induced AP. PMID:25402489

Bettaieb, Ahmed; Chahed, Samah; Tabet, George; Yang, Jun; Morisseau, Christophe; Griffey, Stephen; Hammock, Bruce D.; Haj, Fawaz G.

2014-01-01

296

TRPV1 and TRPA1 antagonists prevent the transition of acute to chronic inflammation and pain in chronic pancreatitis  

PubMed Central

Visceral afferents expressing transient receptor potential channels TRPV1 and TRPA1 are thought to be required for neurogenic inflammation and development of inflammatory hyperalgesia. In a mouse model of chronic pancreatitis (CP) produced by repeated episodes (twice/wk) of caerulein-induced acute pancreatitis (AP), we studied involvement of these TRP channels in pancreatic inflammation and pain-related behaviors. Antagonists of the two TRP channels were administered at different times to block the neurogenic component of AP. Six bouts of AP (over 3 wks) increased pancreatic inflammation and pain-related behaviors, produced fibrosis, sprouting of pancreatic nerve fibers and increased TRPA1 and TRPV1 gene transcripts and a nociceptive marker, pERK, in pancreas afferent somata. Treatment with TRP antagonists, when initiated prior to week 3, decreased pancreatic inflammation and pain-related behaviors and also blocked development of histopathological changes in the pancreas and upregulation of TRPV1, TRPA1 and pERK in pancreatic afferents. Continued treatment with TRP antagonists blocked development of CP and pain behaviors even when mice were challenged with seven more weeks of twice/wk caerulein. When started after week 3, however, treatment with TRP antagonists was ineffective in blocking the transition from AP to CP and the emergence of pain behaviors. These results suggest 1) an important role for neurogenic inflammation in pancreatitis and pain-related behaviors, 2) there is transition from AP to CP, after which TRP channel antagonism is ineffective, and thus 3) that early intervention with TRP channel antagonists may effectively attenuate the transition to and development of CP. PMID:23536075

Schwartz, Erica S.; La, Jun-Ho; Scheff, Nicole N.; Davis, Brian M.; Albers, Kathryn M.; Gebhart, G.F.

2013-01-01

297

Phosphorus-31 nuclear magnetic resonance spectroscopic study of the canine pancreas: applications to acute alcoholic pancreatitis  

SciTech Connect

The first nuclear magnetic resonance spectroscopic study of the canine pancreas is described. Both in-vivo, ex-vivo protocols and NMR observables are discussed. The stability of the ex-vivo preparation based on the NMR observables is established for at least four hours. The spectra obtained from the in-vivo and ex-vivo preparations exhibited similar metabolite ratios, further validating the model. Metabolite levels were unchanged by a 50% increase in perfusion rate. Only trace amounts of phosphocreatine were observed either in the intact gland or in extracts. Acute alcoholic pancreatitis was mimicked by free fatty acid infusion. Injury resulted in hyperamylasemia, edema (weight gain), increased hematocrit and perfusion pressure, and depressed levels of high energy phosphates.

Janes, N.; Clemens, J.A.; Glickson, J.D.; Cameron, J.L.

1988-01-01

298

[Prognostication of course and treatment of peripancreatic infiltrate in patients, suffering an acute necrotic pancreatitis].  

PubMed

Results of treatment of 229 patients, suffering an acute necrotic pancreatitis, complicated by peripancreatic infiltrate, were analyzed. To all the patients antibiotic prophylaxis and antibiotic therapy were conducted. In 63 (27.5%) patients the methods of extracorporal hemocorrection were applied, and in 108 (47.1%)--the "four--catheters" rule (catheter for epidural anesthesia, installment of the feeding intestinal probe further than the Treitz ligament level, the central vein catheterization, the programmed laparocentesis). In 31 (13.5%) patients there were determined the activity of mononuclear phagocytes and production of ROS (the oxygen active forms) by them in peripheral blood with objective for the purulent-septic complications prognostication. In 14 (6.1%) patients purulent--septic complications have occurred, postoperative lethality was 21.4%, general lethality--3.4%. PMID:25097970

Susak, Ia M; Tkachenko, O A; Malysh, I R; Dirda, O O; Fedorchuk, O H

2014-04-01

299

Acute nutrient regulation of the mitochondrial glutathione redox state in pancreatic ?-cells.  

PubMed

The glucose stimulation of insulin secretion by pancreatic ?-cells depends on increased production of metabolic coupling factors, among which changes in NADPH and ROS (reactive oxygen species) may alter the glutathione redox state (EGSH) and signal through changes in thiol oxidation. However, whether nutrients affect EGSH in ?-cell subcellular compartments is unknown. Using redox-sensitive GFP2 fused to glutaredoxin 1 and its mitochondria-targeted form, we studied the acute nutrient regulation of EGSH in the cytosol/nucleus or the mitochondrial matrix of rat islet cells. These probes were mainly expressed in ?-cells and reacted to low concentrations of exogenous H2O2 and menadione. Under control conditions, cytosolic/nuclear EGSH was close to -300 mV and unaffected by glucose (from 0 to 30 mM). In comparison, mitochondrial EGSH was less negative and rapidly regulated by glucose and other nutrients, ranging from -280 mV in the absence of glucose to -299 mV in 30 mM glucose. These changes were largely independent from changes in intracellular Ca(2+) concentration and in mitochondrial pH. They were unaffected by overexpression of SOD2 (superoxide dismutase 2) and mitochondria-targeted catalase, but were inversely correlated with changes in NAD(P)H autofluorescence, suggesting that they indirectly resulted from increased NADPH availability rather than from changes in ROS concentration. Interestingly, the opposite regulation of mitochondrial EGSH and NAD(P)H autofluorescence by glucose was also observed in human islets isolated from two donors. In conclusion, the present study demonstrates that glucose and other nutrients acutely reduce mitochondrial, but not cytosolic/nuclear, EGSH in pancreatic ?-cells under control conditions. PMID:24678915

Takahashi, Hilton K; Santos, Laila R B; Roma, Letícia P; Duprez, Jessica; Broca, Christophe; Wojtusciszyn, Anne; Jonas, Jean-Christophe

2014-06-15

300

[Severe toxic acute liver failure: etiology and treatment].  

PubMed

Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. Acetaminophen, antibiotics, antiepileptics and antituberculous drugs are the first causes of drug-induced liver injury. Severity assessment of the acute hepatitis is critical. Acute liver failure (ALF) is defined by the factor V, respectively more than 50% for the mild ALF and less than 50% for the severe ALF. Neurological examination must be extensive to the search for encephalopathy signs. According to the French classification, fulminant hepatitis is defined by the presence of an encephalopathy in the two first weeks and subfulminant between the second and 12th week after the advent of the jaundice. During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible. PMID:23683460

Amathieu, R; Levesque, E; Merle, J-C; Chemit, M; Costentin, C; Compagnon, P; Dhonneur, G

2013-06-01

301

Severe acute malnutrition during emergencies: burden management, and gaps.  

PubMed

Natural and man-made disasters, including floods, droughts, earthquakes, and armed conflicts, create nutrition crises. Unfortunately, the frequency and severity of such disasters have been increasing since the beginning of the 20th century, and their contribution to the burden of acute malnutrition is increasing every year. However, their contribution to the burden of acute malnutrition is underrecognized due to the ways in which global statistics are built and causes of death are reported. Fortunately, the success of the current protocol for treatment of severe acute malnutrition (SAM) and the integrated approach to treatment has created a momentum allowing expanded coverage of treatment of SAM, especially in humanitarian emergency contexts. For this progress to be maintained and accelerated, changes in nutrition information systems at the national and global levels are needed, and the persisting barriers to the expansion and integration of treatment of SAM into routine health systems need to be removed. Emergency funding approaches and objectives have to include sustaining and amplifying the achievements of the short-term palliative interventions. Nutrition programs implemented in emergency contexts have the capacity to contribute to answering priority research questions, and this capacity should be more optimally utilized. PMID:25069293

Bahwere, Paluku

2014-06-01

302

Contemporary review of drug-induced pancreatitis: A different perspective  

PubMed Central

Although gallstone and alcohol use have been considered the most common causes of acute pancreatitis, hundreds of frequently prescribed medications are associated with this disease state. The true incidence is unknown since there are few population based studies available. The knowledge of drug induced acute pancreatitis is limited by the availability and the quality of the evidence as the majority of data is extrapolated from case reports. Establishing a definitive causal relationship between a drug and acute pancreatitis poses a challenge to clinicians. Several causative agent classification systems are often used to identify the suspected agents. They require regular updates since new drug induced acute pancreatitis cases are reported continuously. In addition, infrequently prescribed medications and herbal medications are often omitted. Furthermore, identification of drug induced acute pancreatitis with new medications often requires accumulation of post market case reports. The unrealistic expectation for a comprehensive list of medications and the multifactorial nature of acute pancreatitis call for a different approach. In this article, we review the potential mechanisms of drug induced acute pancreatitis and provide the perspective of deductive reasoning in order to allow clinicians to identify potential drug induced acute pancreatitis with limited data.

Hung, Whitney Y; Abreu Lanfranco, Odaliz

2014-01-01

303

Contemporary review of drug-induced pancreatitis: A different perspective.  

PubMed

Although gallstone and alcohol use have been considered the most common causes of acute pancreatitis, hundreds of frequently prescribed medications are associated with this disease state. The true incidence is unknown since there are few population based studies available. The knowledge of drug induced acute pancreatitis is limited by the availability and the quality of the evidence as the majority of data is extrapolated from case reports. Establishing a definitive causal relationship between a drug and acute pancreatitis poses a challenge to clinicians. Several causative agent classification systems are often used to identify the suspected agents. They require regular updates since new drug induced acute pancreatitis cases are reported continuously. In addition, infrequently prescribed medications and herbal medications are often omitted. Furthermore, identification of drug induced acute pancreatitis with new medications often requires accumulation of post market case reports. The unrealistic expectation for a comprehensive list of medications and the multifactorial nature of acute pancreatitis call for a different approach. In this article, we review the potential mechanisms of drug induced acute pancreatitis and provide the perspective of deductive reasoning in order to allow clinicians to identify potential drug induced acute pancreatitis with limited data. PMID:25400984

Hung, Whitney Y; Abreu Lanfranco, Odaliz

2014-11-15

304

Morphological features of fluid collections on endoscopic ultrasound in acute necrotizing pancreatitis: do they change over time?  

PubMed Central

Background There have been attempts to develop universally applicable nomenclature for pancreatic fluid collections (PFCs) in acute pancreatitis. But PFCs following acute necrotizing pancreatitis (ANP) has not been studied by sensitive imaging techniques like endoscopic ultrasound (EUS). The aim of the study was to prospectively study morphological structure of pancreatic fluid collections occurring after ANP by serial EUS. Methods Patients with ANP having PFC at ?4 weeks of onset of symptoms seen at our center from October 2011 to November 2012 were prospectively followed up with EUS at 6 weeks, 3 months and 6 months respectively and the amount of solid content in the collection was quantified as percentage amount of echogenic material. The symptomatic patients undergoing EUS/percutaneous drainage also underwent EUS prior to drainage for assessment of solid content. Results Of the 54 patients enrolled, 7 patients were lost to follow up or refused EUS. Forty seven patients (34 males; mean age 36.7±11.6 years) were studied. Etiology of acute pancreatitis was alcohol (n=22), gallstones (n=10), idiopathic (10), gallstones+alcohol (n=3) and drug induced (n=2). Contrast enhanced computed tomography done after 3 days of onset of ANP had shown less than 30%, 30-50% and more than 50% necrosis in 6 (13%), 14 (30%) and 27 (57%) patients respectively. On EUS at 6 weeks, 41/47 (87%) patients had fluid collection with solid debris. Follow up EUS at 3 and 6 months revealed progressively decreasing solid content in PFCs. Conclusions All PFCs following ANP may not have solid necrotic content and over a period of time necrotic content tends to liquefy. This may have therapeutic implications. PMID:24975052

Rana, Surinder S.; Bhasin, Deepak K.; Reddy, Yalaka Rami; Sharma, Vishal; Rao, Chalapathi; Sharma, Ravi K.; Gupta, Rajesh

2014-01-01

305

The role of endoscopy in the management of pancreatic necrosis.  

PubMed

The management of acute pancreatitis has seen many advances over the past three decades. Attempts to improve care have led to new definitions, classification systems, and treatment strategies. Despite those efforts, considerable morbidity and mortality result from complications of severe acute pancreatitis. Much attention has been given to new ways to treat these complications, including inflammatory pancreatic fluid collections and associated infections. Endoscopy has become one of the established modalities for the treatment of these complications in many expert centers. This chapter will specifically address the role of endoscopy in the management of pancreatic necrosis. PMID:25113041

Lewis, Aaron; Partridge, Brett; Haluszka, Oleh

2014-09-01

306

Effects of serine protease inhibitors on accumulation of polymorphonuclear leukocytes in the lung induced by acute pancreatitis in rats  

Microsoft Academic Search

The administration of a high-dose of a serine protease inhibitor is recommended in patients complicated by multiple organ\\u000a failure (MOF), including adult respiratory distress syndrome (ARDS), induced by acute pancreatitis. The accumulation of polymorphonuclear\\u000a leukocytes (PMN) in affected organs is considered to be one of the causative factors of MOF. Adhesion to endothelial cells\\u000a (EC), via adhesion molecules, and the

Yoshiaki Okumura; Hisayuki Inoue; Yoshihide Fujiyama; Tadao Bamba

1995-01-01

307

Accounts of severe acute obstetric complications in Rural Bangladesh  

PubMed Central

Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely and appropriate care seeking for severe obstetric complications may consider targeting of non-certified providers for strengthening of referral linkages between patients and certified facility-based providers. Future research may characterize the treatments and appropriateness of emergency care provided by ubiquitous village doctors and other non-certified treatment providers in rural South Asian settings. In addition, future studies may explore the use of mobile phones in decreasing delays to certified medical care during obstetric emergencies. PMID:22018330

2011-01-01

308

Extracorporeal membrane oxygenation for severe acute respiratory failure  

PubMed Central

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass technique and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The intial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over convential treatment, survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered and will need evaluation by a future RCT. PMID:11094500

Lewandowski, Klaus

2000-01-01

309

Severe acute respiratory syndrome (SARS): epidemiology and clinical features  

PubMed Central

Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a significant morbidity and mortality. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache, and dyspnoea. Older subjects may present without the typical febrile response. Common laboratory features include lymphopenia, thrombocytopenia, raised alanine transaminases, lactate dehydrogenase, and creatine kinase. The constellation of compatible clinical and laboratory findings, together with certain characteristic radiological features and lack of clinical response to broad spectrum antibiotics, should arouse suspicion of SARS. Measurement of serum RNA by real time reverse transcriptase-polymerase chain reaction technique has a detection rate of 75%–80% in the first week of the illness. PMID:15254300

Hui, D; Chan, M; Wu, A; Ng, P

2004-01-01

310

Severe acute respiratory syndrome (SARS) and healthcare workers.  

PubMed

The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE. PMID:15702757

Chan-Yeung, Moira

2004-01-01

311

Cholecystectomy and sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 - 2003: a nationwide register study  

PubMed Central

Background Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. Methods Hospital discharge and death certificate data were linked for patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculated as case fatality rate (CFR) and standardized mortality ratio (SMR). MABP was defined as acute pancreatitis of biliary aetiology without mortality during an index stay of 10 days or shorter. Patients were analysed according to four different treatment policies: Cholecystectomy during index stay (group 1), no cholecystectomy during index stay but within 30 days of index admission (group 2), sphincterotomy but not cholecystectomy within 30 days of index admission (group 3), and neither cholecystectomy nor sphincterotomy within 30 days of index admission (group 4). Results Of 11636 patients with acute biliary pancreatitis, 8631 patients (74%) met the criteria for MABP. After exclusion of those with cholecystectomy or sphincterotomy during the year before index admission (N = 212), 8419 patients with MABP remained for analysis. Patients in group 1 and 2 were significantly younger than patients in group 3 and 4. Length of index stay differed significantly between the groups, from 4 (3-6) days, (representing median, 25 and 75 percentiles) in group 2 to 7 (5-8) days in groups 1. In group 1, 4.9% of patients were readmitted at least once for biliary disease within one year after index admission, compared to 100% in group 2, 62.5% in group 3, and 76.3% in group 4. One year after index admission, 30.8% of patients in group 3 and 47.7% of patients in group 4 had undergone cholecystectomy. SMR did not differ between the four groups. Conclusion Cholecystectomy during index stay slightly prolongs this stay, but drastically reduces readmissions for biliary indications. PMID:19852782

2009-01-01

312

Questioning current concepts in acute pancreatitis: endotoxin contamination of porcine pancreatic elastase is responsible for experimental pancreatitis-associated distant organ failure.  

PubMed

The systemic inflammatory response syndrome is responsible for pancreatitis-associated mortality. Recent in vitro and in vivo studies have suggested that pancreatic elastase is one missing link between the localized inflammatory process in the pancreas and distant organ dysfunction and failure. It has been shown that pancreatic elastase activates transcription factors, including NF-kappaB, and induces TNF-alpha secretion in myeloid cells via TLRs. In this study we demonstrate that a highly purified low endotoxin pancreatic elastase preparation (El-UP) failed both to activate NF-kappaB and to induce TNF-alpha release in RAW 264.7 cells and bone marrow-derived macrophages. In contrast, a less purified elastase preparation (El-IV) caused activation of NF-kappaB and was able to induce TNF-alpha release at very low concentrations. These effects were sensitive to pretreatment of the cells with polymyxin B and were resistant to heat inactivation. Endotoxin activity as determined by the Limulus amebocyte lysate assay was >3 orders of magnitude lower in the low endotoxin elastase preparation (El-UP) compared with less purified elastase preparations (El-IV). In contrast to contaminated elastase or LPS, elastase free of contamination (El-UP) failed to induce elevated serum TNF-alpha levels or pulmonary neutrophil infiltration after i.p. application in mice and did not induce lethality when coinjected with d-galactosamine. Failure of low endotoxin elastase (El-UP) to induce proinflammatory effects in vivo and in vitro was not due to functional inactivity of the elastase preparation, as determined by elastase activity assay. These results question current concepts of direct proinflammatory effects attributed to pancreatic elastase. PMID:15879145

Geisler, Fabian; Algül, Hana; Riemann, Marc; Schmid, Roland M

2005-05-15

313

Primary sclerosing cholangitis in patient with celiac disease complicated by cholecystic empyema and acute pancreatitis  

PubMed Central

Summary Background The association of celiac disease and sclerosing cholangitis is a well known, although unusual, pathologic feature of autoimmunity. Methods A 64 year old patient presenting with sub-acute cholangitis and pancreatitis, treated with cholecystectomy and endoscopic sphincterotomy. The post-operative course, complicated by cholestatic jaundice, and subsequent clinical complications are described, showing how the diagnosis of sclerosing cholangitis was outlined after the Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and confirmed by liver biopsy. Long term treatment with Ursodeoxycholic acid has gradually normalized bilirubin values, while cholestasis enzymes are gradually decreasing. After 18 months bleeding from oesophageal varices ensued, which was controlled through endoscopic ligation. Conclusions The diagnosis of primary sclerosing cholangitis should be taken into account when cholangitis is associated with other immunity derangements and segmentary dilatations of the intra-hepatic bile ducts, but no dilatation of the main bile duct is noticed at imaging or endoscopy. Recovery of hepatic function should be always attempted before bringing the patient to surgery, in order to avoid postoperative hepatic decompensation. PMID:24629813

PICCOLBONI, D.; RAGONE, E.; INZIRILLO, A.; UTILI, R.

2013-01-01

314

Quality of life after acute pancreatitis: a systematic review and meta-analysis.  

PubMed

Patient-centered outcomes, including quality of life (QoL), after acute pancreatitis (AP) remain largely unknown. Our aim was to systematically review the best available evidence on QoL after AP. English-language articles on the effect of AP on QoL were identified in MEDLINE, EMBASE, and Scopus. Results were statistically aggregated to obtain a pooled mean difference (MD) and corresponding 95% confidence interval (CI) for individual QoL domains and component summaries, where appropriate. A total of 16 prospective observational studies encompassing 687 AP patients were included. Four studies comprising 267 AP patients, as measured by SF-36 and SF-12 questionnaires, were suitable for meta-analysis. The general health and vitality domains were significantly worse in the patients compared with healthy controls (MD, -10.90; 95% CI, -15.63 to -6.17; P < 0.00001 and MD, -4.64; 95% CI, -7.32 to -1.95; P = 0.0007, respectively). The remaining individual domains and physical and mental component summary scores did not differ between patients and controls. The QoL seems to be significantly impaired in patients after AP with a need to standardize reporting on QoL. Future studies should investigate the effect of different interventions on patients' QoL. PMID:25333403

Pendharkar, Sayali A; Salt, Kylie; Plank, Lindsay D; Windsor, John A; Petrov, Maxim S

2014-11-01

315

Smoking and risk for acute pancreatitis: a systematic review and meta-analysis.  

PubMed

We aimed to better understand the relationship between smoking and a risk for acute pancreatitis (AP) in existing observational studies. We identified studies by searching the PubMed, Scopus, and Web of Science databases (from inception through August 31, 2013) and by searching bibliographies of relevant articles. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with fixed-effects and random-effects models. A total of 5 studies met inclusion criteria for analysis. Both current smoking (summary RR, 1.74; 95% CI, 1.39-2.17; n = 5 studies) and former smoking (summary RR, 1.32; 95% CI, 1.03-1.71; n = 4 studies) were associated with an increased risk for AP. The positive association of current smoking and risk for AP remained when we limited the meta-analysis to studies that controlled for alcohol intake and body mass index (summary RR, 1.76; 95% CI, 1.31-2.36; n = 4 studies). Both current and former smoking are associated with increased risk for AP. Further investigations, both epidemiological and mechanistic, are needed to establish the extent to which the association can be explained by a causal link and whether smoking cessation can prevent the occurrence and development of AP. PMID:25333404

Yuhara, Hiroki; Ogawa, Masami; Kawaguchi, Yoshiaki; Igarashi, Muneki; Mine, Tetsuya

2014-11-01

316

Ifitm3 Limits the Severity of Acute Influenza in Mice  

PubMed Central

Interferon-induced transmembrane (IFITM) proteins are a family of viral restriction factors that inhibit the entry processes of several pathogenic viruses, including influenza A virus (IAV), in vitro. Here we report that IAV-infected knockout mice lacking the Ifitm locus on chromosome 7 exhibited accelerated disease progression, greater mortality, and higher pulmonary and systemic viral burdens as compared to wild type controls. We further observed that the phenotype of Ifitm3-specific knockout mice was indistinguishable from that of mice lacking the entire Ifitm locus. Ifitm3 was expressed by IAV target cells including alveolar type II pneumocytes and tracheal/bronchial respiratory epithelial cells. Robust Ifitm3 expression was also observed in several tissues in the absence of infection. Among murine Ifitm promoters, only that of Ifitm3 could be induced by type I and II interferons. Ifitm3 could also be upregulated by the gp130 cytokines IL-6 and oncostatin M on cells expressing appropriate receptors, suggesting that multiple cytokine signals could contribute to Ifitm3 expression in a cell or tissue-specific manner. Collectively, these findings establish a central role for Ifitm3 in limiting acute influenza in vivo, and provide further insight into Ifitm3 expression and regulation. PMID:22969429

Bailey, Charles C.; Huang, I-Chueh; Kam, Christina; Farzan, Michael

2012-01-01

317

Heat Shock Response is Associated with Protection Against Acute Interstitial Pancreatitis in Rats  

Microsoft Academic Search

We recently reported that hyperthermia induces pancreatic expression of heat shock proteins (HSPs), particularly HSP70 isoforms, and protects against cerulein pancreatitis. We have now studied whether a double hyperthermia amplifies these effects and whether hyperthermia also protects against dibutyltin dichloride (DBTC)-induced pancreatitis. A further aim was to examine whether hyperthermia induces changes in transforming growth factor-ß1 (TGF-ß1). Following pretreatment without

H. Weber; A. C. C. Wagner; L. Jonas; J. Merkord; T. Hőfken; H. Nizze; P. Leitzmann; B. Gőke; P. Schuff-Werner

2000-01-01

318

Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy  

PubMed Central

AIM: To identify sensitive predictors of clinically relevant postoperative pancreatic fistula (POPF) at the acute phase after pancreatectomy. METHODS: This study included 153 patients diagnosed as having POPFs at postoperative day (POD) 3 after either open pancreatoduodenectomy or distal pancreatectomy between January 2008 and March 2013. The POPFs were categorized into three grades based on the International Study Group on Pancreatic Fistula Definition, and POPFs of grades B or C were considered to be clinically relevant. The predictive performance for the clinically relevant POPF formation of values at PODs 1, 3 and 5 as well as time-dependent changes in levels of inflammatory markers, including white blood cell count, neutrophil count, total lymphocyte count, C-reactive protein (CRP), procalcitonin level, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio, and amylase content in the drain fluid were compared using the receiver operating characteristic (ROC) curve and multivariable analyses. A scoring system for the prediction of clinically relevant POPFs was created using five risk factors identified in this study, and its diagnostic performance was also evaluated. RESULTS: Over time, 77 (50%) of 153 enrolled patients followed a protracted course and were categorized as having clinically relevant POPFs. ROC curve analyses revealed that changes in CRP levels from POD 1 to POD 3 had the greatest area under the curve value (0.767) and that an elevated CRP level of 28.4 mg/L yielded the most optimal predictive value for clinically relevant POPFs. Multivariable analyses for the risk factors of clinically relevant POPFs identified invasive carcinomas of the pancreas and elevation of the CRP level (? 28.4 mg/L, from POD 1 to POD 3) as independent diagnostic factors for clinically relevant POPFs (OR 2.94, 95%CI: 1.08-8.55, P = 0.035 and OR 4.82, 95%CI: 1.25-20.2, P = 0.022, respectively). A gradual increase in the prevalence of clinically relevant POPFs in proportion to the risk classification score was confirmed. A highly elevated CRP level and a risk score ? 8 were significantly associated with a prolonged duration of drain placement and postoperative hospitalization. CONCLUSION: A steep rise in the serum CRP level from POD 1 to POD 3 was a highly predictive factor for subsequent clinically relevant POPFs. PMID:25024608

Kanda, Mitsuro; Fujii, Tsutomu; Takami, Hideki; Suenaga, Masaya; Inokawa, Yoshikuni; Yamada, Suguru; Kobayashi, Daisuke; Tanaka, Chie; Sugimoto, Hiroyuki; Koike, Masahiko; Nomoto, Shuji; Fujiwara, Michitaka; Kodera, Yasuhiro

2014-01-01

319

Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome.  

PubMed

An outbreak of severe acute respiratory syndrome (SARS) occurred in Taiwan in 2003. SARS complicated with rhabdomyolysis has rarely been reported. This study reported three cases of rhabdomyolysis developing during the clinical course of SARS. Thirty probable SARS patients were admitted to the isolation wards at Linkou Chang Gung Memorial Hospital between 4 April and 4 June 2003. Thirty patients, including four men and 26 women aged from 12 to 87 years (mean age 40). Eleven (36.7%) patients had respiratory failure and required mechanical ventilation with paralytic therapy; three (10%) patients had rhabdomyolysis complicated with acute renal failure and one received haemodialysis; four (13.3%) patients died. Three cases with rhabdomyolysis all received sedative and paralytic therapy for mechanical ventilation. Haemodialysis was performed on one patient. Two patients died from multiple organ failure, and one patient fully recovered from rhabdomyolysis with acute renal failure. SARS is a serious respiratory illness, and its aetiology is a novel coronavirus. Rhabdomyolysis resulting from SARS virus infection was strongly suspected. Immobilisation under paralytic therapy and steroids may also be important in developing rhabdomyolysis. PMID:16178983

Chen, L-L; Hsu, C-W; Tian, Y-C; Fang, J-T

2005-10-01

320

Preventive Effect of Three Pomegranate (Punica granatum L.) Seeds Fractions on Cerulein-Induced Acute Pancreatitis in Mice  

PubMed Central

Background: Acute pancreatitis (AP) refers to afflicted inflammation of pancreas with unfavorable adverse effects and developed multiple organ failures. Unfortunately, there is not a certain therapeutic method for this disease. Oxidative stress has a serious role in the pathogenesis of AP. Thus, decreasing of oxidative stress may prevent induction and progression of AP. Punica granatum L. has been extensively used in traditional medicine and possesses various active biological elements. Due to antioxidant and anti-inflammatory properties of pomegranate, it could be considered as a good candidate alternative medicine with beneficial effects on AP. In this study, we decided to study the protective effect of three fractions of pomegranate seeds on cerulein-induced AP. Methods: AP was induced in male Syrian mice by five intraperitoneal (i.p.) injection of cerulein (50 ?g/kg) with 1 h intervals. Treatments with pomegranate freeze-dried powder (PFDP) and hydroalcoholic pomegranate seeds extract (PSE) at doses of 125, 250, 500 mg/kg (i.p.) were started 30 min before pancreatitis induction. Pomegranate seed oil fraction (PSOF) was orally administered (50, 100, 200 ?L/kg) and continued for 10 days. Pancreatic tissue was evaluated for histopathological parameters and pancreatic myeloperoxidase (MPO) activity as well as lipase and amylase levels were measured in plasma. Results: The higher doses of three fractions (250 and 500 mg/kg for PFDP and PSE and doses of 100, 200 ?L/kg for PSOF) significantly reduced amylase and lipase activity in serum (at least P < 0.01), pancreatic MPO activity (P < 0.001), edema, leukocyte infiltration and vacuolization in comparison to the control group (P < 0.05). Conclusions: These results propose that pomegranate seeds fractions can prevent and/or treat the AP. PMID:24829726

Minaiyan, Mohsen; Zolfaghari, Behzd; Taheri, Diana; Gomarian, Mahdi

2014-01-01

321

[Lactic acidosis in a child with acute severe asthma].  

PubMed

Lactic acidosis is a recognized event in adult patients with acute severe asthma (ASA). Only a few cases have been reported in children. Hereinafter is reported the case of a 2-year-old girl hospitalized in the pediatric intensive care unit for ASA, which was treated with high-flow oxygen therapy and intravenous methylprednisolone and salbutamol. During hospitalization, she had metabolic acidosis with a 7.29 pH, a 26mmHg hypocapnia, and a decrease in bicarbonates to 12 mmol/L. The anion gap was increased to 20 mmol/L and lactates to 8 mmol/L. The work-up for a congenital metabolic disease was normal. Progression was propitious with spontaneous improvement of lactic acidosis, and the child was discharged from the intensive care unit after 72 h. The origin of lactic acidosis during ASA seems to be multifactorial. Although its recovery can be spontaneous, it is important to know how to identify it because it can worsen respiratory symptoms and can lead to incongruous therapeutic escalation. PMID:25125034

Perrin, C; Savy, N; Lang, M; Caron, N; Labbé, A

2014-10-01

322

Pancreas divisum and duodenal diverticula as two causes of acute or chronic pancreatitis that should not be overlooked: a case report  

PubMed Central

Introduction Pancreas divisum is a congenital anatomical anomaly characterized by the lack of fusion of the ventral and dorsal parts of the pancreas during the eighth week of fetal development. This condition is found in 5% to 14% of the general population. In pancreas divisum, the increased incidence of acute and chronic pancreatitis is caused by inadequate drainage of secretions from the body, tail and part of the pancreatic head through an orifice that is too small. The incidence of diverticula in the second part of the duodenum is found in approximately 20% of the population. Compression of the duodenal diverticula at the end of the common bile duct leads to the formation of biliary lithiasis (a principal cause of acute pancreatitis), pain associated with biliary lithiasis owing to compression of the common bile duct (at times with jaundice), and compression of the last part of Wirsung's duct or the hepatopancreatic ampulla (ampulla of Vater) that may lead to both acute and chronic pancreatitis. Case presentation We describe the radiological findings of the case of a 75-year-old man with recurrent acute pancreatitis due to a combination of pancreas divisum and duodenal diverticula. Conclusion Magnetic resonance cholangiopancreatography is advisable in patients with recurrent pancreatitis (both acute and chronic) since it is the most appropriate noninvasive treatment for the study of the pancreatic system (and the eventual presence of pancreas divisum) and the biliary systems (eventual presence of biliary microlithiasis). Moreover, it can lead to the diagnostic suspicion of duodenal diverticula, which can be confirmed through duodenography with X-ray or computed tomography scan with a radio-opaque contrast agent administered orally. PMID:18489738

De Filippo, Massimo; Giudici, Emiliano; Sverzellati, Nicola; Zompatori, Maurizio

2008-01-01

323

Pancreatic trauma  

PubMed Central

Introduction Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. Methods A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: ‘pancreatic trauma’, ‘pancreatic duct injury’, ‘radiology AND pancreas injury’, ‘diagnosis of pancreatic trauma’, and ‘management AND surgery’. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Results Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. Conclusions The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases, experienced HPB surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery. PMID:23676806

Bhattacharya, S

2013-01-01

324

[Round Table: Severe asthma in pediatrics: treatment of acute crises].  

PubMed

Morbidity and mortality derived from asthma continue to be a main public health problem in many countries, in spite of the advances in the knowledge on the disease and its treatment. There are several risk factors for asthma attack which have to be considered in the management of patients in order to prevent exacerbations and mortality. Smooth bronchial muscle constriction and inflammation with oedema of the bronchial wall are the facts that cause airway flow and resistance disturbances, with hyperinflation, leading to a bigger respiratory work. On the other hand, the bronchial obstruction leads to a ventilation-perfusion disequilibrium and hypoxia. At the beginning of the process there is hypocarbia, but when the attack progresses muscle fatigue happens, and retention of CO2, being a sing of alarm (predictive of respiratory failure) a normal and rising PaCO2. The evaluation of an acute asthmatic patient should accomplish a clinical and objective assessment (peak flow rate and saturation of O2), in order to classify the crisis in: mild, moderate or severe. Managing acute asthmatic patient includes: oxygen, bronchodilator ss2 agonists at high and even continuous doses and systemic corticosteroids to prevent the progression and to control inflammation. These procedures should be promptly instituted. Although there is less evidence on their beneficial effects other measures as intravenous aminophylline, nebulized anticholynergics, magnesium sulphate and intravenous ss2 agonists may be used when the conventional therapy is not quickly successful and the patient is in a critical situation, at a real risk of respiratory failure, and in order to avoid mechanical ventilation. If this is finally instituted, controlled hypoventilation with permissive hypercarbia is now recommended, to avoid barotrauma, which used to be a frequent complication when more aggressive attitude was the rule. Interaction between paralytic agents and corticosteroids may produce a miopathy, so the recommendation now is to try not to use paralytic agents, even with profound sedation of needed. Sixty four patients were treated on 77 occasions in the Pediatric Intensive Care Unit of our hospital. They were 0,5 to 13,9 years old, being 50% less than 5 years old. It was the first attack in 9 (14%) patients. The standard management consisted of oxygen, frequently or continuously nebulized salbutamol and intravenous methylprednisolone (1 to 6 mg/kg/day). Furthermore nebulized ipratropium bromide was administered 58 times (75%), as well as intravenous aminophylline 69 (89%), intravenous salbutamol 23 (30%), magnesium sulphate 16 (21%) and ketamine 10 (13%). Antibiotics were given 22 times (29%). Two 15 month old infants received mechanical ventilation in three occasions, and relevant complications happened (pneumothorax and myopathy, and pneumomediastinum and bronchiolitis obliterans respectively). Fifty six patients have been followed for a period of 3 to 110 months (median 48 months), and 16 (29%) have needed high doses (equal to or move than 800 mcg of budesonide or equivalent). There are data on lung function in 36 of them, FEV1 is normal (> 85% of predicted, between 86 and 127) in 26 (78%) and < 85% (65 to 84%) of predicted in 8 (22%) FEV1 rises more than 15% (16 to 23%) in four patients after the inhalation of a ss2 agonist. Inhaled anesthetic agents and heliox have been used in some pediatric cases. After a severe asthma attack the strategy of management should be reviewed, as well as the possible risk factors. PMID:10354007

García Martínez, J M

1999-01-01

325

Association between red cell distribution width and acute pancreatitis: a cross-sectional study  

PubMed Central

Objective We investigated whether red cell distribution width (RDW) was associated with mortality in patients with acute pancreatitis (AP). Design A cross-sectional study. Setting Patients with AP were recruited in the emergency department and healthy individuals were recruited in healthcare centre in the First Affiliated Hospital of Zhejiang University. Participants A total of 106 patients with AP and 204 healthy individuals were enrolled. Primary and secondary outcome measures Haematology and biochemistry results of the first test after admission were collected. The significance of the differences in RDW values among healthy individuals, non-survivors of patients with AP, and survivors of patients with AP was determined using one-way analysis of variance. Patients with AP were divided into three groups according to RDW tertiles. All patients with AP were followed up for at least 3?months. Receiver-operating characteristic (ROC) curve analysis and Kaplan-Meier analysis were used to evaluate RDW values to predict mortality of patients with AP. Results The RDW values were non-survivors of patients with AP>healthy individuals>survivors of patients with AP. Patients with AP with the highest RDW tertiles had the lowest levels of Ca, total protein, albumin, haemoglobin, white and red blood cell count, but the highest mortality. The area under the ROC curve of RDW was 0.846 (95% CI 0.727 to 0.964, p<0.001). With a cut-off value of 14.2 for RDW, sensitivity and specificity of RDW to predict mortality were 75.0% and 89.8%, and Kaplan-Meier analysis showed an increase in probability of death with high RDW values. Conclusions There is significant association between RDW and mortality of patients with AP. PMID:25095875

Yao, Jinmei; Lv, Guocai

2014-01-01

326

1HNMR-based metabolomic profile of rats with experimental acute pancreatitis  

PubMed Central

Background Acute pancreatitis (AP) is a common inflammatory disease of the pancreas accompanied by serious metabolic disturbances. Nevertheless, the specific metabolic process of this disease is still unclear. Characterization of the metabolome may help identify biomarkers for AP. To identify potential biomarkers, this study therefore investigated the 1H-nuclear magnetic resonance (NMR)-based metabolomic profile of AP. Methods Fourteen male adult Sprague–Dawley rats were randomized into two groups: the AP group, in which AP was induced by retrograde ductal infusion of 3.5% sodium taurocholate; and the sham operation group (SO), in which rats were infused with 0.9% saline. Blood samples were obtained 12 hours later and a 600 MHz superconducting NMR spectrometer was used to detect plasma metabolites. Principal components analysis (PCA) and partial least squares-discriminant analysis after orthogonal signal correction (OSC-PLS-DA) were used to analyze both longitudinal Eddy-delay (LED) and Carr–Purcell–Meiboom–Gill (CPMG) spectra. Results Differences in plasma metabolites between the two groups were detected by PCA and PLS-DA of 1HNMR spectra. Compared with the SO group, plasma levels of lactate (? 1.3, 1.34, 4.1), valine (? 0.98, 1.02), succinic acid (? 2.38), 3-hydroxybutyric acid (3-HB, ? 1.18), high density lipoprotein (HDL, ? 0.8), and unsaturated fatty acid (UFA, ? 2.78, 5.3) were elevated in the AP group, while levels of glycerol (? 3.58, 3.66), choline (? 3.22), trimethylamine oxide (TMAO, ? 3.26), glucose (? 3–4), glycine (? 3.54), very low density lipoprotein (VLDL, ? 1.34) and phosphatidylcholine (Ptd, ? 2.78) were decreased. Conclusions AP has a characteristic metabolic profile. Lactate, valine, succinic acid, 3-HB, HDL, UFA, glycerol, choline, TMAO, glucose, glycine, VLDL, and Ptd may be potential biomarkers of early stage AP. PMID:24975214

2014-01-01

327

Serum M30 and M65 levels and effects of Ankaferd blood stopper in cerulein induced experimental acute pancreatitis model in rats  

PubMed Central

Background and Aim: The incidence of acute pancreatitis is increasing recently. The aim of this study is to investigate the effect of Ankaferd Blood Stopper (ABS) on experimental model of cerulein induced acute pancreatitis in rats. Materials and Methods: Forty Wistar Albino rats were divided into five groups. Group 1: Sham (n = 8), Group 2: Control group (n = 8), Group 3: Treatment group (n = 8), Group 4: Prophylaxis group (n = 8), Group 5: Prophylaxis treatment group (n = 8). Any practice was not administered to Group 1. Rats were treated with either 1 ml ABS or 1 ml saline via intraperitoneal route before and after inducing acute pancreatitis. Pancreatic tissues were examined histopathologically. Amylase, cytokines (tumor necrosis factor-? and interleukin-1?), and markers of apoptosis (M30 and M65) were also measured in blood samples. Immunohistochemical staining was performed with caspase 3 antibody. Results: We found a statistically significant improvement in histopathological scores in treatment group and prophylaxis group compared with controls. In treatment group, M30 and M65 levels were lower when compared with controls. In prophylaxis group, there was not a statistically significant difference in M30 levels, but M65 levels were lower when compared with controls. Conclusion: In this experimental acute pancreatitis model, we found high histopathological healing effects of ABS treatment and also prophylaxis. ABS treatment and prophylaxis reduced apoptosis. PMID:25126164

Aktas, Bora; Basar, Omer; Y?lmaz, Bar?s; Ekiz, Fuat; Alt?nbas, Akif; Coban, Sahin; Buyukcam, Fatih; Albayrak, Aynur; Ginis, Zeynep; Yuksel, Osman; Delibas?, Tuncay

2014-01-01

328

Severe asthma exacerbation: role of acute Chlamydophila pneumoniae and Mycoplasma pneumoniae infection  

Microsoft Academic Search

BACKGROUND: Chlamydophila pneumoniae and Mycoplasma pneumoniae are associated with acute exacerbation of bronchial asthma (AEBA). The aim of this study was to evaluate the correlation between these acute bacterial infections and the severity of AEBA. METHODS: We prospectively analysed consecutive patients admitted to the Emergency Department with acute asthma exacerbation. In every patient peak expiratory flow (PEF) measurement was performed

Roberto Cosentini; Paolo Tarsia; Ciro Canetta; Giovanna Graziadei; Anna Maria Brambilla; Stefano Aliberti; Maria Pappalettera; Francesca Tantardini; Francesco Blasi

2008-01-01

329

Emphysematous pancreatitis predisposed by Olanzapine  

PubMed Central

A 32-year-old male presented to our intensive care unit with severe abdominal pain and was diagnosed as acute pancreatitis after 2 months of olanzapine therapy for bipolar disorder. His serum lipase was 900 u/L, serum triglyceride 560 mg/dL, and blood sugar, fasting and postprandial were 230 and 478 mg/dL, respectively on admission. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of acute pancreatitis. Repeat CECT showed gas inside pancreas and collection in peripancreatic area and patient underwent percutaneous drainage and antibiotics irrigation through the drain into pancreas. We describe the rare case of emphysematous pancreatitis due to development of diabetes, hypertriglyceridemia and immunosuppression predisposed by short duration olanzapine therapy. PMID:25024479

Samanta, Sukhen; Samanta, Sujay; Banik, Krishanu; Baronia, Arvind Kumar

2014-01-01

330

Brand new SPINK1 and CFTR mutations in a child with acute recurrent pancreatitis: a case report.  

PubMed

We report a case of a 2,5 years old female, referred to our center for pancreatitis. Medical investigation revealed history of acute recurrent pancreatitis (ARP) since 1 year of age. Family history was negative for pancreatitis. Abdominal ultrasonography and magnetic resonance excluded both biliary tract stenosis and anatomic abnormalities. Calcium metabolic disorders, viral and bacterial infections were ruled out. Molecular sequencing of CFTR revealed heterozygosis for the mutation S1235R, a CFTR-related disorders associated mutation. Fecal elastase-1 (E1) was 529 ?g/gr feces (normal value 200-500 ?g/gr feces). No mutation of PRSS1 gene was detected but heterozygosity for p.Lys41Asn (c.123G>C), a new mutation of SPINK1 gene, was revealed. We speculate that the association of both SPINK1 and CFTR gene mutations may be responsible of ARP in our patient. Further studies need to better elucidate the role of genetic factors in ARP, as well as the influence of environmental factors. PMID:24217635

Terlizzi, V; De Gregorio, F; Sepe, A; Amato, N; Arduino, C; Casale, A; Majo, F; Tomaiuolo, R; Castaldo, G; Raia, V

2013-12-01

331

Evaluation of miR-216a and miR-217 as potential biomarkers of acute pancreatic injury in rats and mice.  

PubMed

Mild injury of the exocrine pancreas is often asymptomatic and can be under- or mis-diagnosed. The pancreas-enriched microRNAs miR-216a and miR-217 were evaluated as potential serum biomarkers of exocrine pancreas injury in rodent models of acute pancreatitis induced by caerulein, l-arginine, and pancreatic duct ligation. Both microRNAs showed time- and dose- relevant responses to pancreatic injury and wider dynamic ranges of response than serum amylase or lipase. Pancreas-selective microRNAs were found to be relatively sensitive serum biomarkers of pancreatic injury in rodents with potentially greater specificity than the current standard assays. PMID:25059555

Goodwin, David; Rosenzweig, Barry; Zhang, Jun; Xu, Lin; Stewart, Sharron; Thompson, Karol; Rouse, Rodney

2014-09-01

332

Laparoscopic pancreatic necrosectomy.  

PubMed

We describe a patient with infected pancreatic necrosis who was treated successfully with minimally invasive surgery. Five weeks after an episode of acute uncomplicated pancreatitis, he was found to have infected pancreatic necrosis and splenic vein thrombosis. The patient underwent a laparoscopic pancreatic necrosectomy, splenectomy, and cholecystectomy. Seven days after surgery, the patient was discharged and continued to be asymptomatic for the 6 months of follow-up. PMID:10794217

Hamad, G G; Broderick, T J

2000-04-01

333

Endoscopic ultrasound–guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications  

Microsoft Academic Search

ObjectivesThe aims of this study were to evaluate the diagnostic accuracy of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) in patients with suspected pancreatic cancer, and to assess immediate, acute, and 30-day complications related to EUS-FNA.

Mohamad A Eloubeidi; Victor K Chen; Isam A Eltoum; Darshana Jhala; David C Chhieng; Nirag Jhala; Selwyn M Vickers; C. Mel Wilcox

2003-01-01

334

[Prophylaxis of an acute postoperative pancreatitis and the stress ulcers occurrence after operations, performed on organs of hepatopancreatoduodenal zone, using miniinvasive and open access].  

PubMed

The causes of occurrence and pathogenesis of the most frequent complications, occurring after operations, made on hepatopancreatoduodenal zone organs, using minimally invasive and open accesses, were analyzed. Efficacy of domestic preparation Famozol for prophylaxis of an acute postoperative pancreatitis and the gut stress ulcers was studied. PMID:25097969

Nichita?lo, M E

2014-04-01

335

PSCs and GLP-1R: occurrence in normal pancreas, acute/chronic pancreatitis and effect of their activation by a GLP-1R agonist.  

PubMed

There is increasing concern about the development of pancreatitis in patients with diabetes mellitus who received long-term glucagon-like peptide-1 (GLP-1) analog treatment. Its pathogenesis is unknown. The effects of GLP-1 agonists on pancreatic endocrine cells are well studied; however, there is little information on effects on other pancreatic tissues that might be involved in inflammatory processes. Pancreatic stellate cells (PSCs) can have an important role in pancreatitis, secreting various inflammatory cytokines/chemokines, as well as collagen. In this study, we investigated GLP-1R occurrence in normal pancreas, acute pancreatitis (AP)/chronic pancreatitis (CP), and the effects of GLP-1 analog on normal PSCs, their ability to stimulate inflammatory mediator secretion or proliferation. GLP-1 receptor (GLP-1R) expression/localization in normal pancreas and pancreatitis (AP/CP) tissues were evaluated with histological/immunohistochemical analysis. PSCs were isolated from male Wistar rats. GLP-1R expression and effects of GLP-1 analog on activated PSCs was examined with real-time PCR, MTS assays and western blotting. In normal pancreas, pancreatic ? cells expressed GLP-1R, with only low expression in acinar cells, whereas in AP or CP, acinar cells, ductal cells and activated PSCs expressed GLP-1R. With activation of normal PSCs, GLP-1R is markedly increased, as is multiple other incretin-related receptors. The GLP-1 analog, liraglutide, did not induce inflammatory genes expression in activated PSCs, but induced proliferation. Liraglutide activated multiple signaling cascades in PSCs, and the extracellular signal-regulated kinase pathway mediated the PSCs proliferation. GLP-1Rs are expressed in normal pancreas and there is marked enhanced expression in AP/CP. GLP-1-agonist induced cell proliferation of activated PSCs without increasing release of inflammatory mediators. These results suggest chronic treatment with GLP-1R agonists could lead to proliferation/chronic activation of PSCs, which may lead to important effects in the pancreas. PMID:24217090

Nakamura, Taichi; Ito, Tetsuhide; Uchida, Masahiko; Hijioka, Masayuki; Igarashi, Hisato; Oono, Takamasa; Kato, Masaki; Nakamura, Kazuhiko; Suzuki, Koichi; Jensen, Robert T; Takayanagi, Ryoichi

2014-01-01

336

Statins and their role in acute pancreatitis: Case report and literature review  

PubMed Central

Statin induced pancreatitis has historically been considered a diagnosis of exclusion, with literature references typically in the form of case reports and observational studies. Recently, larger studies have challenged the correlations made by earlier case reports, and instead demonstrate a mild protective effect in statin users. We present a case report of likely statin induced pancreatitis in a 58-year-old male (which we have attributed to drug-drug interaction with resulting inhibition of hepatic cytochrome P450 enzymes) and have reviewed the apparent dichotomy in the available literature. PMID:25133048

Etienne, Denzil; Reda, Yousef

2014-01-01

337

Isolated granulocytic sarcoma of the pancreas: A tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia  

PubMed Central

We report two clinical cases of primary granulocytic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological presentations may have lead to pretherapeutic biopsies of the pancreatic mass in order to indicate primary chemotherapy. Literature review of this rare clinical presentation may help physicians to anticipate diagnostic and therapeutic strategies. PMID:22248364

2012-01-01

338

Severe Aplastic Anemia Manifesting After Complete Remission of Acute Promyelocytic Leukemia: Is it a Fortuitous Association?  

PubMed

Acute leukemia, secondary myelodysplasia and paroxysmal nocturnal hemoglobinuria evolving from severe aplastic anemia (AA) following immunosuppressive therapy are well recognized. However, severe AA occurring after complete remission of acute promyelocytic leukemia (APL) has been documented only once in 2009. We report a case of 30-year-old male diagnosed with APL who achieved complete cytogenetic remission with all-trans retinoic acid based induction regimen and developed severe AA few months later during maintenance therapy. PMID:24554829

Handigund, Rajeshwari Satish; Malur, Prakash R; Dhumale, Annasaheb J; Bali, Akshay; Roy, Maitrayee; Inumella, Suvarna

2014-03-01

339

Therapeutic effect of Tripterygium wilfordii Hook F multiglycosides on gut barrier dysfunction in rats with acute necrotizing pancreatitis.  

PubMed

The aim of the current study was to investigate the therapeutic effect of Tripterygium wilfordii Hook F multiglycosides (TWG) on gut barrier dysfunction in rats with acute necrotizing pancreatitis (ANP). ANP was induced in rats using 3.5% sodium taurocholate. The rats were divided into 3 groups: the sham operation (SO), ANP and ANP+TWG groups. Biochemical and pathological change of pancreatic tissue and ileal mucosa, bacterial cultures and the survival rate were measured following surgery and treatment. TWG treatment significantly decreased amylase and lipase activities and plasma endotoxin and D-lactate levels. Edema and inflammation in the pancreas and ileal mucosa were alleviated. Positive bacterial cultures were significantly reduced. The survival rate of the rats in the ANP+TWG group was higher than that of the rats in the ANP group. TWG treatment showed beneficial effects by protecting the pancreas from bacterial infection caused by gut barrier dysfunction and improving the outcomes of the rats with ANP. PMID:23408793

Wang, Jie; Wu, Gang; Ma, Baojin; Wu, Jianhua; Cai, Duan

2013-02-01

340

Pancreatic cancer  

PubMed Central

Substantial progress has been made in our understanding of the biology of pancreatic cancer, and advances in patients’ management have also taken place. Evidence is beginning to show that screening first-degree relatives of individuals with several family members affected by pancreatic cancer can identify non-invasive precursors of this malignant disease. The incidence of and number of deaths caused by pancreatic tumours have been gradually rising, even as incidence and mortality of other common cancers have been declining. Despite developments in detection and management of pancreatic cancer, only about 4% of patients will live 5 years after diagnosis. Survival is better for those with malignant disease localised to the pancreas, because surgical resection at present offers the only chance of cure. Unfortunately, 80–85% of patients present with advanced unresectable disease. Furthermore, pancreatic cancer responds poorly to most chemotherapeutic agents. Hence, we need to understand the biological mechanisms that contribute to development and progression of pancreatic tumours. In this Seminar we will discuss the most common and deadly form of pancreatic cancer, pancreatic ductal adenocarcinoma. PMID:15051286

Vincent, Audrey; Herman, Joseph; Schulick, Rich; Hruban, Ralph H; Goggins, Michael

2011-01-01

341

Pancreatic pseudocysts.  

PubMed

Improvements in imaging studies and a better understanding of the natural history of pancreatic fluid collections (PFCs) have allowed the different types to be clarified. Stratification of PFCs into subgroups should help in selecting from the increasing current available treatment options, which include percutaneous, endoscopic and surgical drainage. Percutaneous catheter drainage is safe and effective and should be the treatment of choice in poor-risk patients, and for infected pseudocysts related to acute pancreatitis. Endoscopic drainage should be the first management option in suitable pseudocysts related to chronic pancreatitis, if the necessary expertise is available. The high success rate and current low morbidity of elective open surgery mean that it is still the standard of management in this disease. Laparoscopic approaches are gaining favour, predominantly in drainage of collections in the lesser sac, and long-term data are awaited. The precise application of this modality will need to be critically compared with the low morbidity of mini-laparotomy, which is the current standard after non-operative treatment fails in these patients. It is essential to clearly stratify the different types of pancreatic pseudocysts, in particular with relation to acute or chronic pancreatitis, and perform a valid comparison of the different treatment modalities within groups. In this capacity a precise and transparent classification may provide valuable answers, in particular relating to optimal management according to pseudocyst type. PMID:17330634

Apostolou, C; Krige, J E J; Bornman, P C

2006-11-01

342

A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong  

Microsoft Academic Search

background There has been an outbreak of the severe acute respiratory syndrome (SARS) world- wide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong. abstract

Nelson Lee; David Hui; Alan Wu; Paul Chan; Peter Cameron; Gavin M. Joynt; Anil Ahuja; Man Yee Yung; C. B. Leung; S. F. Lui; C. C. Szeto; Sydney Chung; Joseph J. Y. Sung

2010-01-01

343

[A case of intraductal papillary mucinous carcinoma found with acute obstructive suppurative pancreatic ductitis and liver abscess, and associated with a pancreatobiliary fistula].  

PubMed

We report a rare case of intraductal papillary mucinous carcinoma (IPMC) with acute obstructive suppurative pancreatic ductitis (AOSPD), liver abscess, and pancreatobiliary fistula formation. A man in his sixties was admitted to our hospital with a chief complain of high grade fever and anorexia. CT and MRI revealed a multilocular cystic lesion in the pancreatic head, fistula formation between the common bile duct and this cystic lesion, and multiple liver abscess. We performed endoscopic nasopancreatic drainage for the AOSPD, endoscopic biliary drainage for the biliary flow obstruction, and percutaneous transhepatic drainage for the liver abscess. Klebsiella pneumoniae was detected in the culture of pancreatic juice and liver abscess, but not in the bile and blood culture. These culture studies revealed that the liver abscess was caused by AOSPD. The patient underwent pancreaticoduodenectomy for the IPMC. The pathological diagnosis was IPMC. PMID:23831662

Nishie, Hirotada; Okumura, Fumihiro; Fukusada, Shigeki; Inoue, Tadahisa; Kachi, Kenta; Anbe, Kaiki; Natsume, Makoto; Nishi, Yuji; Yoshimura, Norihiro; Mizushima, Takashi; Sano, Hitoshi; Kajikawa, Masaki; Harada, Akio; Naitoh, Itaru; Hayashi, Kazuki; Nakazawa, Takahiro

2013-07-01

344

Home-based therapy for severe acute malnutrition with ready-to-use food.  

PubMed

Severe acute malnutrition is a devastating condition afflicting under-5 children in many developing countries, but concentrated in sub-Saharan Africa. This paper examines the development of home-based lipid-nutrient therapeutic foods for the treatment of acute malnutrition in sub-Saharan Africa and the adoption of these therapies as a standard of care for non-complicated cases of acute malnutrition. Several of the early key clinical and operational effectiveness trials are discussed as well as the adoption of home-based treatment as a standard operating procedure in regions where malnutrition is present. PMID:25066618

Murray, Ellen; Manary, Mark

2014-11-01

345

Gallstone pancreatitis--a critical review of current treatment strategies.  

PubMed

This review critically analyses the role of urgent biliary decompression in the management of acute gallstone pancreatitis with the emphasis on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). In an analysis of currently available prospective randomised trials the role of routine urgent ERCP with or without ES in patients with predicted severe pancreatitis is challenged. Patients with persistent biliary obstruction and associated cholangitis appear to be the only subgroup who may benefit from urgent biliary intervention. PMID:11424863

Bornman, P C; Beckingham, I J; Krige, J E

2000-12-01

346

Pharmacological blockade of the MaxiK channel attenuates experimental acute pancreatitis and associated lung injury in rats.  

PubMed

Increasing evidence has recently demonstrated that soluble heparan sulfate (HS), a degradation product of extracellular matrix produced by elastase, plays a key role in the aggravation of acute pancreatitis (AP) and associated lung injury. However little is known about the detailed mechanism underlying HS-induced inflammatory cascade. Our previous work has provided a valuable clue that a large-conductance K(+) channel (MaxiK) was involved in the HS-stimulated activation of murine macrophages. Here we attempted to ask whether pharmacological inhibition of the MaxiK channel will exert beneficial effects on the treatment of AP and secondary lung injury. The protective effects of paxilline, a specific blocker of MaxiK, on rats against sodium taurocholate induced AP were evaluated. Our data showed that paxilline substantially attenuated AP and resultant lung injury, mainly by limiting the burst of inflammatory responses, as proven by decreased plasma concentrations of tumor necrosis factor-? and macrophage inflammatory protein-2, together with unimpaired pancreatic enzyme activities in rats suffering from AP. Compared with the therapeutic administration, pre-treatment of paxilline showed superior potential to slow down the progress of AP. Furthermore, AP rats received paxilline exhibited improved histopathologic alterations both in the pancreas and the lungs, and even lower lung MPO activity. Taken together, our study provides evidence that MaxiK is involved in the spread of inflammatory responses and the following lung injury during the attack of AP, indicating that this ion channel is a promising candidate as a therapeutic target for AP. PMID:24836752

Ren, Jian-Dong; Xing, Yong-Jun; Fan, Kai-Hua; Yu, Bo-Tao; Jin, Wei-Hua; Jiang, Yan; Jing, Li; Wu, Xue-Chai; Wang, Shi-Hua; Wu, Juan; Chen, Hua

2014-07-01

347

Exogenous Glucose Administration Impairs Glucose Tolerance and Pancreatic Insulin Secretion during Acute Sepsis in Non-Diabetic Mice  

PubMed Central

Objectives The development of hyperglycemia and the use of early parenteral feeding are associated with poor outcomes in critically ill patients. We therefore examined the impact of exogenous glucose administration on the integrated metabolic function of endotoxemic mice using our recently developed frequently sampled intravenous glucose tolerance test (FSIVGTT). We next extended our findings using a cecal ligation and puncture (CLP) sepsis model administered early parenteral glucose support. Methods Male C57BL/6J mice, 8-12 weeks, were instrumented with chronic indwelling arterial and venous catheters. Endotoxemia was initiated with intra-arterial lipopolysaccharide (LPS; 1 mg/kg) in the presence of saline or glucose infusion (100 µL/hr), and an FSIVGTT was performed after five hours. In a second experiment, catheterized mice underwent CLP and the impact of early parenteral glucose administration on glucose homeostasis and mortality was assessed over 24 hrs. Measurements And MAIN RESULTS: Administration of LPS alone did not impair metabolic function, whereas glucose administration alone induced an insulin sensitive state. In contrast, LPS and glucose combined caused marked glucose intolerance and insulin resistance and significantly impaired pancreatic insulin secretion. Similarly, CLP mice receiving parenteral glucose developed fulminant hyperglycemia within 18 hrs (all > 600 mg/dl) associated with increased systemic cytokine release and 40% mortality, whereas CLP alone (85 ± 2 mg/dL) or sham mice receiving parenteral glucose (113 ± 3 mg/dL) all survived and were not hyperglycemic. Despite profound hyperglycemia, plasma insulin in the CLP glucose-infused mice (3.7 ± 1.2 ng/ml) was not higher than sham glucose infused mice (2.1 ± 0.3 ng/ml). Conclusions The combination of parenteral glucose support and the systemic inflammatory response in the acute phase of sepsis induces profound insulin resistance and impairs compensatory pancreatic insulin secretion, leading to the development of fulminant hyperglycemia. PMID:23826335

Zou, Baobo; Guo, Lanping; Stefanovski, Darko; Alonso, Laura C.; Garcia-Ocana, Adolfo; O'Donnell, Christopher P.; McVerry, Bryan J.

2013-01-01

348

Severe acute respiratory syndrome (SARS): lessons learnt in Hong Kong.  

PubMed

Many healthcare workers were infected while looking after the SARS patients on the medical wards in 2003. The high infectivity of the SARS coronavirus with peak viral load on day 10 of illness when patients were ill, overcrowding of the old medical wards with low air changes/hr (ACH), and aerosol-generating procedures while resuscitating the patients were the major factors. Procedures reported to present an increased risk of SARS transmission include tracheal intubation, non-invasive ventilation, tracheotomy and manual ventilation before intubation whereas oxygen therapy and bed distance <1 m were also implicated. Studies based on laser visualization technique with smoke particles as smokers in the human patient simulator has shown that oxygen therapy via Hudson mask and nasal cannula could disperse exhaled air of patients to 0.4 and 1 m respectively whereas jet nebulizer could disperse exhaled air >0.8 m from the patient. Bigger isolation rooms with 16 ACH are more effective than smaller isolation rooms with 12 ACH in removing exhaled air and preventing room contamination but at the expense of more noise and electricity consumption. Non-invasive ventilation via face masks and single circuit can disperse exhaled air from 0.4 to 1 m. Both higher inspiratory pressures and use of whisper swivel device (to facilitate carbon dioxide removal) could increase the exhaled air leakage and isolation room contamination during on-invasive ventilation. Addition of a viral-bacterial filter during manual ventilation by bagging may reduce the exhaled air leakage forward and yet increase the sideway leakage. N95 mask was more effective than surgical mask in preventing expelled air leakage during patient's coughing but there was still significant sideway leakage to 15 cm. Clinicians should be aware of air leakage from the various face masks and adopt strict infection control measures during resuscitation of patients with severe respiratory infections. Carefully designed clinical trials are required to determine the optimal timing and dosage of any antiviral agents, convalescent plasma, and immuno-modulating agents in the treatment of the possibly immune-mediated lung injury in SARS and newly emerged infection such as the Middle East Respiratory Syndrome. PMID:23977432

Hui, David S

2013-08-01

349

Severe acute respiratory syndrome (SARS): lessons learnt in Hong Kong  

PubMed Central

Many healthcare workers were infected while looking after the SARS patients on the medical wards in 2003. The high infectivity of the SARS coronavirus with peak viral load on day 10 of illness when patients were ill, overcrowding of the old medical wards with low air changes/hr (ACH), and aerosol-generating procedures while resuscitating the patients were the major factors. Procedures reported to present an increased risk of SARS transmission include tracheal intubation, non-invasive ventilation, tracheotomy and manual ventilation before intubation whereas oxygen therapy and bed distance <1 m were also implicated. Studies based on laser visualization technique with smoke particles as smokers in the human patient simulator has shown that oxygen therapy via Hudson mask and nasal cannula could disperse exhaled air of patients to 0.4 and 1 m respectively whereas jet nebulizer could disperse exhaled air >0.8 m from the patient. Bigger isolation rooms with 16 ACH are more effective than smaller isolation rooms with 12 ACH in removing exhaled air and preventing room contamination but at the expense of more noise and electricity consumption. Non-invasive ventilation via face masks and single circuit can disperse exhaled air from 0.4 to 1 m. Both higher inspiratory pressures and use of whisper swivel device (to facilitate carbon dioxide removal) could increase the exhaled air leakage and isolation room contamination during on-invasive ventilation. Addition of a viral-bacterial filter during manual ventilation by bagging may reduce the exhaled air leakage forward and yet increase the sideway leakage. N95 mask was more effective than surgical mask in preventing expelled air leakage during patient’s coughing but there was still significant sideway leakage to 15 cm. Clinicians should be aware of air leakage from the various face masks and adopt strict infection control measures during resuscitation of patients with severe respiratory infections. Carefully designed clinical trials are required to determine the optimal timing and dosage of any antiviral agents, convalescent plasma, and immuno-modulating agents in the treatment of the possibly immune-mediated lung injury in SARS and newly emerged infection such as the Middle East Respiratory Syndrome. PMID:23977432

2013-01-01

350

Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury  

Microsoft Academic Search

Purpose  Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury\\u000a (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children\\u000a with severe TBI at hospital discharge and 6 months later.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective analysis of blood glucose levels in children with severe TBI at a

José Roberto Tude Melo; Federico Di Rocco; Stéphane Blanot; Anne Laurent-Vannier; Rodolfo Casimiro Reis; Thomas Baugnon; Christian Sainte-Rose; Jamary Olveira-Filho; Michel Zerah; Philippe Meyer

2010-01-01

351

Translocation (8;21) acute myeloid leukemia presenting as severe aplastic anemia  

PubMed Central

We report a case of t(8;21) acute myeloid leukemia presenting as severe aplastic anemia. While initial bone marrow biopsy lacked any cytogenetic abnormalities in 20 analyzed metaphases, repeat bone marrow biopsy eight days later demonstrated this translocation. Initial cytogenetic analysis of 20 metaphases was therefore insufficient to make the diagnosis of hypocellular acute myeloid leukemia. We discuss that further complementary molecular tests, such as CGH, would likely provide a more robust diagnosis of hematopoietic diseases. PMID:25003026

Purev, Enkhtsetseg; Dumitriu, Bogdan; Hourigan, Christopher S.; Young, Neal S.; Townsley, Danielle M.

2014-01-01

352

Severe Acute Respiratory Syndrome and the Delivery of Continuing Medical Education: Case Study from Toronto  

ERIC Educational Resources Information Center

Introduction: Severe acute respiratory syndrome (SARS) struck Toronto in the spring of 2003, causing many deaths, serious morbidity, forced quarantine of thousands of individuals, and the closure of all provincial hospitals for several weeks. Given the direction by public health authorities to cancel or postpone all continuing medical education…

Davis, Dave; Ryan, David; Sibbald, Gary; Rachlis, Anita; Davies, Sharon; Manchul, Lee; Parikh, Sagar

2004-01-01

353

Factors Predicting Bacterial Involvement in Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Background: Strategies aiming at reducing antibiotic use are required in the intensive care unit (ICU). Although antibiotic treatment is recommended in patients with severe exacerbation of chronic obstructive pulmonary disease (COPD), a bacterial etiology is found in only a half of these patients. Objectives: The aim of this study was to determine factors predicting bacterial isolation in severe acute exacerbations

Saad Nseir; Béatrice Cavestri; Christophe di Pompeo; Maimouna Diarra; Hélčne Brisson; Malcolm Lemyze; Micheline Roussel-Delvallez; Alain Durocher

2008-01-01

354

Association of Thymidylate Synthase Polymorphisms with Acute Pancreatitis and/or Peripheral Neuropathy in HIV-Infected Patients on Stavudine-Based Therapy  

PubMed Central

Background Low expression thymidylate synthase (TS) polymorphism has been associated with increased stavudine triphosphate intracellular (d4T-TP) levels and the lipodystrophy syndrome. The use of d4T has been associated with acute pancreatitis and peripheral neuropathy. However, no relationship has ever been proved between TS polymorphisms and pancreatitis and/or peripheral neuropathy. Methods We performed a case-control study to assess the relationship of TS and methylene-tetrahydrofolate reductase (MTHFR) gene polymorphisms with acute pancreatitis and/or peripheral neuropathy in patients exposed to d4T. Student’s t test, Pearson’s correlations, one-way ANOVA with Bonferroni correction and stepwise logistic regression analyses were done. Results Forty-three cases and 129 controls were studied. Eight patients (18.6%) had acute pancreatitis, and 35 (81.4%) had peripheral neuropathy. Prior AIDS was more frequent in cases than in controls (OR?=?2.36; 95%CI 1.10–5.07, P?=?0.0247). L7ow expression TS and MTHFR genotype associated with increased activity were more frequent in patients with acute pancreatitis and/or peripheral neuropathy than in controls (72.1% vs. 46.5%, OR?=?2.97; 95%CI: 1.33–6.90, P?=?0.0062, and 79.1% vs. 56.6%, OR?=?2.90, 95%CI: 1.23–7.41, P?=?0.0142, respectively). Independent positive or negative predictors for the development of d4T-associated pancreatitis and/or peripheral neuropathy were: combined TS and MTHFR genotypes (reference: A+A; P?=?0.002; ORA+B?=?0.34 [95%CI: 0.08 to 1.44], ORB+A?=?3.38 [95%CI: 1.33 to 8.57], ORB+B?=?1.13 [95%CI: 0.34 to 3.71]), nadir CD4 cell count >200 cells/mm3 (OR?=?0.38; 95%CI: 0.17–0.86, P?=?0.021), and HALS (OR?=?0.39 95%CI: 0.18–0.85, P?=?0.018). Conclusions Low expression TS plus a MTHFR genotype associated with increased activity is associated with the development of peripheral neuropathy in d4T-exposed patients. PMID:23468971

Torres, Ferran; Salazar, Juliana; Gutierrez, Maria del Mar; Mateo, Maria Gracia; Martinez, Esteban; Domingo, Joan Carles; Fernandez, Irene; Villarroya, Francesc; Ribera, Esteban; Vidal, Francesc; Baiget, Montserrat

2013-01-01

355

Pathobiology of Alcoholic Pancreatitis  

Microsoft Academic Search

This paper provides a summary of the effects of alcohol abuse on the pathobiologic responses that occur during acute and chronic pancreatitis considering both the human disease and animal\\/tissue models. The effects are multiple and include ones on cell death leading to necrosis; on inflammation resulting in a sensitized response to pancreatic stress; and fibrosis through effects of ethanol on

Stephen J. Pandol; Michael Raraty

2007-01-01

356

TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos).  

PubMed

Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html. PMID:23340953

Yokoe, Masamichi; Takada, Tadahiro; Strasberg, Steven M; Solomkin, Joseph S; Mayumi, Toshihiko; Gomi, Harumi; Pitt, Henry A; Garden, O James; Kiriyama, Seiki; Hata, Jiro; Gabata, Toshifumi; Yoshida, Masahiro; Miura, Fumihiko; Okamoto, Kohji; Tsuyuguchi, Toshio; Itoi, Takao; Yamashita, Yuichi; Dervenis, Christos; Chan, Angus C W; Lau, Wan-Yee; Supe, Avinash N; Belli, Giulio; Hilvano, Serafin C; Liau, Kui-Hin; Kim, Myung-Hwan; Kim, Sun-Whe; Ker, Chen-Guo

2013-01-01

357

Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality.  

PubMed

OBJECTIVE. To review demographics of patients with acute pyelonephritis, their outcomes of severe upper urinary tract infection, and to identify risk factors for long hospital stay and mortality. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients admitted between June 2007 and June 2012 for acute pyelonephritis were identified. Those with the most severe outcomes were analysed of their mortality, need for care in the intensive care unit, or necessitation of urological intervention. RESULTS. Overall, 68 patients fulfilled our criteria for severe acute pyelonephritis. The female-to-male ratio was 7:3. Their mean age was 58 years. Overall, 57% of the patients had impaired renal function and 37% were diabetic; 47% developed shock after admission and 56% required further intensive care unit care; 75% of the patients demonstrated radiological evidence of urinary tract obstruction and required subsequent drainage procedures. Five patients died due to severe acute pyelonephritis. The prevalence of bacteraemia and bacteriuria was 57% and 74%, respectively. Escherichia coli accounted for the majority of causative organisms. Four risk factors-bacteraemia, shock, need for intensive care, and suppurative pyelonephritis-were associated with hospital stay of longer than 14 days. Old age (?65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. CONCLUSION. There was high prevalence of bacteraemia and septic shock in patients with severe acute pyelonephritis. The factors of old age (?65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. With the support of intensive care, early recognition of urinary tract obstruction and timely drainage, patients with severe acute pyelonephritis generally carry a good prognosis. PMID:24625386

Chung, Vera Y; Tai, C K; Fan, C W; Tang, C N

2014-08-01

358

Arsenic-Induced Pancreatitis  

PubMed Central

The introduction of all-trans retinoic acid (ATRA) and arsenic trioxide has brought about tremendous advancement in the treatment of acute promyelocytic myelogenous leukemia (APML). In most instances, the benefits of these treatments outweigh the risks associated with their respective safety profiles. Although acute pancreatitis is not commonly associated with arsenic toxicity, it should be considered as a possible side effect. We report a case of arsenic-induced pancreatitis in a patient with APML. PMID:22606427

Connelly, Sean; Zancosky, Krysia; Farah, Katie

2011-01-01

359

T helper 2 (Th2) T cells induce acute pancreatitis and diabetes in immune-compromised nonobese diabetic (NOD) mice.  

PubMed

Autoimmune diabetes is caused by the CD4(+), T helper 1 (Th1) cell-mediated apoptosis of insulin-producing beta cells. We have previously shown that Th2 T cells bearing the same T cell receptor (TCR) as the diabetogenic Th1 T cells invade islets in neonatal nonobese diabetic (NOD) mice but fail to cause disease. Moreover, when mixed in excess and cotransferred with Th1 T cells, Th2 T cells could not protect NOD neonates from Th1-mediated diabetes. We have now found, to our great surprise, the same Th2 T cells that produced a harmless insulitis in neonatal NOD mice produced intense and generalized pancreatitis and insulitis associated with islet cell necrosis, abscess formation, and subsequent diabetes when transferred into immunocompromised NOD.scid mice. These lesions resembled allergic inflamation and contained a large eosinophilic infiltrate. Moreover, the Th2-mediated destruction of islet cells was mediated by local interleukin-10 (IL-10) production but not by IL-4. These findings indicate that under certain conditions Th2 T cells may not produce a benign or protective insulitis but rather acute pathology and disease. Additionally, these results lead us to question the feasibility of Th2-based therapy in type I diabetes, especially in immunosuppressed recipients of islet cell transplants. PMID:9221759

Pakala, S V; Kurrer, M O; Katz, J D

1997-07-21

360

The intestinal mucus layer is a critical component of the gut barrier that is damaged during acute pancreatitis.  

PubMed

Gut barrier failure has been implicated in the progression from single-organ injury to multiple-organ failure. The unstirred mucus layer is a major component of the physiological gut barrier; its role in acute pancreatitis (AP) is not clearly defined. Rats underwent biliopancreatic duct ligation-induced AP; two controls were used: biliopancreatic duct ligation with drainage and sham duct ligation. After 4.5 h, serum and ascitic amylase activity was measured. Mucus was analyzed for reactive nitrogen intermediate-mediated damage, reactive oxygen species-induced damage, and total antioxidant capacity. Mucus coverage and villous injury were assessed histologically. Ileum permeability was measured by diffusion of a fluorescent Dextran probe. Histology and morphology of the mucus layer were validated in a mouse AP model (intraductal taurocholate plus cerulein). Biliopancreatic duct ligation increased serum ?-amylase, ascitic volume, and ascitic ?-amylase. Intestinal permeability was increased, which was associated with loss of the unstirred mucus layer but not villous injury. These changes correlated with increased reactive oxygen species- and- reactive nitrogen intermediate-mediated mucus damage as well as decreased mucus total antioxidant capacity but were not present in the two control groups. Using a different model of AP in mice, the finding of mucus layer disruption was recapitulated at 6 h after AP, but by 24 h, rebound hypersecretion of inspissated mucus was seen. These results support the hypothesis that damage to the unstirred mucus layer with evidence of oxidative stress occurs during AP-induced gut barrier failure. PMID:24978882

Fishman, Jordan E; Levy, Gal; Alli, Vamsi; Zheng, Xiaozhong; Mole, Damian J; Deitch, Edwin A

2014-09-01

361

Early high volume lung lavage for acute severe smoke inhalation injury in dogs.  

PubMed

The aim of the present study was to investigate the safety and short?term results of early high volume lung lavage in the treatment of acute severe smoke inhalation injuries in dogs. A high?volume normal saline complex solution lavage in the left lung was performed 1 h subsequent to bilateral pulmonary acute severe sawdust smoke inhalation injury in dogs. Lavage of the right lung was conducted following an interval of 30 min or 4 h. The perfluorodecalin lavage was performed in dogs with unilateral pulmonary acute severe sawdust smoke inhalation injury. The present study identified that lavage with an interval of 4 h between two lungs was safer compared with a 30?min interval. Following lavage, the increase in the levels of free radical metabolites and inflammatory mediators in the lung homogenate was reduced. Acute severe smoke inhalation injury in one lung evidently caused a secondary injury to the other lung in the dogs. Perfluorodecalin lavage did not achieve the same effect in cleansing the lungs as the normal saline, but a greater comprehensive short?term outcome was obtained. These observations demonstrated that early high?volume lung lavage following severe smoke inhalation injury could relieve primary injuries and secondary local and general inflammatory reactions in dogs. An improved comprehensive short?term outcome was obtained in the perfluorodecalin?lavaged dogs. PMID:24366331

Nie, Fachuan; Su, Dong; Shi, Ying; Chen, Jinmei; Wang, Haihui; Qin, Wanxiang; Wang, Suxia; Chen, Yaohua

2014-03-01

362

Quantitative Evaluation of the Severity of Acute Illness in Adult Patients with Tick-Borne Encephalitis  

PubMed Central

The aim of the present study was to quantify the severity of acute illness in patients with tick-borne encephalitis and to ascertain this approach by comparing it to standard clinical assessment. We designed scoring system for quantification of the severity of acute illness in patients with tick-borne encephalitis. Certain number of points was allotted to the presence, intensity, and duration of individual symptoms/signs. According to the obtained score the disease was classified as mild, moderate, and severe. Tick-borne encephalitis was assessed clinically as mild when only signs/symptoms of meningeal involvement were found, moderate in case of monofocal neurological signs and/or mild to moderate signs/symptoms of central nervous system dysfunction, and severe in patients with multifocal neurological signs and/or symptoms of severe dysfunction of central nervous system. By designed scoring system 282 adult patients, 146 males and 136 females, average aged 52.2?±?15.5 years (range 15–82 years), with confirmed tick-borne encephalitis, were prospectively assessed. In 279/282 (98.9%) patients the severity according to clinical assessment matched with the score ranges for mild, moderate, and severe disease. The proposed approach enables precise and straightforward appraisal of the severity of acute illness and could be useful for comparison of findings within/between study groups. PMID:24895617

Bogovic, Petra; Logar, Mateja; Avsic-Zupanc, Tatjana; Strle, Franc; Lotric-Furlan, Stanka

2014-01-01

363

Severe acute hepatitis E in an HIV infected patient: Successful treatment with ribavirin.  

PubMed

In industrialized countries, most cases of hepatitis E virus (HEV) infection in humans are autochthonous, mainly through foodborne and zoonotic transmission routes. In Europe, genotype 3 is a cause of acute self-limiting viral hepatitis, but can also be responsible for chronic hepatitis in immunocompromised patients. Ribavirin has been successfully used in the treatment of chronic hepatitis E and in a few cases of severe acute hepatitis E in immunocompetent patients. We report here the case of a 39 year-old man infected with HIV presenting with acute hepatitis E (genotype 3c). Unlike most cases, evolution was severe with a fall of prothrombin time down to 45%. Treatment with ribavirin allowed rapid viral clearance and a gradual normalization of liver function tests. PMID:24894604

Robbins, A; Lambert, D; Ehrhard, F; Brodard, V; Hentzien, M; Lebrun, D; Nguyen, Y; Tabary, T; Peron, J M; Izopet, J; Bani-Sadr, F

2014-08-01

364

Selected Cytokines in Patients with Pancreatic Cancer: A Preliminary Report  

PubMed Central

Background/Aims Recent experimental studies have suggested that various cytokines may be important players in the development and progression of pancreatic cancer. However, these findings have not yet been verified in a clinical setting. Methods In this study, we examined the levels of a broad panel of cytokines, including interleukin (IL)-1, IL-6, IL-8, IL-10, IL-12, IL-17, and IL-23, as well as tumor necrosis factor alpha (TNF?) and granulocyte-colony stimulating factor (G-CSF) in patients with pancreatic adenocarcinoma (n?=?43), other pancreatic malignancies (neuroendocrine [n?=?10] and solid pseudopapillary tumors [n?=?3]), and healthy individuals (n?=?41). Results We found that there were higher levels of IL-6, IL-8, IL-10 and TNF? in patients with pancreatic cancer compared to healthy controls (for all, at least p<0.03). Cancer patients had lower IL-23 concentrations than healthy individuals and patients diagnosed with other types of malignancies (for both, p?=?0.002). Levels of IL-6, IL-8, IL-10, and IL-23 were significantly associated with the direct number of circulating bone marrow (BM)-derived mesenchymal or very small embryonic/epiblast-like stem cells (SCs) in patients with pancreatic cancer. Moreover, our study identified a potential ability of IL-6, IL-8, IL-10, IL-23, and TNF? levels to enable discrimination of pancreatic cancer from other pancreatic tumors and diseases, including acute and chronic pancreatitis and post-pancreatitis cysts (with sensitivity and specificity ranging between 70%–82%). Conclusions Our study i) supports the significance of selected cytokines in the clinical presentation of pancreatic cancer, ii) highlights numerous associations between selected interleukins and intensified BMSCs trafficking in patients with pancreatic cancer, and iii) preliminarily characterizes the diagnostic potential of several cytokines as potential novel clinical markers of pancreatic cancer in humans. PMID:24849506

Blogowski, Wojciech; Deskur, Anna; Budkowska, Marta; Salata, Daria; Madej-Michniewicz, Anna; Dabkowski, Krzysztof; Dolegowska, Barbara; Starzynska, Teresa

2014-01-01

365

ACUTE TOXICITY OF AMMONIA TO SEVERAL DEVELOPMENTAL STAGES OF RAINBOW TROUT, SALMO GAIRDNERI  

E-print Network

of Salmo trutta. Penaz observed an increase in sensitivity of the eggs with age to brief (120 minACUTE TOXICITY OF AMMONIA TO SEVERAL DEVELOPMENTAL STAGES OF RAINBOW TROUT, SALMO GAIRDNERI STANLEY to determine the stage of development at which eggs and larvae of rainbow trout, Salmo gairdneri, were most

366

Virus Research 120 (2006) 146155 Inhibition of severe acute respiratory syndrome-associated coronavirus  

E-print Network

, Galveston, TX 77555, USA f Autoimmune Technologies, LLC, New Orleans, LA 70112, USA Received 20 July 2005 of SARS-CoV and murine hepatitis virus (MHV) were identified. Peptides analogous to regions of the N; Peptide inhibitor; Murine hepatitis virus; Six-helix bundle; Anti-viral 1. Introduction Severe acute

Wimley, William C.

367

Control of the 20022003 severe acute respiratory syndrome (SARS) outbreak was based on rapid diagnosis  

E-print Network

Control of the 2002­2003 severe acute respiratory syndrome (SARS) outbreak was based on rapid originated in Guangdong Province, China, in November 2002 (1). Researchers at the Erasmus Medical Center to another. Control of an outbreak relies partly on identify- ing what disease parameters are likely to lead

Hyman, James "Mac"

368

Population mortality during the outbreak of Severe Acute Respiratory Syndrome in Toronto  

Microsoft Academic Search

BACKGROUND: Extraordinary infection control measures limited access to medical care in the Greater Toronto Area during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. The objective of this study was to determine if the period of these infection control measures was associated with changes in overall population mortality due to causes other than SARS. METHODS: Observational study of death registry

Stephen W Hwang; Angela M Cheung; Rahim Moineddin; Chaim M Bell

2007-01-01

369

Controlled trial of bowel rest in the treatment of severe acute colitis  

Microsoft Academic Search

In a prospective, randomised clinical trial, 47 patients with severe, acute, non-infective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27

P B McIntyre; J Powell-Tuck; S R Wood; J E Lennard-Jones; E Lerebours; P Hecketsweiler; J P Galmiche; R Colin

1986-01-01

370

Animal coronaviruses: what can they teach us about the severe acute respiratory syndrome?  

Microsoft Academic Search

Summary In 2002, a new coronavirus (CoV) emerged in the People's Republic of China, associated with a severe acute respiratory syndrome (SARS) and mortality in humans. The epidemic rapidly spread throughout the world before being contained in 2003, although sporadic cases occurred thereafter in Asia. The virus is thought to be of zoonotic origin from a wild animal reservoir (Himalayan

L. J. Saif

2004-01-01

371

Abstract --Highly infectious diseases such as SARS (Severe Acute Respiratory Syndrome), Avian Influenza (Bird Flu),  

E-print Network

Abstract -- Highly infectious diseases such as SARS (Severe Acute Respiratory Syndrome), Avian to the global population. Detection and pre- vention of infectious diseases is notoriously complex and prob of cases and transmission routes in a rapid manner is crucial in pre- venting the infectious disease from

Si, Yain Whar "Lawrence"

372

The Mental Health of Hospital Workers Dealing with Severe Acute Respiratory Syndrome  

Microsoft Academic Search

Background: The aim of this study was to explore the impact of the severe acute respiratory syndrome (SARS) on health care workers in Taiwan. The possible predisposing and perpetuating factors in developing mental symptoms were investigated. Methods: Participantsconsisted of 135 health care workers who had had contact with or took care of patients who were probable or suspected SARS cases,

Yi-Ching Lu; Bih-Ching Shu; Yong-Yuan Chang; For-Wey Lung

2006-01-01

373

Acute acalculous cholecystitis in severely traumatized patients: a prospective sonographic study  

Microsoft Academic Search

Summary  Acute acalculous cholecystitis is a well known complication in severely traumatized patients. Existing data originate from retrospective analyses and episodic case reports. In a prospective ultrasonographic study 25 polytraumatized patients admitted to our intensive care unit between January 1, 1989, and December 31, 1989, were examined in daily intervals for this condition. Trauma scoring was performed according to the injury

M. Imhof; J. Raunest; U. Rauen; Ch. Ohmann

1992-01-01

374

Assessment of Immunoreactive Synthetic Peptides from the Structural Proteins of Severe Acute Respiratory Syndrome Coronavirus  

Microsoft Academic Search

Background: The widespread threat of severe acute respiratory syndrome (SARS) to human life has spawned challenges to develop fast and accurate analyt- ical methods for its early diagnosis and to create a safe antiviral vaccine for preventive use. Consequently, we thoroughly investigated the immunoreactivities with patient sera of a series of synthesized peptides from SARS-coronavirus structural proteins. Methods: We synthesized

Jingqiang Wang; Jie Wen; Jingxiang Li; Jianning Yin; Qingyu Zhu; Hao Wang; Yongkui Yang; Wei Li; Xiaolei Li; Shengyong Huang; Ruifu Yang; Xumin Zhang; Ling Yang; Ting Zhang; Ye Yin; Xiaodai Cui; Xiangjun Tang; Luoping Wang; Bo He; Lianhua Ma; Tingting Lei; Changqing Zeng; Jianqiu Fang; Jun Yu; Jian Wang; Huanming Yang; Matthew B. West; Aruni Bhatnagar; Youyong Lu; Ningzhi Xu; Siqi Liu

375

Severe Acute Respiratory Syndrome epidemic and change of people's health behavior in China  

Microsoft Academic Search

Severe Acute Respiratory Syndrome (SARS) has become a new worldwide epidemic whose origin was until recently unknown. It is the un- predictable nature of this epidemic that makes people want answers to some important ques- tions about what they can do to protect them- selves. This study presents an inquiry into people's knowledge and self-reported changes in behavior in response

Xiaodong Tan; Shiyue Li; Chunhong Wang; Xiaoqing Chen; Xiaomin Wu

2004-01-01

376

Viral Pathogens and Severe Acute Respiratory Syndrome: Oligodynamic Ag1 for Direct Immune Intervention  

Microsoft Academic Search

This retrospective study of silver-based therapeutics briefly reviews their history, and then explores the modern application of charged silver particles, especially as an antiviral agent. The recent outbreak of severe acute respiratory syndrome (SARS) suggests this is timely. Medical literature shows that a variety of viruses have been successfully treated with silver- based drugs. However, 'silver salts' and\\/or inferior silver

ERIC J. RENTZ

377

Acute renal failure in a Caucasian traveler with severe malaria: a case report  

PubMed Central

Key Clinical Message Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.

Meremo, Alfred J; Kilonzo, Semvua B; Munisi, David; Kapinga, Janet; Juma, Mwinyikondo; Mwanakulya, Simfukwe; Mpondo, Bonaventura

2014-01-01

378

Illness in Intensive Care Staff after Brief Exposure to Severe Acute Respiratory Syndrome  

Microsoft Academic Search

Severe acute respiratory syndrome (SARS) is a threat to healthcare workers. After a brief, unexpected exposure to a patient with SARS, 69 intensive-care staff at risk for SARS were interviewed to evaluate risk factors. SARS developed in seven healthcare workers a median of 5 days (range 3-8) after last exposure. SARS developed in 6 of 31 persons who entered the

Damon C. Scales; Karen Green; Adrienne K. Chan; Susan M. Poutanen; Donna Foster; Kylie Nowak; Janet M. Raboud; Refik Saskin; Stephen E. Lapinsky; Thomas E. Stewart

379

The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach  

PubMed Central

Background Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from extended family members, donations from neighbors and the community, and additional benefits from employers. However, insured households overall had positive perceptions of insurance. PMID:25308817

Aji, Budi; Yamamoto, Shelby Suzanne; Sauerborn, Rainer

2014-01-01

380

Mechanism of kinin release during experimental acute pancreatitis in rats: evidence for pro- as well as anti-inflammatory roles of oedema formation.  

PubMed

1 Kinin B(2) receptor antagonists or tissue kallikrein (t-KK) inhibitors prevent oedema formation and associated sequelae in caerulein-induced pancreatitis in the rat. We have now further investigated the mechanism of kinin generation in the pancreas. 2 Kinins were elevated in the pancreatic tissue already before oedema formation became manifest. Peak values (421+/-59 pmol g(-1) dry wt) were reached at 45 min and remained elevated for at least 2 h; a second increase was observed at 24 h. Pretreatment with the B(2) receptor antagonist icatibant abolished kinin formation, while post-treatment was ineffective. 3 Total kininogen levels were very low in the pancreas of controls, but increased 75-fold during acute pancreatitis. This increase was absent in rats that were pretreated with icatibant. 4 During pancreatitis, t-KK-like and plasma kallikrein (p-KK)-like activity in the pancreas, as well as trypsinogen activation peptide (TAP) increased significantly. Icatibant pretreatment further augmented t-KK about 100-fold, while p-KK was significantly attenuated; TAP levels remained unaffected. 5 Endogenous protease inhibitors (alpha(1)-antitrypsin, alpha(2)-macroglobulin) were low in normal tissues, but increased 45- and four-fold, respectively, during pancreatitis. This increase was abolished when oedema formation was prevented by icatibant. 6 In summary, oedema formation is initiated by t-KK; the ensuing plasma protein extravasation supplies further kininogen and active p-KK to the tissue. Concomitantly, endogenous protease inhibitors in the oedema fluid inhibit up to 99% of active t-KK. Our data thus suggest a complex interaction between kinin action and kinin generation involving positive and negative feedback actions of the inflammatory oedema. PMID:12770935

Griesbacher, Thomas; Rainer, Irmgard; Tiran, Beate; Fink, Edwin; Lembeck, Fred; Peskar, Bernhard A

2003-05-01

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