Sample records for severe acute pancreatitis

  1. Severe Acute Pancreatitis and Pregnancy

    Microsoft Academic Search

    K. W. Robertson; I. S. Stewart; C. W. Imrie

    2006-01-01

    For most patients with pregnancy-associated pancreatitis there is little maternal survival threat and only occasionally are there foetal deaths. We describe 4 young women with pregnancy-associated severe acute pancreatitis who each had gallstones. Their ages were 17, 18, 20 and 24 years. Each was a tertiary referral to our unit in Glasgow and each pursued a life-threatening course with hospital

  2. Severe Acute Pancreatitis: Case-Oriented Discussion of Interdisciplinary Management

    Microsoft Academic Search

    Pietro Renzulli; Stephan M. Jakob; Martin Täuber; Daniel Candinas; Beat Gloor

    2005-01-01

    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

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

    Microsoft Academic Search

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

    2007-01-01

    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

  4. Imaging and imaging-guided therapy in severe acute pancreatitis

    Microsoft Academic Search

    Kenneth D. Carpenter; Patrick C. Freeny

    1996-01-01

    Effective utilization of imaging in patients with severe acute pancreatitis requires an understanding of the subtypes and\\u000a complications of pancreatitis. Imaging, particularly computed tomography, can confirm the diagnosis of pancreatitis, identify\\u000a local complications, offer prognostic information, and guide therapeutic interventions. Conventional radiography, ultrasound,\\u000a endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging have important adjunctive roles in the evaluation\\u000a and treatment of

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

    Microsoft Academic Search

    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

    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

  6. Acute Pancreatitis: Extrapancreatic Necrosis Volume as Early Predictor of Severity.

    PubMed

    Meyrignac, Olivier; Lagarde, Séverine; Bournet, Barbara; Mokrane, Fatima Zohra; Buscail, Louis; Rousseau, Hervé; Otal, Philippe

    2015-07-01

    Purpose To determine the volume of extrapancreatic necrosis that predicts severe acute pancreatitis and to assess the reliability of this threshold in predicting severe acute pancreatitis compared with current scoring systems and C-reactive protein (CRP) levels. Materials and Methods This institutional review board-approved, HIPAA-compliant retrospective study included patients with acute pancreatitis who were examined with computed tomography (CT) 2-6 days after disease onset. Extrapancreatic necrosis volume, Balthazar score, and CT severity index (CTSI) were calculated. CRP levels 48 hours after the onset of symptoms were reviewed. Outcome parameters included organ failure, infection, need for surgery or percutaneous intervention, duration of hospitalization, and/or death. Receiver operating characteristic (ROC) curves were constructed to determine the optimal threshold for predicting clinical outcomes. Pairwise comparisons of areas under ROC curves (AUCs) from the different grading systems were performed. Interobserver and intraobserver agreement in the grading of extrapancreatic necrosis was assessed by using ? statistics. Results In 264 patients, significant relationships were found between extrapancreatic necrosis volume and organ failure, infection, duration of hospitalization, need for intervention, and death (P < .001 for all). The optimal threshold for predicting severe acute pancreatitis was 100 mL. Sensitivity and specificity were 95% (19 of 20) and 83% (142 of 172), respectively, for predicting organ failure (vs 100% [20 of 20] and 46% [79 of 172] for the Balthazar score and 25% [five of 20] and 95% [163 of 172] for the CTSI). The extrapancreatic necrosis AUC was the highest for all systems. Interobserver and intraobserver agreement based on the 100-mL threshold was considered to be excellent. Conclusion A simple grading system based on an objective criterion such as a threshold of 100 mL of extrapancreatic necrosis provides more reliable information for predicting acute pancreatitis outcomes than do the current scoring systems. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:25642743

  7. Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation.

    PubMed

    Patel, Krutika; Trivedi, Ram N; Durgampudi, Chandra; Noel, Pawan; Cline, Rachel A; DeLany, James P; Navina, Sarah; Singh, Vijay P

    2015-03-01

    Visceral fat necrosis has been associated with severe acute pancreatitis (SAP) for over 100 years; however, its pathogenesis and role in SAP outcomes are poorly understood. Based on recent work suggesting that pancreatic fat lipolysis plays an important role in SAP, we evaluated the role of pancreatic lipases in SAP-associated visceral fat necrosis, the inflammatory response, local injury, and outcomes of acute pancreatitis (AP). For this, cerulein pancreatitis was induced in lean and obese mice, alone or with the lipase inhibitor orlistat and parameters of AP induction (serum amylase and lipase), fat necrosis, pancreatic necrosis, and multisystem organ failure, and inflammatory response were assessed. Pancreatic lipases were measured in fat necrosis and were overexpressed in 3T3-L1 cells. We noted obesity to convert mild cerulein AP to SAP with greater cytokines, unsaturated fatty acids (UFAs), and multisystem organ failure, and 100% mortality without affecting AP induction or pancreatic necrosis. Increased pancreatic lipase amounts and activity were noted in the extensive visceral fat necrosis of dying obese mice. Lipase inhibition reduced fat necrosis, UFAs, organ failure, and mortality but not the parameters of AP induction. Pancreatic lipase expression increased lipolysis in 3T3-L1 cells. We conclude that UFAs generated via lipolysis of visceral fat by pancreatic lipases convert mild AP to SAP independent of pancreatic necrosis and the inflammatory response. PMID:25579844

  8. Update on the management of acute severe pancreatitis.

    PubMed

    Ponette, J; Wilmer, A

    2001-01-01

    Acute severe pancreatitis is an aggressive disease with a mortality rate of up to 30 percent. In recent years therapy has shifted away from early surgery to intensive medical care. This article focuses on several issues of the management of acute severe pancreatitis emphasising evidence from recent clinical trials and recommendations from recent consensus conferences. Since a correct assessment of the severity of the disease is mandatory as early as possible in the treatment, several multiple scoring factor systems and individual risk factors are explained. The indications and the optimal timing of ERCP are discussed. Prophylactic administration of antibiotics, intravenously or by means of a selective digestive decontamination scheme, seems to be beneficial in decreasing morbidity but not mortality. Adequate nutritional support, preferably achieved by enteral feeding, is an important component in the supportive therapy. Protease inhibitors and anti-secretory drugs have not proven to be of benefit in improving outcome. Immunomodulating substances like platelet activating antagonists are promising but further studies are necessary to confirm the results of the early studies. Finally, indications for surgery are discussed. PMID:11484510

  9. Predicting Fatal Outcome in the Early Phase of Severe Acute Pancreatitis by Using Novel Prognostic Models

    Microsoft Academic Search

    Kimmo I. Halonen; Ari K. Leppäniemi; Johan E. Lundin; Pauli A. Puolakkainen; Esko A. Kemppainen; Reijo K. Haapiainen

    2003-01-01

    Background\\/Aims: Survival in acute pancreatitis and particularly in severe acute and necrotizing pancreatitis is a combination of therapy-associated and patient-related factors. There are only few relevant methods for predicting fatal outcome in acute pancreatitis. Scores such as Ranson, Imrie, Blamey, and APACHE II are practical in assessing the severity of the disease, but are not sufficiently validated for predicting fatal

  10. Treatment of severe acute pancreatitis and its complications

    PubMed Central

    Zerem, Enver

    2014-01-01

    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

  11. Mesenchymal stem cells improve intestinal integrity during severe acute pancreatitis.

    PubMed

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

    2014-10-01

    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

  12. Acute Pancreatitis and Pregnancy

    MedlinePLUS

    Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as the sudden inflammation of the pancreas manifested ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

  13. Acute kidney injury in severe acute pancreatitis: an experience from a tertiary care center.

    PubMed

    Kumar, Ravindra; Pahwa, Naresh; Jain, Neeraj

    2015-01-01

    Acute kidney injury (AKI) is an important cause of morbidity and mortality in severe acute pancreatitis (SAP). We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the SAP study patients. There was a significant association of diabetes and alcohol with AKI in patients with SAP. Alcohol was found to be an independent significant risk factor for AKI in SAP. All the eight patients with SAP who expired had AKI. None of the patients of SAP without AKI expired during the study. We conclude that the patients with SAP with AKI have a greater mortality rate as compared with the SAP patients without AKI. PMID:25579716

  14. Severe Transient Hyperglycemia in a Prediabetic Patient during Mild Acute Pancreatitis.

    PubMed

    Reghina, Aura Diana; Craciun, Silvia; Fica, Simona

    2015-01-01

    A 30-year-old obese male patient had been diagnosed with diabetes mellitus due to acute hyperglycemia and ketonuria. He also presented with severe hypertriglyceridemia and high levels of serum lipase. He was initially misdiagnosed with type 1 diabetes and treated with insulin for one month. At two months from first presentation, pancreatic antibodies were negative, and the C-peptide level was normal. A1c level was 5.9% without insulin treatment. The association between diabetes mellitus and acute pancreatitis is well established. We reported a case of severe transient hyperglycemia during mild acute pancreatitis in a metabolically ill patient. PMID:25918533

  15. Early Nasogastric Feeding in Predicted Severe Acute Pancreatitis

    PubMed Central

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

    2006-01-01

    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

  16. Acute Lipotoxicity Regulates Severity of Biliary Acute Pancreatitis without Affecting Its Initiation

    PubMed Central

    Durgampudi, Chandra; Noel, Pawan; Patel, Krutika; Cline, Rachel; Trivedi, Ram N.; DeLany, James P.; Yadav, Dhiraj; Papachristou, Georgios I.; Lee, Kenneth; Acharya, Chathur; Jaligama, Deepthi; Navina, Sarah; Murad, Faris; Singh, Vijay P.

    2015-01-01

    Obese patients have worse outcomes during acute pancreatitis (AP). Previous animal models of AP have found worse outcomes in obese rodents who may have a baseline proinflammatory state. Our aim was to study the role of acute lipolytic generation of fatty acids on local severity and systemic complications of AP. Human postpancreatitis necrotic collections were analyzed for unsaturated fatty acids (UFAs) and saturated fatty acids. A model of biliary AP was designed to replicate the human variables by intraductal injection of the triglyceride glyceryl trilinoleate alone or with the chemically distinct lipase inhibitors orlistat or cetilistat. Parameters of AP etiology and outcomes of local and systemic severity were measured. Patients with postpancreatitis necrotic collections were obese, and 13 of 15 had biliary AP. Postpancreatitis necrotic collections were enriched in UFAs. Intraductal glyceryl trilinoleate with or without the lipase inhibitors resulted in oil red O–positive areas, resembling intrapancreatic fat. Both lipase inhibitors reduced the glyceryl trilinoleate–induced increase in serum lipase, UFAs, pancreatic necrosis, serum inflammatory markers, systemic injury, and mortality but not serum alanine aminotransferase, bilirubin, or amylase. We conclude that UFAs are enriched in human necrotic collections and acute UFA generation via lipolysis worsens pancreatic necrosis, systemic inflammation, and injury associated with severe AP. Inhibition of lipolysis reduces UFA generation and improves these outcomes of AP without interfering with its induction. PMID:24854864

  17. Effects of Local Pancreatic Renin-Angiotensin System on the Microcirculation of Rat with Severe Acute Pancreatitis

    PubMed Central

    Feng, Ling; Long, Haocheng; Wang, Hui; Feng, Jiarui; Chen, Feixiang

    2015-01-01

    Severe acute pancreatitis (SAP) is normally related to multiorgan dysfunction and local complications. Studies have found that local pancreatic renin-angiotensin system (RAS) was significantly upregulated in drug-induced SAP. The present study aimed to investigate the effects of angiotensin II receptors inhibitor valsartan on dual role of RAS in SAP in a rat model and to elucidate the underlying mechanisms. 3.8% sodium taurocholate (1 ml/kg) was injected to the pancreatic capsule in order for pancreatitis induction. Rats in the sham group were injected with normal saline in identical locations. We also investigated the regulation of experimentally induced SAP on local RAS expression in the pancreas through determination of the activities of serum amylase, lipase and myeloperoxidase, histological and biochemical analysis, radioimmunoassay, fluorescence quantitative PCR and Western blot analysis. The results indicated that valsartan could effectively suppress the local RAS to protect against experimental acute pancreatitis through inhibition of microcirculation disturbances and inflammation. The results suggest that pancreatic RAS plays a critical role in the regulation of pancreatic functions and demonstrates application potential as AT1 receptor antagonists. Moreover, other RAS inhibitors could be a new therapeutic target in acute pancreatitis. PMID:26170733

  18. Multisystemic production of interleukin 10 limits the severity of acute pancreatitis in mice

    PubMed Central

    Van Laethem, J-L; Eskinazi, R; Louis, H; Rickaert, F; Robberecht, P; Deviere, J

    1998-01-01

    Background—Interleukin 10 (IL-10) decreases the severity of experimental acute pancreatitis. The role of endogenous IL-10 in modulating the course of pancreatitis is currently unknown. ?Aims—To examine the systemic release of IL-10 and its messenger RNA production in the pancreas, liver, and lungs and analyse the effects of IL-10 neutralisation in caerulein induced acute pancreatitis in mice. ?Methods—Acute necrotising pancreatitis was induced by intraperitoneal caerulein. Serum levels of IL-10 and tumour necrosis factor (TNF), and tissue IL-10 and TNF-? gene expression were assessed. After injecting control antibody or after blocking the activity of endogenous IL-10 by a specific monoclonal antibody, the severity of acute pancreatitis was assessed in terms of serum enzyme release, histological changes, and systemic and tissue TNF production. ?Results—In control conditions, serum IL-10 levels increased and correlated with the course of pancreatitis, with a maximal value eight hours after induction. Both IL-10 and TNF-? messengers showed a similar course, and were identified in the pancreas, liver, and lungs. Neutralisation of endogenous IL-10 significantly increased the severity of pancreatitis and associated lung injury as well as serum TNF protein levels (+75%) and pancreatic, pulmonary, and hepatic TNF messenger expression (+33%, +29%, +43%, respectively). ?Conclusions—In this non-lethal model, systemic release of IL-10 correlates with the course of acute pancreatitis. This anti-inflammatory response parallels the release of TNF and both cytokines are produced multisystemically. Endogenous IL-10 controls TNF-? production and plays a protective role in the local and systemic consequences of the disease. ?? Keywords: pancreatitis; interleukin 10; tumour necrosis factor ?; adult respiratory distress syndrome PMID:9863488

  19. Acute pancreatitis.

    PubMed

    Harper, Simon J F; Cheslyn-Curtis, Sarah

    2011-01-01

    Acute pancreatitis (AP) is an important cause of morbidity and mortality worldwide and the annual incidence appears to be increasing. It presents as a mild self-limiting illness in 80% of patients. However, one-fifth of these develop a severe complicated life-threatening disease requiring intensive and prolonged therapeutic intervention. Alcohol and gallstone disease remain the commonest causes of AP but metabolic abnormalities, obesity and genetic susceptibility are thought be increasingly important aetiological factors. The prompt diagnosis of AP and stratification of disease severity is essential in directing rapid delivery of appropriate therapeutic measures. In this review, the range of diagnostic and prognostic assays, severity scoring systems and radiological investigations used in current clinical practice are described, highlighting their strengths and weaknesses. Increased understanding of the complex pathophysiology of AP has generated an array of new potential diagnostic assays and these are discussed. The multidisciplinary approach to management of severe pancreatitis is outlined, including areas of controversy and novel treatments. PMID:20926469

  20. Rosiglitazone attenuates the severity of hyperlipidemic severe acute pancreatitis in rats

    PubMed Central

    NIYAZ, BATUR; ZHAO, KAI-LIANG; LIU, LI-MIN; CHEN, CHEN; DENG, WEN-HONG; ZUO, TENG; SHI, QIAO; WANG, WEI-XING

    2013-01-01

    Peroxisome proliferator-activated receptor-? (PPAR-?) ligand regulates adipocyte differentiation and insulin sensitivity, and exerts antihyperlipidemic and anti-inflammatory effects. However, the mechanisms by which PPAR-? ligands affect hyperlipidemia with severe acute pancreatitis (SAP) have not been fully elucidated. The present study investigated the effects of rosiglitazone, a PPAR-? ligand, on hyperlipidemia with SAP in a rat model. The hyperlipidemia was induced with a high-fat diet and SAP was induced by the administration of sodium taurocholate (TCA). The hyperlipidemia was shown to aggravate the severity of the sodium taurocholate-induced SAP. However, rosiglitazone demonstrated significant antihyperlipidemic and anti-inflammatory effects in the rats with high-lipid diet-induced hyperlipidemia and SAP. PMID:24137303

  1. Upregulation of PIAS1 protects against sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury

    Microsoft Academic Search

    Ping Chen; Liya Huang; Yunwei Sun; Yaozong Yuan

    2011-01-01

    The regulator of cytokine signaling known as protein inhibitor of activated STAT-1 (PIAS1) is increasingly understood to have diverse regulatory functions for inflammation, but its effect in inflammatory conditions such as severe acute pancreatitis (SAP) has not previously been reported. The aim of this study was to investigate the effect of upregulation of PIAS1 on SAP associated with acute lung

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

    PubMed Central

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

    2014-01-01

    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. PMID:25325011

  3. Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.

    PubMed Central

    Luiten, E J; Hop, W C; Lange, J F; Bruining, H A

    1995-01-01

    OBJECTIVE: A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA: Secondary pancreatic infection is the major cause of death in patients with acute necrotizing pancreatitis. Controlled clinical trials to study the effect of selective decontamination in such patients are not available. METHODS: Between April 22, 1990 and April 19, 1993, 102 patients with severe acute pancreatitis were admitted to 16 participating hospitals. Patients were entered into the study if severe acute pancreatitis was indicated, on admission, by multiple laboratory criteria (Imrie score > or = 3) and/or computed tomography criteria (Balthazar grade D or E). Patients were randomly assigned to receive standard treatment (control group) or standard treatment plus selective decontamination (norfloxacin, colistin, amphotericin; selective decontamination group). All patients received full supportive treatment, and surveillance cultures were taken in both groups. RESULTS: Fifty patients were assigned to the selective decontamination group and 52 were assigned to the control group. There were 18 deaths in the control group (35%), compared with 11 deaths (22%) in the selective decontamination group (adjusted for Imrie score and Balthazar grade: p = 0.048). This difference was mainly caused by a reduction of late mortality (> 2 weeks) due to significant reduction of gram-negative pancreatic infection (p = 0.003). The average number of laparotomies per patient was reduced in patients treated with selective decontamination (p < 0.05). Failure of selective decontamination to prevent secondary gram-negative pancreatic infection with subsequent death was seen in only three patients (6%) and transient gram-negative pancreatic infection was seen in one (2%). In both groups of patients, all gram-negative aerobic pancreatic infection was preceded by colonization of the digestive tract by the same bacteria. CONCLUSION: Reduction of gram-negative colonization of the digestive tract, preventing subsequent pancreatic infection by means of selective decontamination, significantly reduces morbidity and mortality in patients with severe acute necrotizing pancreatitis. PMID:7618970

  4. Ablation of phosphoinositide 3-kinase-gamma reduces the severity of acute pancreatitis.

    PubMed

    Lupia, Enrico; Goffi, Alberto; De Giuli, Paolo; Azzolino, Ornella; Bosco, Ornella; Patrucco, Enrico; Vivaldo, Maria Cristina; Ricca, Marco; Wymann, Matthias P; Hirsch, Emilio; Montrucchio, Giuseppe; Emanuelli, Giorgio

    2004-12-01

    In pancreatic acini, the G-protein-activated phosphoinositide 3-kinase-gamma (PI3K gamma) regulates several key pathological responses to cholecystokinin hyperstimulation in vitro. Thus, using mice lacking PI3K gamma, we studied the function of this enzyme in vivo in two different models of acute pancreatitis. The disease was induced by supramaximal concentrations of cerulein and by feeding mice a choline-deficient/ethionine-supplemented diet. Although the secretive function of isolated pancreatic acini was identical in mutant and control samples, in both models, genetic ablation of PI3K gamma significantly reduced the extent of acinar cell injury/necrosis. In agreement with a protective role of apoptosis in pancreatitis, PI3K gamma-deficient pancreata showed an increased number of apoptotic acinar cells, as determined by terminal dUTP nick-end labeling and caspase-3 activity. In addition, neutrophil infiltration within the pancreatic tissue was also reduced, suggesting a dual action of PI3K gamma, both in the triggering events within acinar cells and in the subsequent neutrophil recruitment and activation. Finally, the lethality of the choline-deficient/ethionine-supplemented diet-induced pancreatitis was significantly reduced in mice lacking PI3K gamma. Our results thus suggest that inhibition of PI3K gamma may be of therapeutic value in acute pancreatitis. PMID:15579443

  5. Ablation of Phosphoinositide 3-Kinase-? Reduces the Severity of Acute Pancreatitis

    PubMed Central

    Lupia, Enrico; Goffi, Alberto; De Giuli, Paolo; Azzolino, Ornella; Bosco, Ornella; Patrucco, Enrico; Vivaldo, Maria Cristina; Ricca, Marco; Wymann, Matthias P.; Hirsch, Emilio; Montrucchio, Giuseppe; Emanuelli, Giorgio

    2004-01-01

    In pancreatic acini, the G-protein-activated phosphoinositide 3-kinase-? (PI3K?) regulates several key pathological responses to cholecystokinin hyperstimulation in vitro. Thus, using mice lacking PI3K?, we studied the function of this enzyme in vivo in two different models of acute pancreatitis. The disease was induced by supramaximal concentrations of cerulein and by feeding mice a choline-deficient/ethionine-supplemented diet. Although the secretive function of isolated pancreatic acini was identical in mutant and control samples, in both models, genetic ablation of PI3K? significantly reduced the extent of acinar cell injury/necrosis. In agreement with a protective role of apoptosis in pancreatitis, PI3K?-deficient pancreata showed an increased number of apoptotic acinar cells, as determined by terminal dUTP nick-end labeling and caspase-3 activity. In addition, neutrophil infiltration within the pancreatic tissue was also reduced, suggesting a dual action of PI3K?, both in the triggering events within acinar cells and in the subsequent neutrophil recruitment and activation. Finally, the lethality of the choline-deficient/ethionine-supplemented diet-induced pancreatitis was significantly reduced in mice lacking PI3K?. Our results thus suggest that inhibition of PI3K? may be of therapeutic value in acute pancreatitis. PMID:15579443

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

    Microsoft Academic Search

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

    2007-01-01

    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

  7. Honokiol attenuates the severity of acute pancreatitis and associated lung injury via acceleration of acinar cell apoptosis.

    PubMed

    Weng, Te I; Wu, Hsiao Yi; Chen, Bo Lin; Liu, Shing Hwa

    2012-05-01

    Severe acute pancreatitis remains a life-threatening disease with a high mortality rate among a defined proportion of those affected. Apoptosis has been hypothesized to be a beneficial form of cell death in acute pancreatitis. Honokiol, a low-molecular-weight natural product, possesses the ability of anti-inflammation and apoptosis induction. Here, we investigate whether honokiol can ameliorate severe acute pancreatitis and the associated acute lung injury in a mouse model. Mice received six injections of cerulein at 1-h intervals, then given one intraperitoneal injection of bacterial lipopolysaccharide for the induction of severe acute pancreatitis. Moreover, mice were intraperitoneally given vehicle or honokiol 10 min after the first cerulein injection. Honokiol protected against the severity of acute pancreatitis in terms of increased serum amylase and lipase levels, pancreas pathological injury, and associated acute lung injury. Honokiol significantly reduced the increases in serum tumor necrosis factor-?, interleukin 1, and nitric oxide levels 3 h and serum high-mobility group box 1 24 h after acute pancreatitis induction. Honokiol also significantly decreased myeloperoxidase activities in the pancreas and the lungs. Endoplasmic reticulum stress-related molecules eIF2? (phosphorylated) and CHOP protein expressions, apoptosis, and caspase-3 activity were increased in the pancreas of mice with severe acute pancreatitis, which was unexpectedly enhanced by honokiol treatment. These results suggest that honokiol protects against acute pancreatitis and limits the spread of inflammatory damage to the lung in a severe acute pancreatitis mouse model. The acceleration of pancreatic cell apoptosis by honokiol may play a pivotal role. PMID:22258232

  8. Endotoxaemia and serum tumour necrosis factor as prognostic markers in severe acute pancreatitis.

    PubMed Central

    Exley, A R; Leese, T; Holliday, M P; Swann, R A; Cohen, J

    1992-01-01

    Endotoxaemia and circulating tumour necrosis factor are important prognostic factors in severe sepsis and are implicated in the pathogenesis of septic shock. Because clinical and pathological features in acute pancreatitis are similar to septic shock this study sought to determine whether endotoxin and tumour necrosis factor were prognostic factors in 38 patients with prognostically severe acute pancreatitis. Endotoxaemia, present in 19/37 (51%) patients on day 1, was more common in nonsurvivors than survivors (10/11, 91% v 9/26, 35%, p = 0.003). Day 1 serum endotoxin concentrations were higher in patients with a severe outcome (median (interquartile range) 314 (173-563) pg/ml v 0 (0-185) pg/ml, p<0.01) and in non-survivors (266 (173-586) pg/ml v 0 (0-165) pg/ml, p<0.01). Serum tumour necrosis factor was detectable in 47 of 109 samples (43%) from 38 patients (median 35 pg/ml, range 5-943 pg/ml). Day 1 serum tumour necrosis factor correlated with a worse prognostic score and a severe outcome in all patients (n = 38, r = 0.36, p = 0.027; r = 0.33, p<0.05) and with mortality in patients with gall stones (n = 23, r = 0.50, p = 0.02). Our data suggest that endotoxin and tumour necrosis factor could be prognostic factors in severe acute pancreatitis. PMID:1398241

  9. Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis.

    PubMed Central

    Winslet, M; Hall, C; London, N J; Neoptolemos, J P

    1992-01-01

    The sensitivity of diagnostic serum amylase (greater than 1000 iu/l) was assessed in 417 patients with acute pancreatitis as a result of gall stones (258), alcohol (104), or miscellaneous causes (55), of whom 111 (27%) had a clinically severe attack (including 34 deaths). On hospital admission, an amylase value diagnostic of pancreatitis was found in 96.1% of all mild cases and in 87.4% of severe cases (p less than 0.001); at 48 hours these values were 33.3% and 48.2% respectively (p = 0.026). Diagnostic amylase levels for alcoholic patients were found in 86% of mild cases on admission and in 76% of severe cases (p less than 0.001, compared with other groups). The diagnostic levels were also significantly lower at 24 hours for both the alcoholic and miscellaneous groups compared with the gall stone group (p less than 0.001). Eight of 27 (30%) patients with a serum amylase activity less than 1000 iu/l had pancreatic necrosis compared with 12 of the remaining 390 (3.1%) patients (p less than 0.001); the mortality was also significantly different (44% v 5.6% respectively, p less than 0.001). These data support the view that more sensitive tests for acute pancreatitis are needed for routine use especially in those whose disease has an alcoholic aetiology. PMID:1379569

  10. [Acute hypertrygliceridemic pancreatitis].

    PubMed

    Senosiain Lalastra, Carla; Tavío Hernández, Eduardo; Moreira Vicente, Victor; Maroto Castellanos, Maite; García Sánchez, Maria Concepción; Aicart Ramos, Marta; Téllez Vivajos, Luis; Cuño Roldán, José Luis

    2013-04-01

    Acute hypertriglyceridemic pancreatitis is the third cause of acute pancreatitis in the Western population. There is usually an underlying alteration in lipid metabolism and a secondary factor. Clinical presentation is similar to that of pancreatitis of other etiologies, but the course of acute hypertriglyceridemic pancreatitis seems to be worse and more recurrent. Some laboratory data can be artefacts, leading to diagnostic errors. This is the case of amylase, which can show false low levels. Treatment is based on intense fluidotherapy and analgesia. When there is no response to conservative management, other methods to lower triglyceride levels should be used. Several options are available, such as plasmapheresis, insulin, and heparin. The present article provides a review of the current literature on this entity. PMID:23522394

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

    PubMed Central

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

    2014-01-01

    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

  12. Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis

    PubMed Central

    Rickes, S; Uhle, C; Kahl, S; Kolfenbach, S; Monkemuller, K; Effenberger, O; Malfertheiner, P

    2006-01-01

    Aim This prospective study aimed to compare the accuracy of echo enhanced ultrasound with spiral computed tomography (CT) in assessing acute pancreatitis and to explore the correlation between ultrasound findings and clinical outcome. Methods Thirty one patients (24 men and 7 women, median age 39?years, range 19–67?years) with acute pancreatitis were investigated by contrast enhanced CT and echo enhanced ultrasound within 72?hours after admission. Echo enhanced ultrasound (with intravenous injection of 2.4?ml SonoVue, pulse inversion technique, mechanical index 0.1 to 0.2, Siemens Elegra) was performed following conventional ultrasound. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI). Correlations between CTSI and USSI and between USSI and clinical parameters were tested by Spearman's rank correlation coefficient. Results A strong correlation was demonstrated between CTSI and USSI (r?=?0.807, p<0.01). Ultrasound correlated with the following: the Ranson score (r?=?0.401, p<0.05), C?reactive protein levels 48?hours after admission (r?=?0.536, p<0.01), duration of hospitalisation (r?=?0.422, p<0.05), and clinical outcome regarding morbidity, including local and systemic complications (r?=?0.363, p<0.05). Based on CT findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detecting severe acute pancreatitis based on imaging criteria (Balthazar score D or E and/or presence of hypoperfusion compatible with necrosis and/or SI?3) were, respectively, 82% (95% CI 61 to 93), 89% (95% CI 57 to 98), 95% (95% CI 75 to 99), and 67% (95% CI 39 to 86). Conclusion Echo enhanced ultrasound produces excellent results in the staging of acute pancreatitis severity. The procedure is cheaper and has fewer contraindications than CT. Further multicentre studies need to be performed before including the method in the diagnostic algorithm of patients with acute pancreatitis. PMID:16033880

  13. SEW2871 Alleviates the Severity of Caerulein-Induced Acute Pancreatitis in Mice.

    PubMed

    Zou, Lei; Ke, Lu; Wu, Congye; Tong, Zhihui; Li, Weiqin; Li, Ning; Li, Jieshou

    2015-07-01

    Sphingosine-1-phosphate type-1 receptor (S1P1) agonists have the potential to inhibit the egress of lymphocytes, and have been demonstrated to provide protective effects on some acute inflammatory diseases. However, the value of S1P1 agonists on acute pancreatitis (AP) remains unclear. The aim of this study was to explore the effect of SEW2871, a S1P1-selective agonist, on caerulein-induced AP in mice. AP was induced by giving eight intraperitoneal injections of caerulein (50?µg/kg/h) at hourly intervals. SEW2871 was administered by gavage, at a dose of 20?mg/kg, at 0?h and 12?h after the first intraperitoneal injection of caerulein. The mice were sacrificed at 24?h. Severity of AP, serum amylase and lipase activity, levels of serum cytokines, pancreatic myeloperoxidase (MPO) activity, CD45+CD4+ T lymphocytes in blood, CD4+ T cell infiltration in the pancreas, and proinflammatory cytokine production were assessed. Furthermore, the expression of signal transducer and activator of transcription (STAT) 3 and phospho-STAT3 (p-STAT3) in the pancreas was also evaluated. The results revealed that the administration of SEW2871 ameliorated the severity of AP, by a reduction of serum pancreatic enzyme activity and levels of cytokines, decreased pancreatic MPO activity, depletion of CD4+CD45+ T lymphocytes in the blood and a reduction of CD4+ T cell infiltration in the pancreas. Furthermore, the expression of proinflammatory cytokines mRNA and p-STAT3 were also suppressed by SEW2871 treatment. These results suggest that SEW2871 treatment attenuates the severity of caerulein-induced AP in mice, which may provide a new therapeutic approach for AP therapy. PMID:25948069

  14. Therapeutic effect of human clonal bone marrow-derived mesenchymal stem cells in severe acute pancreatitis.

    PubMed

    Jung, Kyung Hee; Yi, TacGhee; Son, Mi Kwon; Song, Sun U; Hong, Soon-Sun

    2015-05-01

    Severe acute pancreatitis (SAP), a common necroinflammatory disease initiated by the premature activation of digestive enzymes within the pancreatic acinar cells, is associated with significant morbidity and mortality. In this study, we investigated whether human bone marrow-derived clonal mesenchymal stem cells (hcMSCs), isolated from human bone marrow aspirate according to our newly established isolation protocol, have potential therapeutic effects in SAP. SAP was induced by three intraperitoneal (i.p.) injections of cerulein (100 ?g/kg) and sequential LPS (10 mg/kg) in Sprague-Dawley (SD) rats. hcMSCs (1 × 10(6)/head) were infused on 24 h after LPS injection via the tail vein. The rats were sacrificed 3 days after infusion of hcMSCs. We observed that infused hcMSCs reduced the levels of serum amylase and lipase. Infused hcMSCs ameliorated acinar cell necrosis, pancreatic edema, and inflammatory infiltration. Also, infused hcMSCs decreased the level of malondialdehyde, and increased the levels of glutathione peroxidase and superoxide dismutase. The number of TUNEL positive acinar cells was reduced after hcMSCs infusion. In addition, hcMSCs reduced the expression levels of pro-inflammation mediators and cytokines, and increased the expression of SOX9 in SAP. Taken together, hcMSCs could effectively relieve injury of pancreatitis as a promising therapeutics for SAP. PMID:25142942

  15. Fibrosis Reduces Severity of Acute-on-Chronic Pancreatitis in Humans

    PubMed Central

    Acharya, Chathur; Cline, Rachel A.; Jaligama, Deepthi; Noel, Pawan; Delany, James P.; Bae, Kyongtae; Furlan, Alessandro; Baty, Catherine J.; Karlsson, Jenny M.; Rosario, Bedda L; Patel, Krutika; Mishra, Vivek; Durgampudi, Chandra; Yadav, Dhiraj; Navina, Sarah; Singh, Vijay P.

    2013-01-01

    BACKGROUND & AIMS Acute pancreatitis (AP) and chronic pancreatitis (CP) share etiologies, but AP can be more severe and has higher mortality. We investigated features of CP that protect against severity. The amount of intra-pancreatic fat (IPF) is increased in obesity and fibrosis is increased in CP; so we studied whether fibrosis or fat regulate severity of AP attacks in patients with CP. METHODS We reviewed records from the University of Pittsburg Medical Center Autopsy database (1998–2008) for patients with diagnosed AP (n=23), CP (n=35), or both (AP-on-CP; n=15). Pancreatic histology samples from these patients and 50 randomly selected Controls (no pancreatic disease) were analyzed, and IPF data were correlated with computed tomography data. An adipocyte and acinar cell transwell co-culture system, with or without collagen Type-I (collagen-I), was used to study the effects of fibrosis on acinar-adipocyte interactions. We studied the effects of non-esterified fatty acids (NEFA) and adipokines on acinar cells in culture. RESULTS Levels of IPF were significantly higher among non-obese patients with CP than non-obese Controls. In CP or AP-on-CP, areas of IPF were surrounded by significantly more fibrosis than in Controls or patients with AP. Fat necrosis (FN)-associated peri-fat acinar necrosis (PFAN, indicated by NEFA spillage) contributed to most of the necrosis observed in AP samples; however, PFAN and total necrosis were significantly lower in samples from patients with CP and AP-on-CP. Fibrosis appeared to wall off the FN and limit PFAN, reducing acinar necrosis. In vitro, collagen-I limited the lipolytic flux between acinar cells and adipocytes and prevented increases in adipokines in the acinar compartment. This was associated with reduced acinar cell necrosis. However, NEFA, but not adipokines, caused acinar-cell necrosis. CONCLUSIONS Based on analysis of pancreatic samples from patients with CP, AP and AP-on-CP, and in vitro studies, fibrosis reduces the severity of acute exacerbations of CP by reducing lipolytic flux between adipocytes and acinar cells. PMID:23684709

  16. Comparison of scoring systems in predicting the severity of acute pancreatitis

    PubMed Central

    Cho, Joon Hyun; Kim, Tae Nyeun; Chung, Hyun Hee; Kim, Kook Hyun

    2015-01-01

    AIM: To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis (AP). METHODS: We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012. Ranson, Acute Physiology and Chronic Health Evaluation (APACHE)-II, and bedside index for severity in acute pancreatitis (BISAP) scores, and computed tomography severity index (CTSI) of all patients were calculated. Serum C-reactive protein (CRP) levels were measured at admission (CRPi) and after 24 h (CRP24). Severe AP was defined as persistent organ failure for more than 48 h. The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve (AUC). RESULTS: Of 161 patients, 21 (13%) were classified as severe AP, and 3 (1.9%) died. Statistically significant cutoff values for prediction of severe AP were Ranson ? 3, BISAP ? 2, APACHE-II ? 8, CTSI ? 3, and CRP24 ? 21.4. AUCs for Ranson, BISAP, APACHE-II, CTSI, and CRP24 in predicting severe AP were 0.69 (95%CI: 0.62-0.76), 0.74 (95%CI: 0.66-0.80), 0.78 (95%CI: 0.70-0.84), 0.69 (95%CI: 0.61-0.76), and 0.68 (95%CI: 0.57-0.78), respectively. APACHE-II demonstrated the highest accuracy for prediction of severe AP, however, no statistically significant pairwise differences were observed between APACHE-II and the other scoring systems, including CRP24. CONCLUSION: Various scoring systems showed similar predictive accuracy for severity of AP. Unique models are needed in order to achieve further improvement of prognostic accuracy. PMID:25741146

  17. Describing Peripancreatic Collections in Severe Acute Pancreatitis Using Morphologic Terms: An International Interobserver Agreement Study

    Microsoft Academic Search

    Hjalmar C. van Santvoort; Thomas L. Bollen; Marc G. Besselink; Peter A. Banks; Marja A. Boermeester; Casper H. van Eijck; Jonathan Evans; Patrick C. Freeny; Lars Grenacher; John J. Hermans; Karen D. Horvath; David M. Hough; Johan S. Laméris; Maarten S. van Leeuwen; Koenraad J. Mortele; John P. Neoptolemos; Michael G. Sarr; Santhi Swaroop Vege; Jens Werner; Hein G. Gooszen

    2008-01-01

    Background\\/Aims: The current terminology for describing peripancreatic collections in acute pancreatitis (AP) derived from the Atlanta Symposium (e.g. pseudocyst, pancreatic abscess) has shown a very poor interobserver agreement, creating the potential for patient mismanagement. A study was undertaken to determine the interobserver agreement for a new set of morphologic terms to describe peripancreatic collections in AP. Methods: An international, interobserver

  18. Acute pancreatitis and hypertriglyceridemia.

    PubMed

    Lindberg, Deborah A

    2009-01-01

    Pancreatitis is a condition characterized by painful inflammation of the pancreas and can be either chronic or acute. The most common causes of acute pancreatitis (AP) in the United States are gallstones and excessive alcohol consumption. In addition, significantly elevated serum triglyceride levels can precipitate episodes of AP. Genetic defects are associated with severe elevations in serum triglyceride levels, whereas poorly controlled diabetes, obesity, and high-fat diets can contribute to elevated triglyceride levels substantial enough to provoke pancreatitis (secondary hypertriglyceridemia). Treatment of hypertriglyceridemia-induced AP consists of immediate reduction in serum triglyceride levels and long-term medications and lifestyle modifications. Nurses are instrumental in patient education about lifelong treatment strategies. PMID:19357469

  19. Upregulation of PIAS1 protects against sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury.

    PubMed

    Chen, Ping; Huang, Liya; Sun, Yunwei; Yuan, Yaozong

    2011-06-01

    The regulator of cytokine signaling known as protein inhibitor of activated STAT-1 (PIAS1) is increasingly understood to have diverse regulatory functions for inflammation, but its effect in inflammatory conditions such as severe acute pancreatitis (SAP) has not previously been reported. The aim of this study was to investigate the effect of upregulation of PIAS1 on SAP associated with acute lung injury (ALI), and its subsequent effect on disease severity. Sprague-Dawley rats were given an IV injection of adenovirus serotype 5 (Ad5)/F35-PIAS1, Ad5/F35-vector or saline before induction of SAP. The control group received only a sham operation. Lung and pancreas samples were harvested 16h after induction. The protein levels of PIAS1 in tissue were investigated. The severity of pancreatic injury was determined by a histological score of pancreatic injury, serum amylase, and pancreatic water content. The lung injury was evaluated by measurement of pulmonary microvascular permeability, lung myeloperoxidase activity and malondialdehyde levels. The survival rates of rats were also analyzed. The results found that in Ad5/F35-PIAS1 treated rats, serum tumor necrosis factor (TNF)-?, interleukin (IL)-1? and IL-6 levels were decreased but showed no influence on the levels of IL-10, and the severity of pancreatic tissue injury was less compared with either untreated SAP or Ad5/F35-vector treated rats (P<0.01). The administration of Ad5/F35-PIAS1 in SAP-induced rats downregulated the activity of the signal transducer and activator of transcription-1 (STAT1) pathway and the expressions of matrix metalloproteinase-9 (MMP-9) and intercellular adhesion molecule (ICAM)-1 protein in lung. Thus, compared with the untreated SAP rats, the inflammatory response and the severity of ALI decreased, and the survival rates increased (P<0.01). These findings suggest that PIAS1 could augment anti-inflammatory activity by inhibiting STAT1, thus attenuating the severity of SAP associated with ALI. PMID:21419645

  20. Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

    PubMed Central

    Wang, Hong-Liang; Yu, Kai-Jiang

    2015-01-01

    AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis. METHODS: Thirty-one intensive care unit (ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group (n = 15; July 1, 2012 to June 30, 2014) or a control group (n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration (CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 mL/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups. RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group (13.33% vs 37.50%; P < 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group (7.4 ± 1.35 d vs 9.19 ± 2.99 d, P < 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group (3.47 ± 0.52 d vs 7.90 ± 1.14 d, P < 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups (60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment (37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P < 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups. CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.

  1. Efficacy and mechanism of Salvia miltiorrhizae injection in the treatment of rats with severe acute pancreatitis.

    PubMed

    Zhang, Ruiping; Zhang, Xiping; Zhang, Jie; Wu, Junsheng; Ye, Qian; Xu, Rujun; Ye, Jing; Fang, Xin; Jin, Lu; He, Jiao; Yuan, Wenqin

    2009-04-01

    To study the efficacy and mechanism of Salvia miltiorrhizae injection in the treatment of severe acute pancreatitis. SAP rat models were prepared and randomly divided into model control group and treated group. The sham-operated group was also set. At 3, 6 and 12 h after operation, the mortality rate, ascitic volumes, pathological changes in the pancreas, contents of amylase and endotoxin in plasma as well as IL-6, IL-18, ET-1 and NO in serum, the staining intensity of Bax and NF-kappaB p56 proteins, and the changes in apoptosis index of pancreatic cells in rats in each group were observed. The pathological severity scores (at 3, 6 and 12 h after operation), contents of plasma endotoxin (at 6 and 12 h after operation) and serum IL-6 (at 6 and 12 h after operation) were significantly lower than those in model control group (P < 0.05, P < 0.01 and P < 0.01, respectively); the staining intensity and the product of the staining intensity and positive staining rate of Bax protein in the pancreas were significantly higher than those in model control group (P < 0.01). Salvia miltiorrhizae is able to reduce the contents of plasma endotoxin and serum IL-6, promote the expression of Bax protein in pancreas, improve the pathological changes in the pancreas, and decrease the mortality rate of rats, thereby showing therapeutic effect on rats with SAP. PMID:19238530

  2. Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: a prospective study.

    PubMed

    London, N J; Neoptolemos, J P; Lavelle, J; Bailey, I; James, D

    1989-03-01

    One hundred and fifty-two patients were admitted to a single hospital with a diagnosis of acute pancreatitis during a 31-month period. Of these, 126 patients had contrast-enhanced abdominal computed tomography (CT) scans within 72 h of admission; 92 of these attacks were clinically mild, 34 were clinically severe. A single consultant radiologist reported the scans 'blind' and noted whether pancreatic enhancement was normal, increased or decreased, and whether there was loss of peripancreatic tissue planes. The maximum anteroposterior measurement of the pancreatic head and body were multiplied together to produce a 'pancreatic size index' (cm2). Significantly more patients with severe attacks had decreased pancreatic enhancement (79 versus 58 per cent, P = 0.01) and loss of peripancreatic tissue planes (82 versus 54 per cent, P = 0.006). The median (range) pancreatic size index for clinically severe attacks was 12.8 cm2 (3.0-52.5), and for mild attacks was 6.0 cm2 (1.1-23.4), P less than 0.0001. Modified Glasgow criteria had a sensitivity of 85 per cent and specificity of 79 per cent for clinically severe attacks. A pancreatic size index of greater than or equal to 10 cm2 had a sensitivity of 71 per cent and specificity of 77 per cent for clinically severe attacks. In conclusion, although there were highly significant differences between the clinically severe and mild groups with respect to pancreatic enhancement, peripancreatic tissue planes and pancreatic size indices, these CT criteria did not improve on modified Glasgow criteria for prediction of disease severity. PMID:2720324

  3. Acute Necrotizing Pancreatitis in Children

    PubMed Central

    Raizner, Aileen; Phatak, Uma Padhye; Baker, Kenneth; Patel, Mohini G.; Husain, Sohail Z.; Pashankar, Dinesh S.

    2015-01-01

    Objective Necrotizing pancreatitis is very rare in children. In this case series, we describe the etiologic factors, course, and outcome of acute necrotizing pancreatitis in children. Study Design We performed a retrospective study of children with necrotizing pancreatitis diagnosed over the last 21 years at Yale New Haven Children’s Hospital. Computed tomography (CT) scan criteria were used to diagnose necrotizing pancreatitis and to assess severity index. Charts were reviewed to collect demographic data, etiology, details of hospital stay, complications, and outcome. Results Eight children (mean age 12.8 years; range 4 to 20.7 years) had necrotizing pancreatitis. Etiologic factors were medications, diabetes, gallstones, and alcohol. All patients had a prolonged hospitalization (9 to 40 days; mean 18 days) and five patients required admission to the pediatric intensive care unit. During the hospital stay, patients developed complications involving the respiratory, hematological, renal, metabolic, and circulatory systems. All patients had aggressive supportive medical therapy and none required surgical intervention. There were no deaths attributable to pancreatitis. Late complications following hospital discharge occurred in six patients and included pseudocysts, transient hyperglycemia, diabetes, and pancreatic exocrine insufficiency. The CT severity index correlated with the risk of complications. Conclusions Acute necrotizing pancreatitis has a variable etiology in children. CT scan is useful for the diagnosis and assessment of severity. Necrotizing pancreatitis in children is associated with severe acute and late complications and requires intensive medical therapy. PMID:23102790

  4. Management of acute pancreatitis.

    PubMed

    Goldenberg, David E; Gordon, Stuart R; Gardner, Timothy B

    2014-08-01

    Acute pancreatitis (AP) is a common medical condition with extensive morbidity and mortality. Approximately 210,000 Americans are hospitalized each year; and 5% of patients with AP will die. It is also an expensive condition, costing 2.6 billion dollars (United States) in 2009 alone. Moreover, the incidence is increasing - the National Hospital Discharge Survey showed hospitalizations increased from 78 per 100,000 in 2007 to 90 per 100,000 just three years later in 2010. There is no proven pharmacologic entity to treat the inflammatory response associated with acute pancreatitis; supportive care with IV fluids, bowel rest and pain control are the mainstays of therapy. Recently, new developments to help increase survival and minimize morbidity with several key interventions have been investigated. This summary highlights new studies and meta-analyses to provide current opinion on treatment of this morbid condition. PMID:24766182

  5. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis

    Microsoft Academic Search

    A C J Windsor; S Kanwar; A G K Li; E Barnes; J A Guthrie; J I Spark; F Welsh; P J Guillou; J V Reynolds

    1998-01-01

    Background—In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis.Aims—To determine whether TEN can attenuate the acute phase response and improve clinical

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

    PubMed Central

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

    2013-01-01

    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

  7. Protective effect of adenoviral transfer of heme oxygenase-1 gene on rats with severe acute pancreatitis.

    PubMed

    Zhang, Feihu; Fei, Jian; Zhao, Bing; Chen, Erzhen; Mao, Enqiang

    2014-09-01

    It is widely accepted that the pathophysiological mechanism of severe acute pancreatitis (SAP) is characterized by the systemic inflammatory response, which eventually causes systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and even death. Heme oxygenase (HO)-1 has been proved to exert anti-inflammatory benefit in a variety of inflammatory diseases, and a variety of methods by which HO-1 overexpression can be induced have been reported. In this study, we hypothesized that transfer of HO-1 gene by adenoviral vector could inhibit the systemic inflammation and the development of MODS. Sprague-Dawley (SD) rats were used as subjects in this study. Each was made into SAP model by retrograded injection through pancreatic duct with 5% sodium taurocholate (0.1 mL/100 g). Normal saline (1 mL/animal) or adenoviral HO-1 gene (Adv-HO-1, 2.0 × 10 PFU/mL/animal) or adenoviral empty vectors (Adv-0, 2.0 × 10 PFU/mL/animal) were injected intraperitoneally. HO-1 expression in serum and tissues including pancreas, liver and kidney was measured and observed to be upregulated in the rats treated with Adv-HO-1. The administration of Adv-HO-1 also inhibited the expression of tumor necrosis factor (TNF)-? and boosted the expression of interleukin-10 (IL-10). The decreasing serum concentration of ALT, AST, BUN and CREA, the amelioration of histopathologic damage in pancreas, liver and kidney tissues, the improvement of survival rate were all observed in rats treated with Adv-HO-1 comparing to others. As a result, this study showed that Adv-HO-1 could exert protective effect including anti-inflammation and organ protection through enhancing the expression of HO-1 in SAP. PMID:24694788

  8. Efficacy of glucocorticoids in rodents of severe acute pancreatitis: a meta-analysis

    PubMed Central

    Yu, Min; Yang, Zhen; Zhu, Yin; Lu, Nonghua

    2014-01-01

    Background: The use of corticosteroid in the management of severe acute pancreatitis (SAP) remains contentious and is still being debated despite many pre-clinical studies demonstrating benefits. The limitations of clinical research on corticosteroid in SAP are disparities with regard to benefit, a lack of adequate safety data and insufficient understanding of its mechanisms of action. Thus, we performed a meta-analysis to assess the effectiveness of corticosteroid in experimental SAP and take a closer look at the relation between the animal studies and prospective trials. Methods: Studies investigating corticosteroid use in rodent animal models of SAP were identified by searching multiple three electronic databases through October 2013, and by reviewing references lists of obtained articles. Data on mortality, changes of ascitic fluid and histopathology of pancreas were extracted. A random-effects model was used to compute the pooled efficacy. Publication bias and sensitivity analysis were also performed. Results: We identified 15 published papers which met our inclusion criteria. Corticosteroid prolonged survival by a factor of 0.35 (95% CI 0.21-0.59). Prophylactic use of corticosteroid showed efficacy with regards to ascitic fluid and histopathology of pancreas, whereas therapeutic use did not. Efficacy was higher in large dose and dexamethasone groups. Study characteristics, namely type of steroids, rout of delivery, genders and strains of animal, accounted for a significant proportion of between-study heterogeneity. No significant publication bias was observed. Conclusions: On the whole, corticosteroids have showed beneficial effects in rodent animal models of SAP. Prophylactic use of corticosteroid has failed to validate usefulness in prophylaxis of postendoscopic retrogradcholangiopancreatography pancreatitis. Further appropriate and informative animal experiments should be performed before conducting clinical trials investigating therapeutic use in SAP. PMID:25120741

  9. [Prolonged acute pancreatitis after bone marrow transplantation].

    PubMed

    De Singly, B; Simon, M; Bennani, J; Wittnebel, S; Zagadanski, A-M; Pacault, V; Gornet, J-M; Allez, M; Lémann, M

    2008-04-01

    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

  10. Pancreatitis associated protein as an early marker of acute pancreatitis.

    PubMed Central

    Kemppainen, E; Sand, J; Puolakkainen, P; Laine, S; Hedström, J; Sainio, V; Haapiainen, R; Nordback, I

    1996-01-01

    BACKGROUND: Measuring serum pancreatitis associated protein (PAP) in acute pancreatitis has proved valuable to monitoring the course of the disease and the recovery of the patient. AIMS: The aim was to analyze the utility of PAP on admission as a diagnostic and prognostic marker of acute pancreatitis. PATIENTS: Values of PAP were prospectively analyzed in 80 healthy volunteers, 164 patients with abdominal pain but without pancreatitis, 109 patients with mild acute pancreatitis, and 38 patients with severe acute pancreatitis. METHODS: The diagnosis of acute pancreatitis was verified with clinical, laboratory, radiological, and in some cases findings at operation or necropsy. RESULTS: Mean (95% confidence intervals) serum PAP values were 27 (24 to 29) micrograms/l in healthy volunteers, 78 (59 to 96) micrograms/l in patients with abdominal pain, 191 (134 to 247) micrograms/l, in patients with mild acute pancreatitis, and 599 (284 to 914) micrograms/l in patients with severe acute pancreatitis. Differences between the groups were significant (p = 0.04 - 0.01). Despite the differences in means, the ranges overlapped between the groups. The sensitivity of PAP on admission to detect acute pancreatitis was 38%-53% and the respective specificity 89%-77% depending on the cut off level. The sensitivity of PAP to detect severe acute pancreatitis was 45%-68% and the specificity 74%-59% depending on the cut off level. CONCLUSIONS: Admission PAP did not distinguish severe from mild acute pancreatitis better than C reactive protein. Measurement of PAP does not give appreciable diagnostic advantages in the early phase of acute pancreatitis. PMID:9026481

  11. Vascular Endothelial Injury and Apoptosis in Rats with Severe Acute Pancreatitis

    PubMed Central

    Ge, Ning; Xia, Qing; Yang, Zhong-Hua; Ding, Qun-Fang; Zeng, Zhi

    2015-01-01

    We explored mechanisms of vascular endothelial injury that lead to systemic multiple organ failure by detecting the soluble endothelial protein C receptor (sEPCR), von Willebrand factor (vWF), serum nitric oxide (NO), and tumor necrosis factor alpha (TNF-?) and Bcl-2 mRNA and Bax mRNA expression in a severe acute pancreatitis (SAP) rat model. Compared to controls, the levels of TNF-?, vWF, and sEPCR were significantly increased in the experimental group at 12 hours and 24 hours and the NO level was significantly decreased. After 12 hours, the aortic endothelial apoptosis index and Bax mRNA expression in aortic endothelial cells had increased in the experimental group, but Bcl-2 mRNA levels had decreased. All these changes appeared at both 12?h and 24 hours. The results indicated that vascular endothelial injury and apoptosis markers were elevated in SAP. Endothelial injury and increased apoptosis in the experimental group were related to the increased expression of TNF-?. PMID:25688263

  12. Experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis by TAE.

    PubMed

    Zhou, Feng; Wang, Chunyou; Xiong, Jiongxin; Wan, Chidan; Zheng, Chuansheng

    2005-01-01

    The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5% (17/19), the incidence of re-bleeding after TAE was 36.8% (7/19) and the successful rate of hemostatis by second TAE was 71.4% (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery; In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE. PMID:16116967

  13. Ulinastatin promotes T lymphocyte apoptosis in rats with severe acute pancreatitis via mitochondrial pathways.

    PubMed

    Wang, C L; Li, N; Ma, T; Zhang, P; You, S Y

    2015-01-01

    We explored the influence of ulinastatin on apoptosis of T lymphocytes in rats with severe acute pancreatitis (SAP) and the effect of ulinastatin on mitochondrial apoptosis pathways in spleen lymphocytes. Thirty-six Wistar rats were randomly divided into three groups (N = 12): a sham operated group, a SAP group, and an ulinastatin-treated SAP group. The SAP model was established by injecting 5% sodium taurocholate into the intrapancreatobiliary duct. Study rats were sacrificed after 24 h, and splenic lymphocytes were then collected. CD4(+) and CD8(+) T lymphocytes were labeled by direct immune fluorescence assays; the percentage of apoptotic cells, mitochondrial membrane potential levels, and mitochondria permeability transition pore opening levels were measured by flow cytometry. In the ulinastatin-treated SAP group, the ratio of CD4(+)/CD8(+) T lymphocytes was significantly higher than that in the SAP group, and the apoptosis percentage of CD4(+) T lymphocytes was significantly decreased. The percentage of lymphocytes with an abnormal opening of the mitochondrial permeability transition pore and lymphocytes with decreased mitochondrial membrane potential in the ulinastatin-treated SAP group were significantly lower than that in the SAP group. Ulinastatin can directly enhance immunological function and attenuate immune suppression in SAP rats through inhibiting the apoptosis of CD4(+) T lymphocytes. These study findings demonstrate that therapeutic effects may occur through inhibiting the apoptosis induced by mitochondrial signaling pathways. PMID:26125748

  14. A New Combination Therapy in Severe Acute Pancreatitis—Hyperbaric Oxygen Plus 3-Aminobenzamide

    PubMed Central

    Inal, Volkan; Mas, Mehmet Refik; Isik, Ahmet Turan; Comert, Bilgin; Ayd?n, Sezai; Mas, Nukhet; Deveci, Mehmet Salih; Tasci, Ilker; Yamanel, Levent; Cinar, Esref; Unal, Mehmet Tahir

    2015-01-01

    Objectives This study was designed to evaluate effects of hyperbaric oxygen (HBO) plus 3-aminobenzamide (3-AB) cotreatment on tissue oxidative stress parameters (TOSp), tissue histopathology scores (THSc), and bacterial translocations (Bact-Trans) in an experimental model of severe acute pancreatitis (AP). Methods Seventy-five Sprague-Dawley rats were randomized into 5 groups. Group 1 received sham. Severe AP was induced by intraductal taurocholate infusion and then group 2 received saline, group 3 received 3-AB, group 4 received 3-AB plus HBO, and group 5 received HBO. 3-Aminobenzamide (10 mg/kg per day, once daily, intraperitoneal) and saline (1 mL/kg) were started right after the induction, whereas HBO (2,8 atm pressure, BID, 90 minutes each) was started at the sixth hour. The rats were euthanized at the 54th hour, and TOSp, THSc, and Bact-Trans were studied. Results In treatment groups 3 and 5, Bact-Trans (P < 0.05, P < 0.05), TOSp (P < 0.05, P < 0.05), and THSc (P < 0.001, P < 0.001) were significantly lower than controls. In addition to these findings, group 4 (cotreatment) showed the most significant effect on Bact-Trans and THSc (P < 0.001, P < 0.001) and also better in TOSp (P < 0.02). Conclusions Poly(ADP-ribose) polymerase inhibition by 3-AB and HBO treatment alone was effective in the course of severe AP, and favorable with cotreatment because of the improved cascades of inflammatory process by different aspects. PMID:25347462

  15. Prognosis of acute pancreatitis.

    PubMed

    Imrie, C W

    1995-01-01

    The prognosis of an individual attack of acute pancreatitis is dependent on its severity and whether or not sepsis develops in or around the pancreas. Approximately 20-25% of patients with acute pancreatitis have a severe form of the disease which usually necessitates high dependency or intensive care management in the first week or two of illness. While most of these patients can readily be identified by experienced clinical judgement a proportion of them do not appear unduly ill at first presentation. For this reason a number of objective grading systems have been devised which identified the group of patients with the greatest likelihood of developing major complications and being at risk of death. The most commonly utilised systems in the United Kingdom are the eight factor Glasgow scoring scale and the APACHE II system. The measurement of C-reactive protein is also helpful and it has recently been shown that the combining of the Glasgow scoring system with CRP results in 80% or better sensitivity and specificity for those who develop major clinical complications. The body mass index (BMI) when over 30 kgs/m2 is also a useful marker of an adverse outcome, and CT scanning is another method of grading severity. The newer markers of interleukin 6 and PMN elastase have yet to be proved in a large prospective clinical study but do show considerable promise as being of value in identifying the patient at risk. PMID:7668494

  16. Acute pancreatitis in children and adolescents

    PubMed Central

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

    2014-01-01

    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

  17. From moderately severe to severe hypertriglyceridemia induced acute pancreatitis: circulating miRNAs play role as potential biomarkers.

    PubMed

    An, Fangmei; Zhan, Qiang; Xia, Min; Jiang, Lisha; Lu, Guoming; Huang, Mindan; Guo, Jizhong; Liu, Side

    2014-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  19. Ulinastatin enhances the therapeutic effect of intraperitoneal lavage on severe acute pancreatitis in rats

    PubMed Central

    FENG, CONG; SU, XUAN; CHEN, LI; ZHOU, XUAN; LI, BEI; WANG, LI-LI; LV, FA-QIN; LI, TAN-SHI

    2015-01-01

    The present study investigated the therapeutic effect of peritoneal lavage with ulinastatin on the outcome of rats with severe acute pancreatitis (SAP). A total of 110 male Wistar rats were randomly divided into the following groups: Control (C), SAP model (SAP), saline lavage (SL), intravenous ulinastatin (IU) and low-dose (LUL), medium-dose (MUL), high-dose (HUL) and ultrahigh-dose (UHUL) ulinastatin lavage. The treatments were performed immediately subsequent to the establishment of the SAP model. Intraperitoneal lavage with or without ulinastatin was performed for 3 h. Survival time was recorded for 12 h and the median survival time was calculated. Histopathological analyses, and measurements of plasma amylase and lipase levels were performed. Blood pH, lactic acid and base excess were also detected. The LUL, MUL, HUL, UHUL and IU groups showed an increase in the median survival time compared with the SAP group, with the maximal effect observed in the MUL group (P<0.01). The SL, MUL and IU groups showed a reduced activity of amylase and lipase compared with the SAP group. The SL (P<0.01) and the MUL groups (P<0.01) additionally showed a reduction in the lactic acid in arterial blood relative to the SAP group but the IU group did not. The MUL group showed greater improvements in pH (P<0.01) and base excess (P<0.01) versus the SAP group than the SL and IU groups. Furthermore the MUL group demonstrated a more marked reduction in the histological changes in necrosis, edema and inflammation compared with the SL and IU groups. Intraperitoneal lavage with ulinastatin significantly improves the prognosis of SAP in rats.

  20. Overexpressed miRNA-155 dysregulates intestinal epithelial apical junctional complex in severe acute pancreatitis

    PubMed Central

    Tian, Rui; Wang, Rui-Lan; Xie, Hui; Jin, Wei; Yu, Kang-Long

    2013-01-01

    AIM: To investigate whether miRNA-155 (miR-155) dysregulates apical junctional complex (AJC) protein expression in experimental severe acute pancreatitis (SAP). METHODS: Twenty-four male BALB/c mice were randomly assigned to two groups: the SAP group (n = 12) receiving sequential intraperitoneal injection of 50 µg/kg caerulein and 10 mg/kg lipopolysaccharide over 6 h, and the control group (n = 12) receiving intraperitoneal injection of normal saline. Animals were sacrificed 3 h following the last injection for collection of blood samples and pancreas and distal ileal segment specimens. Routine pancreas and intestine histology was used to assess SAP pathology and intestinal epithelial barrier damage. Levels of serum amylase, diamine oxidase (DAO), and tumor necrosis factor (TNF)-? were determined using commercial kits. Total RNA samples were isolated from intestinal epithelial specimens and reversely transcribed into cDNA. miR-155 and RhoA mRNA expression profiles were determined using quantitative real-time polymerase chain reaction. Target genes for miR-155 were predicted using the miRTarBase database, RNA22 and PicTar computational methods. Western blotting was performed to quantitate the protein expression levels of the target gene RhoA, as well as zonula occludens (ZO)-1 and E-cadherin, two AJC component proteins. RESULTS: Intraperitoneal injection of caerulein and lipopolysaccharide successfully induced experimental acute pancreatic damage (SAP vs control, 10.0 ± 2.0 vs 3.2 ± 1.2, P < 0.01) and intestinal epithelial barrier damage (3.2 ± 0.7 vs 1.4 ± 0.7, P < 0.01). Levels of serum amylase (21.6 ± 5.1 U/mL vs 14.3 ± 4.2 U/mL, P < 0.01), DAO (21.4 ± 4.1 mg/mL vs 2.6 ± 0.8 mg/mL, P < 0.01), and TNF-? (61.0 ± 15.1 ng/mL vs 42.9 ± 13.9 ng/mL, P < 0.01) increased significantly in SAP mice compared to those in control mice. miR-155 was significantly overexpressed in SAP intestinal epithelia (1.94 ± 0.50 fold vs 1.03 ± 0.23 fold, P < 0.01), and RhoA gene containing three miR-155-specific binding sites in the three prime untranslated regions was one of the target genes for miR-155. RhoA (22.7 ± 5.8 folds vs 59.6 ± 11.6 folds, P < 0.01), ZO-1 (46 ± 18 folds vs 68 ± 19 folds, P < 0.01), and E-cadherin proteins (48 ± 15 folds vs 77 ± 18 folds, P < 0.01) were underexpressed in SAP intestinal epithelia although RhoA mRNA expression was not significantly changed in SAP (0.97 ± 0.18 folds vs 1.01 ± 0.17 folds, P > 0.05). CONCLUSION: TNF-?-regulated miR-155 overexpression inhibits AJC component protein syntheses of ZO-1, and E-cadherin by downregulating post-transcriptional RhoA expression, and disrupts intestinal epithelial barrier in experimental SAP. PMID:24363519

  1. Predictors of Percutaneous Catheter Drainage (PCD) after Abdominal Paracentesis Drainage (APD) in Patients with Moderately Severe or Severe Acute Pancreatitis along with Fluid Collections

    PubMed Central

    Liu, Wei-hui; Wang, Tao; Yan, Hong-tao; Chen, Tao; Xu, Chuan; Ye, Ping; Zhang, Ning; Liu, Zheng-cai; Tang, Li-jun

    2015-01-01

    Aims Although we previously demonstrated abdominal paracentesis drainage (APD) preceding percutaneous catheter drainage (PCD) as the central step for treating patients with moderately severe (MSAP) or severe acute pancreatitis (SAP), the predictors leading to PCD after APD have not been studied. Methods Consecutive patients with MSAP or SAP were recruited between June 2011 and June 2013. As a step-up approach, all patients initially received medical management, later underwent ultrasound-guided APD before PCD, if necessary, followed by endoscopic necrosectomy through the path formed by PCD. APD primarily targeted fluid in the abdominal or pelvic cavities, whereas PCD aimed at (peri)pancreatic fluid. Results Of the 92 enrolled patients, 40 were managed with APD alone and 52 received PCD after APD (14 required necrosectomy after initial PCD). The overall mortality was 6.5%. Univariate analysis showed that among the 20 selected parameters, 13 factors significantly affected PCD intervention after APD. Multivariate analysis revealed that infected (peri)pancreatic collections (P = -0.001), maximum extent of necrosis of more than 30% of the pancreas (P = -0.024), size of the largest necrotic peri(pancreatic) collection (P = -0.007), and reduction of (peri)pancreatic fluid collections by <50% after APD (P = -0.008) were all independent predictors of PCD. Conclusions Infected (peri)pancreatic collections, a largest necrotic peri(pancreatic) collection of more than 100 ml, and reduction of (peri)pancreatic fluid collections by <50% after APD could effectively predict the need for PCD in the early course of the disease. PMID:25659143

  2. Prevention effects of ND-07, a novel drug candidate with a potent antioxidative action and anti-inflammatory action, in animal models of severe acute pancreatitis.

    PubMed

    Lee, Jin Hwan; An, Chun San; Yun, Bok Sun; Kang, Kum Suk; Lee, Young Ae; Won, Sun Mi; Gwag, Byoung Joo; Cho, Sung Ig; Hahm, Ki-Baik

    2012-07-15

    Oxidative stress and inflammation both play major roles in the development of the acute pancreatitis. Currently, a pancreatic enzyme inhibitor with limited efficacy is only clinically available in a few countries, and antioxidants or non-steroidal anti-inflammatory drugs (NSAIDs) provide only partial tissue protection in acute pancreatitis animal models. Here, we introduce a new drug candidate for treating acute pancreatitis named ND-07 [chemical name: 2-acetoxy-5-(2-4-(trifluoromethyl)-phenethylamino)-benzoic acid] that exhibits both potent antioxidative and anti-inflammatory activities. In an electron spin resonance (ESR) study, ND-07 almost blocked hydroxyl radical generation as low as 0.05 ?M and significantly suppressed DNA oxidation and cell death in a lipopolysaccharide (LPS)-stimulated pancreatic cell line. In a cerulein plus LPS-induced acute pancreatitis model, ND-07 pretreatment showed significant tissue protective effects, with reductions of serum amylase and lipase levels and pancreatic wet weights. ND-07 not only diminished the plasma levels of malondialdehyde (MDA) and nitric oxide but also significantly decreased prostaglandin E? (PGE?) and expression of tumor necrotizing factor-alpha (TNF-?) in the pancreatic tissue. In a severe acute necrotizing pancreatitis model induced by a choline deficient, ethionine-supplemented (CDE) diet, ND-07 dramatically protected the mortality even without any death, providing attenuation of pancreas, lung, and liver damages as well as the reductions in serum levels of lactate dehydrogenase (LDH), amylase and lipase, MDA levels in the plasma and pancreatic tissues, plasma levels of TNF-?, and interleukin-1 (IL-1?). These findings suggest that current dual synergistic action mechanisms of ND-07 might provide a superior protection for acute pancreatitis than conventional drug treatments. PMID:22575522

  3. 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

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

    2014-01-01

    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

  4. Ascaris-induced acute pancreatitis.

    PubMed

    Khuroo, M S; Zargar, S A; Yattoo, G N; Koul, P; Khan, B A; Dar, M Y; Alai, M S

    1992-12-01

    The incidence, clinical disease and outcome of acute pancreatitis caused by ascariasis in an endemic area of Kashmir, India, was studied prospectively. Ascariasis was an aetiological factor in 59 of 256 patients (23.0 per cent) with acute pancreatitis. Worms had invaded the bile duct in 51 patients, the pancreatic duct in four and both ducts in four. Pancreatitis was mild in 46 patients and severe in 13. Associated pyogenic cholangitis was present in eight. Acute complications occurred in 11 patients. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all cases within 72 h of admission and delineated ascarides in the duodenum invading the ampullary orifice (44 patients), in the bile duct (55) and in the pancreatic duct (eight). At ERCP, worms were extracted from the ampullary orifice and removed via the mouth of 33 patients with intractable epigastric pain, leading to rapid relief of symptoms. The eight patients with pyogenic cholangitis underwent endoscopic nasobiliary drainage to decompress the bile ducts; worms were extracted from the bile duct of three of these patients using a Dormia basket. A total of 56 patients recovered from acute illness with a combination of conservative and endoscopic treatment; the other three required emergency surgery. At a mean(s.d.) follow-up of 19(7) months, ten patients showed symptomatic worm reinvasion of the biliary tree. The overall mortality rate was 3 per cent. PMID:1486433

  5. Pharmacologic therapy for acute pancreatitis

    PubMed Central

    Kambhampati, Swetha; Park, Walter; Habtezion, Aida

    2014-01-01

    While conservative management such as fluid, bowel rest, and antibiotics is the mainstay of current acute pancreatitis management, there is a lot of promise in pharmacologic therapies that target various aspects of the pathogenesis of pancreatitis. Extensive review of preclinical studies, which include assessment of therapies such as anti-secretory agents, protease inhibitors, anti-inflammatory agents, and anti-oxidants are discussed. Many of these studies have shown therapeutic benefit and improved survival in experimental models. Based on available preclinical studies, we discuss potential novel targeted pharmacologic approaches that may offer promise in the treatment of acute pancreatitis. To date a variety of clinical studies have assessed the translational potential of animal model effective experimental therapies and have shown either failure or mixed results in human studies. Despite these discouraging clinical studies, there is a great clinical need and there exist several preclinical effective therapies that await investigation in patients. Better understanding of acute pancreatitis pathophysiology and lessons learned from past clinical studies are likely to offer a great foundation upon which to expand future therapies in acute pancreatitis. PMID:25493000

  6. [Severe acute pancreatitis and infection by influenza A (H1N1) virus in a child: case report].

    PubMed

    Rodríguez Schulz, Diego; Martínez, Agustina; Guzmán, María Belén; Robledo, Hugo; Capocasa, Patricia; Martínez, Luz; Garnero, Analía

    2015-08-01

    Acute pancreatitis is an inflammatory disease of the pancreas, characterized by abdominal pain and high level of pancreatic enzymes. Pancreatitis is the most common disease of pancreas in children and adults. For the diagnosis we need 2 of 3 characteristics: abdominal pain characteristic of acute pancreatitis, amylase and/or lipase 3 times higher than the normal upper limit and characteristic findings in images. The etiologies are multiple: trauma, metabolic disease and infections: mixovirus, HIV, measles, coxsackie, hepatitis B, C, cytomegalovirus, varicella, herpes simplex. Three cases of PA associated with H1N1 Influenza virus were reported, only one in a child with uncomplicated features. PMID:26172021

  7. Early prediction of severe acute pancreatitis by urinary ?-2 microglobulin/saposin B peak ratios on MALDI-TOF.

    PubMed

    Chang, Chiz-Tzung; Liao, Hsin-Yi; Huang, Wen-Hsin; Lin, Shih-Yi; Tsai, Tsung-Yu; Yang, Chao-Yuh; Tsai, Fuu-Jen; Chen, Chao-Jung

    2015-02-01

    The current methods for predicting severe acute pancreatitis (severe AP) are either complicated or lack efficient sensitivity and specificity. In this study, a simple and practical approach was developed to predict severe AP by using peak intensity ratio of urinary ?-2 microglobulin (B2M) to saposin B (SB) on MALDI-TOF MS. Patients with B2M/SB ratio higher than 1.127 present severe AP symptom with a higher Ranson score, computed tomography (CT) grade and longer hospitalization with a sensitivity of 83.7% and specificity of 74.3%. Label-free quantitative proteomics by nanoLC-MS/MS was applied to urine of severe AP patients and found that severe AP is accompanied with kidney injury and inflammation. The measurement of B2M/SB ratios by MALDI-TOF MS could be a simple, accurate and rapid method to diagnose severe AP as well as to monitor AP progression. PMID:25447703

  8. The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis

    PubMed Central

    Ma, Cheng-En

    2015-01-01

    Purpose The Bedside Index for Severity in Acute Pancreatitis (BISAP) score has been developed to identify patients at high risk for mortality or severe disease early during the course of acute pancreatitis. We aimed to undertake a meta-analysis to quantify the accuracy of BISAP score for predicting mortality and severe acute pancreatitis (SAP). Materials and Methods We searched the databases of Pubmed, Embase, and the Cochrane Library to identify studies using the BISAP score to predict mortality or SAP. The pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) were calculated from each study and were compared with the traditional scoring systems. Results Twelve cohorts from 10 studies were included. The overall sensitivity of a BISAP score of ?3 for mortality was 56% (95% CI, 53%-60%), with a specificity of 91% (95% CI, 90%-91%). The positive and negative likelihood ratios were 5.65 (95% CI, 4.23-7.55) and 0.48 (95% CI, 0.41-0.56), respectively. Regarding the outcome of SAP, the pooled sensitivity was 51% (43%-60%), and the specificity was 91% (89%-92%). The pooled positive and negative likelihood ratios were 7.23 (4.21-12.42) and 0.56 (0.44-0.71), respectively. Compared with BISAP score, the Ranson criteria and APACHE?score showed higher sensitivity and lower specificity for both outcomes. Conclusions The BISAP score was a reliable tool to identify AP patients at high risk for unfavorable outcomes. Compared with the Ranson criteria and APACHE?score, BISAP score outperformed in specificity, but having a suboptimal sensitivity for mortality as well as SAP. PMID:26091293

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

    PubMed Central

    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

    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

  10. [Acute pancreatitis: an overview of the management].

    PubMed

    Rebours, V

    2014-10-01

    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 50 years, the presence of a tumor (benign or malignant) has to be specifically ruled out, using CT-scan, MRI and endoscopic ultrasound. PMID:24837648

  11. H2S mitigates severe acute pancreatitis through the PI3K/AKT-NF-?B pathway in vivo

    PubMed Central

    Rao, Chun-Yan; Fu, Lan-Ying; Hu, Chang-Lun; Chen, Dai-Xing; Gan, Tian; Wang, Yi-Cheng; Zhao, Xiao-Yan

    2015-01-01

    AIM: To study the effect of hydrogen sulfide (H2S) on severe acute pancreatitis (SAP) in a rat model. METHODS: Sprague-Dawley (SD) rats were administered an intraperitoneal injection of saline containing 20% L-Arg (250 mg/100 g) hourly for over 2 h to induce SAP. The rats were treated with DL-propargylglycine (PAG, 50 mg/kg) or different dosages of NaHS (5 mg/kg, 10 mg/kg, 20 mg/kg or 100 mg/kg). PAG or NaHS was administered 1 h before induction of pancreatitis. Rats were sacrificed 24 h after the last L-Arg injection. Blood and pancreas tissues were collected. RESULTS: The H2S and cystathionine-?-lyase mRNA levels in SAP rats were signi?cantly lower than those in the control group, and treatment with PAG further reduced the H2S level. Nevertheless, H2S was significantly increased after NaHS administration compared with the SAP group, and the degree of upregulation was associated with the NaHS dosage. NaHS reduced the levels of plasma amylase, interleukin-6 and myeloperoxidase in pancreatic tissue. NaHS suppressed the degradation of I?B? and the activity of nuclear factor-?B, as well as the phosphorylation of PI3K/AKT. CONCLUSION: H2S plays an anti-inflammatory role in SAP in vivo. PMID:25914464

  12. Managing acute and chronic pancreatitis.

    PubMed

    Skipworth, James R A; Shankar, Arjun; Pereira, Stephen P

    2010-10-01

    Pancreatitis may be acute or chronic. Although both can be caused by similar aetiologies, they tend to follow distinct natural histories. Around 80% of acute pancreatitis (AP) diagnoses occur secondary to gallstone disease and alcohol misuse. AP is commonly associated with sudden onset of upper abdominal pain radiating to the back that is usually severe enough to warrant the patient seeking urgent medical attention. Onset of pain may be related to a recent alcohol binge or rich, fatty meal. The patient may appear unwell, be tachycardic and have exquisite tenderness in the upper abdomen. Overall, 10-25% of AP episodes are classified as severe, leading to an associated mortality rate of 7.5%. Disease severity is best predicted from a number of clinical scoring systems which can be applied at diagnosis in association with repeated clinical assessment, measurement of acute inflammatory markers, and CT. All patients with suspected AP should be referred urgently. Chronic pancreatitis (CP) follows continued, repetitive or sustained injury to the pancreas and 70% of diagnoses occur secondary to alcohol abuse. The characteristic presenting feature of CP is insidious progression of chronic, severe, upper abdominal pain, radiating to the back, caused by a combination of progressive pancreatic destruction, inflammation and duct obstruction. Signs and symptoms include weight loss and steatorrhoea and later on diabetes. CP patients may also present with recurrent episodes mimicking AP, both symptomatically and metabolically. Diagnosis of CP should be based on symptom profile, imaging and assessment of exocrine and endocrine pancreatic function. CT should be the first-line imaging investigation. PMID:21141249

  13. Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients: A Retrospective Study.

    PubMed

    Qiu, Lei; Sun, Rui Qing; Jia, Rong Rong; Ma, Xiu Ying; Cheng, Li; Tang, Mao Chun; Zhao, Yan

    2015-06-01

    It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the prognosis of HLAP.This study retrospectively analyzed all consecutively diagnosed AP patients between September 2008 and March 2014. We compared the clinical characteristics between HLAP and nonhyperlipidemic acute pancreatitis. The bedside index for severity of acute pancreatitis (BISAP), Ranson, computed tomography severity index (CTSI), and systemic inflammatory response syndrome (SIRS) scores were applied within 48?hours following admission.Of 909 AP patients, 129 (14.2%) had HLAP, 20 were classified as severe acute pancreatitis (SAP), 8 had pseudocysts, 9 had pancreatic necrosis, 30 had pleural effusions, 33 had SIRS, 14 had persistent organ failure, and there was 1 death. Among the HLAP patients, the area under curves for BISAP, Ranson, SIRS, and CTSI in predicting SAP were 0.905, 0.938, 0.812, and 0.834, 0.874, 0.726, 0.668, and 0.848 for local complications, and 0.904, 0.917, 0.758, and 0.849 for organ failure, respectively.HLAP patients were characterized by younger age at onset, higher recurrence rate, and being more prone to pancreatic necrosis, organ failure, and SAP. BISAP, Ranson, SIRS, and CTSI all have accuracy in predicting the prognosis of HLAP patients, but each has different strengths and weaknesses. PMID:26061329

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

    PubMed Central

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

    2014-01-01

    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

  15. Endothelin receptor blockade in severe acute pancreatitis leads to systemic enhancement of microcirculation, stabilization of capillary permeability, and improved survival rates

    Microsoft Academic Search

    Thomas Foitzik; Guido Eibl; Hubert G. Hotz; Jörg Faulhaber; Michael Kirchengast; Heinz J. Buhr

    2000-01-01

    Background. We previously demonstrated that therapy with a new endothelin A receptor antagonist (ET-RA) significantly reduced mortality rates in severe acute pancreatitis (AP) in the rat without attenuating local signs of disease severity (intrapancreatic protease activation, acinar cell necrosis). This raised the question as to why ET-RA was so effective. The purpose of this study was to assess the effect

  16. Changes of amount and ultrastructure of interstitial cells of Cajal in rats with severe acute pancreatitis and their importance

    PubMed Central

    Zhao, Yujie; Li, Guoxia; Sun, Xiaomin; Xu, Ping; Lou, Xiaoli; Tang, Maochun

    2015-01-01

    Objective: To investigate the changes in the amount and ultrastructure of interstitial cells of Cajal (ICC) in rats with severe acute pancreatitis (SAP) and their importance. Methods: A modified Aho method was employed to establish a SAP rat model. Laser scanning confocal immunofluorescence microscopy was employed to detect the amount of ICC, and transmission electron microscopy was employed for observation of ultrastructure of ICC and nerve-ICC-smooth muscle network. Results: The amount of ICC reduced, the intercellular space of ICC was enlarged, cell processes reduced or were absent, cell morphology was irregular, and ICC had unclear borderline, reduced organelles, impaired organelles, nuclear shrinkage and deformation. The junctions between ICC and between ICC and smooth muscle cell/nerve reduced, and the network-like structure was disrupted. Conclusion: In SAP, ICC reduces, with disrupted ultrastructure, and the integrity of network among intestinal nerve, ICC and smooth muscle is impaired, both of which may affect the intestinal functions.

  17. Alpha 2 macroglobulin state in acute pancreatitis. Raised values of alpha 2 macroglobulin-protease complexes in severe and mild attacks

    Microsoft Academic Search

    R E Banks; S W Evans; D Alexander; F Van Leuven; J T Whicher; M J McMahon

    1991-01-01

    Plasma values of C reactive protein, alpha 1 proteinase inhibitor, alpha 2 macroglobulin, and complexed alpha 2 macroglobulin have been determined in serial samples from 27 patients with acute pancreatitis. Complexed alpha 2 macroglobulin was measured by a novel enzyme linked immunosorbent assay with a monoclonal antibody specific for the complexed form. Patients with severe illness had lower concentrations of

  18. Role of bone marrow-derived mesenchymal stem cells in a rat model of severe acute pancreatitis

    PubMed Central

    Tu, Xiao-Huang; Song, Jing-Xiang; Xue, Xiao-Jun; Guo, Xian-Wei; Ma, Yun-Xia; Chen, Zhi-Yao; Zou, Zhong-Dong; Wang, Lie

    2012-01-01

    AIM: To investigate the role and potential mechanisms of bone marrow mesenchymal stem cells (MSCs) in severe acute peritonitis (SAP). METHODS: Pancreatic acinar cells from Sprague Dawley rats were randomly divided into three groups: non-sodium deoxycholate (SDOC) group (non-SODC group), SDOC group, and a MSCs intervention group (i.e., a co-culture system of MSCs and pancreatic acinar cells + SDOC). The cell survival rate, the concentration of malonaldehyde (MDA), the density of superoxide dismutase (SOD), serum amylase (AMS) secretion rate and lactate dehydrogenase (LDH) leakage rate were detected at various time points. In a separate study, Sprague Dawley rats were randomly divided into either an SAP group or an SAP + MSCs group. Serum AMS, MDA and SOD, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-? levels, intestinal mucosa injury scores and proliferating cells of small intestinal mucosa were measured at various time points after injecting either MSCs or saline into rats. In both studies, the protective effect of MSCs was evaluated. RESULTS: In vitro, The cell survival rate of pancreatic acinar cells and the density of SOD were significantly reduced, and the concentration of MDA, AMS secretion rate and LDH leakage rate were significantly increased in the SDOC group compared with the MSCs intervention group and the Non-SDOC group at each time point. In vivo, Serum AMS, IL-6, TNF-? and MAD level in the SAP + MSCs group were lower than the SAP group; however serum IL-10 level was higher than the SAP group. Serum SOD level was higher than the SAP group at each time point, whereas a significant between-group difference in SOD level was only noted after 24 h. Intestinal mucosa injury scores was significantly reduced and the proliferating cells of small intestinal mucosa became obvious after injecting MSCs. CONCLUSION: MSCs can effectively relieve injury to pancreatic acinar cells and small intestinal epithelium, promote the proliferation of enteric epithelium and repair of the mucosa, attenuate systemic inflammation in rats with SAP. PMID:22611322

  19. Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome

    PubMed Central

    Zhu, Hui-ming; Guo, Shao-qing; Liao, Xiu-min; Zhang, Li; Cai, Li

    2015-01-01

    BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery (ENOTES) in treating severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS). METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared. RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II (APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day (P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group (P<0.05). There were significant differences in complications and mortality between the two groups (P<0.01). CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications. PMID:25802562

  20. Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: Canary in a Coal Mine? Results from a Rigorous Validation Protocol

    PubMed Central

    Bhandari, Vimal; Jaipuria, Jiten; Chawla, Avneet Singh

    2013-01-01

    Background/Aims Intra-abdominal hypertension (IAH) is being increasingly reported in patients with severe acute pancreatitis (SAP) with worsened outcomes. The present study was undertaken to evaluate intra-abdominal pressure (IAP) as a marker of severity in the entire spectrum of acute pancreatitis and to ascertain the relationship between IAP and development of complications in patients with SAP. Methods IAP was measured via the transvesical route by measurements performed at admission, once after controlling pain and then every 4 hours. Data were collected on the length of the hospital stay, the development of systemic inflammatory response syndrome (SIRS), multiorgan failure, the extent of necrosis, the presence of infection, pleural effusion, and mortality. Results In total, 40 patients were enrolled and followed up for 30 days. The development of IAH was exclusively associated with SAP with an APACHE II score ?8 and/or persistent SIRS, identifying all patients who were going to develop abdominal compartment syndrome (ACS). The presence of ACS was associated with a significantly increased extent of pancreatic necrosis, multiple organ failure, and mortality. The mean admission IAP value did not differ significantly from the value obtained after pain control or the maximum IAP measured in the first 5 days. Conclusions IAH is reliable marker of severe disease, and patients who manifest organ failure, persistent SIRS, or an Acute Physiology and Chronic health Evaluation II score ?8 should be offered IAP surveillance. Severe pancreatitis is not a homogenous entity. PMID:24312716

  1. Protective effect of Lai Fu Cheng Qi decoction on severe acute pancreatitis-induced myocardial injury in a rat model

    PubMed Central

    LI, NAN; TIAN, YING; WANG, CHUNLI; ZHANG, PENG; YOU, SHENGYI

    2015-01-01

    The aim of the present study was to evaluate the effects of Lai Fu Cheng Qi decoction on myocardial injury in rats with severe acute pancreatitis (SAP). In total, 30 rats were randomly divided into sham, SAP and decoction treatment groups. SAP was induced by a retrograde pancreatic duct injection of 5% sodium taurocholate in the SAP and decoction treatment groups. Rats in decoction treatment group also received intragastric administration of Lai Fu Cheng Qi decoction. The serum levels of creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) were detected using an automatic biochemical analyzer. In addition, myocardial Na+-K+-ATPase activity was analyzed using a spectrophotometric method and the mitochondrial membrane potential was measured by flow cytometry. Myocardial apoptosis was assessed using a TUNEL assay and pathological changes to the heart and pancreas were detected by hematoxylin and eosin staining. Compared with the rats in the sham group, rats in the SAP and decoction treatment groups exhibited significantly higher levels of serum CK-MB and LDH, apoptosis index and pathological scores, and had significantly lower levels of Na+-K+-ATPase activity and mitochondrial membrane potential. However, when compared with the SAP group, the serum levels of CK-MB and LDH, the pathological scores of the pancreas and heart, and the myocardial cell apoptosis index in the decoction treatment group were significantly lower. Furthermore, the Na+-K+-ATPase activity and mitochondrial membrane potential were significantly increased in the decoction treatment group when compared with the SAP group. Therefore, Lai Fu Cheng Qi decoction was shown to exert a protective effect on myocardial injury induced by SAP in rats. PMID:25780399

  2. Effects of PDTC on NF-?B expression and apoptosis in rats with severe acute pancreatitis-associated lung injury

    PubMed Central

    Kan, Shihai; Zhou, Hongying; Jin, Changzhu; Yang, Huijun

    2015-01-01

    We investigated the effects of pyrrolidine dithiocarbamate (PDTC) on intrapulmonary expression of nuclear factor-?B (NF-?B), and apoptosis in rats with severe acute pancreatitis (SAP). We induced SAP, then used immunohistochemistry, TUNEL staining, quantitative PCR assays and western blotting to examine PDTC effects. Treatment with PDTC resulted in interstitial edema and widening of the basement membrane, with swollen mitochondria and aggregation of nuclear chromatin. Expression of NF-?B, Fas, Bcl-2 and TNF-? in lung tissues of SAP rats was increased, with NF-?B, Fas and TNF-? levels maximal after 6 h. PDTC appeared to ameliorate pathological changes, with low levels of NF-?B, Fas, TNF-?, and Caspase-3 mRNA observed and a lower apoptosis index compared with that seen in SAP rats. Expression of NF-?B could be involved in lung tissue apoptosis during SAP. We postulate that PDTC inhibits the activation of NF-?B and apoptosis, effectively alleviating the severity of lung injury.

  3. [Acute pancreatitis and ectopic pancreas].

    PubMed

    Vix, J; Rohr, S; Faure, F; Jung, E; Meyer, C

    1997-07-01

    We report the case of a 28-year-old woman with a pancreatic heterotopia presenting with a history of acute pancreatitis. Symptoms were epigastric pains. Abdomino-pelvic CT Scan revealed a tumor located in gastro-duodenal area. Exploratory surgery was performed, and the segment containing the mass was resected. Histopathologic examination of the lesion revealed heterotopic pancreatic tissue without malignancy. PMID:9378788

  4. Prognostic indicators in acute pancreatitis: CT vs APACHE II

    Microsoft Academic Search

    J. T. De Sanctis; M. J. Lee; G. S. Gazelle; G. W. Boland; E. F. Halpern; S. Saini; P. R. Mueller

    1997-01-01

    Purpose:To investigate the correlation between established contrast-enhanced computed tomography (CECT) criteria of disease severity in acute pancreatitis and the APACHE (Acute Physiology and Chronic Health Evaluation) II score and to assess the utility of each as prognostic indicators in acute pancreatitis.

  5. Calpain I inhibitor ameliorates the indices of disease severity in a murine model of cerulein-induced acute pancreatitis

    Microsoft Academic Search

    Ioannis Virlos; Emanuela Mazzon; Ivana Serraino; Tiziana Genovese; Rosanna Di Paola; Christoph Thiemerman; Ajith Siriwardena; Salvatore Cuzzocrea

    2004-01-01

    Objective Nuclear factor-?B (NF-?B) is a transcription factor which plays a pivotal role in the induction of genes involved in the response to injury and inflammation. Calpain I inhibitor is a potent antioxidant which is an effective inhibitor of NF-?B. This study examined whether the postulate that calpain I inhibitor attenuates experimental acute pancreatitis. Design and setting In a murine

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

    PubMed Central

    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

    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

  7. Early peritoneal lavage with ulinastatin improves outcome and enhances multi-organ protection in a model of severe acute pancreatitis

    PubMed Central

    FENG, CONG; SU, XUAN; ZHOU, XUAN; WANG, LI-LI; LI, BEI; CHEN, LI; LV, FA-QIN; LI, TAN-SHI

    2015-01-01

    The aim of this study was to investigate the effect of early peritoneal lavage with ulinastatin on the outcome of a rat model of severe acute pancreatitis (SAP). A total of 80 male Wistar rats were randomly divided into the following groups: Sham-operated (C), SAP model (M), saline lavage (SL), intravenous ulinastatin (IU), early ulinastatin lavage (EUL) and late ulinastatin lavage (LUL). Intraperitoneal lavage or injection were performed immediately subsequent to the establishment of the SAP model in groups SL, IU and EUL and 3 h later in group LUL. Intraperitoneal lavage with or without ulinastatin was performed for 3 h. The survival time of the rats in groups C, M, EUL and LUL was recorded over a 12-h period and the median survival time was calculated. At 3 h after the induction of SAP, histopathological analyses were performed and the biochemical parameters of groups C, M, SL, IU and EUL were assessed. Groups EUL and LUL exhibited an increased median survival time compared with Group M, with the survival time of the rats in group EUL markedly longer than that in the group LUL rats. Group SL, IU and EUL rats were found to have reduced plasma activities of amylase, lipase, aspartate transaminase and alanine transaminase, with the biggest change observed in the group EUL rats. Furthermore, the intervention in groups SL and EUL was more effective at reducing creatinine and urea levels than that in group IU. Rats in group EUL exhibited a greater inhibition of the SAP-induced increase in troponin T levels than rats in groups SL and IU. The pathological severity scores of the pancreas, liver, kidney and lung in group EUL were significantly lower than those in groups M and better than those in groups SL and IU. In conclusion, early intraperitoneal lavage with ulinastatin significantly improves the median survival time and protects multi-organ function in an SAP model. PMID:25780405

  8. Research on scutellarin parenteral solution's protective effects in rats with severe acute pancreatitis and multiple organ injuries.

    PubMed

    Hanqing, Chen; Xiping, Zhang; Jingmin, Ou; Jun, Jiang; Dijiong, Wu

    2012-06-01

    The aim of this study was to observe scutellarin parenteral solution's therapeutic effects and mechanisms in rats with severe acute pancreatitis (SAP). We divided SD rats into four groups randomly: (1) sham-operated group, (2) model control group, (3) scutellarin-treated group, and (4) Salvia miltiorrhiza-treated group. All of those rats in the abovementioned groups are randomly subdivided into 6 and 12 h subgroups, respectively, according to the postoperative time. Rats have been mercifully killed at different time after operation, and then detected their serum amylase, contents of ALT, AST, BUN, and Cr and observed the pathologic changes of multiple organs (pancreas, liver, kidneys, and lungs). We found that the survival rates have no marked differences (P??0.05). ALT serum contents in S. miltiorrhiza-treated group (6 and 12 h) and scutellarin-treated group (12 h) are obviously less than those in model control group (P?severity scores in scutellarin-treated group (6 and 12 h) have reduced (P??0.05). We think the scutellarin parenteral solution has a certain protective effect on SAP rats' multiple organ injuries. PMID:22105928

  9. Somatostatin therapy of acute experimental pancreatitis.

    PubMed Central

    Lankisch, P G; Koop, H; Winckler, K; Fölsch, U R; Creutzfeldt, W

    1977-01-01

    Because somatostatin (SRIF) reduces exocrine pancreatic secretion, its effect on acute pancreatitis was investigated in rats. Linear SRIF reduced serum amylase and lipase but had no effect on pancreatic necrosis, oedema, leucocyte infiltration, and enzyme content. The mortality rate was not reduced. These results do not recommend the use of SRIF in the treatment of acute pancreatitis. PMID:604191

  10. Effects of dexamethasone and Salvia miltiorrhizae on the small intestine and immune organs of rats with severe acute pancreatitis.

    PubMed

    Xiping, Zhang; Yan, Pan; Xinmei, Huang; Guanghua, Feng; Meili, Ma; Jie, Ni; Fangjie, Zhang

    2010-08-01

    To observe the protecting effects and mechanisms of Dexamethasone and Salviae miltiorrhizae on intestinal mucosa and immune organs (spleen, thymus and lymph node) in rats with severe acute pancreatitis (SAP). The rats were randomly divided into sham-operated, model control, Dexamethasone treated group and Salviae miltiorrhizae treated group. At 3, 6 and 12 h after operation, the mortality rate, pathological changes of intestinal mucosa and immune organs as well as the contents of serum PAF, IL-1 beta and sIL-2R were observed, respectively. The mortality rate and the contents of PAF (at 3 and 6 h), IL-1 beta (at all time points) and sIL-2R (at 3 and 6 h) as well as the pathological scores of thymus (at all time points) and spleen (at 3 h) in Dexamethasone treated group were significantly lower than those in model control groups (P < 0.05). The contents of PAF (at 3 and 12 h), IL-1 beta (at 6 and 12 h) and sIL-2R (at 3 and 6 h) as well as the pathological scores of thymus (at all time points) and spleen (at 3 and 12 h) in Salviae miltiorrhizae treated group were markedly lower than those in model control groups (P < 0.05). Since both Dexamethasone and Salvia miltiorrhizae can reduce the contents of serum PAF, sIL-2R and IL-1 beta, mitigate the pathological changes in the small intestine, spleen and thymus and reduce the mortality rate of SAP rats, they show good therapeutic effects on SAP rats. PMID:20127399

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

    PubMed Central

    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

    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

  12. Effect of salvia miltiorrhizae on pulmonary apoptosis of rats with severe acute pancreatitis or obstructive jaundice.

    PubMed

    Xiping, Zhang; Jun, Fu; Chengjun, Wu; Meili, Ma; Ping, Yan; Jing, Ye; Qijun, Yang; Feibo, Zhu; Rongcao, Ying

    2009-10-01

    To investigate the effect of apoptosis about Salvia miltiorrhizae injection on the lungs of SAP and OJ rats. Total 288 rats were used for SAP-associated experiments and OJ-associated experiments, respectively. The rats were randomly divided into sham-operated, model control and treated group. According to the difference of time points after operation, the SAP rats in each group were subdivided into 3, 6 and 12 h groups while the OJ rats were divided into 7, 14, 21 and 28 days groups. The pathological changes, expression levels of Bax protein and apoptotic indexes in the lungs of SAP or OJ rats were observed, and the mortality rates of SAP or OJ rats were recorded, respectively. The numbers of dead SAP and OJ rats in treated groups declined. The pathological changes in the lungs of SAP or OJ rats in treated groups were relieved to varying degrees. There was no marked difference in pathological severity scores and the positive staining intensity of Bax protein between treated groups and model control groups (all P > 0.05). Salvia miltiorrhizae has some protective effect on the lungs of rats with SAP or OJ which may be related apoptosis although our results can not find significant difference between treated groups and model control groups. PMID:19543819

  13. Fatal Pancreatic Panniculitis Associated with Acute Pancreatitis: A Case Report

    PubMed Central

    Lee, Woo Sun; Kim, Mi Yeon; Kim, Sang Woo; Paik, Chang Nyol; Kim, Hyung Ok

    2007-01-01

    Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation. PMID:17982246

  14. Significance of resistin expression in acute pancreatitis

    PubMed Central

    XUE, LE-NING; WANG, XIAO-YONG; TAN, YONG; LIN, MIN; ZHANG, WEI; XU, KE-QUN

    2015-01-01

    The aim of the present study was to detect the expression of resistin in rats with acute pancreatitis (AP) and investigate its significance in the pathogenesis of AP. In total, 40 Sprague-Dawley rats were randomly divided into four groups (n=10), including the normal control, sham-operated, acute edematous pancreatitis (AEP) and acute necrotizing pancreatitis (ANP) groups. Following the establishment of animal models, the levels of serum resistin, C-reactive protein (CRP), tumor necrosis factor-? (TNF-?) and interleukin (IL)-1? were measured using ELISA. Resistin expression in the pancreatic tissues was detected using an immunohistochemical method. In addition, the mRNA expression of resistin in the pancreatic tissues was analyzed with quantitative polymerase chain reaction. The levels of serum amylase, serum resistin, TNF-?, IL-1? and CRP were all significantly higher in the AEP and ANP groups when compared with the control and sham-operated groups (P<0.01), as were the pancreas/body weight ratios and pathological scores of the pancreas. These increases were more significant in the ANP group than in the AEP group (P<0.05). The mRNA expression levels of resistin in the pancreatic tissues were markedly higher in the AEP and ANP groups when compared with the control and sham-operated groups (P<0.01), particularly in the pancreatic tissues of the ANP group, which exhibited notably higher levels compared with the AEP group. The serum resistin level was found to positively correlate with the serum levels of CRP, TNF-? and IL-1?, and the pathological scores of the pancreatic tissues. In conclusion, the results indicated that resistin may be associated with the occurrence and development of AP; thus, the protein may be a valuable indicator for assessing the severity of AP. PMID:25780448

  15. Development of acute pancreatitis after Nissen fundoplication.

    PubMed

    Inoue, Mikihiro; Uchida, Keiichi; Otake, Kohei; Okigami, Masato; Maji, Tomoaki; Kusunoki, Masato

    2015-04-01

    Acute pancreatitis subsequent to Nissen fundoplication for gastroesophageal reflux disease (GERD) is an extremely rare adverse event. We describe a pediatric case of acute pancreatitis resulting from superior mesenteric artery syndrome (SMAS) and gas bloat after fundoplication. Gas bloat is one of the known postoperative complications after Nissen fundoplication. Poor nutrition status, which is often associated with severe pediatric GERD, is a risk factor for SMAS. In this case, development of gas bloat and SMAS led to the formation of a closed loop and increased intraluminal pressure of the duodenum and pancreatic duct. Many pediatric patients who need anti-reflux surgery face the risk of developing this entity. Preventive measures, such as treatment with prokinetics and frequent small-volume meals, should be considered until improvement of nutritional status after fundoplication. PMID:25868962

  16. Impact of Global Fxr Deficiency on Experimental Acute Pancreatitis and Genetic Variation in the FXR Locus in Human Acute Pancreatitis

    PubMed Central

    Nijmeijer, Rian M.; Schaap, Frank G.; Smits, Alexander J. J.; Kremer, Andreas E.; Akkermans, Louis M. A.; Kroese, Alfons B. A.; Rijkers, Ger. T.; Schipper, Marguerite E. I.; Verheem, André; Wijmenga, Cisca; Gooszen, Hein G.; van Erpecum, Karel J.

    2014-01-01

    Background Infectious complications often occur in acute pancreatitis, related to impaired intestinal barrier function, with prolonged disease course and even mortality as a result. The bile salt nuclear receptor farnesoid X receptor (FXR), which is expressed in the ileum, liver and other organs including the pancreas, exhibits anti-inflammatory effects by inhibiting NF-?B activation and is implicated in maintaining intestinal barrier integrity and preventing bacterial overgrowth and translocation. Here we explore, with the aid of complementary animal and human experiments, the potential role of FXR in acute pancreatitis. Methods Experimental acute pancreatitis was induced using the CCK-analogue cerulein in wild-type and Fxr-/- mice. Severity of acute pancreatitis was assessed using histology and a semi-quantitative scoring system. Ileal permeability was analyzed in vitro by Ussing chambers and an in vivo permeability assay. Gene expression of Fxr and Fxr target genes was studied by quantitative RT-PCR. Serum FGF19 levels were determined by ELISA in acute pancreatitis patients and healthy volunteers. A genetic association study in 387 acute pancreatitis patients and 853 controls was performed using 9 tagging single nucleotide polymorphisms (SNPs) covering the complete FXR gene and two additional functional SNPs. Results In wild-type mice with acute pancreatitis, ileal transepithelial resistance was reduced and ileal mRNA expression of Fxr target genes Fgf15, SHP, and IBABP was decreased. Nevertheless, Fxr-/- mice did not exhibit a more severe acute pancreatitis than wild-type mice. In patients with acute pancreatitis, FGF19 levels were lower than in controls. However, there were no associations of FXR SNPs or haplotypes with susceptibility to acute pancreatitis, or its course, outcome or etiology. Conclusion We found no evidence for a major role of FXR in acute human or murine pancreatitis. The observed altered Fxr activity during the course of disease may be a secondary phenomenon. PMID:25470824

  17. Acute Pancreatitis Due to a Duodenal Ulcer

    PubMed Central

    Pyeon, Sung Ik; Kim, Yong Tae; Lee, Ban Seok; Lee, Sang Ho; Lee, Jae Nam; Cheong, Jae Hoon; Oh, Kong Jin

    2014-01-01

    Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar. PMID:25505728

  18. Pancreatic ductal system obstruction and acute recurrent pancreatitis

    Microsoft Academic Search

    M Delhaye; C Matos; M Arvanitakis

    2008-01-01

    Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial, chronic pancreatitis, tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction. This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.

  19. [The systemic inflammatory response syndrome correction in acute destructive pancreatitis].

    PubMed

    Agapov, M A; Khoreva, M V; Gorski?, V A

    2011-01-01

    Acute pancreatitis is a disease of variable severity. In which some patients experience mild, self-limited attacks while others manifest a severe, highly morbid, and frequently lethal attack. The exact mechanisms by which diverse etiological factors induce an attack are still unclear. Recent studies have established the role played by inflammatory mediators in the pathogenesis of acute pancreatitis. In our research we have estimated influence of not steroid anti-inflammatory preparation on synthesis pro-and anti-inflammatory Cytokines at healthy donors and at patients with Acute pancreatitis. PMID:22363994

  20. New diagnostic criteria of acute pancreatitis.

    PubMed

    Kiriyama, Seiki; Gabata, Toshifumi; Takada, Tadahiro; Hirata, Koichi; Yoshida, Masahiro; Mayumi, Toshihiko; Hirota, Masahiko; Kadoya, Masumi; Yamanouchi, Eigoro; Hattori, Takayuki; Takeda, Kazunori; Kimura, Yasutoshi; Amano, Hodaka; Wada, Keita; Sekimoto, Miho; Arata, Shinju; Yokoe, Masamichi; Hirota, Morihisa

    2010-01-01

    Practical guidelines for the diagnosis of acute pancreatitis are presented so that a rapid and adequate diagnosis can be made. When acute pancreatitis is suspected in patients with acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of acute pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other acute abdominal diseases are ruled out if local findings associated with pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having acute pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting acute pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of acute pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of acute pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of acute pancreatitis. Elucidation of the etiology of acute pancreatitis should be continued after a diagnosis of acute pancreatitis. In the process of the etiologic elucidation of acute pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced acute pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US. PMID:20012328

  1. Finasteride use and acute pancreatitis in Taiwan.

    PubMed

    Lai, Shih-Wei; Lai, Hsueh-Chou; Lin, Cheng-Li; Liao, Kuan-Fu

    2015-06-01

    The aim of this study was to examine whether there is an association between finasteride use and the risk of acute pancreatitis. This population-based case-control study used the database of the Taiwan National Health Insurance Program. There were 2,530 male subjects aged 40-84 years with a first-attack of acute pancreatitis during the period of 1998-2011 as the case group and 10,119 randomly selected subjects without acute pancreatitis as the control group. Both groups were matched by age and index year of diagnosing acute pancreatitis. Subjects who never had finasteride prescription were defined as "never use." Subjects who at least received 1 prescription for finasteride before the date of diagnosing acute pancreatitis were defined as "ever use." The association of acute pancreatitis with finasteride use was examined by the odds ratio (OR) and 95% confidence interval (CI) using the multivariable unconditional logistic regression model. The crude OR of acute pancreatitis was 1.78 (95%CI 1.33, 2.39) for subjects with ever use of finasteride, when compared with subjects with never use of finasteride. After adjusting for potential confounders, the adjusted OR of acute pancreatitis decreased to 1.25 (95%CI 0.90, 1.73) for subjects with ever use of finasteride, but no statistical significance was seen. No association can be detected between finasteride use and the risk of acute pancreatitis. PMID:25573785

  2. Experimental acute pancreatitis in rats after chronic and chronic plus acute ethanol administration in combination with a pancreatic juice edema.

    PubMed

    Letko, G; Siech, M; Sokolowski, A; Spormann, H

    1989-01-01

    The influence of long-term (26 weeks) and long-term plus acute ethanol administration on the development of acute pancreatitis was studied in rats. While both these treatments alone did not induce pancreatitis in any rat, extrapancreatic fat necrosis and histologic lesions of the pancreas were found in the majority of animal 24 hours after additional establishing of a pancreatic juice edema by an obstruction/hypersecretion mechanism. Severity and frequency of findings were significantly increased by additional short-term ischemia (25 min) of the pancreas. In control rats without ethanol ingestion, the edema receded without any lesions, and after additional ischemia significantly fewer rats exhibited signs of acute pancreatitis when compared to the ethanol-treated groups. An experimental model of acute alcoholic pancreatitis is presented with ethanol ingestion, temporary ductal obstruction and stimulation of secretion being essential constituents, which may be of clinical relevance, too. PMID:2753627

  3. [Unusual presentation of hypertriglyceridemic acute pancreatitis in a child].

    PubMed

    Boutbaoucht, M; Mouaffak, Y; Dilai, M-O; Najib, M; Jalal, H; El Adib, A-G; Younous, S

    2012-03-01

    Acute pancreatitis in children is rare and is characterized by clinical, biological, and etiological polymorphism. We report the case of a 6-year-old child who underwent surgery for intestinal obstruction. The diagnosis of acute pancreatitis was made after the surgical exploration. Initial laboratory tests showed hyperlipasemia and mild hypertriglyceridemia. After 2 weeks of hospitalization, we found severe hypertriglyceridemia, which was considered the cause of acute pancreatitis. Based on a review of the literature, we emphasize the importance of considering acute pancreatitis in the diagnosis of abdominal pain in children. Hypertriglyceridemia is one of its rare causes and must be detected because specific treatments are needed. Blood triglyceride concentration in the initial phase can be misleading and the assay should be repeated after the acute episode. PMID:22269915

  4. Pomalidomide suppresses cerulein-induced acute pancreatitis in mice

    Microsoft Academic Search

    Ming Jen Tsai; Chinpiao Chen; Sung-Ho Chen; Yen Ta Huang; Ted H. Chiu

    2011-01-01

    Background  An overproduction of proinflammatory mediators in severe acute pancreatitis contributes to the systemic inflammatory response,\\u000a which may lead to multiorgan damage and even death. Thus, inflammatory cytokines, e.g., tumor necrosis factor (TNF)-? and\\u000a interleukin (IL)-1?, may be novel targets for the treatment of acute pancreatitis. The aim of this study was to investigate\\u000a the therapeutic effects of pomalidomide (or CC-4047),

  5. [Myocardial infarction as complication of acute pancreatitis].

    PubMed

    Asfalou, I; Miftah, F; Kendoussi, M; Raissouni, M; Benyass, A; Moustaghfir, A; Zbir, E; Hda, A; Hamani, A

    2011-01-01

    We report a case of an acute pancreatitis complicated by myocardial infarction with normal coronary arteries on angiography. This observation presents a double interest. First, it illustrates unusual forms of coronary disease represented by the non-atherosclerotic infarction. On the other hand, it shows that the multiple visceral damage associated with acute pancreatitis can include myocardial infarction which complications aggravate prognosis. PMID:21232905

  6. Magnetic Resonance Imaging for the Normal Mesostenium and Involvement of the Mesostenium in Acute Pancreatitis

    PubMed Central

    Chi, Xiao Xiao; Zhang, Xiao Ming; Chen, Tian Wu; Tang, Wei; Xiao, Bo; Ji, Yi Fan; Huang, Xiao Hua

    2014-01-01

    The main point of this paper is to study MRI findings of the normal mesostenium and the involvement of the mesostenium in acute pancreatitis and to discuss the relationship between the involvement of the mesostenium and the severity of acute pancreatitis. In clinical practice, the mesenterical involvement in acute pancreatitis was often observed on MRI in daily works, which was little recorded in the reported studies. We conducted the current study to assess the mesenterical involvement in acute pancreatitis with MRI. We found that the mesenterical involvement of acute pancreatitis patients is common on MRI. The mesenterical involvement has a positive correlation with the MR severity index and the Acute Physiology and Chronic Healthy Evaluation II scoring system. It has been shown that MR can be used to visualize mesenterical involvement, which is a supplementary indicator in evaluating the severity of acute pancreatitis and local and systemic complications. PMID:25136639

  7. Can early endoscopic ultrasound predict pancreatic necrosis in acute pancreatitis?

    PubMed Central

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

    2014-01-01

    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

  8. Acute idiopathic pancreatitis: clinical and diagnostic contribution.

    PubMed

    Forte, A; Montesano, G; Gallinaro, L; Bertagni, A; Turano, R; Hueck, S; Illuminati, G

    1997-01-01

    Acute idiopathic pancreatitis is a term used when no underlying cause can be identified on routine investigations. However more specialized investigations, such as endoscopic, endoscopic retrocolangio pancreopathy (CPRE), may detect aetiological factors, particularly biliary sludge and pancreatic duct abnormalities. The authors, reviewing the current literature, report their caseload of idiopathic pancreatitis. They conclude that CPRE is indicated if ultrasonography shows a calibre of the common duct at the superior limits of normal values and in each idiopathic recurrent AP. PMID:9444796

  9. Cutting-edge information for the management of acute pancreatitis.

    PubMed

    Takada, Tadahiro; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Wada, Keita; Amano, Hodaka; Gabata, Toshifumi; Arata, Shinjyu; Hirota, Morihisa; Yokoe, Masamichi; Kiriyama, Seiki; Nakayama, Takeo; Otomo, Kuni; Tanaka, Masao; Shimosegawa, Tooru

    2010-01-01

    Considering that the Japanese (JPN) guidelines for the management of acute pancreatitis were published in Takada et al. (J HepatoBiliary Pancreat Surg 13:2-6, 2006), doubts will be cast as to the reason for publishing a revised edition of the Guidelines for the management of acute pancreatitis: the JPN guidelines 2010, at this time. The rationale for this is that new criteria for the severity assessment of acute pancreatitis were made public on the basis of a summary of activities and reports of shared studies that were conducted in 2008. The new severity classification is entirely different from that adopted in the 2006 guidelines. A drastic revision was made in the new criteria. For example, about half of the cases that have been assessed previously as being 'severe' are assessed as being 'mild' in the new criteria. The JPN guidelines 2010 are published so that consistency between the criteria for severity assessment in the first edition and the new criteria will be maintained. In the new criteria, severity assessment can be made only by calculating the 9 scored prognostic factors. Severity assessment according to the contrast-enhanced computed tomography (CT) grade was made by scoring the poorly visualized pancreatic area in addition to determining the degree of extrapancreatic progress of inflammation and its extent. Changes made in accordance with the new criteria are seen in various parts of the guidelines. In the present revised edition, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is treated as an independent item. Furthermore, clinical indicators (pancreatitis bundles) are presented to improve the quality of the management of acute pancreatitis and to increase adherence to new guidelines. PMID:20020160

  10. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: A prospective randomized double-blind study

    PubMed Central

    Karakan, Tarkan; Ergun, Meltem; Dogan, Ibrahim; Cindoruk, Mehmet; Unal, Selahattin

    2007-01-01

    AIM: To compare the beneficial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP). METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE II score, Balthazar’s CT score and CRP were assessed daily during the study period. RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE II normalization (APACHE II score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05). CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy. PMID:17569144

  11. Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

    PubMed Central

    Samal, Sunita; Gupta, Shweta; Begum, Jasmina; Ghose, Seetesh

    2015-01-01

    We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome. PMID:25738042

  12. Hormonal protection in acute pancreatitis by ghrelin, leptin and melatonin

    PubMed Central

    Jaworek, Jolanta; Konturek, Stanis?aw Jan

    2014-01-01

    Acute pancreatitis is a nonbacterial disease of the pancreas. The severe form of this ailment is characterized by high mortality. Whether acute pancreatitis develops as the severe type or resolves depends on the intensity of the inflammatory process which is counteracted by the recruitment of innate defense mechanisms. It has been shown that the hormones ghrelin, leptin and melatonin are able to modulate the immune function of the organism and to protect the pancreas against inflammatory damage. Experimental studies have demonstrated that the application of these substances prior to the induction of acute pancreatitis significantly attenuated the intensity of the inflammation and reduced pancreatic tissue damage. The pancreatic protective mechanisms of the above hormones have been related to the mobilization of non-specific immune defense, to the inhibition of nuclear factor kappa B and modulation of cytokine production, to the stimulation of heat shock proteins and changes of apoptotic processes in the acinar cells, as well as to the activation of antioxidant system of the pancreatic tissue. The protective effect of ghrelin seems to be indirect and perhaps dependent on the release of growth hormone and insulin-like growth factor 1. Leptin and ghrelin, but not melatonin, employ sensory nerves in their beneficial action on acute pancreatitis. It is very likely that ghrelin, leptin and melatonin could be implicated in the natural protection of the pancreatic gland against inflammatory damage because the blood levels of these substances increase in the initial phase of pancreatic inflammation. The above hormones could be a part of the innate resistance system which might remove noxious factors and could suppress or attenuate the inflammatory process in the pancreas. PMID:25493003

  13. Imaging and intervention in acute pancreatitis.

    PubMed

    Balthazar, E J; Freeny, P C; vanSonnenberg, E

    1994-11-01

    An International Symposium was held in Atlanta in 1992 to present the state of the art of diagnostic evaluation and management of acute pancreatitis and to agree on an acceptable series of clinical definitions for classifying the disease and its complications. The symposium was composed of 40 internationally recognized experts in pancreatic disease from 15 countries representing six disciplines (anatomy, gastroenterology, internal medicine, pathology, radiology, and surgery). The purpose of this article is to present the radiologically relevant aspects of the symposium; to define the state of the art of imaging and intervention in acute pancreatitis, particularly how and when to use computed tomography and how and when to perform percutaneous therapy versus surgery; and to encourage radiologists to use precise and proper nomenclature when describing the morphologic manifestations of acute pancreatitis as depicted by various imaging modalities. PMID:7972730

  14. Quetiapine-induced hypertriglyceridaemia causing acute pancreatitis.

    PubMed

    Franco, John Mark; Vallabhajosyula, Saraschandra; Griffin, Timothy John

    2015-01-01

    Second-generation antipsychotics have well-known metabolic side effects such as hyperlipidaemia and hyperglycaemia. A middle-aged man presented with epigastric and flank pain associated with nausea, and was noted to have elevated triglycerides (3590?mg/dL or 40.53?mmol/L), lipase and glucose. Haematological parameters revealed neutropenia with pancytopaenia. The patient was started on conservative management for acute pancreatitis, and on intravenous insulin and oral gemfibrozil for lowering of his triglycerides. He gradually improved and was transitioned to oral atorvastatin and fenofibrate. His triglycerides, glucose and leucocyte counts normalised at discharge and he was transitioned to ziprasidone. The combination of hypertriglyceridaemia, worsening hyperglycaemia and neutropenia made us suspect quetiapine as the causative agent. Medications cause only 0.1-7% of acute pancreatitis cases, with quetiapine implicated in only five-reported cases. Hypertriglyceridaemia (>600?mg/dL or 6.77?mmol/L) is frequently reported with quetiapine use, but severe hypertriglyceridaemia (>1000?mg/dL or 11.29?mmol/L) has been reported in <10 patients. PMID:25976202

  15. Surgical and interventional management of complications caused by acute pancreatitis

    PubMed Central

    Karakayali, Feza Y

    2014-01-01

    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. PMID:25309073

  16. A Novel Model of Severe Gallstone Pancreatitis: Murine Pancreatic Duct Ligation Results in Systemic Inflammation and Substantial Mortality

    Microsoft Academic Search

    Isaac Samuel; Zuobiao Yuan; David K. Meyerholz; Erik Twait; Deborah E. Williard; Duraisamy Kempuraj

    2010-01-01

    Background: Suitable experimental models of gallstone pancreatitis with systemic inflammation and mortality are limited. We developed a novel murine model of duct-ligation-induced acute pancreatitis associated with multiorgan dysfunction and severe mortality. Methods: Laparotomy was done on C57\\/BL6 mice followed by pancreatic duct (PD) ligation, bile duct (BD) ligation without PD ligation, or sham operation. Results: Only mice with PD ligation

  17. Incremental dynamic bolus computed tomography of acute pancreatitis.

    PubMed

    Freeny, P C

    1993-06-01

    Acute pancreatitis represents a wide spectrum of inflammatory disease involving the pancreas, peripancreatic tissues, adjacent solid organs, gastrointestinal and biliary tract, and vascular system. The extent and severity of the inflammatory process determines the prognosis of the patient and the need for specific surgical, endoscopic, and radiologically-guided intervention. Computed tomography is the single best imaging test for evaluating patients with acute pancreatitis. It can accurately stage the inflammatory process and can identify associated complications that require careful observation or immediate intervention. It also is essential for guiding percutaneous catheter placement for treatment of infected and noninfected fluid collections. PMID:8370977

  18. Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study

    PubMed Central

    Chen, Xinglin; Liu, Tao; Gou, Shanmiao; Chen, Changzhong; Xiao, Jun; Jin, Xin; He, Zhiqiang; Dong, Liming; Zhang, Yushun; Luo, Na; Wu, Heshui; Wang, Chunyou

    2015-01-01

    Objective Many studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients. Methods In total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded. Results Within 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient’s sex, local complications, ascites, and serum amylase levels. Conclusions CVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different. PMID:26053865

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

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

    2009-01-01

    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

  1. Acute pancreatitis in infants and children.

    PubMed Central

    Hillemeier, C.; Gryboski, J. D.

    1984-01-01

    Acute pancreatitis is being encountered more often in children due to antimetabolite therapy, accidental injury, and traumatic battering. Pancreatitis may occur in the absence of traditionally elevated serum amylase and lipase, and initial diagnosis may depend upon ultrasonography. Traditional therapy of enteric rest with nasogastric suction has been supported by the use of parenteral nutrition. Newer pharmaceutical agents have been ineffective in altering the course of the illness or in preventing complications of pseudocyst or abscess. PMID:6382834

  2. Severe acute respiratory syndrome

    Microsoft Academic Search

    Y Guan; K Y Yuen; J S M Peiris

    2004-01-01

    Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress

  3. Acute recurrent pancreatitis: Etiopathogenesis, diagnosis and treatment

    PubMed Central

    Testoni, Pier Alberto

    2014-01-01

    Acute recurrent pancreatitis (ARP) refers to a clinical entity characterized by episodes of acute pancreatitis which occurs on more than one occasion. Recurrence of pancreatitis generally occurs in a setting of normal morpho-functional gland, however, an established chronic disease may be found either on the occasion of the first episode of pancreatitis or during the follow-up. The aetiology of ARP can be identified in the majority of patients. Most common causes include common bile duct stones or sludge and bile crystals; sphincter of oddi dysfunction; anatomical ductal variants interfering with pancreatic juice outflow; obstruction of the main pancreatic duct or pancreatico-biliary junction; genetic mutations; alcohol consumption. However, despite diagnostic technologies, the aetiology of ARP still remains unknown in up to 30% of cases: in these cases the term “idiopathic” is used. Because occult bile stone disease and sphincter of oddi dysfunction account for the majority of cases, cholecystectomy, and eventually the endoscopic biliary and/or pancreatic sphincterotomy are curative in most of cases. Endoscopic biliary sphincterotomy appeared to be a curative procedure per se in about 80% of patients. Ursodeoxycholic acid oral treatment alone has also been reported effective for treatment of biliary sludge. In uncertain cases toxin botulin injection may help in identifying some sphincter of oddi dysfunction, but this treatment is not widely used. In the last twenty years, pancreatic endotherapy has been proven effective in cases of recurrent pancreatitis depending on pancreatic ductal obstruction, independently from the cause of obstruction, and has been widely used instead of more aggressive approaches. PMID:25493002

  4. Recurrent acute pancreatitis in patients with cystic fibrosis with normal pancreatic enzymes.

    PubMed

    Shwachman, H; Lebenthal, E; Khaw, K T

    1975-01-01

    Ten adolescent and young adults with cystic fibrosis (CF) have had well-documented recurrent attacks of acute pancreatitis. The diagnosis of CF in each patient was delayed because they did not have pancreatic insufficiency. The diagnosis of CF was documented by the typical pulmonary involvement and elevated sweat sodium and chloride levels in all cases and a positive family history in six of the ten patients. Two patients were diagnosed as having acute pancreatitis before the diagnosis of CF was made, thus indicating that acute pancreatitis may be the presenting complaint in the young adult with CF. The diagnosis of acute pancreatitis was based on the presence of severe abdominal pain, usually with vomiting, tenderness in the mid-epigastrium, elevated serum and urinary amylase and serum lipase. Attacks were precipitated by fatty meals, alcohol ingestion; postcholecystectomy and tetracycline administration. In some patients no precipitating event could be elicited. Intravenous secretin-pancreozymin stimulation tests revealed a diminished bicarbonate secretion with little effect on the secretion of the zymogen enzymes. A mild attack of pancreatitis occurred after secretin-pancreozymin stimulation. The endocrine pancreatic function tested in four patients was normal as revealed by the glucose tolerance tests and determinations of serum insulin, growth hormone and free fatty acid. Transduodenal pancreatograms were performed in three patients; one showed a normal pancreatic duct, one showed duct obstruction and in the third patient a beady type of narrowing was found. The selenomethionine Se 75 uptake of the pancreas was noted only in the head of the pancreas. This suggests that loss of function occurs initially to a greater extent in the tail and body of the pancreas. Three patients died and showed characteristic lesions of CF. PMID:1110867

  5. The adrenocorticotropic hormone-induced cortisol response in acute pancreatitis

    Microsoft Academic Search

    AB Johan Groeneveld

    2009-01-01

    ABSTRACT: The evidence that severe acute pancreatitis can result in critical illness-related corticosteroid insufficiency following impaired adrenal secretion is accumulating. The study by Peng and coworkers in Critical Care certainly contributes to that idea, even though the question whether relative adrenal insufficiency should prompt for treatment by substitution doses of corticosteroids remains unresolved. The study is discussed in terms of

  6. Fatal Outcome in Acute Pancreatitis: Its Occurrence and Early Prediction

    Microsoft Academic Search

    Torsten Blum; Patrick Maisonneuve; Albert B. Lowenfels; Paul Georg Lankisch

    2001-01-01

    Background\\/Aims: This study aims to determine predictability of death in acute pancreatitis at a secondary-care hospital in Germany. Methods: This study is part of an ongoing study on the epidemiology of acute pancreatitis and covers 368 patients with a first attack of acute pancreatitis in Lüneburg county from 1988 to 1999. Early and late mortality were defined as ?1 weeks

  7. Transition of rat pancreatic juice edema into acute pancreatitis by single ethanol administration.

    PubMed

    Letko, G; Nosofsky, T; Lessel, W; Siech, M

    1991-03-01

    The present study was done to determine the influence of single oral, intravenous and intraperitoneal ethanol administration at pre-existing pancreatic juice edema on frequency and severity of acute pancreatitis (AP). The rats were divided into six control (isolated treatment) and five study groups (edema plus varied ethanol application). 24 h postoperatively quality and quantity of macroscopic and histopathologic changes were graded on an arbitrary scale. While in the controls AP was not induced in any rat, in the study groups extrapancreatic fat necrosis and histologic lesions of the pancreas were found in the majority of animals. The individual rats revealed a remarkable variation of the severity of changes. A detailed differentiation of pancreatic necroses revealed a dominance of intrapancreatic fat necrosis and acinar necrosis at the periphery of lobules. The findings observed were widely independent of the way of ethanol administration. The present approach offers a simple and reproducible animal model to study the influence of acute ethanol application on development of AP and hints on the involvement of disturbances of the pancreatic microcirculation and of acinar cell metabolism in the pathogenesis of ethanol-induced acute pancreatitis. PMID:2068007

  8. Beneficial effects of trypsin inhibitors derived from a spider venom peptide in L-arginine-induced severe acute pancreatitis in mice.

    PubMed

    Ning, Weiwen; Wang, Yongjun; Zhang, Fan; Wang, Hengyun; Wang, Fan; Wang, Xiaojuan; Tang, Huaxin; Liang, Songping; Shi, Xiaoliu; Liu, Zhonghua

    2013-01-01

    HWTI is a 55-residue protein isolated from the venom of the spider Ornithoctonus huwena. It is a potent trypsin inhibitor and a moderate voltage-gated potassium channel blocker. Here, we designed and expressed two HWTI mutants, HWTI-mut1 and HWTI-mut2, in which the potassium channel inhibitory activity was reduced while the trypsin inhibitory activity of the wild type form (approximately 5 EPU/mg) was retained. Animal studies showed that these mutants were less toxic than HWTI. The effects of HWTI and HWTI-mut1 were examined in a mouse model of acute pancreatitis induced by intraperitoneal injection of a large dose of L-arginine (4 mg/kg, twice). Serum amylase and serum lipase activities were assessed, and pathological sections of the pancreas were examined. Treatment with HWTI and HWTI-mut1 significantly reduced serum amylase and lipase levels in a dose dependent manner. Compared with the control group, at 4 mg/kg, HWTI significantly reduced serum amylase level by 47% and serum lipase level by 73%, while HWTI-mut1 significantly reduced serum amylase level by 59% and serum lipase level by 72%. Moreover, HWTI and HWTI-mut1 effectively protected the pancreas from acinar cell damage and inflammatory cell infiltration. The trypsin inhibitory potency and lower neurotoxicity of HWTI-mut1 suggest that it could potentially be developed as a drug for the treatment of acute pancreatitis with few side effects. PMID:23613780

  9. [A case of acute pancreatitis and acute hepatitis caused by ingestion of Ceramium kondoi].

    PubMed

    Kim, Da-bin; Cho, Yoo-Kyung; Song, Hyun Joo; Song, Byung-Cheol

    2013-11-01

    In Korea, the use of herbal remedies is a common cause of drug-induced liver injury. However, the occurrence of both acute pancreatitis and acute hepatitis after taking herbal remedies has rarely been reported. Herein, we report a case of concurrent acute pancreatitis and acute hepatitis associated with Ceramium kondoi ingestion. A 58-year-old woman was diagnosed with advanced gastric cancer 7 months ago. Total gastrectomy and adjuvant chemotherapy was performed without complications. The patient had been well until recently, when she presented with severe abdominal pain after ingestion of Ceramium kondoifor 4 weeks. The laboratory findings demonstrated elevated liver enzymes and lipase, and abdominal computed tomography revealed pancreas swelling with fat infiltration. The diagnosis was made based on the diagnostic criteria for drug induced pancreatitis and the Russel Uclaf Causality Assessment Method scale for drug-induced liver injury. After cessation of Ceramium kondoi, she showed clinical and biochemical improvement. PMID:24262598

  10. Development of acute pancreatitis in rats after single ethanol administration and induction of a pancreatic juice edema.

    PubMed

    Siech, M; Heinrich, P; Letko, G

    1991-02-01

    The effect of an acute gastral ethanol application and an additional induction of a pancreatic juice edema by an obstruction/hyperstimulation mechanism was studied in rats. Neither ethanol administration nor the combination of ductal obstruction and secretory stimulation resulted in an acute pancreatitis when applied independently. A combination of these factors, however, led to the development of AP in two-thirds of the rats treated in this manner. Its severity was evaluated by the degree of extrapancreatic fat necrosis, the increase in serum amylase and lipase activities, and by histologic investigations. It is assumed that a pancreatic juice edema, provoked by pancreatic secretion at temporary ductal obstruction, could be an important cofactor in formation of ethanol-induced acute pancreatitis. PMID:2033327

  11. Similar morphological and intracellular biochemical changes in alcoholic acute pancreatitis and ischemic acute pancreatitis in rats.

    PubMed

    Siech, M; Weber, H; Letko, G; Dummler, W; Schoenberg, M H; Beger, H G

    1997-01-01

    Pancreatic hyperstimulation with simultaneous duct obstruction does not cause the typical features of acute pancreatitis, therefore the role of an additional challenge, such as either ethanol intoxication or short-term ischemia, was studied. Alcoholic pancreatitis was induced in 28 rats by acute ethanol intoxication (0.25 LD50) and an obstruction/hyperstimulation mechanism (clip of the biliopancreatic duct for 20 min and intravenous stimulation with 5 U of cholecystokinin and secretin each). Ischemic pancreatitis was performed by obstruction/hyperstimulation and subsequent pancreatic ischemia by clamping the supplying arteries for 40 min. The macro- and microscopic alterations were evaluated and graded by a scoring system. Additionally, the pancreas was removed in 50% of the animals and the pancreatic acini were prepared. From those acini the intracellular enzymes trypsinogen, kallikreinogen, amylase, lipase, glucuronidase, and acidic phosphatases were determined. While obstruction/hyperstimulation, 40 min of ischemia, or ethanol alone did not induce acute pancreatitis, a combination of obstruction/hyperstimulation with either ethanol or ischemia resulted in acute pancreatitis in 68 and 60% of treated rats, respectively. Similarly, both models were characterized by extrapancreatic fat necrosis and acinar necrosis at the periphery of the lobules. Almost all intracellular enzymes were elevated in both pancreatitis models compared to sham-operated controls. Both alcohol and ischemia were insults that sensitize the pancreas to develop acute pancreatitis after obstruction/hyperstimulation. Since the observed morphologic and enzymatic alterations in both models are very similar, alcohol and ischemia might have some common pathways by which they make the pancreas vulnerable to enzymatic attacks. PMID:8981505

  12. The Atlanta Classification of acute pancreatitis revisited

    Microsoft Academic Search

    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

    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

  13. A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation.

    PubMed

    Choi, Jong Kyoung; Lee, Sang Hyub; Kwak, Min Sun; Kim, Jai Hwan; Jang, Eun Sun; Hwang, Sung Wook; Hwang, Jin Hyeok; Joo, Li Jin; Yoon, Yoo Seok; Kim, Hae Ryoung

    2010-03-01

    Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy. PMID:20479928

  14. Enteral nutrition and immune modulation of acute pancreatitis

    PubMed Central

    Hegazi, Refaat A; DeWitt, Tiffany

    2014-01-01

    Enteral nutrition has been strongly recommended by major scientific societies for the nutritional management of patients with acute pancreatitis. Providing severe acute pancreatitis patients with enteral nutrition within the first 24-48 h of hospital admission can help improve outcomes compared to parenteral nutrition and no feeding. New research is focusing in on when and what to feed to best improve outcomes for acute pancreatitis patients. Early enteral nutrition have the potential to modulate the immune responses. Despite this consistent evidence of early enteral nutrition in patients with acute pancreatitis, clinical practice continues to vary due to individual clinician preference. Achieving the immune modulating effects of enteral nutrition heavily depend on proper placement of the feeding tube and managing any tube feeding associated complications. The current article reviews the immune modulating effects of enteral nutrition and pro- and prebiotics and suggests some practical tools that help improve the patient adherence and tolerance to the tube feeding. Proper selection of the type of the tube, close monitoring of the tube for its placement, patency and securing its proper placement and routine checking the gastric residual volume could all help improve the outcome. Using peptide-based and high medium chain triglycerides feeding formulas help improving feeding tolerance. PMID:25473161

  15. Severe acute asthma.

    PubMed

    Racusin, Diana Alex; Fox, Karin Anneliese; Ramin, Susan Marie

    2013-08-01

    Asthma is common among women of reproductive age and affects between 4% and 8% of pregnant women. Pregnancy outcomes are correlated to the degree of asthma severity and control. Approximately one-third of pregnant women with asthma remain stable, a third will have improvement of their asthma, and a third will have worsening of the disease. Pregnant women with severe asthma are at markedly increased risk of maternal and perinatal morbidity and mortality, preeclampsia, low-birth weight infants, and preterm delivery. A severe asthma exacerbation in a pregnant woman may be clinically daunting, however immediate intervention with appropriate supplemental oxygenation, medical therapy, and intubation if necessary can be life-saving. A focus on maternal well-being and pulmonary function in a pregnant asthmatic is essential to ensure optimal outcomes for both mother and her fetus. This article will provide an overview of asthma management, particularly in the acute care setting. PMID:23916022

  16. Acute scrotal pain as sole presentation of acute pancreatities

    PubMed Central

    Wilde, Caroline; Abdelrazeq, Ayman

    2014-01-01

    Pancreatitis has a myriad of different presentations although commonly presents with epigastric pain radiating to the back, nausea and vomiting. There are five case reports in the English literature of scrotal pain and swelling in severe alcoholic pancreatitis, two of which underwent surgical exploration. We present the first case of mild pancreatitis presenting with scrotal pain in the absence of any other symptoms or signs. We conclude that in any patient with unexplained scrotal pain, even in the absence of physical signs the possibility of pancreatitis should be considered. PMID:25528028

  17. 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

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

    2014-10-01

    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

  18. [Pancreatic cystadenocarcinoma revealed by an acute pancreatitis and exploratory surgery. A rare case report].

    PubMed

    Bedioui, H; Moalla N-Manai, M Hédi; Chahbani, S; Gordah, Ahmed; Essoussi, M; Ben Aleya, M

    2003-08-01

    Cystadenocarcinoma of the pancreas is a rare malignant tumor. It may appear as a typical pseudocyst on ultrasonography or CT scan. It is exceptionally revealed by an acute pancreatitis. Authors report a new case of cystadenocarcinoma of pancreas misinterpreted as pancreatic pseudocyst complicating acute pancreatitis. The diagnosis was established at laparotomy by discovering a locally advanced tumor of pancreatic tail with hepatic and peritoneal carcinosis metastasis. PMID:14608744

  19. Impaired glucose tolerance in acute pancreatitis

    PubMed Central

    Kikuta, Kazuhiro; Masamune, Atsushi; Shimosegawa, Tooru

    2015-01-01

    Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In spite of the pivotal role of the endocrine pancreas in glucose metabolism, the impact of impaired glucose tolerance on AP has not been fully elucidated. A meta-analysis of seven observational studies showed that type 2 diabetes mellitus (DM) was associated with an increased risk of AP. The increased risk of AP shown in the meta-analysis was independent of hyperlipidemia, alcohol use and gallstones. Anti-diabetic drugs including incretins might increase the risk of AP, but no intervention trials have confirmed this. Although a controversial finding, DM seems to be associated with severe attacks and organ failure in AP. We analyzed the results of a nationwide epidemiological survey of AP in Japan. We studied the impact of pre-existing DM on the clinical course of AP in 1954 cases for which information on DM status was available at the onset of AP. The prevalence of DM in AP patients (12.8%) was higher than that in the general population in Japan (10.5%). AP patients with DM had higher morbidity of cardiovascular and renal failure than those without DM. About 35% of the idiopathic AP patients with DM had renal failure. The mortality of AP patients with DM (4.0%) was higher than that of AP patients without DM (1.7%). If stratified by etiology, idiopathic, but not alcoholic or biliary, AP patients with DM were predisposed to increased mortality (9.7%). In conclusion, impaired glucose tolerance might have an impact on the development and clinical outcome of AP. However, the impact might depend on the cause of hyperglycemia, the condition of DM including severity, duration and treatment, and the characteristics of the AP patients including age, etiology and comorbidity.

  20. Arginine induced acute pancreatitis alters the actin cytoskeleton and increases heat shock protein expression in rat pancreatic acinar cells

    PubMed Central

    Tashiro, M; Schafer, C; Yao, H; Ernst, S; Williams, J

    2001-01-01

    Arginine induced acute pancreatitis was evaluated as a novel and distinct form of experimental pancreatitis with particular attention to the actin cytoskeleton and expression of heat shock or stress proteins. Arginine induced a dose related necrotising pancreatitis in rats, as shown by histological evaluation, and an increase in serum amylase. Severe pancreatitis induced by 4.5 g/kg arginine was accompanied by dramatic changes in the actin cytoskeleton, as visualised with rhodamine phallodin. Intermediate filaments were also disrupted, as visualised by cytokeratin 8/18 immunocytochemistry. Arginine pancreatitis was accompanied by a stress response with a large increase in the small heat shock protein HSP27, as well as HSP70, peaking at 24 hours and localised to acinar cells. There was a lower increase in HSP60 and HSP90 and no effect on GRP78. HSP27 was also shifted to phosphorylated forms during pancreatitis. A lower dose of arginine (3.0 g/kg) induced less pancreatitis but a larger increase in HSP70 and HSP27 expression and phosphorylation of HSP27. Thus HSP expression can be overwhelmed by severe damage. The present work in conjunction with earlier work on caerulein induced pancreatitis indicates that changes in the actin cytoskeleton are an early component in experimental pancreatitis.???Keywords: experimental pancreatitis; pancreas; actin cytoskeleton; cytokeratins; heat shock proteins; HSP27; rat PMID:11454802

  1. Incremental dynamic boles computed tomography of acute pancreatitis

    Microsoft Academic Search

    Patrick C. Freeny

    1993-01-01

    Summary  Acute pancreatitis represents a wide spectrum of inflammatory disease involving the pancreas, peripancreatic tissues, adjacent\\u000a solid organs, gastrointestinal and biliary tract, and vascular system. The extent and severity of the inflammatory process\\u000a determines the prognosis of the patient and the need for specific surgical, endoscopic, and radiologically-guided intervention.\\u000a Computed tomography is the single best imaging test for evaluating patients with

  2. The Atlanta Classification of acute pancreatitis revisited

    Microsoft Academic Search

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

    2007-01-01

    Background: In a complex disease such as acute pancreatitis, correct terminology and clear definitions\\u000aare important. The clinically based Atlanta Classification was formulated in 1992, but in recent years\\u000ait has been increasingly criticized. No formal evaluation of the use of the Atlanta definitions in the\\u000aliterature has ever been performed.\\u000aMethods: A Medline literature search sought studies published after

  3. Pathophysiologic factors in recurrent acute pancreatitis

    Microsoft Academic Search

    Larry C. Carey

    1985-01-01

    No single pathophysiologic factor has been identified as the cause of recurrent acute pancreatitis. A systematic search should\\u000a be undertaken in every patient to identify one of a myriad of factors that have been shown to play a part in causing this\\u000a distressing illness. The abuse of alcohol remains the likeliest cause, and further research may reveal an inborn error

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

    PubMed Central

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

    2009-01-01

    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

  5. Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient

    PubMed Central

    Packer, Clifford D.

    2015-01-01

    Acute obstructive suppurative pancreatic ductitis (AOSPD), defined as suppuration from the pancreatic duct without associated pseudocyst, abscess, or necrosis, is a rare complication of chronic pancreatitis. We present the first case of AOSPD in an asymptomatic patient with a polymicrobial infection and review the literature on this rare clinical entity. PMID:25688269

  6. 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

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

    2014-01-01

    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

  7. Acute pancreatitis with gliptins: Is it a clinical reality?

    PubMed

    Jayaraman, Muthukrishnan; Kumar, Sandeep; Sood, Atul Kumar

    2013-10-01

    There are reports of acute pancreatitis with the use of dipeptidyl peptidase-4 inhibitors (gliptins). This class of drugs is widely being prescribed for type 2 diabetes mellitus (DM) in our country. We evaluated the incidence of acute pancreatitis with the use of gliptins during the period January 2012-June 2013. Patients of type 2 DM on treatment with any of the gliptins (Sitagliptin, vildagliptin, or saxagliptin) for at least 1 month duration were included. A total of 185 patients were included (205.3 patient years of follow-up). Five of them had history of acute pancreatitis (all mild) >6 months prior to inclusion with complete resolution and no chronic pancreatitis. One patient (0.48 per 100 patient years) presented with mild acute pancreatitis which resolved in 8 days. Asymptomatic elevation of serum amylase > 3× upper limit of normal was noted in five patients (2.4 per 100 patient years), without any sonological evidence of pancreatitis, which resolved on withdrawal of gliptins. None of the patients with previous history of pancreatitis had a recurrence of pancreatitis. In a group at low risk of acute pancreatitis, incidence of acute pancreatitis is low with the use of gliptins. PMID:24251202

  8. Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience

    PubMed Central

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

    2014-01-01

    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

  9. Acute Pancreatitis: The Role of Imaging and Interventional Radiology

    SciTech Connect

    Maher, Michael M.; Lucey, Brian C.; Gervais, Debra A.; Mueller, Peter R. [Massachusetts General Hospital, Boston, MA and Harvard Medical School Boston, MA, Division of Abdominal Imaging and Interventional Radiology (United States)], E-mail: pmueller@partners.org

    2004-09-15

    Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure. Fortunately, 70-80% of patients with acute pancreatitis have a benign self-limiting course. The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20-30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments.

  10. Biliary tract and pancreatic surgery complicated by acute pancreatitis: a clinical analysis

    PubMed Central

    Sun, Chenggang; Li, Xin; Sun, Jintang; Zou, Peng; Gao, Shubo; Zhang, Peixun

    2015-01-01

    Objective: To study the clinical treatment features of biliary tract and pancreatic surgery complicated by acute pancreatitis. Methods: A retrospective analysis of 21 cases of biliary tract and pancreatic surgery complicated by acute pancreatitis in the Department of General Surgery in our hospital during May 2005 to July 2011 was performed; the clinical treatment features were analyzed in terms of surgical option, onset interval of acute pancreatitis after last surgery, length of stay in hospital and Ranson score. Results: There was no statistic difference between the two groups (A: The onset interval of acute pancreatitis after last surgery < 0.5 year. B: The onset interval of acute pancreatitis after last surgery > 0.5 year) in pathogenetic condition and length of stay in hospital. All patients were discharged after treatment, a follow-up of 6-18 months found no recurrence of pancreatitis. Conclusion: There is no relevance between the treatment feature and onset interval of biliary and pancreatic surgery complicated by acute pancreatitis. The disease is still treated meanly with symptomatic and supportive treatment, while the etiological treatment is also particularly important.

  11. Paraganglioma with acute hyperamylasaemia masquerading as acute pancreatitis.

    PubMed

    Ho, E T; Gardner, D S

    2011-12-01

    Phaeochromocytomas are rare catecholamine-producing tumours. Although classically described to present with headache, diaphoresis and palpitations, they also present in unusual ways; hyperamylasaemia is one such rare presentation. We describe a man with an extra-adrenal phaeochromocytoma (paraganglioma) presenting with diaphoresis, abdominal pain and multi-organ failure. He had hyperamylasaemia of 1,087 (normal range [NR] 44-161) U/L, which mimicked acute severe pancreatitis. Serum lipase and radiographic imaging of the pancreas appeared normal, and the serial amylase levels normalised over six days upon stabilisation of his condition. 24-hour urinary metanephrines of 10,406 (NR 400-1,500) nmol/day suggested a catecholamine-secreting tumour, and metaiodobenzylguanine scintigraphy confirmed this. We postulate that amylase (of the salivary isotype) is released by hypoxic tissues when high catecholamine levels cause vasoconstriction and that fluctuating hypotension decreases organ perfusion. This case highlights the need for awareness of rare presentations of phaeochromocytomas and encourages physicians to rethink the diagnosis when investigations are inconsistent. PMID:22159946

  12. Towards a Novel Treatment Strategy for Acute Pancreatitis

    Microsoft Academic Search

    Joan M. Braganza

    2001-01-01

    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

  13. [5-fluorouracil treatment of acute pancreatitis and of pancreatic and duodenal fistulae].

    PubMed

    Georgescu, T; Naftali, Z; Varga, A; Simon, G; Pan?, C; Cr?ciun, C; Nistor, V; Ilniczky, P; Bo?ianu, A; Kovács, M

    1990-01-01

    In acute pancreatitis the mechanism involved in the auto-amplification of morbid phenomena can be suppressed in most of the cases by inhibiting the pancreatic secretion. This can also enhance the repair of pancreatic, duodenal and jejunal fistulae. On the basis of experimental studies carried out by Johnson, and on the clinical studies of Guttmann, as well as on original studies done by the authors, Ftorafur was included in the complex therapy of acute pancreatitis, and of pancreatic and duodenal fistulae. A group of 14 cases of acute pancreatitis, were treated. These included 5 necrotic-haemorrhagic pancreatitis, and 9 oedematous pancreatitis. The drug was given by continuous intravenous perfusion in doses of 1,200-1,600 mg per day, for a period of 6-12 days. In all the cases the clinical improvement of the patients as well as recovery of normal values of blood amylase were spectacular, and full recovery was achieved in all the cases. Ftorafur was also used in 3 cases of pancreatic fistulae, and in 2 cases of duodenal fistulae, and recovery was also achieved in a very short time. On the basis of this experience, although small, the authors recommend the introduction of Ftorafur in the complex therapy of acute pancreatitis, as well as in that of pancreatic and duodenal fistulae. Following administration of Ftorafur no adverse effects were noted, and in the doses mentioned above this drug did not delay the repair of surgical wounds. PMID:2149191

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

    SciTech Connect

    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

    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.

  15. Pancreatic function, quality of life and costs at long-term follow-up after acute pancreatitis

    PubMed Central

    Andersson, Bodil; Pendse, Marie-Louise; Andersson, Roland

    2010-01-01

    AIM: To evaluate long-term endocrine and exocrine pancreatic function, quality of life and health care costs after mild acute pancreatitis and severe acute pancreatitis (SAP). METHODS: Patients prospectively included in 2001-2005 were followed-up after 42 (36-53) mo. Pancreatic function was evaluated with laboratory tests, the oral glucose tolerance test (OGTT), fecal elastase-1 and a questionnaire. Short Form (SF)-36, was completed. RESULTS: Fourteen patients with a history of SAP and 26 with mild acute pancreatitis were included. Plasma glucose after OGTT was higher after SAP (9.2 mmol/L vs 7.0 mmol/L, P = 0.044). Diabetes mellitus or impaired glucose tolerance in fasting plasma glucose and/or 120 min plasma glucose were more common in SAP patients (11/14 vs 11/25, P = 0.037). Sick leave, time until the patients could take up recreational activities and time until they had recovered were all longer after SAP (P < 0.001). No significant differences in SF-36 were seen between the groups, or when comparing with age and gender matched reference groups. Total hospital costs, including primary care, follow-up and treatment of complications, were higher after SAP (median €16 572 vs €5000, P < 0.001). CONCLUSION: Endocrine pancreatic function was affected, especially after severe disease. SAP requires greater resource use with long recovery, but most patients regained a good quality of life. PMID:20954281

  16. Study on acute recent stage pancreatitis

    PubMed Central

    Feng, Ye-Chen; Wang, Min; Zhu, Feng; Qin, Ren-Yi

    2014-01-01

    Acute pancreatitis (AP) is an inflammatory disease of the pancreas which involves the pancreas and surrounding tissue, and systemic inflammation with a characteristic systemic increase of vascular permeability and increased risk of multiple organ dysfunction. Currently, the pathogenesis of AP is fuzzy, and the diagnosis and treatment need to be standardized. Nevertheless, increased knowledge of AP may achieve more thorough understanding of the pathogenesis. The use of further advanced diagnostic tools and superior treatment, potentially will help clinicians to manage AP at an appropriate stage. However, in view of the multi factorial disease and the complex clinical manifestations, the management of patients with AP is also remaining areas for improvement. PMID:25473166

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

    PubMed Central

    Abed, Alireza; Minaiyan, Mohsen; Ghannadi, Alireza; Mahzouni, Parvin; Babavalian, Mohammad Reza

    2012-01-01

    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

  18. The relative safety of MRI contrast agent in acute necrotizing pancreatitis.

    PubMed Central

    Werner, J; Schmidt, J; Warshaw, A L; Gebhard, M M; Herfarth, C; Klar, E

    1998-01-01

    OBJECTIVE: To validate the safety of gadolinium-diethylenetriamine pentaacetic acid (GD-DTPA) by measuring its effect on pancreatic capillary perfusion and acinar injury in acute pancreatitis. BACKGROUND: Contrast-enhanced computed tomography (CECT) is proposed as a gold standard for early evaluation of acute necrotizing pancreatitis. However, iodinated contrast media used for CECT have been shown in these circumstances to reduce pancreatic capillary flow and increase necrosis and mortality. Recent reports suggest that post-GD MRI provides images comparable to CECT in the assessment of severe acute pancreatitis. METHODS: Necrotizing pancreatitis was induced in 14 Wistar rats by intraductal glycodeoxycholic acid (10 mM/L) and intravenous caerulein (5 microg/kg/h) over 6 hours. Intravital microscopic quantitation of pancreatic capillary blood flow was performed using fluorescein isothiocyanate-labeled erythrocytes after induction of pancreatitis and 30 and 60 minutes after an intravenous bolus of either Ringer's solution or GD-DTPA (0.2 mL/kg). RESULTS: The two study groups were comparable with regard to mean arterial pressure, heart rate, arterial blood gases, hematocrit, amylase, lipase, and trypsinogen activation peptide production throughout the experiment. GD-DTPA did not reduce capillary flow (1.93 +/- 0.05 nL/capillary/min) compared to animals infused with Ringer's solution (1.90 +/- 0.06 nL/capillary/min). CONCLUSIONS: Intravenous injection of GD-DTPA does not further impair pancreatic microcirculation or increase acinar injury in acute necrotizing pancreatitis. Because of this advantage over CT contrast medium, further development of MRI as a staging tool in acute pancreatitis seems desirable. PMID:9445117

  19. Effects of urtica dioica extract on experimental acute pancreatitis model in rats

    PubMed Central

    Yilmaz, Baris; Basar, Ömer; Aktas, Bora; Altinbas, Akif; Ekiz, Fuat; Büyükcam, Fatih; Albayrak, Aynur; Ginis, Zeynep; Öztürk, Gülfer; Coban, Sahin; Ucar, Engin; Kaya, Oskay; Yüksel, Osman; Caner, Sedat; Delibasi, Tuncay

    2014-01-01

    Acute pancreatitis is the acute inflammation of pancreas and peripancreatic tissues, and distant organs are also affected. The aim of this study was to investigate the effect of Urtica dioica extract (UDE) treatment on cerulein induced acute pancreatitis in rats. Twenty-one Wistar Albino rats were divided into three groups: Control, Pancreatitis, and UDE treatment group. In the control group no procedures were performed. In the pancreatitis and treatment groups, pancreatitis was induced with intraperitoneal injection of cerulein, followed by intraperitoneal injection of 1 ml saline (pancreatitis group) and 1 ml 5.2% UDE (treatment group). Pancreatic tissues were examined histopathologically. Pro-inflammatory cytokines (tumor necrosis factor-?), amylase and markers of apoptosis (M30, M65) were also measured in blood samples. Immunohistochemical staining was performed with Caspase-3 antibody. Histopathological findings in the UDE treatment group were less severe than in the pancreatitis group (5.7 vs 11.7, p = 0.010). TNF-? levels were not statistically different between treated and control groups (63.3 vs. 57.2, p = 0.141). UDE treatment was associated with less apoptosis [determined by M30, caspase-3 index (%)], (1.769 vs. 0.288, p = 0.056; 3% vs. 2.2%, p = 0.224; respectively). UDE treatment of pancreatitis merits further study. PMID:24995088

  20. Effects of urtica dioica extract on experimental acute pancreatitis model in rats.

    PubMed

    Yilmaz, Baris; Basar, Omer; Aktas, Bora; Altinbas, Akif; Ekiz, Fuat; Büyükcam, Fatih; Albayrak, Aynur; Ginis, Zeynep; Oztürk, Gülfer; Coban, Sahin; Ucar, Engin; Kaya, Oskay; Yüksel, Osman; Caner, Sedat; Delibasi, Tuncay

    2014-01-01

    Acute pancreatitis is the acute inflammation of pancreas and peripancreatic tissues, and distant organs are also affected. The aim of this study was to investigate the effect of Urtica dioica extract (UDE) treatment on cerulein induced acute pancreatitis in rats. Twenty-one Wistar Albino rats were divided into three groups: Control, Pancreatitis, and UDE treatment group. In the control group no procedures were performed. In the pancreatitis and treatment groups, pancreatitis was induced with intraperitoneal injection of cerulein, followed by intraperitoneal injection of 1 ml saline (pancreatitis group) and 1 ml 5.2% UDE (treatment group). Pancreatic tissues were examined histopathologically. Pro-inflammatory cytokines (tumor necrosis factor-?), amylase and markers of apoptosis (M30, M65) were also measured in blood samples. Immunohistochemical staining was performed with Caspase-3 antibody. Histopathological findings in the UDE treatment group were less severe than in the pancreatitis group (5.7 vs 11.7, p = 0.010). TNF-? levels were not statistically different between treated and control groups (63.3 vs. 57.2, p = 0.141). UDE treatment was associated with less apoptosis [determined by M30, caspase-3 index (%)], (1.769 vs. 0.288, p = 0.056; 3% vs. 2.2%, p = 0.224; respectively). UDE treatment of pancreatitis merits further study. PMID:24995088

  1. Pancreaticojejunostomy For Severe Symptomatic Chronic Pancreatitis

    PubMed Central

    Denton, G. W. L.; Brough, W. A.

    1992-01-01

    The role of operation, particularly pancreaticojejunostomy, in the treatment of abdominal pain from chronic pancreatitis is controversial, but relief of pancreatic duct obstruction may decrease the rate of pancreatic organ failure. Our results over 6 years in 13 carefully selected patients suggest that pancreatic drainage does relieve pain but is less effective in preventing pancreatic exocrine failure. Pain was the indication for operation in all patients. PMID:1610724

  2. Acute necrotizing pancreatitis: a multicenter study.

    PubMed

    Fernández-Cruz, L; Navarro, S; Valderrama, R; Sáenz, A; Guarner, L; Aparisi, L; Espi, A; Jaurietta, E; Marruecos, L; Gener, J

    1994-04-01

    A multicenter study of acute necrotizing pancreatitis (ANP) classified in accordance with the Balthazar criteria (grades D and E), has been performed in 12 teaching hospitals. A total of 233 patients were reviewed, and the mortality rate was 26.6%. The most common etiology was biliary pancreatitis (45.5%). Among the complications, shock, renal insufficiency, pulmonary insufficiency and hemorrhagic gastritis were associated with a mortality rate of 51-66%. Diffuse fluid collections were associated with a higher mortality rate (26.8%) than localized fluid collections (14.5%). In 106 patients with gallstone pancreatitis, early surgery was performed in 17, and 5 patients (29.4%) died. No mortality was observed in 32 patients with delayed surgery. Sphincterotomy was performed in 13 patients, and 4 (30.7%) died. Early surgery (necrosectomy and closed peritoneal lavage) was undertaken in 75 patients, with a mortality rate of 39%. In conclusion, the morbidity and mortality rates of ANP can be improved with proper monitoring, adequate supportive care and the judicious use of surgery based on clinical and morphological findings. PMID:8056412

  3. Association between Red Blood Cell Distribution Width and Acute Pancreatitis

    PubMed Central

    Karabulut, Keziban Uçar; Narc?, Hüseyin; Uçar, Y?ld?z; Uyar, Mehmet

    2014-01-01

    Background We aimed to determine whether there are any alterations in red blood cell width in patients diagnosed with acute pancreatitis. Material/Methods This was a retrospective study of records of patients treated in emergency units and diagnosed with acute pancreatitis between January 2011 and April 2013. Records were investigated regarding patient age, sex, and causes of acute pancreatitis. Red blood cell width and amylase values obtained from the patients during diagnosis and after a full recovery from acute pancreatitis were added to the records. Results Recorded red blood cell width and amylase values of 104 patients diagnosed with acute pancreatitis were statistically compared according to the time of sample collection. Samples were collected in the post-diagnostic period and after full recovery. Values of red blood cell width and amylase were found to be significantly higher in samples collected during hospital admission in comparison to those obtained from patients after fully recovering from acute pancreatitis (p<0.05). Conclusions An increase in red blood cell width value is a marker of acute pancreatitis; therefore, we suggest that red blood cell width can be used as a tool for the early diagnosis and assessment of disease progression. PMID:25428195

  4. The regulatory role of immunosuppressants on immune abnormalities in acute pancreatitis

    PubMed Central

    DUAN, LIGENG; MA, YU; CHI, JUNLIN; WANG, XU; WESLEY, ALEXANDER J.; CHEN, XIAOLI

    2014-01-01

    The uncontrolled progression of the inflammatory cascade is the main cause underlying the development of multiple organ dysfunction syndrome (MODS) in acute pancreatitis. In this study, we investigated the effects of several immunosuppressants on mitigating the systemic inflammatory reaction syndrome (SIRS) and the compensatory anti-inflammatory response syndrome (CARS) associated with acute pancreatitis. A total of 93 male Sprague Dawley rats were divided into 5 groups: group 1 was the sham group and group 2 underwent laparoscopic intrapancreatic duct injection of sodium taurocholate to induce pancreatitis. The remaining 3 groups were the same as group 2, with the addition of methylprednisolone, cyclophosphamide or methotrexate treatment (metastab, CTX or MTX groups, respectively). Following establishment of the acute pancreatitis model, the serum levels of inflammatory and anti-inflammatory cytokines in groups 2, 3, 4 and 5 were found to be significantly elevated. Following immunosuppressant administration, the levels of all inflammatory and anti-inflammatory cytokines investigated in groups 3, 4 and 5 were decreased compared to those in group 2. The pancreatic amylase levels and pancreatic wet weight (PWW) were also decreased in groups 3, 4 and 5 compared to those in group 2. Therefore, immunosuppressants may reduce inflammation-related cytokine levels in acute pancreatitis and relieve disease progression. PMID:24649095

  5. Preoperative Acute Pancreatitis in Periampullary Tumors: Implications for Surgical Management

    Microsoft Academic Search

    Mert Erkan; Jörg Kleeff; Carolin Reiser; Ulf Hinz; Irene Esposito; Helmut Friess; Markus W. Büchler

    2007-01-01

    Background: Pancreatitis is the most serious complication of endoscopic retrograde cholangiopancreatography (ERCP), occurring in 2–20% of the patients. Currently there is no information about the impact of preoperative pancreatitis on the surgical management of periampullary tumors. Methods: Ten patients with periampullary tumors and preoperative acute pancreatitis were retrospectively analyzed. Four patients who underwent pylorus-preserving pancreaticoduodenectomy (group A) and 6 patients

  6. Serial computed tomography scanning in acute pancreatitis: a prospective study.

    PubMed Central

    London, N J; Neoptolemos, J P; Lavelle, J; Bailey, I; James, D

    1989-01-01

    One hundred and two patients with acute pancreatitis had abdominal computed tomography (CT) scans within 72 hours of admission, at one week and at six weeks. Twenty eight attacks were clinically severe, 74 clinically mild. Ninety three (91%) admission scans, 85 (84%) one week scans, and 52 (51%) six week scans were abnormal. The aetiology of the pancreatitis could be inferred from 28 (27%) of admission scans, the CT sign of fatty liver having a sensitivity of 21% and specificity of 100% for alcoholic aetiology. The sensitivity of CT for gall stone aetiology was 34%, specificity 100%. The pancreatic size indices (max anteroposterior measurement of head x max anteroposterior measurement of body) of those patients with severe attacks were significantly greater than those with mild attacks on admission, at one week and at six weeks (p less than 0.004). Fourteen pseudocysts were detected by CT, five (36%) of which were clinically apparent. The pseudocyst size indices (max anteroposterior x max transverse measurement) of the pseudocysts which were clinically apparent were significantly greater than those which were not apparent (p less than 0.01) and only those pseudocysts with a size index greater than or equal to 15 cm2 required treatment. PMID:2651228

  7. Enteral nutrition in acute pancreatitis: A review of the current evidence

    PubMed Central

    Oláh, Attila; Romics Jr, Laszlo

    2014-01-01

    The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed enteral nutrition, nasogastric vs nasojejunal feeding, and early oral diet and immunonutrition, particularly glutamine and probiotic supplementation. Finally, current applicable guidelines and the effects of these guidelines on clinical practice are discussed. The latest meta-analyses suggest that enteral nutrition significantly reduces the mortality rate of severe acute pancreatitis compared to parenteral feeding. To maintain gut barrier function and prevent early bacterial translocation, enteral feeding should be commenced within the first 24 h of hospital admission. Also, the safety of nasogastric feeding, which eases the administration of enteral nutrients in the clinical setting, is likely equal to nasojejunal feeding. Furthermore, an early low-fat oral diet is potentially beneficial in patients with mild pancreatitis. Despite the initial encouraging results, the current evidence does not support the use of immunoenhanced nutrients or probiotics in patients with acute pancreatitis. PMID:25473164

  8. A prospective study of radionuclide biliary scanning in acute pancreatitis.

    PubMed Central

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

    1983-01-01

    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

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

    SciTech Connect

    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

    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.

  10. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group].

    PubMed

    Hritz, István; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Kelemen, Dezs?; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Szücs, Ákos; Takács, Tamás; Tiszlavicz, László; Hegyi, Péter

    2015-02-15

    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary. PMID:25661970

  11. A case of acute pancreatitis complicating salmonella enteritis

    Microsoft Academic Search

    Hirotoshi Hamaguchi; Yoshinori Okabayashi; Ryoji Yoneda; Hirohisa Ueno; Seitetsu Yoon; Motoyoshi Sakaue; Masato Kasuga

    1999-01-01

    Summary  We report a case of acute pancreatitis complicating Salmonella enteritis. A 43-yr-old woman who was admitted to our department\\u000a because of Salmonella enteritis developed clinical acute pancreatitis with laboratory and radiographic signs on the fourth\\u000a hospital day. She was free from symptoms on the eighth hospital day, but her elevated serum amylase and lipase levels persisted\\u000a for more than 2

  12. Early phase of acute pancreatitis: Assessment and management

    PubMed Central

    Phillip, Veit; Steiner, Jörg M; Algül, Hana

    2014-01-01

    Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis. PMID:25133018

  13. Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis.

    PubMed

    Clavé, P; Guillaumes, S; Blanco, I; Nabau, N; Mercé, J; Farré, A; Marruecos, L; Lluís, F

    1995-08-01

    To determine the utility of serum amylase (AMY), lipase (Lp), pancreatic isoamylase (isoA), phospholipase A (PLA), and urine AMY in the diagnosis of acute pancreatitis, samples of serum and urine were obtained on admission and every day thereafter for 5 days from 384 patients with acute abdominal pain. Diagnostic accuracy, determined as the area under the receiver operating characteristic curve, was > 0.975 for serum AMY, Lp, isoA, and urine AMY. For each of these enzymes, a threshold value (twice to sixfold the upper limit of the reference values) offering diagnostic efficiency > 95% could be determined. In contrast, accuracy and efficiency of serum PLA were low. The profiles of these enzymes in acute pancreatitis decreased in a parallel fashion over 5 days except for PLA. We conclude that diagnostic utilities are similar for serum AMY, Lp, isoA, and urine AMY for acute pancreatitis, provided that an appropriate threshold is established. PMID:7543034

  14. Bifid tail of the pancreas with localized acute pancreatitis.

    PubMed

    Koyasu, Sho; Isoda, Hiroyoshi; Nakase, Hiroshi; Kodama, Yuzo; Chiba, Tsutomu; Togashi, Kaori

    2013-12-25

    Bifid tail of the pancreas is an extremely rare developmental anomaly, and its clinical importance is not well known. We report the case of a 28-year-old man with acute pancreatitis limited to one side of a bifid tail with no otherwise detectable parenchymal edema on magnetic resonance (MR) imaging. Neither was there evidence of other anatomical ductal abnormalities that could have contributed to the patient's pancreatitis. To the best of our knowledge, this is the first report to suggest that bifid tail of the pancreas might cause acute pancreatitis. PMID:24172786

  15. The Role of Nonenhanced Magnetic Resonance Imaging in the Early Assessment of Acute Pancreatitis

    Microsoft Academic Search

    Davor Štimac; Damir Mileti?; Mladen Radi?; Irena Krznari?; Marzena Mazur-Grbac; Domagoj Perkovi?; Sandra Mili?; Vesna Golubovi?

    2007-01-01

    BACKGROUND AND AIMS:Computed tomography (CT), especially contrast-enhanced CT (CECT), provides important information on the severity and prognosis of acute pancreatitis (AP). Magnetic resonance imaging (MRI) has become a useful tool as an alternative to CT in the assessment of AP. The primary aim of our study was to determine the diagnostic value of nonenhanced MRI (NEMRI) to assess severity and

  16. Dexamethasone down-regulates the inflammatory mediators but fails to reduce the tissue injury in the lung of acute pancreatitis rat models.

    PubMed

    Yubero, Sara; Manso, Manuel A; Ramudo, Laura; Vicente, Secundino; De Dios, Isabel

    2012-08-01

    Pulmonary complications are frequent in the course of acute pancreatitis. We investigate the effects of dexamethasone on lung injury in mild and severe AP. Mild and severe acute pancreatitis was induced in rats by bile-pancreatic duct obstruction and infusion of 3.5% sodium taurocholate into the bile-pancreatic duct, respectively. Dexamethasone (1 mg/kg) was given by intramuscular injection 1 h after acute pancreatitis. Plasma amylase activity was measured to evaluate the pancreas damage. Lungs were harvested for analysing mRNA expression of monocyte chemoattractant protein-1 (MCP-1), cytokine-induced neutrophil chemoattractant (CINC), P-selectin and intercellular adhesion molecule-1 (ICAM-1), myeloperoxidase (MPO) activity (as index of neutrophil infiltration) and histological examination. Dexamethasone reduced the hyperamylasemia and hindered the pulmonary upregulation of MCP-1, CINC, P-selectin and ICAM-1, in both mild and severe acute pancreatitis. Despite this, dexamethasone treatment failed to reduce MPO activity and histological alterations developed in lungs during acute pancreatitis, either in bile-pancreatic duct obstruction or sodium taurocholate model. We conclude that pulmonary local factors different from inflammatory mediators contribute to leukocyte recruitment, so that although dexamethasone down-regulated the lung expression of chemokines and adhesion molecules during acute pancreatitis it was not able to prevent leukocyte infiltration, which could be responsible for maintaining the lung injury in either mild or severe acute pancreatitis. PMID:22691809

  17. [Meperidine (pethidine) outdated as analgesic in acute pancreatitis].

    PubMed

    van Voorthuizen, T; Helmers, J H; Tjoeng, M M; Otten, M H

    2000-04-01

    The most important symptom in acute pancreatitis is pain. This pain often is so severe that treatment is started with opioid analgesics. In daily practice meperidine is often the analgesic of first choice because it is supposed to cause less spasm of the M. sphincter ampullae hepatopancreaticae (sphincter of Oddi). Drawbacks of the use of meperidine compared with other opiods are myoclonias, tremors and convulsions due to accumulation of the metabolite norpethidine, and hypotension, tachycardia and erythema due to release of more histamine from mast cells. From literature study it appeared that all opioids have a spasmogenic effect on the sphincter of Oddi, that there are no good arguments to assume that this effect is less when meperidine is used, and that there is no good evidence that this spasmogenic effect of opioid analgesics influences the course of acute pancreatitis in an unfavourable way. Since the profile of effects and side effects of meperidine is unfavourable, we prefer the use of opioids with a larger therapeutic width. PMID:10774293

  18. Controversial role of toll-like receptors in acute pancreatitis

    PubMed Central

    Vaz, Juan; Akbarshahi, Hamid; Andersson, Roland

    2013-01-01

    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

  19. Evaluation of Patient-Reported Outcome in Subjects Treated Medically for Acute Pancreatitis: A Follow-Up Study

    Microsoft Academic Search

    R. Pezzilli; A. M. Morselli-Labate; D. Campana; R. Casadei; E. Brocchi; R. Corinaldesi

    2009-01-01

    Aims: To explore the quality of life in patients treated medically during the acute phase of pancreatitis as well as at 2 and 12 months after discharge from the hospital. Patients: 40 patients were studied. The etiology of the pancreatitis was biliary causes in 31 patients and non-biliary causes in 9; mild disease was present in 29 patients and severe

  20. Bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis.

    PubMed

    Thajudeen, Bijin; Budhiraja, Pooja; Bracamonte, Erika R

    2013-10-01

    Renal artery thrombosis is a rare, but serious and often under-diagnosed condition. We report a case of bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis. A 66-year-old female presented with abdominal pain and acute kidney injury (AKI). A renal biopsy showed organized intraluminal thrombi and a computer tomography scan of the abdomen showed bilateral renal artery thrombosis. Emergent laprotomy showed necrosed pancreas. Doppler studies showed deep vein thrombosis of the lower extremities and internal jugular vein thrombosis. Workup for hypercoagulability was unremarkable. The final diagnosis was AKI secondary to bilateral renal artery thrombosis probably due to hypercoagulability of acute necrotizing pancreatitis. PMID:26064514

  1. Acute pancreatitis presenting as back pain: a case report

    PubMed Central

    Decina, Philip A; Vallee, Dwight; Mierau, Dale

    1992-01-01

    A man with acute back pain presented to a chiropractic clinic with clinical symptoms and signs suggesting abdominal disease rather than mechanical spine pain. He was referred to a local hospital emergency where a diagnosis of acute pancreatitis secondary to chronic cholecystitis was made. The diagnostic images are compared to normal studies. The characteristic clinical examination findings found with back pain due to acute pancreatitis are compared to those typically seen with mechanical spine pain. ImagesFigure 1Figure 2aFigure 2bFigure 3Figure 4aFigure 4bFigure 5aFigure 5b

  2. Bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis

    PubMed Central

    Thajudeen, Bijin; Budhiraja, Pooja; Bracamonte, Erika R.

    2013-01-01

    Renal artery thrombosis is a rare, but serious and often under-diagnosed condition. We report a case of bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis. A 66-year-old female presented with abdominal pain and acute kidney injury (AKI). A renal biopsy showed organized intraluminal thrombi and a computer tomography scan of the abdomen showed bilateral renal artery thrombosis. Emergent laprotomy showed necrosed pancreas. Doppler studies showed deep vein thrombosis of the lower extremities and internal jugular vein thrombosis. Workup for hypercoagulability was unremarkable. The final diagnosis was AKI secondary to bilateral renal artery thrombosis probably due to hypercoagulability of acute necrotizing pancreatitis.

  3. Tissue-Specific Cytokine Production During Experimental Acute Pancreatitis (A Probable Mechanism for Distant Organ Dysfunction)

    Microsoft Academic Search

    James G. Norman; Gregory W. Fink; Woody Denham; Jun Yang; Gay Carter; Cheryl Sexton; Julie Falkner; William R. Gower; Michael G. Franz

    1997-01-01

    Our purpose was to determine if cytokines are produced systemically during acute pancreatitis. Proinflammatory cytokines are elevated during acute pancreatitis and have been implicated in the progression of pancreatitis-associated multiple organ dysfunction. Whether these mediators are produced within all tissues or very few specific organs is not known. Edematous pancreatitis was induced in adult male mice by IP injection of

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

    PubMed Central

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

    2014-01-01

    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

  5. Acute pancreatitis in systemic lupus erythematosus: report of a case unrelated to drug therapy.

    PubMed Central

    Wolman, R; de Gara, C; Isenberg, D

    1988-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease that can affect most organs or systems. It most frequently involves the joints, skin, and the kidneys. It less commonly involves the central nervous system, heart, and lungs. Acute pancreatitis in SLE is rare. It is usually mild, occurring in association with more severe organ involvement elsewhere. A patient with newly diagnosed SLE is reported who developed acute fulminant pancreatitis unrelated to concomitant drug therapy and who eventually died of complications including a systemic fungal infection related to this. PMID:3345108

  6. Pulmonary Lymphangitis Carcinomatosa and Acute Pancreatitis: A Rare Presentation of Choledochal Cyst

    PubMed Central

    Kelly, D. M.; O'Donnell, P. J.

    1999-01-01

    Pulmonary lymphangitis carcinomatosa is an unusal cause of death in a young adult. This case describes an apparently healthy young woman who presented with severe acute pancreatitis, which is a recognized complication of a choledochal cyst. Autopsy examination revealed advanced malignancy with poorly differentiated adenocarcinoma penetrating the wall of the choledochal cyst and metastatic adenocarcinoma in the lymph nodes, lungs and kidneys. This case emphasises the unusual presentation of a choledochal cyst with acute pancreatitis and the aggressive nature of malignancy associated with this congenital anomaly. PMID:10371061

  7. In vitro, but not in vivo, reversibility of peritoneal macrophages activation during experimental acute pancreatitis

    PubMed Central

    Gea-Sorlí, Sabrina; Closa, Daniel

    2009-01-01

    Background Systemic inflammatory response syndrome is one of the major pathobiologic processes underlying severe acute pancreatitis and the degree of macrophage activation could be one of the factors that finally determine the severity of the disease. We evaluated the activation phenotype in peritoneal macrophages during the progression of an experimental model of acute pancreatitis induced in rats by intraductal administration of 5% sodium taurocholate and the effect of IL-4 and IL-13 to modulate this activation. Samples of pancreas, lung and adipose tissue as well as plasma were also obtained. In some animals IL4 and IL13 were injected 1 h after induction in order to modulate macrophage activation. The expressions of TNF? and Mannose Receptor, as indicators of classical and alternative macrophage activation, were evaluated. Levels of myeloperoxidase and plasma lipase were determined to evaluate the severity of the inflammatory process. The stability of IL-4 in ascitic fluid and plasma was evaluated. Results Peritoneal macrophages showed a classical M1 activation clearly induced 3 h after pancreatitis induction and maintained until 18 h. Treatment with IL-4 and IL-13 reversed the activation of macrophages from a classical M1 to alternative M2 in vitro, but failed to modulate the response of peritoneal macrophages in vivo despite a reduction in inflammation was observed in lung and adipose tissue. Finally, IL-4 shows a short half-live in ascitic fluid when compared with plasma. Conclusion Peritoneal macrophages adopt a pro-inflammatory activation early during acute pancreatitis. Treatment with M2 cytokines could revert in vitro the pancreatitis-induced activation of macrophages but fails to modulate its activation in vivo. This treatment has only a moderate effect in reducing the systemic inflammation associated to acute pancreatitis. Hydrolytic enzymes presents in ascitic fluid could be involved in the degradation of cytokines, strongly reducing its utility to modulate peritoneal macrophages in pancreatitis. PMID:19646232

  8. Cathepsin L inactivates human trypsinogen whereas cathepsin L deletion reduces the severity of pancreatitis in mice

    PubMed Central

    Wartmann, Thomas; Mayerle, Julia; Kähne, Thilo; Sahin-Tóth, Miklós; Ruthenbürger, Manuel; Matthias, Rainer; Kruse, Anne; Reinheckel, Thomas; Peters, Christoph; Weiss, F. Ulrich; Sendler, Matthias; Hans-Lippert; Schulz, Hans-Ulrich; Aghdassi, Ali; Dummer, Annegret; Teller, Steffen; Halangk, Walter; Lerch, Markus M.

    2010-01-01

    Background & Aims Acute pancreatitis is characterized by an activation cascade of digestive enzymes in the pancreas. The first of these, trypsinogen, can be converted to active trypsin by the peptidase cathepsin B (CTSB). We investigated whether cathepsin L (CTSL), the second most abundant lysosomal cysteine proteinase, can also process trypsinogen to active trypsin and has a role in pancreatitis. Methods In CTSL-deficient (Ctsl?/?) mice, pancreatitis was induced by injection of cerulein or infusion of taurocholate into the pancreatic duct. Human tissue, pancreatic juice, mouse pancreatitis specimens, and recombinant enzymes were studied by enzyme assay, immunoblot, N-terminal sequencing, immunocytochemistry, and electron microscopy analyses. Isolated acini from Ctsl?/? and Ctsb?/? mice were studied. Results CTSL was expressed in human and mouse pancreas, where it colocalized with trypsinogen in secretory vesicles and lysosomes and was secreted into pancreatic juice. Severity of pancreatitis was reduced in Ctsl?/? mice, compared with wild-type controls, whereas apoptosis and intrapancreatic trypsin activity were increased in Ctsl?/? mice. CTSL induced cleavage of trypsinogen occurred 3 amino acids toward the C terminus from the CTSB activation site and resulted in a truncated, inactive form of trypsin and an elongated propeptide (TAP). This elongated TAP was not detected by ELISA but was effectively converted to an immunoreactive form by CTSB. Levels of TAP thus generated by CTSB were not associated with disease severity, although this is what the TAP-ELISA is used to determine in the clinic. Conclusions CTSL inactivates trypsinogen and counteracts the ability of CTSB to form active trypsin. In mouse models of pancreatitis, absence of CTSL induces apoptosis and reduces disease severity. PMID:19900452

  9. Describing computed tomography findings in acute necrotizing pancreatitis with the Atlanta classification: an interobserver agreement study

    Microsoft Academic Search

    Marc G. H. Besselink; Hjalmar C. van Santvoort; Thomas L. Bollen; Maarten S. van Leeuwen; J. S. Lameris; Eric J. van der Jagt; Simon P. Strijk; Erik Buskens; Patrick C. Freeny; Hein G. Gooszen

    2006-01-01

    OBJECTIVES: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was undertaken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the Atlanta classification. METHODS: Preoperative contrast-enhanced CTs from 70 consecutive patients (49 men; median age, 59 years; range, 29-79 years) operated for

  10. [Invasive and non-invasive diagnostic methods for evaluation of hypovolemia in acute pancreatitis].

    PubMed

    Gundling, F; Teich, N; Pehl, C; Schepp, W

    2006-12-01

    Severe acute pancreatitis leads to a dramatic fluid loss in the intraperitoneal space which may result in circulatory decompensation. Sequestration of fluid can amount up to 40 percent of the circulating blood volume. The amount of fluid and electrolyte replacement is often misjudged leading to a higher rate of complications and a higher mortality rate of the disease. Furthermore, subsequent and adequate fluid resuscitation seems to influence the prognostic course of the disease by improving the perfusion and oxygenation of the pancreas. Otherwise volume overload may cause cardiopulmonary decompensation in the case of synchronous cardiopulmonary comorbidities. Therefore, an important part of treatment relies on careful haemodynamic monitoring, if necessary managed in an intensive care unit. Usually most patients with acute pancreatitis will be treated on a non-intensive medical ward which allows a differentiated and continuous haemodynamic monitoring only to a limited extent. Apart from monitoring circulatory parameters and measuring central venous pressure, there are other clinical methods, laboratory tests and radiological diagnostic procedures to determine the amount of intravascular fluid deficit and the individual volume demand of patients with acute pancreatitis. Prospective clinical trials for evaluation of pancreatitis-specific volume management do not exist so far. The aim of this review is to provide background information on invasive and non-invasive diagnostic methods for detection of circulatory hypovolemia in acute pancreatitis. PMID:17163376

  11. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    PubMed

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis. PMID:1413937

  12. Postmenopausal hormone replacement therapy and risk of acute pancreatitis: a prospective cohort study

    PubMed Central

    Oskarsson, Viktor; Orsini, Nicola; Sadr-Azodi, Omid; Wolk, Alicja

    2014-01-01

    Background: Several case reports have suggested that women’s use of exogenous sex hormones is associated with acute pancreatitis; however, relevant epidemiologic data are sparse. We examined the association between postmenopausal hormone replacement therapy and risk of acute pancreatitis. Methods: We conducted a prospective study involving 31 494 postmenopausal women (aged 48–83 yr) from the population-based Swedish Mammography Cohort. Participants completed a baseline questionnaire in 1997 assessing their use of hormone replacement therapy. We linked the cohort to the hospital-based Swedish National Patient Register to determine hospital admissions for acute pancreatitis through 2010. Relative risks (RRs) were calculated using Cox proportional hazard models. Results: Over a total follow-up of 389 456 person-years, we identified 237 cases of incident acute pancreatitis. The age-standardized incidence rates per 100 000 person-years were 71 cases among women who had ever used hormone replacement therapy and 52 cases among women who had never used such hormones. Among ever users of hormone replacement therapy, the multivariable-adjusted RR of acute pancreatitis was 1.57 (95% confidence interval [CI] 1.20–2.05) compared with never users. The risk did not differ by current or past use, but it seemed to be higher among women who used systemic therapy (RR 1.92, 95% CI 1.38–2.66) and among those with duration of therapy of more than 10 years (RR 1.87, 95% CI 1.11–3.17). Interpretation: Use of postmenopausal hormone replacement therapy was associated with increased risk of acute pancreatitis. Physicians should consider this potential increase in risk when prescribing such therapy. PMID:24468693

  13. Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis.

    PubMed

    Saif, M-Wasif; Khubchandani, Sapna; Walczak, Marek

    2007-09-28

    Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma. More than 50% of patients have some site of extra-nodal involvement at diagnosis, including the gastrointestinal tract and bone marrow. However, a diffuse large B-cell lymphoma presenting as acute pancreatitis is rare. A 57-year-old female presented with abdominal pain and matted lymph nodes in her axilla. She was admitted with a diagnosis of acute pancreatitis. Abdominal computed tomography (CT) scan showed diffusely enlarged pancreas due to infiltrative neoplasm and peripancreatic lymphadenopathy. Biopsy of the axillary mass revealed a large B-cell lymphoma. The patient was classified as stage IV, based on the Ann Arbor Classification, and as having a high-risk lymphoma, based on the International Prognostic Index. She was started on chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). Within a week after chemotherapy, the patient's abdominal pain resolved. Follow-up CT scan of the abdomen revealed a marked decrease in the size of the pancreas and peripancreatic lymphadenopathy. A literature search revealed only seven cases of primary involvement of the pancreas in B-cell lymphoma presenting as acute pancreatitis. However, only one case of secondary pancreatic involvement by B-cell lymphoma presenting as acute pancreatitis has been published. Our case appears to be the second report of such a manifestation. Both cases responded well to chemotherapy. PMID:17828824

  14. [Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) -associated glomerulonephritis with acute pancreatitis: a case report].

    PubMed

    Iida, Takeshi; Amari, Yoshifumi; Yurugi, Takatomi; Nakajima, Fumitaka

    2015-01-01

    We report here a case of a 64-year-old woman with myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) -associated glomerulonephritis who developed acute pancreatitis. The patient was admitted to our hospital because of abnormal urinalysis findings, edema, and progressive renal failure. Laboratory studies showed a high white blood cell count (11,570/?L), anemia (hemoglobin 7.8 g/dL), and elevated serum creatinine (2.36 mg/dL) and C-reactive protein (12.20 mg/dL) levels. Furthermore, the MPO-ANCA titer was very high (1,625 U/mL, normal range < 10 U/mL). Histopathological findings of the renal biopsy were consistent with microscopic polyangiitis. Accordingly, we diagnosed MPO-ANCA-associated glomerulonephritis. On the day after the renal biopsy, the patient complained of low back pain. Computed tomography (CT) revealed postbiopsy hemorrhage. Thereafter, the patient's symptoms and laboratory studies gradually worsened. A repeat CT performed a few days later revealed no changes in the perirenal hematoma; however, an enlarged pancreas head was incidentally observed. There was no obvious cause of acute pancreatitis, and MPO-ANCA-associated vasculitis, although rare, was suspected as the cause. We initiated prednisolone pulse therapy for vasculitis along with the administration of nafamostat mesilate and ulinastatin for acute pancreatitis. Subsequently, the levels of pancreatic enzymes gradually increased, but several days later, abdominal magnetic resonance imaging showed improvement in the pancreas head. The pancreatitis gradually resolved over time. Acute pancreatitis occurring concurrently with MPO-ANCA-associated glomerulonephritis is extremely rare. To our knowledge, only a few such cases have been reported and have suggested that steroid therapy may play a role in triggering pancreatic involvement. In our case, however, an enlarged pancreas head was observed before steroid therapy was initiated. Therefore, we consider our case to be very rare. PMID:26126336

  15. Severe acute malnutrition and infection

    PubMed Central

    Jones, Kelsey D J; Berkley, James A

    2014-01-01

    Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

  16. A Case of Acute Pancreatitis Associated with Risperidone Treatment

    PubMed Central

    Ueno, Shu-ichi

    2014-01-01

    Acute pancreatitis with antipsychotic treatment is rare but sometimes causes a fatal adverse effect. Most cases of acute pancreatitis due to atypical antipsychotic agents are reported to occur within six months of starting antipsychotic administration. Acute pancreatitis caused by risperidone is rare. The patient had a high fever, stomachache and vomiting. The results of the abdominal computed tomograhpy scan were negative. The results of the abdominal ultrasonography were positive for gallstones in gallbladder and distention of the common bile duct. She had been fasting and received antibiotic intravenous injections. Amylase and lipase titers were high. After risperidone discontinuation, both the levels of the amylase and the lipase were gradually decreased. Three months later, the patient still maintains a good clinical balance. Although atypical antipsychotic-induced pancreatitis has been reported in conjunction with hyperglycemia, the pathophysiologic mechanism of these adverse events remains unclear. This case got pancreatitis 6 month after risperidone treatment. Using the antipsychotic agents, it is necessary to monitor pancreas function. PMID:24851124

  17. A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis

    PubMed Central

    Terayama, Takero; Hifumi, Toru; Kiriu, Nobuaki; Kato, Hiroshi; Koido, Yuichi; Ichinose, Yoshiaki; Morimoto, Kohei; Yasuhiro, Kuroda

    2014-01-01

    BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites. METHODS: A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography (CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fluid administration, and electrolyte replacement. However, on the 14th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fluid. Percutaneous transgastric drainage was performed and a 14 French gauge (Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space. RESULTS: After drainage, the patient recovered well and the last catheter was removed on day 123 of admission. CONCLUSIONS: Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts. PMID:25548607

  18. Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent Road Closure: Pancreatic Colonic Fistula Presenting as a Large Bowel Obstruction Treated with Pancreatic Duct Stenting

    PubMed Central

    Cochrane, Justin; Schlepp, Greg

    2015-01-01

    Context. Colonic complications associated with acute pancreatitis have a low incidence but carry an increased risk of mortality with delayed diagnosis and treatment. Pancreatic colonic fistula is most commonly associated with walled off pancreatic necrosis or abscess formation and rarely forms spontaneously. Classic clinical manifestations for pancreatic colonic fistula include diarrhea, hematochezia, and fever. Uncommonly pancreatic colonic fistula presents as large bowel obstruction. Case. We report a case of a woman with a history of recurrent episodes of acute pancreatitis who presented with large bowel obstruction secondary to pancreatic colonic fistula. Resolution of large bowel obstruction and pancreatic colonic fistula was achieved with pancreatic duct stenting. Conclusion. Pancreatic colonic fistula can present as large bowel obstruction. Patients with resolved acute pancreatitis who have radiographic evidence of splenic flexure obstruction, but without evidence of mechanical obstruction on colonoscopy, should be considered for ERCP to evaluate for PCF. PCF not associated with walled off pancreatic necrosis or peritoneal abscess can be treated conservatively with pancreatic duct stenting. PMID:25893120

  19. [Management of septic complications od acute necrotizing pancreatitis].

    PubMed

    Márton, J; Farkas, G; Szederkényi, E; Avramov, K

    1995-04-23

    The authors present the case of a 47 year old male patient with acute necrotizing pancreatitis complicated with widespread mesenteric necrosis and abscess. The critically ill patient (APACHE score: 28.5) underwent on seven operations and required 50 days of intensive care. The authors analyse the conditions of successful treatment and emphasize the importance of new available therapeutic approaches and instruments. PMID:7746659

  20. Serum enzymes and other laboratory tests in acute pancreatitis.

    PubMed

    Clavien, P A; Burgan, S; Moossa, A R

    1989-12-01

    This review evaluates selective enzymes and blood tests available for the diagnosis and prognosis of acute pancreatitis. It is concluded that serum amylase and lipase measurements represent the best available diagnostic methods. Newer alternative assays still require careful evaluation. PMID:2691011

  1. Towards a Novel Treatment Strategy for Acute Pancreatitis

    Microsoft Academic Search

    Joan M. Braganza

    2001-01-01

    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

  2. Acute Pancreatitis: The Pathophysiological Role of Cytokines and Integrins

    Microsoft Academic Search

    Maher O. Osman; Steen L. Jensen

    1999-01-01

    As Moynihan [1] wrote in 1925, ‘Acute pancreatitis (AP) is the most terrible of all the calamities that occur in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it, all render it the most formidable of catastrophes’. Since then, AP has continued to be a common and

  3. Genetics of acute and chronic pancreatitis: An update.

    PubMed

    Ravi Kanth, Vv; Nageshwar Reddy, D

    2014-11-15

    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

  4. Genetics of acute and chronic pancreatitis: An update

    PubMed Central

    Ravi Kanth, VV; Nageshwar Reddy, D

    2014-01-01

    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

  5. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia.

    PubMed

    Quintanilla-Flores, Dania Lizet; Flores-Caballero, Miguel Ángel; Rodríguez-Gutiérrez, René; Tamez-Pérez, Héctor Eloy; González-González, José Gerardo

    2014-01-01

    Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification. PMID:24716037

  6. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia

    PubMed Central

    Quintanilla-Flores, Dania Lizet; Flores-Caballero, Miguel Ángel; Rodríguez-Gutiérrez, René; Tamez-Pérez, Héctor Eloy; González-González, José Gerardo

    2014-01-01

    Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification. PMID:24716037

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

    PubMed Central

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

    2014-01-01

    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

  8. Duration of injury correlates with necrosis in caerulein-induced experimental acute pancreatitis: implications for pathophysiology

    PubMed Central

    Jacob, Tony G; Raghav, Rahul; Kumar, Ajay; Garg, Pramod K; Roy, Tara S

    2014-01-01

    Pancreatic acinar cell necrosis is indicative of severe pancreatitis and the degree of necrosis is an index of its outcome. We studied whether the dose and duration of injury correlates with severity, particularly in terms of necrosis, in caerulein-induced acute pancreatitis (AP) in Swiss albino mice. In addition to control group 1 (G1), groups 2 and 3 received four injections of caerulein every hour but were sacrificed at five hours (G2) and nine hours (G3) respectively, and group 4 received eight injections and was sacrificed at nine hours (G4). The severity of pancreatitis was assessed histopathologically and biochemically. The histopathological scores of pancreatitis in groups 3 and 4 were significantly higher than in groups 1 and 2 (4 vs. 1, 4 vs. 2, 3 vs. 1, 3 vs. 2; P < 0.05). TUNEL-positive apoptotic cells were significantly higher in groups 2 and 3 compared with groups 1 and 4 (P < 0.05). Necrosis was significantly more in group 4 than other groups (37.49% (4.68) vs. 19.97% (1.60) in G2; 20.36% (1.56) in G3; P = 0.006 for G 2 vs. 4 and P = 0.019 for G 3 vs. 4). Electron microscopy revealed numerous autophagosomes in groups 2 and 3 and mitochondrial damage and necrosis in group 4. The pancreatic and pulmonary myeloperoxidase activity in group 4 was significantly higher than that in the other groups (P < 0.01). Hence, severity of pancreatitis is a function of the dose of injurious agent, while inflammation is both dose and duration dependent, which may also explain the wide spectrum of severity of AP seen in clinical practice. PMID:24761825

  9. Management of acute severe colitis.

    PubMed

    Jakobovits, Simon L; Travis, S P L

    2005-01-01

    The management of acute severe ulcerative colitis depends on early recognition of the unwell patient with colitis, the prompt initiation of treatment and objective assessment of the likelihood of medical failure. This deters 'hopeful expectation' in an attempt to avoid surgery. Intravenous corticosteroids remain first-line therapy but are completely effective in only 40%, partially effective in 30% and around 30% come to colectomy. The decision to use ciclosporin or infliximab for those with a poor response to steroids should be made at an early stage, often 3 or 4 days after starting intensive therapy. Decision-making is becoming more difficult with agents such as visilizumab, tacrolimus and the technique of leucocytapheresis as further options. Nevertheless, intravenous corticosteroids and timely colectomy have reduced mortality from nearly 30% to < 1% in specialist centres. Ciclosporin has delayed the need for urgent colectomy in many patients, but long-term follow-up suggests the majority come to colectomy within 7 years. Long-term outcome with newer agents, including infliximab, is not yet known. PMID:16847166

  10. Melatonin Reduces Lipid Peroxidation and Tissue Edema in Cerulein-Induced Acute Pancreatitis in Rats

    Microsoft Academic Search

    Wenbo Qi; Dun-Xian Tan; Russel J. Reiter; Seok Joong Kim; Lucien C. Manchester; Javier Cabrera; Rosa M. Sainz; Juan Carlos Mayo

    1999-01-01

    Since oxygen free radicals and lipidperoxidation have been implicated in the pathogenesis ofan early stage of acute pancreatitis, we examinedwhether melatonin, a recently discovered free-radicalscavenger, could attenuate pancreatic injury inSprague-Dawley rats with cerulein-induced pancreatitis.Acute pancreatitis was induced by four intraperitonealinjections of cerulein (50 µg\\/kg body wt) given at1-hr intervals. Thirty minutes after the lastcerulein injection, the rats were killed and

  11. [Clinical and laboratory diagnosis of an acute biliary pancreatitis].

    PubMed

    Vasylyuk, S M; Ivanyna, V V

    2015-02-01

    In 126 patients, suffering an acute biliary pancreatitis (ABP), clinical examination was conducted. In 65 patients (1-st group) the isolated cholecystolithiasis was noted; in 35 (2-nd group)--cholelithiasis, which did not cause obturation of common biliary duct; in 26 (3-rd group)--cholelithiasis, which caused the biliary ways obturation (including calculi, which were incorporated into the duodenal papilla magna ostium). Clinical course of an ABP have differed depending on localization of calculi of extrahepatic biliary ducts. In patients, suffering ABP, a biochemical signs of hepatocytes functional disorders were observed, impacting the need for hepatoprotector preparations inclusion into complex of perioperative conservative therapy. Determination of activity of pancreatic ?-amylase in the blood serum and conduction of the ACTIM Pancreatitis test con- stitute the most sensitive and specific methods of the ABP biochemical diagnosis. PMID:25985693

  12. Tissue Pharmacology of Da-Cheng-Qi Decoction in Experimental Acute Pancreatitis in Rats

    PubMed Central

    Zhao, Xianlin; Zhang, Yumei; Li, Juan; Wan, Meihua; Zhu, Shifeng; Guo, Hui; Xiang, Jin; Thrower, Edwin C.; Tang, Wenfu

    2015-01-01

    Objectives. The Chinese herbal medicine Da-Cheng-Qi Decoction (DCQD) can ameliorate the severity of acute pancreatitis (AP). However, the potential pharmacological mechanism remains unclear. This study explored the potential effective components and the pharmacokinetic characteristics of DCQD in target tissue in experimental acute pancreatitis in rats. Methods. Acute pancreatitis-like symptoms were first induced in rats and then they were given different doses of DCQD (6?g/kg, 12?g/kg, and 24?g/kg body weight) orally. Tissue drug concentration, tissue pathological score, and inflammatory mediators in pancreas, intestine, and lung tissues of rats were examined after 24 hours, respectively. Results. Major components of DCQD could be found in target tissues and their concentrations increased in conjunction with the intake dose of DCQD. The high-dose compounds showed maximal effect on altering levels of anti-inflammatory (interleukin-4 and interleukin-10) and proinflammatory markers (tumor necrosis factor ? and interleukin-6) and ameliorating the pathological damage in target tissues (P < 0.05). Conclusions. DCQD could alleviate pancreatic, intestinal, and lung injury by altering levels of inflammatory cytokines in AP rats with tissue distribution of its components. PMID:26199633

  13. Ultrasonography of acute pancreatitis -- an essay in images.

    PubMed

    Badea, Radu

    2005-03-01

    Acute pancreatitis is a relatively frequent disorder with an increased risk potential. Ultrasound may represent the first imaging technique to be used in disease evaluation. The diagnosis is usually made based on the increase in pancreas volume and on the changes in structure detected on the ultrasound examination. The most frequent complications are: local and distal collections, parenchyma necrosis, superinfection and vascular involvement. PMID:15800700

  14. Painless acute pancreatitis associated with sorafenib treatment: a case report

    Microsoft Academic Search

    Toshiyuki Kanemitu; Akihito Kamoto; Mototaka Satoh; Naoki Mori; Kenichiro Sekii; Toshiaki Yoshioka; Hiroaki Itatani; Takashi Fujimoto

    2011-01-01

    Sorafenib is a multikinase inhibitor that is used for the treatment of metastatic renal-cell carcinoma. We report the case\\u000a of a patient with painless acute pancreatitis associated with sorafenib treatment. The patient was a 71-year-old man who had\\u000a undergone surgery for left renal carcinoma and tumor thrombus in the inferior vena cava and right atrium (IVC-RA). After a\\u000a follow-up period

  15. Epidemiology, Classification, Etiopathogenesis, and Diagnosis of Acute Pancreatitis

    Microsoft Academic Search

    Gianluca Guercioni; Walter Siquini; Emidio Senati

    \\u000a In 1925, Moynihan described the dramatic nature of acute pancreatitis as the “most terrible of all calamities that occurs\\u000a in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the\\u000a mortality attendant upon it renders it the most formidable of catastrophes” [1]. From mild and self-limiting disease to multiorgan failure and sepsis,

  16. Afferent loop obstruction after gastrectomy simulating acute pancreatitis.

    PubMed

    Alawneh, I

    1980-01-01

    After gastrectomy and Billroth II anastomosis, if the afferent loop is too long, it may kink and herniate, resulting in obstruction. If it is too short, it may produce acute angulation with obstruction. This condition often simulates acute pancreatitis when the amylase level in urine and serum is increased. Three cases of afferent loop obstruction are reported. The patient who did not undergo laparotomy died; the other two were operated on and survived. The diagnosis, etiology and treatment of these complications are discussed, and similar cases reported in the literature are cited. PMID:6161096

  17. Role of Substance P and the Neurokinin 1 Receptor in Acute Pancreatitis and Pancreatitis-Associated Lung Injury

    Microsoft Academic Search

    Madhav Bhatia; Ashok K. Saluja; Bernd Hofbauer; Jean-Louis Frossard; Hong Sik Lee; Ignazio Castagliuolo; Chi-Chung Wang; Norma Gerard; Charalabos Pothoulakis; Michael L. Steer

    1998-01-01

    Substance P, acting via the neurokinin 1 receptor (NK1R), plays an important role in mediating a variety of inflammatory processes. However, its role in acute pancreatitis has not been previously described. We have found that, in normal mice, substance P levels in the pancreas and pancreatic acinar cell expression of NK1R are both increased during secretagogue-induced experimental pancreatitis. To evaluate

  18. A retrospective study of acute pancreatitis in patients with hemorrhagic fever with renal syndrome

    PubMed Central

    2013-01-01

    Background Etiological diagnosis is an important part of the diagnosis and treatment of acute pancreatitis. Hantavirus infection is a rare cause of acute pancreatitis, which is easy to ignore. There is a need to analyze clinical features of acute pancreatitis caused by Hantavirus. Methods This is a retrospective study conducted from May 1, 2006 to May 31, 2012 on patients diagnosed with hemorrhagic fever with renal syndrome at our hospital. We reviewed these patients medical records, laboratory results and radiologic examinations to determine the prevalence and summarize clinical features of acute pancreatitis in patients with hemorrhagic fever with renal syndrome. Results A total of 218 patients were diagnosed with hemorrhagic fever with renal syndrome during the 6-year study period. Only 2.8% (6/218) of the total hemorrhagic fever with renal syndrome patients were diagnosed with acute pancreatitis. The first symptom for all six of the patients with acute pancreatitis was fever. All six patients experienced hemorrhage and thrombocytopenia during the disease course, which was different from general acute pancreatitis. In addition, we presented two misdiagnosed clinical cases. Conclusions Acute pancreatitis is not a frequent complication in patients with hemorrhagic fever with renal syndrome. Clinicians should be alerted to the possibility of hemorrhagic fever with renal syndrome when acute pancreatitis patients with epidemiological data have high fever before abdominal pain. PMID:24345089

  19. Problems of pancreatitis

    Microsoft Academic Search

    Andrew L. Warshaw

    1986-01-01

    Pancreatitis is not one disease but several and perhaps many. Diagnosis is imperfect in all forms and the usual lack of histologic\\u000a material has hampered attempts to understand the pathogenesis and possible interrelationships of the different forms of pancreatic\\u000a inflammation. Acute pancreatitis does not as a rule evolve into chronic pancreatitis, even after multiple recurrences. Recurrent\\u000a acute attacks can be

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

    Microsoft Academic Search

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

    1995-01-01

    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

  1. Decreased survival rate of pancreatic acinar cells isolated from rats with acute pancreatitis.

    PubMed

    Schulz, H U; Letko, G; Spormann, H

    1990-04-01

    Viable acinar cells were isolated from normal rat pancreas as well as from pancreata pretreated in situ by a short-term ischemia without and with reperfusion, induction of a pancreatic juice edema, and acute pancreatitis (AP), respectively. The isolated cells were incubated at 37 degrees C in an oxygenated Krebs-Henseleit bicarbonate buffer lacking any nutrient. As an analog to in vivo acinar cell necrosis, the decline of the isolated cells was followed up in vitro. During the first 5-6 h of incubation, the percentage of damaged cells increased only slightly. A second phase of about 30 min followed, during which nearly all residual cells died. The mean half-life (t50) of the cells in all experimental groups ran to about 330 min, with the exception of the AP group (t50 = 132 min). The importance of an intact energy metabolism to prevent premature cell killing was underlined indirectly by the diminished t50 (about 120 min in all groups) of the cells exposed to excess 2,4-dinitrophenol, an uncoupler of oxidative phosphorylation. The results suggest that experimental AP induced by a combination of biliary-pancreatic duct obstruction, stimulation of pancreatic secretion, and short-term pancreatic ischemia with subsequent reperfusion finds a reflection within the acinar cells themselves and that these effects are not clouded by the isolation procedure. Thus, the application of acinar cells isolated from pancreatic glands pretreated in situ may offer a new tool for pathophysiological research into AP at the cellular level. PMID:2398282

  2. Not Your Everyday Case of Acute Pancreatitis: A Rare Complication of a Common Diagnosis

    PubMed Central

    Howerton, Douglas; Johnson, David A.

    2013-01-01

    Pancreaticopericardial fistula is an extremely rare complication of chronic pancreatitis and is virtually unheard of in the setting of acute pancreatitis. A 67-year-old male presented with acute pancreatitis complicated by pancreaticopericardial fistulization. The patient's initial presentation was consistent with tamponade physiology. Computed tomography demonstrated a gas-containing pericardial fluid llection extending into the anterior upper abdomen and ill-defined fluid collections within the pancreas representing necrosis with probable infection. Surgical exploration of the window revealed a pancreatic pericardial fistula and an infected window. The patient ultimately passed away from septic shock. We present this rare complication of pancreatitis and review the relevant literature.

  3. Acute pancreatitis possibly caused by allergy to bananas.

    PubMed

    Inamura, H; Kashiwase, Y; Morioka, J; Kurosawa, M

    2005-01-01

    We are reporting a forty-seven year old female who had three attacks of acute pancreatitis after having; eaten bananas. She was treated with a light diet and intravenous fluids during each of her admissions. The treatment concluded with the disappearance of clinical symptoms such as epigastralgia, nausea, vomiting and diarrhea within a few days. In addition, elevated serum and urine amylase levels returned to normal values in parallel with the clinical symptoms. The data during her three attacks of acute pancreatitis were as follows: serum total IgE level = 644 IU/mL, specific IgE to bananas = 2.18 UA/ml. No remarkable abnormalities were present in sonography, computed tomography, magnetic resonance imaging of the abdomen, and magnetic resonance cholangiopancreatography. Endoscopic examination of the upper digestive tract showed the ampulla of Vater swollen and edematous, thus a biopsy was performed. Toluidine blue staining and immunohistochemical staining against human mast cell tryptase with the biopsy specimens showed mast cells accumulating in mucosa and submucosa. By avoiding consumption of bananas, she has not suffered from any additional attacks of pancreatitis since the third attack in the last thirty-four months up to this day of December 10, 2004. PMID:16261961

  4. Development of acute pancreatitis caused by sodium valproate in a patient with bipolar disorder on hemodialysis for chronic renal failure: a case report

    PubMed Central

    2014-01-01

    Background Cases of acute pancreatitis caused by sodium valproate (VPA) have been reported by many authors thus far. However, most of these were cases with epilepsy. Chronic renal failure is also regarded as a risk factor for acute pancreatitis. Here, we report a case of acute pancreatitis development due to VPA in a patient with bipolar disorder on hemodialysis for chronic renal failure. Case presentation The patient was a 52-year-old Japanese male who was diagnosed as bipolar disorder on hemodialysis for renal failure. He was treated with VPA and manic symptoms gradually stabilized. However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. Hence, we diagnosed the case as acute pancreatitis caused by VPA. We discontinued oral medication, and he was started on a pancreatic enzyme inhibitor, antibiotics, and transfusion, and he showed improvement. Conclusion It has been reported that acute pancreatitis induced by VPA is caused by intermediate metabolites of VPA. We consider that patients with renal failure are prone to pancreatitis caused by VPA because of the accumulation of these intermediate metabolites. We need close monitoring for serious adverse effects such as pancreatitis when we prescribe VPA to patients with bipolar disorder on hemodialysis for chronic renal failure, although VPA is safer than other mood stabilizers. PMID:24679075

  5. Effect of lornoxicam therapy on expression of TLR2 and TLR4 mRNA during systemic complications of acute pancreatitis.

    PubMed

    Gorskii, V A; Agapov, M A; Khoreva, M V; Petrov, V A; Kravchenko, A Yu; Battaev, A I

    2014-11-01

    Primary pancreatic injury that occurs in acute pancreatitis leads to necrosis of pancreatic cells and is accompanied by the development systemic inflammatory response of varying severity. Systemic inflammatory response, in turn, can lead to the development of multiple organ dysfunction syndrome and death of patients. The release of damage-associated molecular patterns into the extracellular space is the trigger pathological mechanism underlying these processes. The released patterns exert their effects via Toll-like receptors (TLR). These findings suggest that TLR can be considered a new target for therapeutic intervention in acute pancreatitis. We studied mRNA expression of TLR2 and TLR4 in the peripheral blood mononuclear cells from the patients with acute pancreatitis and showed a decrease in the examined parameters associated with lornoxicam treatment. Anti-mediator therapy decreased mortality in these patients. PMID:25403387

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

    PubMed

    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

    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

  7. Primary Pancreatic Lymphoma Simulating Acute Cholestatic Hepatitis in a 7-Year-Old Child

    PubMed Central

    Agrawal, Nitesh; Alam, Seema; Rawat, Dinesh; Khanna, Rajeev; Bansal, Kalpana; Bihari, Chhagan

    2015-01-01

    Primary pancreatic lymphoma in children has been described infrequently in literature, and its acute presentation as cholestatic hepatitis is similarly rare. We report a case of a 7-year-old child with primary pancreatic lymphoma presenting as acute infective hepatitis, leading to delay in correct diagnosis and management.

  8. Effects of Soluble Epoxide Hydrolase Deficiency on Acute Pancreatitis in Mice

    E-print Network

    Hammock, Bruce D.

    Effects of Soluble Epoxide Hydrolase Deficiency on Acute Pancreatitis in Mice Ahmed Bettaieb1, California, United States of America Abstract Background: Acute pancreatitis (AP) is a frequent- and arginine-induced AP in mice. In addition, amylase and lipase levels were lower in cerulein-treated Ephx2 KO

  9. Nafamostat mesilate on the course of acute pancreatitis

    Microsoft Academic Search

    Francesco Marotta; Edoardo Fesce; I Indira Rezakovic; Hua De Chui; Kunihiko Suzuki; Gaetano Idéo

    1994-01-01

    Summary  Three hundred sixty Sprague-Dawley rats were allocated into four groups, according to different content of a 24-h iv infusion\\u000a performed 1 h after intrabiliary injection of enterokinase\\/sodium taurocholate to induce acute pancreatitis (AP): (1) Saline;\\u000a (2) 5 ?g\\/kg\\/h nafamostat mesilate (FUT-175); (3) 10 ?g\\/kg\\/h FUT-175; and (4) 25 ?g\\/kg\\/h FUT-175. Peritoneal fluid was removed\\u000a and exchanged with 1 mL 3.33Mfluorescein-isothiocyanate-conjugated

  10. The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors1

    PubMed Central

    Roberts, SE; Akbari, A; Thorne, K; Atkinson, M; Evans, PA

    2013-01-01

    Background The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years. Aim To establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption. Methods Use of record linked inpatient, mortality and primary care data for 10 589 hospitalised cases of acute pancreatitis between 1999 and 2010. Results The incidence of acute pancreatitis was 30.0 per 100 000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100 000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35–44 (5.7%) and 45–54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24–77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine. Conclusions The study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation. PMID:23859492

  11. Management of necrotizing pancreatitis

    Microsoft Academic Search

    John Slavin; Paula Ghaneh; Robert Sutton; Mark Hartley; Peter Rowlands; Conall Garvey; Mark Hughes; John Neoptolemos

    Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for

  12. The angle of pancreaticobiliary junction correlates with acute pancreatitis: a magnetic resonance cholangiopancreatography study

    PubMed Central

    Liu, Nian; Zhang, Xiao-Ming; Dong, Guo-Li; Jing, Zong-Lin; Gao, Cai-Liang; Tang, Meng-Yue

    2015-01-01

    Objective To study the correlation between the angle of the pancreaticobiliary junction (APJ) and the prevalence of acute pancreatitis using magnetic resonance cholangiopancreatography (MRCP). Materials and methods From February 2014 to October 2014, thirty two subjects with normal pancreas (group A) and 40 patients with acute pancreatitis (group B) who underwent MRCP were enrolled into our study. The type of biliary duct and main pancreatic duct joining the duodenal wall was reviewed and divided into V, B-P and P-B type. The V type is the pancreatic duct and biliary duct joining the duodenal wall without a common channel; the B-P type is the biliary duct draining into the pancreatic duct and forming a common channel; and the P-B type is the pancreatic duct draining into the biliary duct and forming a common channel. APJ was measured on MRCP. The correlation between the APJ and the prevalence of acute pancreatitis was analyzed. Results The APJ in group A was smaller than in group B (51.45°±13.51° vs. 65.76°±15.61°, P<0.05). According to the type of biliary duct and main pancreatic duct joining the duodenal wall, the prevalence of acute pancreatitis in the V type and in the B-P type was higher than in the P-B type (12/17 vs. 10/29, or 18/26 vs. 10/29, respectively, all P<0.05), whereas there were no significant difference for the prevalence of acute pancreatitis between the V type and B-P type (P>0.05). The APJ were 59.32°±20.04°, 60.22°±11.06°, 57.13°±17.27°, respectively in V type, B-P type and P-B type joining of main pancreatic duct (P>0.05). Conclusions A larger APJ is related to a higher prevalence of acute pancreatitis.

  13. Pharmacokinetic and pharmacodynamic studies of four major phytochemical components of Da-Cheng-Qi decoction to treat acute pancreatitis.

    PubMed

    Zhao, Jianlei; Tang, Wenfu; Wang, Jia; Xiang, Jin; Gong, Hanlin; Chen, Guangyuan

    2013-01-01

    The medicinal herb formulation Da-Cheng-Qi decoction (DCQD) has been shown to ameliorate the severity of acute pancreatitis by regulating an apoptosis-necrosis switch in cells. The active components responsible for this effect and their detailed mechanism of action remain unclear. Here we determine the pharmacokinetic characteristics of the four most abundant compounds in DCQD using a rat model of severe acute pancreatitis. Acute pancreatitis-like symptoms were first induced in rats and then they were given DCQD orally. Rhein was found in rat serum at much higher levels than magnolol, hesperidin, or naringin, even though it was the least abundant of the four compounds in the DCQD. We also examined pharmacodynamics in AR42J cells stimulated with 10(-8) M cerulein as a cellular model of acute pancreatitis. After pretreating AR42J cells with individual compounds and then exposing them to cerulein, we determined cell viability, levels of apoptosis and necrosis, and numbers of cells positive for reactive oxygen species (ROS). Pretreatment with any of the four DCQD compounds increased cell viability and the apoptosis index, while also reducing necrosis and ROS generation. The compounds showed maximal effect in AR42J cells around the same time that they showed maximum serum concentration in rats. Although all four components appear to play a role in an apoptosis-necrosis cellular switch in vitro, rhein may be the most bioactive DCQD ingredient. PMID:23739595

  14. Extracorporeal support for severe acute respiratory failure.

    PubMed

    Fanelli, V; Costamagna, A; Ranieri, V Marco

    2014-08-01

    Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO(2) removal (ECCO(2)R) techniques have increasingly been applied in patients with severe acute lung injury refractory to conventional mechanical ventilatory support. The objectives of this article are to review current concepts of extracorporeal life support techniques (ECMO and ECCO(2)R systems) and provide the rationale for their application in patients with acute respiratory distress syndrome, chronic obstruction pulmonary disease, and as adjunctive therapy for bridging patients to lung transplantation. PMID:25111648

  15. Imaging tests for accurate diagnosis of acute biliary pancreatitis.

    PubMed

    ?urlin, Valeriu; S?ftoiu, Adrian; Dumitrescu, Daniela

    2014-11-28

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end, bile duct microscopic analysis may be performed by bile harvested during ERCP in case of recurrent attacks of ABP and these should be followed by laparoscopic cholecystectomy. PMID:25469022

  16. Imaging tests for accurate diagnosis of acute biliary pancreatitis

    PubMed Central

    Surlin, Valeriu; S?ftoiu, Adrian; Dumitrescu, Daniela

    2014-01-01

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end, bile duct microscopic analysis may be performed by bile harvested during ERCP in case of recurrent attacks of ABP and these should be followed by laparoscopic cholecystectomy. PMID:25469022

  17. Diagnostic challenges of Wilson’s disease presenting as acute pancreatitis, cholangitis, and jaundice

    PubMed Central

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

    2013-01-01

    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

  18. Effect of temporary ischemia upon development and histological patterns of acute pancreatitis in the rat.

    PubMed

    Spormann, H; Sokolowski, A; Letko, G

    1989-05-01

    To study the importance of a disturbed energy metabolism for the development of acute pancreatitis (AP) rats pretreated either by induction of a juice edema or by intraductal trypsin instillation were subjected to temporary pancreatic ischemia. By means of a scoring system quality and quantity of pathomorphologic parameters were quantified 24 h postoperatively. There was a clear correlation between macroscopic and histologic scores independent of the model used. While a juice edema or 40 min ischemia alone did not induce AP, a combination of both led in half of the animals treated to AP. This was mainly characterized by extrapancreatic fat necrosis. Besides less specific fat necrosis the histologic examination of the pancreas revealed acinar necroses at the periphery of the lobules as a frequent injury pattern. After trypsin injection a persistent pancreatic edema, hemorrhages, fat and parenchymal necroses were typical findings. Both focal centro-lobular and extended sublobular or lobular necroses were histologically observed. An additional temporary ischemia augmented significantly the severity of findings, however, their quality was not essentially changed. From the present results it can be concluded that an alteration of the pancreatic energy metabolism, e.g. by hypoperfusion or ischemia, may be an important pathogenic factor in precipitating experimental AP. PMID:2748464

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

    PubMed Central

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

    2014-01-01

    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

  20. Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs

    PubMed Central

    Kim, Hyun-wook; Oh, Ye-in; Choi, Ji-hye; Kim, Dae-yong

    2014-01-01

    Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs. PMID:24962411

  1. Angio-CT: diagnosis and detection of complications of acute pancreatitis.

    PubMed

    Freeny, P C

    1991-04-01

    The ability of high-resolution, current-generation fast (sub-2 sec) CT scanners to display the precise cross-sectional anatomy of the pancreas and surrounding organs and structures had made it the most efficacious imaging modality for evaluation of patients with known or suspected acute pancreatitis. The use of angio-CT (automatic table incrementation, dynamic scanning mode, simultaneous intravenous infusion of a large bolus of contrast) has further extended its use for detection of parenchymal necrosis and vascular involvement. CT now plays a central role in diagnosis, prognostication (staging of severity of disease), detection of complications, and guidance for percutaneous techniques. PMID:1855765

  2. Cyclosporine in steroid refractory acute severe colitis.

    PubMed

    Kumar, N Suraj; Khosla, Rajiv; Makharia, Govind K

    2014-08-01

    Approximately 15-20% patients with ulcerative colitis (UC) suffer from a severe flare during their lifetime which required hospitalization. Intravenous corticosteroids are the first line of therapy for acute severe UC. While almost 70-80% of patients respond to corticosteroids 20% do not. Although colectomy for UC is curative, it has its problems such as increased frequency of stool and pouchitis, which led to search for colon rescue therapy. Cyclosporine and anti-tumor necrosis factor-alpha (anti-TNF á) have emerged as effective colon rescue therapy. While the short-term efficacy of cyclosporine in preventing colectomy is 64-86%, the long-term efficacy is not as good and almost 70% eventually require colectomy over 1-7 years. The efficacy of cyclosporine is equivalent both at a high and low doses and cyclosporine is now used most often as a low dose regime in patients with steroid refractory acute severe UC. Furthermore, recent data suggest that the both cyclosporine and infliximab are equally effective in steroid refractory acute severe UC. Monitoring patients for adverse events and serum cyclosporine levels is mandatory. The response to both cyclosporine and infliximab is rapid and usually occurs within 4-5 days. Despite mounting evidence of its efficacy, cyclosporine remains largely underused because it requires intense monitoring for toxicity especially at higher dosage. Gastroenterologists need to be more familiar with cyclosporine for the management of steroid refractory acute severe UC. PMID:25735123

  3. Usefulness of Technetium99m Hexamethylpropylene Amine Oxime-Labeled Leukocyte Scintigraphy to Detect Pancreatic Necrosis in Patients with Acute Pancreatitis

    Microsoft Academic Search

    Antonio López; Leticia de la Cueva; María Jesús Martínez; Fernando Gómez; Tomás Ripollés; Ramón Sopena; Eduardo Moreno-Osset

    2007-01-01

    Background: In acute pancreatitis (AP), pancreatic necrosis (PN) is an important local complication that can be identified by means of contrast-enhanced computed tomography (CECT). Pancreatic leukocyte infiltration is a significant pathogenic event in the development of PN that can be detected by labeled leukocyte scintigraphy (LLS). The aim of this study was to evaluate the utility of LLS with technetium-99m

  4. Research: Treatment: Relative risk of acute pancreatitis in initiators of exenatide twice daily compared with other anti-diabetic medication: a follow-up study

    PubMed Central

    Wenten, M; Gaebler, J A; Hussein, M; Pelletier, E M; Smith, D B; Girase, P; Noel, R A; Braun, D K; Bloomgren, G L

    2012-01-01

    Aims Previously, a retrospective cohort study found no increased risk of acute pancreatitis with current or recent use of exenatide twice daily compared with use of other anti-diabetic drugs. This follow-up study investigated incident acute pancreatitis, with the use of a different data source and analytic method, in patients exposed to exenatide twice daily compared with patients exposed to other anti-diabetic medications. Methods A large US health insurance claims database was used. Eligible patients had ?months continuous enrollment without a claim for pancreatitis and a claim for a new anti-diabetic medication on or after 1 June 2005 to 31 March 2009. Cases of acute pancreatitis were defined as hospitalized patients with an Internation Classification of Disease9 code of 577.0 in the primary position. A discrete time survival model was used to evaluate the relationship between exenatide twice daily and acute pancreatitis. Results Of 482034 eligible patients, 24237 initiated exenatide twice daily and 457797 initiated another anti-diabetic medication. Initiators of exenatide twice daily had more severe diabetes compared with initiators of other anti-diabetic medications. After adjustments for propensity score, insulin and use of medication potentially associated with acute pancreatitis, the odds ratio with exenatide twice daily exposure was 0.95 (95%CI 0.65–1.38). A secondary analysis that examined current, recent and past medication exposure found no increased risk of acute pancreatitis with exenatide twice daily, regardless of exposure category. Conclusion This study indicates that exposure to exenatide twice daily was not associated with an increased risk of acute pancreatitis compared with exposure to other anti-diabetic medications. These results should be interpreted in light of potential residual confounding and unknown biases. PMID:22416857

  5. Procalcitonin in severe acute respiratory syndrome (SARS)

    Microsoft Academic Search

    Ai Ping Chua; Kang Hoe Lee

    2004-01-01

    Objective and methods. The role of procalcitonin (PCT) in severe acute respiratory syndrome (SARS) has not been highlighted so far. We described retrospectively eight cases of sepsis from pneumonia of various microbiological aetiologies including two due to SARS, compared their PCT concentrations and provided further descriptors of SARS as a viral pneumonia.Results. Like any viral pneumonia, patients with SARS had

  6. Alcohol Consumption in Patients with Acute or Chronic Pancreatitis

    Microsoft Academic Search

    J. Sand; P. G. Lankisch; I. Nordback

    2007-01-01

    Understanding of the relation between the alcoholic consumption and the development of pancreatitis should help in defining the alcoholic etiology of pancreatitis. Although the association between alcohol consumption and pancreatitis has been recognized for over 100 years, it remains still unclear why some alcoholics develop pancreatitis and some do not. Surprisingly little data are available about alcohol amounts, drinking patterns,

  7. Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis

    PubMed Central

    Shimoda, Mistuyosi; Sakamoto, Takashi; Tauchi, Kastunori; Shimada, Kastuo; Goka, Takeichi; Bandou, Tadashi; Fujimaki, Masao; Yamanaka, Ademar

    1998-01-01

    We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection. PMID:18493467

  8. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin

    PubMed Central

    Erkan, Nazif; Yakan, Savas; Yildirim, Mehmet; Carti, Erdem; Ucar, Deniz; Oymaci, Erkan

    2015-01-01

    Introduction Hypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented. Aim To present 12 cases of AP successfully treated by insulin administration. Material and methods Three hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study. Results Serum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed. Conclusions Our results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP. PMID:25960810

  9. The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

    PubMed Central

    Sun, Wei-Chih; Chan, Hoi-Hung; Lai, Kwok-Hung; Tsai, Tzung-Jiun; Lin, Huey-Shyan; Lin, Kung-Hung; Wang, Kai-Ming; Kao, Sung-Shuo; Chiang, Po-Hung; Cheng, Jin-Shiung; Hsu, Ping-I; Tsai, Wei-Lun; Chen, Wen-Chi; Li, Yun-Da; Wang, E-Ming

    2015-01-01

    Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD) for the treatment of acute biliary pancreatitis (ABP). Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73) were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD) in 149 patients. The mean dilating balloon size was 10.5?mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2%) adverse events and 2 (1.1%) intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease. PMID:25949236

  10. Acute prevertebral abscess secondary to infected pancreatic pseudocyst.

    PubMed

    Bhandarkar, Ajay M; Pillai, Suresh; Venkitachalam, Shruti; Anand, Aishwarya

    2014-01-01

    We report a case of a middle aged, man with diabetes who presented with dysphagia and odynophagia. On evaluation, he was diagnosed to have an acute prevertebral abscess with an unusual aetiology, an infected pseudocyst of pancreas. Contrast-enhanced CT revealed an enhancing collection in the prevertebral space extending to the retrogastric space and communicating with the body of the pancreas via the oesophageal hiatus. Transoral incision and drainage of the prevertebral abscess were performed. Nasogastric tube was placed in the prevertebral space for continuous drainage and daily irrigation. Supportive intravenous broad spectrum antibiotic therapy along with the surgical intervention led to the resolution of the prevertebral abscess and the infected pancreatic pseudocyst. PMID:24408943

  11. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis

    Microsoft Academic Search

    Juan Miguel Acosta; Roberto Rossi; Carlos Luis Ledesma

    1977-01-01

    Screening stools for gallstones in patients with acute pancreatitis has been found to be a valuable diagnostic procedure in clinical practice. It is particularly helpful to know that a patient with pancreatitis has gallstones and, therefore, the disease is probably caused by the passage of these stones. A detailed description of the technique employed for stool screening is presented. The

  12. Can diphenhydramine prevent organophosphate-induced acute pancreatitis? An experimental study in rats

    Microsoft Academic Search

    Yusuf Yürümez; Yücel Yavuz; Önder ?ahin; ?. Hakk? Çiftçi; Seda Özkan; Mehmet Emin Büyükokuro?lu

    2007-01-01

    Acute pancreatitis (AP) is a well known complication of organophosphate (OP) poisoning and the true incidence is unknown; but, may be more common than clinically suspected. Previous studies suggest that Diphenhydramine (DPH) may be useful as an alternative or adjunctive therapy in OP poisoning. The aim of this experimental study was to investigate whether DPH could prevent or diminish pancreatic

  13. SPINK1 N34S Is Strongly Associated With Recurrent Acute Pancreatitis but Is Not a Risk Factor for the First or Sentinel Acute Pancreatitis Event

    Microsoft Academic Search

    Elie Aoun; Venkata Muddana; Georgios I Papachristou; David C Whitcomb

    2010-01-01

    OBJECTIVES:Serine protease inhibitor Kazal type 1 (SPINK1) gene mutations have been associated with chronic pancreatitis of different etiologies; however, little is known about their role in the pathogenesis of acute pancreatitis (AP). Our aim was to study the prevalence of the SPINK1 N34S polymorphism in patients with sentinel and recurrent AP (RAP).METHODS:Patients with AP were enrolled, and genetic tests were

  14. Pancreatitis-imaging approach

    PubMed Central

    Busireddy, Kiran K; AlObaidy, Mamdoh; Ramalho, Miguel; Kalubowila, Janaka; Baodong, Liu; Santagostino, Ilaria; Semelka, Richard C

    2014-01-01

    Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. Imaging plays a signi?cant role in the diagnosis, severity assessment, recognition of complications and guiding therapeutic interventions. In the setting of pancreatitis, wider availability and good image quality make multi-detector contrast-enhanced computed tomography (MD-CECT) the most used imaging technique. However, magnetic resonance imaging (MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization. This article reviews the proposed definitions of revised Atlanta classification for acute pancreatitis, illustrates a wide range of morphologic pancreatic parenchymal and associated peripancreatic changes for different types of acute pancreatitis. It also describes the spectrum of early and late chronic pancreatitis imaging findings and illustrates some of the less common types of chronic pancreatitis, with special emphasis on the role of CT and MRI. PMID:25133027

  15. [Peripartum cardiomyopathy, acute autoimmune pancreatitis and periadipose tissue inflammation - autoimmune reaction?].

    PubMed

    Kobielusz-Gembala, Iwona; Zmuda, Witold; Piecuch, Anna; Bo?dys, Aleksandra; Basiak, Marcin; Okopie?, Bogus?aw

    2013-01-01

    A case of 26 year-old female with peripartum cardiomyopathy, acute pancreatitis, periadipose tissue inflammation due to unknown cause and multiple organ dysfunction syndrome complication is presented. PMID:23797439

  16. [Acute pancreatitis and acalculous cholecystitis associated with viral hepatitis A].

    PubMed

    Arcana, Ronald; Frisancho, Oscar

    2011-01-01

    We report the case of a 14 year-old male from Lima. He is a student with a history of bronchial asthma since age 4 receives conditional salbutamol, corticosteroids used for asthma attacks (a crisis in 2010, 1 month ago) Refuses surgery or transfusions. He presented with a two weeks for abdominal pain, nausea, fever, and jaundice. Epigastric pain is colicky and radiated back to righ upper quadrant, refers in addition to nausea and fever, for ten days notice jaundice of skin and sclera. On examen he was lucid, with jaundice of skin and mucous membranes. There was no palpable lymph nodes, abdomen with bowel sounds, soft, depressible, liver span of 15cm, positive Murphy, no peritonitis. The laboratory findings showed hemoglobin 13gr, MCV 90, platelets 461.000/mm3, WBC 4320/mm, lymphocytes 1700 (39%). total bilirubin: 8.8, B Direct: 7.6, ALT (alanine aminotransferase): 3016, AST (aspartate aminotransferase): 984, alkaline phosphatase: 250, albumin: 3.34gr%, globulin: 2.8, amylase: 589 (high serum amylase), TP: 17, INR: 1.6, VHA IgM positive. 89 mg glucose, urea 19 mg%, creatinine 0.5 mg Hemoglobin 13gr, MCV 90 Platelet 461000/mm3, WBC 4320/mm, Lymphocytes 1700 (39%). The nuclear magnetic resonance showed hepatomegaly associated with thickening of gallbladder wall without stones up to 11mm inside. No bile duct dilatation, bile duct 4mm, pancreas increased prevalence of body size. Mild splenomegaly and free fluid in the space of Morrison and right flank. Abdominal ultrasound revealed a gallbladder wall thickness (11mm), without stones in his light. Pancreas to increase volume with peripancreatic fluid free perivesicular with a volume of 430 cc. Findings consistent with acute acalculous cholecystitis and acute pancreatitis. CT-scan showed enlarged pancreas with predominance of body and tail with peripancreatic edema; the gallbladder was thickening. We report this case because the extrahepatic manifestations of viral hepatitis A infection are uncommon, specially the associated with acute acalculous cholecystitis and acute pancreatitis simultaneous. PMID:21836659

  17. Patient selection and timing of dynamic computed tomography in acute pancreatitis.

    PubMed

    Lucarotti, M E; Virjee, J; Alderson, D

    1993-11-01

    Dynamic computed tomography (CT) is the most accurate method for determining the extent of necrosis in acute pancreatitis. Debate exists, however, regarding patient selection and the optimal timing of CT. This study examined selection based on biochemical and/or clinical criteria and the influence of delayed dynamic CT performed 5-10 days after the onset of an attack. A total of 120 patients with acute pancreatitis were studied. Dynamic CT was performed if any of the following criteria were identified: a biochemically severe attack (according to Glasgow criteria) in the first 24 h, C-reactive protein (CRP) level above 120 mg/l in the first 3 days or failure of clinical resolution within 7 days. Of 42 patients selected for CT, five died from multisystem organ failure before day 5. There were no deaths or delayed complications in the 78 patients not selected for scanning. Positive Glasgow criteria alone in the scanned group had a sensitivity for predicting necrosis (as recognized by CT) of 22 per cent and a specificity of 20 per cent. Measurement of CRP level alone had a sensitivity of 26 per cent and specificity of 80 per cent. Failure of clinical resolution had a sensitivity of only 7 per cent but a specificity of 100 per cent. The combination of Glasgow criteria and CRP level had a sensitivity of 44 per cent and specificity of 100 per cent. Delayed complications (pseudocyst, five; infection, six) occurred only in patients with necrosis, and there were two deaths. An 'at-risk' group can be identified for CT on the basis of biochemical and clinical observations. Neither routine nor emergency dynamic CT in acute pancreatitis seems justified. PMID:8252345

  18. Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

    PubMed Central

    Lee, Jun Young; Chung, Jin Soo

    2012-01-01

    Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma. PMID:22977802

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

    Microsoft Academic Search

    Patrick C. Freeny; Ellen Hauptmann; Sandra J. Althaus; L. William Traverso; Mika Sinanan

    1998-01-01

    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

  20. Ordered transcriptional factor recruitment and epigenetic regulation of tnf - ? in necrotizing acute pancreatitis

    Microsoft Academic Search

    J. Sandoval; J. Pereda; J. L. Rodriguez; J. Escobar; J. Hidalgo; L. A. B. Joosten; L. Franco; J. Sastre; G. López-Rodas

    2010-01-01

    ?he expression of the critical initiator cytokine TNF-? was strongly upregulated in vivo in acute necrotic pancreatitis (AP)\\u000a in rodents and in vitro in TNF-? activated acinar AR42J cells. Upregulation of tnf-?, inos,\\u000a icam-1 and il-6 occurred both in TNF-? receptor 1 and 2 knock-out mice, but not in TNF-? knock-out mice, in cerulein-induced acute pancreatitis.\\u000a Chromatin immunoprecipitation analysis showed

  1. Experimental Models of Pancreatitis

    PubMed Central

    Hyun, Jong Jin

    2014-01-01

    Acute pancreatitis is an inflammatory disease characterized by interstitial edema, inflammatory cell infiltration, and acinar cell necrosis, depending on its severity. Regardless of the extent of tissue injury, acute pancreatitis is a completely reversible process with evident normal tissue architecture after recovery. Its pathogenic mechanism has been known to be closely related to intracellular digestive enzyme activation. In contrast to acute pancreatitis, chronic pancreatitis is characterized by irreversible tissue damage such as acinar cell atrophy and pancreatic fibrosis that results in exocrine and endocrine insufficiency. Recently, many studies of chronic pancreatitis have been prompted by the discovery of the pancreatic stellate cell, which has been identified and distinguished as the key effector cell of pancreatic fibrosis. However, investigations into the pathogenesis and treatment of pancreatitis face many obstacles because of its anatomical location and disparate clinical course. Due to these difficulties, most of our knowledge on pancreatitis is based on research conducted using experimental models of pancreatitis. In this review, several experimental models of pancreatitis will be discussed in terms of technique, advantages, and limitations. PMID:24944983

  2. Acute Pancreatitis Complicated by Massive Inferior Vena Cava and Right Atrial Thrombosis: A Case Report.

    PubMed

    Lee, Kangeui; Ko, Jung-In; Park, Taejin

    2015-07-01

    Venous thrombosis is a relatively common complication of acute pancreatitis. A 58-year-old man came to our emergency department with abdominal pain. Pancreatitis complicated with a huge thrombosis through inferior vena cava (IVC) to right atrium and left renal vein was diagnosed. Gabexate and enoxaparin were administered for pancreatitis and thrombosis. Surgical removal of thrombosis was considered but was not possible because of poor general condition. Despite conservative management, the patient expired. We believe this is the first case of pancreatitis complicated by right atrial thrombosis. PMID:25765632

  3. Metastatic Small Cell Carcinoma of Lung To Pancreas Mimicking As Acute Pancreatitis: A Case Report

    PubMed Central

    Agarwal, Lakshmi; Choudhary, Pradeep; Vashist, Neelu; Rai, Naresh N.

    2015-01-01

    Small cell carcinoma (SCC) of lung is a highly malignant tumour and is notorious for early and widespread metastasis at the time of presentation. However, metastasis to pancreas occurs uncommonly. Metastatic lesions comprise of 3% of all pancreatic malignancies. We hereby present a rare case report where patient presented with symptoms of acute pancreatitis & diagnosed with SCC of lung, retrospectively. This case emphasize that acute pancreatitis can be a manifestation of malignancy and fine needle aspiration cytology can play a diagnostic role in such cases.

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

    SciTech Connect

    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

    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.

  5. Acute pancreatitis and normoamylasemia. Not an uncommon combination.

    PubMed Central

    Clavien, P A; Robert, J; Meyer, P; Borst, F; Hauser, H; Herrmann, F; Dunand, V; Rohner, A

    1989-01-01

    A consecutive series of 352 attacks of acute pancreatitis (AP) was studied prospectively in 318 patients. AP was ascertained by contrast-enhanced CT scan in all but four cases in which diagnosis was made at operation or autopsy. Sixty-seven of these cases (19%) had normal serum amylase levels on admission (i.e., less than 160 IU/L, a limit that includes 99% of control values), a figure considerably higher than generally admitted. When compared to AP with elevated serum amylase, normoamylasemic pancreatitis was characterized by the following: (1) the prevalence of alcoholic etiology (58% vs. 33%, respectively, p less than 0.01), (2) a greater number of previous attacks in alcoholic pancreatitis (0.7 vs. 0.4, p less than 0.01); and (3) a longer duration of symptoms before admission (2.4 vs. 1.5 days, p less than 0.005). In contrast AP did not appear to differ significantly in terms of CT findings, Ranson's score, and clinical course, when comparing normo- and hyperamylasemic patients, although there was a tendency for normoamylasemic patients to follow milder courses. Serum lipase was measured in 65 of these normoamylasemic cases and was found to be elevated in 44 (68%), thus increasing diagnostic sensitivity from 81% when amylase alone is used to 94% for both enzymes. A peritoneal tab was obtained in 44 cases: amylase concentration in the first liter of dialysate was greater than 160 IU/L in 24 cases (55%), and lipase was greater than 250 U/L in 31 cases (70%). Twelve of these 44 cases had low peritoneal fluid and plasma concentrations for both enzymes. Thus little gain in diagnostic sensitivity was obtained when adding peritoneal values (96%) to serum determinations. AP is not invariably associated with elevated serum amylase. Multiple factors may contribute to the absence of hyperamylasemia on admission, including a return to normal enzyme levels before hospitalization or the inability of inflamed pancreases to produce amylase. Approximately two thirds of cases with normal amylasemia were properly identified by serum lipase determinations. AP does not appear to behave differently when serum amylase is normal or elevated, and should therefore be submitted to similar therapeutic regimens in both conditions. PMID:2479346

  6. Epidemiology of Acute Pancreatitis in the North Adriatic Region of Croatia during the Last Ten Years

    PubMed Central

    Stimac, Davor; Mikolasevic, Ivana; Krznaric-Zrnic, Irena; Radic, Mladen; Milic, Sandra

    2013-01-01

    Introduction. Several European studies have reported an increase in the incidence rate of acute pancreatitis (AP). Therefore, we studied the incidence rate of AP in the North Adriatic Region in Croatia, as well as epidemiological analysis concerning etiology, age, gender, and severity of disease. Methods. We analyzed 922 patients with confirmed diagnosis of AP (history, clinical and laboratory findings, and imaging methods) admitted to our hospital during a ten-year period (2000–2009). Epidemiological analysis was carried out focusing on incidence, demographic data, and etiology, as well as severity of the disease based on the Ranson and APACHE II scores. Results. The incidence rate varied from 24 to 35/100 000 inhabitants annually. Mean age was 60 ± 16 years. There were 53% men and 47% women among the patients. Most frequent etiologies of AP were biliary stones in 60% and alcohol abuse in 19% of patients. According to the Ranson and APACHE II scores, pancreatitis was considered to be severe in 50% and 43% of the cases, respectively. Conclusion. In our region the incidence of AP was around 30 per 100,000 population per year during the ten-year period studied. The mean age at admission was 60 years and etiology was predominantly biliary. In our region, we have shown epidemiological characteristics of AP typical for Mediterranean countries. PMID:23476641

  7. Pancreatitis

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses both acute and chronic pancreatitis, including causes, symptoms, diagnosis, and treatment options. It also reviews the anatomy of the digestive system. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  8. Intramural Duodenal Hematoma with Acute Pancreatitis in a Patient With an Overt Pancreatic Malignancy

    PubMed Central

    Shah, Apeksha; Ali, Ijlal; Islam, Raafa; Siddiqui, Ali A.

    2014-01-01

    Intramural hematomas have rarely been associated with pancreatitis, and to date there is only 1 case report of an intramural hematoma occurring with pancreatic adenocarcinoma. We describe a patient who presented with gastric outlet obstruction secondary to a spontaneous intramural duodenal hematoma and was found to have a pancreatic adenocarcinoma on endoscopic ultrasound (EUS) after it was not visualized by computed tomography (CT).

  9. Intracellular activation of trypsinogen in transgenic mice induces acute but not chronic pancreatitis

    PubMed Central

    Gaiser, Sebastian; Daniluk, Jaroslaw; Liu, Yan; Tsou, Lilian; Chu, Jun; Lee, Woojin; Longnecker, Daniel S; Logsdon, Craig D; Ji, Baoan

    2014-01-01

    Background and aims Premature intra-acinar activation of trypsinogen is widely considered key for both the initiation of acute pancreatitis and the development of chronic pancreatitis. However, the biological consequences of intracellular trypsinogen activation have not been directly examined. To do so, a new mouse model was developed. Methods Mice were engineered to conditionally express an endogenously activated trypsinogen within pancreatic acinar cells (PACE-trypon). Hallmarks of pancreatitis were determined and findings were correlated to the level (zygosity) and extent (temporal and spatial) of conditional PACE-trypon expression. Furthermore, the impact of acinar cell death in PACE-trypon mice was assessed and compared with a model of selective diphtheria toxin (DT)-mediated induction of acinar apoptosis. Results Initiation of acute pancreatitis was observed with high (homozygous), but not low (heterozygous) levels of PACE-trypon expression. Subtotal (maximal-rapid induction) but not limited (gradual-repetitive induction) conditional PACE-trypon expression was associated with systemic complications and mortality. Rapid caspase-3 activation and apoptosis with delayed necrosis was observed, and loss of acinar cells led to replacement with fatty tissue. Chronic inflammation or fibrosis did not develop. Selective depletion of pancreatic acinar cells by apoptosis using DT evoked similar consequences. Conclusions Intra-acinar activation of trypsinogen is sufficient to initiate acute pancreatitis. However, the primary response to intracellular trypsin activity is rapid induction of acinar cell death via apoptosis which facilitates resolution of the acute inflammation rather than causing chronic pancreatitis. This novel model provides a powerful tool to improve our understanding of basic mechanisms occurring during pancreatitis. PMID:21471572

  10. Clinical impact of preoperative acute pancreatitis in patients who undergo pancreaticoduodenectomy for periampullary tumors

    PubMed Central

    Chen, Yong-Hua; Xie, Si-Ming; Zhang, Hao; Tan, Chun-Lu; Ke, Neng-Wen; Mai, Gang; Liu, Xu-Bao

    2015-01-01

    AIM: To investigate the impact of preoperative acute pancreatitis (PAP) on the surgical management of periampullary tumors. METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. Thirty-four patients who underwent pancreaticoduodenectomy (PD) and 4 patients who underwent total pancreatectomy were compared with a control group of 145 patients without PAP during the same period. RESULTS: The preoperative waiting time was significantly shorter for the concomitant PAP patients who underwent a resection (22.4 d vs 54.6 d, P < 0.001) compared to those who did not. The presence of PAP significantly increased the rate of severe complications (Clavien grade 3 or higher) (17.6% vs 4.8%, P = 0.019) and lengthened the hospital stay (19.5 d vs 14.5 d, P = 0.006). A multivariate logistic regression analysis revealed that PAP was an independent risk factor for postoperative pancreatic fistula (OR = 2.91; 95%CI: 1.10-7.68; P = 0.032) and severe complications (OR = 4.70; 95%CI: 1.48-14.96; P = 0.009) after PD. There was no perioperative mortality. CONCLUSION: PAP significantly increases the incidence of severe complications and lengthens the hospital stay following PD. PD could be safely performed in highly selective patients with PAP. PMID:26078571

  11. Acute pancreatitis due to extracorporeal shock wave lithotripsy: a rare complication.

    PubMed

    Limon, Onder; Kantar, Funda Ugur; Sahin, Erkan; Arslan, Murat; Ugurhan, Asl? Ayd?noglu

    2014-11-01

    Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most renal and upper ureteral stones. Although extensive data have documented its safety, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and rupture of aortic aneurysms. Here, we report a 41-year-old woman who underwent ESWL for a calculus at the right renal pelvis and immediately developed acute pancreatitis after the procedure. Although the possibility of post-ESWL acute pancreatitisis extremely low, physicians must be aware of this complication in emergency departments. PMID:24908440

  12. Chronic pancreatitis

    MedlinePLUS

    Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, gets worse over time, and leads ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  13. Pefloxacin penetration into human necrotic pancreatic tissue

    Microsoft Academic Search

    E. Bertazzoni Minelli; A. Benini; A. Muner; C. Bassi; H. Abbas; P. Pederzoli

    1996-01-01

    Antibiotic prophylaxis may be useful in acute necrotising pancreatitis, a disease associated with a considerable incidence of infectious complications. The aim of this study was to assess pefloxacin penetration into necrotic pancreatic tissue during human necrotic pancreatitis. Ten patients (mean age 53-2 ± 17-4 years) with severe acute pancreatitis (mean Ranson score 4-3) were studied. Pefloxacin was administered at a

  14. An Unexpected Result of Obesity Treatment: Orlistat-Related Acute Pancreatitis

    PubMed Central

    Kose, Murat; Emet, Samim; Akpinar, Timur Selcuk; Ilhan, Mehmet; Gok, Ali Fuat Kaan; Dadashov, Mubariz; Tukek, Tufan

    2015-01-01

    Orlistat is a pancreatic lipase inhibitor which is used to treat obesity. Due to the increasing prevalence of obesity, orlistat use is thought to rise progressively. We report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging; in addition, the case had significantly elevated serum amylase levels. A 54-year-old male who had a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain, nausea and vomiting lasting for 24 h. Abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas. Based on these findings, it was concluded that edematous pancreatitis was in its initial stage. Orlistat is a drug that is increasingly widespread use due to obesity. More attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis (alcohol use, height, serum calcium and lipid levels).

  15. Experimental acute pancreatitis--a quantification of dynamics at enzymic and histomorphologic levels.

    PubMed

    Spormann, H; Sokolowski, A; Letko, G

    1989-09-01

    To study the dynamics of pathomorphologic alterations in the development of acute pancreatitis (AP) and the corresponding changes of the patterns of pancreatic enzymes in rats AP was induced by: 1) combination of a pancreatic juice edema and temporary pancreatic ischemia, ii) by intraductal instillation of trypsin, and iii) by trypsin instillation in combination with ischemia. At 4, 8 and 24 h postoperatively the histologic findings and the activities of lipase and alpha-amylase in the pancreas and the serum were analyzed. The histologic sum score of the individual rats did not correlate with their enzymic patterns in pancreas and in serum. In all three models there was a development of parenchymal necrosis independent of the existence of pancreatic fat necrosis. Therefore, it is not probable that fat necrosis represents an obligatory precondition for the initiation of autodigestion. PMID:2813189

  16. Protective effect of lawsone on L-Arginine induced acute pancreatitis in rats.

    PubMed

    Biradar, Sandeep; Veeresh, B

    2013-03-01

    The efficacy of lawsone against L-arginine induced acute pancreatitis was determined at 24 h by determination of serum levels of amylase, lipase and proinflammatory cytokines [tumor necrosis factor (TNF)-alpha, C-reactive proteins and interleukin (IL)], pancreatic myeloperoxidase (MPO) activity, lipid peroxidation (thiobarbituric acid reactive substances (TBARS)], nitrate/nitrite levels, and the wet weight/body weight ratio. Lawsone and methylprednisolone treatments significantly attenuated the L-arginine- induced increases in pancreatic wet weight/body weight ratio, and decreased the serum levels of amylase and lipase, and TNF-alpha and IL-6 and significantly lowered pancreatic levels of MPO, TBARS, and nitrate/nitrite. The histoimmunological findings further proved the amelioration of pancreatic injury by lawsone and further proved anti-inflammatory and antioxidant agent property of lawsone. PMID:23678547

  17. 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

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

    2014-01-01

    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

  18. Valproate-Associated Acute Pancreatitis in a Child With Neuronal Ceroid Lipofuscinosis

    Microsoft Academic Search

    Dinesh Talwar

    1994-01-01

    An 11-year-old girl with juvenile neuronal ceroid lipofuscinosis developed acute pancreatitis secondary to valproic acid treatment, which resolved after discontinuation of the medication and conservative treatment. To my knowledge, this is the first reported case of neuronal ceroid lipofuscinosis with valproate-associated pancreatitis. Children with neuronal ceroid lipofuscinosis may be susceptible to developing this complication. (J Child Neurol 1994;9:36-37).

  19. Pancreatitis

    MedlinePLUS

    ... hormones important in maintaining normal blood sugar levels. Pancreatitis is an inflammation, or swelling, of the pancreas. Causes of pancreatitis include gallstones and toxins such as excessive alcohol. ...

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

    Microsoft Academic Search

    Birger Sandzén; Markku M Haapamäki; Erik Nilsson; Hans C Stenlund; Mikael Öman

    2009-01-01

    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

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

    Microsoft Academic Search

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

    1996-01-01

    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

  2. Effect of endothelin and endothelin receptor blockade on capillary permeability in experimental pancreatitis

    PubMed Central

    Eibl, G; Hotz, H; Faulhaber, J; Kirchengast, M; Buhr, H; Foitzik, T.

    2000-01-01

    BACKGROUND—Capillary leakage with fluid loss into the third space contributes to many of the early systemic complications in severe acute pancreatitis. There has been increasing interest in endothelin as one of the factors affecting capillary permeability.?AIM—To elucidate further the role of endothelin in the development of capillary leakage in acute pancreatitis by investigating the effect of exogenous endothelin administration and endothelin receptor blockade in sham operated animals and two models of acute pancreatitis.?METHODS—Determination of capillary permeability in the pancreas and colonic mucosa by quantifying extravasation of fluorescein labelled dextran using a novel computer assisted video image analysis system.?RESULTS—Pancreatic and colonic capillary permeability increased stepwise from mild to severe acute pancreatitis. Endothelin increased pancreatic and colonic capillary permeability in healthy animals and animals with mild acute pancreatitis but had no additional adverse effect in severe acute pancreatitis. Endothelin receptor blockade decreased pancreatic capillary permeability in sham operated rats but had no effect on the colon. In mild and severe acute pancreatitis, endothelin receptor blockade stabilised increased capillary permeability in both the pancreas and colon.?CONCLUSIONS—Endothelin plays an important role in mediating capillary permeability in the pancreas. In severe pancreatitis, it increases capillary permeability even outside the pancreas, thereby contributing to capillary leakage. Endothelin receptor blockade significantly reduces capillary permeability in acute pancreatitis both in and outside the pancreas, suggesting a therapeutic approach to counteract capillary leakage in severe acute pancreatitis.???Keywords: pancreatitis; endothelin; endothelin receptor antagonist; microcirculation; capillary permeability; fluid sequestration PMID:10673302

  3. Late-Onset Ornithine Carbamoyltransferase Deficiency Accompanying Acute Pancreatitis and Hyperammonemia

    PubMed Central

    Machado, Marcel Cerqueira Cesar; Fonseca, Gilton Marques; Jukemura, José

    2013-01-01

    Hyperammonemia related to urea cycle disorders is a rare cause of potentially fatal encephalopathy that is encountered in intensive care units (ICUs). Left undiagnosed, this condition may manifest irreversible neuronal damage. However, timely diagnosis and treatment initiation can be facilitated simply by increased awareness of the ICU staff. Here, we describe a patient with acute severe pancreatitis who developed hyperammonemia and encephalopathy without liver disease. Urea cycle disorder was suspected and hemodialysis was initiated. Following reduction of ammonia levels, subsequent treatment included protein restriction and administration of arginine and sodium benzoate. The patient was discharged to home after 47 days with plasma ammonia within normal range and without neurological symptoms. In clinical care settings, patients with neurological symptoms unexplained by the present illness should be assessed for serum ammonia levels to disclose any urea cycle disorders to initiate timely treatment and improve outcome. PMID:24073003

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

    NASA Astrophysics Data System (ADS)

    Parzyan, G. R.; Geinits, A. V.

    2001-04-01

    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.

  5. Pathophysiological Mechanisms of Acute Pancreatitis Define Inflammatory Markers of Clinical Prognosis.

    PubMed

    Minkov, Georgi A; Halacheva, Krasimira S; Yovtchev, Yovcho P; Gulubova, Maya V

    2015-07-01

    Development of acute pancreatitis illustrates the need to understand the basic mechanisms of disease progression to drive the exploration of therapeutic options. Cytokines play a major role in the pathogenesis of acute pancreatitis as underlying systemic inflammatory response, tissue damage, and organ dysfunction. However, little is known about circulating concentrations of these inflammatory markers and their real impact on clinical practice. Experimental studies have suggested that the prognosis for acute pancreatitis depends on the degree of pancreatic necrosis and the intensity of multisystem organ failure generated by the systemic inflammatory response. This suggests an intricate balance between localized tissue damage with proinflammatory cytokine production and a systemic anti-inflammatory response that restricts the inappropriate movement of proinflammatory agents into the circulation. Implication of such mediators suggests that interruption or blunting of an inappropriate immune response has the potential to improve outcome. A detailed understanding of pathophysiological processes and immunological aspects in patients with acute pancreatitis is the basis for the development of therapeutic strategies that will provide significant reductions in morbidity and mortality. PMID:26061557

  6. Acute pancreatitis associated with herpes zoster: Case report and literature review

    PubMed Central

    Wang, Zhen; Ye, Jun; Han, Yue-Hua

    2014-01-01

    Varicella-zoster virus (VZV) is a type of herpes virus known to cause varicella, mainly in young children, and herpes zoster in adults. Although generally non-lethal, VZV infection can be associated with serious complications, particularly in adults. Acute pancreatitis caused by VZV infection is a rare event, with reports primarily concerning immunocompromised individuals. Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection. The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side. A diagnosis of acute pancreatitis was confirmed based on abdominal pain, elevated levels of urine and serum amylase, and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography. This case highlights that, though rare, acute pancreatitis should be considered in VZV patients who complain of abdominal pain, especially in the epigastric area. Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality. PMID:25548507

  7. Acute pancreatitis as the initial presentation in pediatric systemic lupus erythematosus.

    PubMed

    Rose, Winsley; Puliyel, Mammen M; Moses, Prabhakar D; Danda, Debasis

    2009-08-01

    It is exceptionally rare for acute pancreatitis to be the presenting manifestation of childhood systemic lupus erythematosus. We report a 14-year-old girl who presented with a history of fever, generalized rash, arthralgia and abdominal pain. Her serum amylase was 1472U/L and lipase 3316 U/L suggestive of acute pancreatitis. Other investigations revealed pancytopenia, low complement, high 24-hour urinary protein and elevated ANA and dsDNA. She was treated with IV methylprednisone, followed by oral steroids. PMID:19475344

  8. Coordinate Regulation of Secretory Stress Proteins (PSP\\/ reg, PAP I, PAP II, and PAP III) in the Rat Exocrine Pancreas during Experimental Acute Pancreatitis

    Microsoft Academic Search

    R. Graf; M. Schiesser; A. Lüssi; Ph. Went; G. A. Scheele; D. Bimmler

    2002-01-01

    Background. Pancreatic stone protein (PSP\\/reg) is a constitutively secreted protein in pancreatic juice. Pancreatitis-associated protein (PAP) belongs to the same family of proteins. PAP is highly increased during acute pancreatitis, while no exact data exist regarding PSP\\/reg protein synthesis and secretion. Recently, an attempt to determine PSP\\/reg and PAP levels in sera of rats with acute pancreatitis showed a significant

  9. Soluble Epoxide Hydrolase Pharmacological Inhibition Ameliorates Experimental Acute Pancreatitis in Mice.

    PubMed

    Bettaieb, Ahmed; Chahed, Samah; Bachaalany, Santana; Griffey, Stephen; Hammock, Bruce D; Haj, Fawaz G

    2015-08-01

    Acute pancreatitis (AP) is an inflammatory disease, and is one of the most common gastrointestinal disorders worldwide. Soluble epoxide hydrolase (sEH; encoded by Ephx2) deficiency and pharmacological inhibition have beneficial effects in inflammatory diseases. Ephx2 whole-body deficiency mitigates experimental AP in mice, but the suitability of sEH pharmacological inhibition for treating AP remains to be determined. We investigated the effects of sEH pharmacological inhibition on cerulein- and arginine-induced AP using the selective sEH inhibitor 1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU), which was administered before and after induction of pancreatitis. Serum amylase and lipase levels were lower in TPPU-treated mice compared with controls. In addition, circulating levels and pancreatic mRNA of the inflammatory cytokines tumor necrosis factor-?, interleukin Il-1?, and Il-6 were reduced in TPPU-treated mice. Moreover, sEH pharmacological inhibition before and after induction of pancreatitis was associated with decreased cerulein- and arginine-induced nuclear factor-?B inflammatory response, endoplasmic reticulum stress, and cell death. sEH pharmacological inhibition before and after induction of pancreatitis mitigated cerulein- and arginine-induced AP. This work suggests that sEH pharmacological inhibition may be of therapeutic value in acute pancreatitis. PMID:25993999

  10. Lympho- and Hemodynamics in Dogs with Acute Experimental Pancreatitis.

    PubMed

    Abdreshov, S N; Bulekbaeva, L E; Demchenko, G A

    2015-05-01

    Dogs with experimental pancreatitis showed increased lymph fl ow, impaired rheological properties of the lymph and blood plasma, and increased plasma and blood levels of glucose, ALT, and AST. PMID:26033584

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

    PubMed Central

    Li, Xueping; Ma, Fengbo; Jia, Kezhi

    2014-01-01

    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

  12. Systemic Inflammation with Multiorgan Dysfunction Is the Cause of Death in Murine Ligation-Induced Acute Pancreatitis

    Microsoft Academic Search

    Zuobiao Yuan; David K. Meyerholz; Erik C. Twait; Duraisamy Kempuraj; Deborah E. Williard; Isaac Samuel

    Background  We have previously shown that distal pancreatic duct ligation-induced acute pancreatitis in mice is associated with substantial\\u000a mortality.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We examined the cause of death in duct ligation-induced acute pancreatitis in mice by serial examination of multiple parameters\\u000a in three experimental groups: distal pancreatic duct ligation (PD), bile duct ligation alone (BD), and sham operation (S).\\u000a \\u000a \\u000a \\u000a \\u000a Results  BD and S had no

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

    PubMed Central

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

    2014-01-01

    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

  14. Management of acute, severe ulcerative colitis.

    PubMed

    Sachar, David B

    2012-02-01

    When a patient is hospitalized with acute, severe ulcerative colitis, the primary decision is whether or not to proceed directly to surgery. Absolute indications for an immediate colectomy include exsanguinating hemorrhage, perforation and cancer. If medical therapy is undertaken, however, the decision for urgent surgery or non-operative salvage therapy will still be required in 15-50% of the patients in which there is a failure to respond within 3-5 days to a standard regimen of i.v. steroids, antibiotics, decompressive maneuvers, fluid and electrolyte replacement and other supportive measures. The options for medical salvage therapy are usually cyclosporine or infliximab. There are theoretical and practical arguments on each side; the current GETAID and CONSTRUCT trials will probably provide support for either. The choice between colectomy or medical salvage therapy, however, must not be delayed under any circumstances. Before choosing salvage therapy, one must first be certain that there is the luxury of time, that there is a post-hospital strategy for the maintenance of remission and that the colon is worth saving. The priority is not so much saving colons as it is saving lives. PMID:22257473

  15. Management of acute severe ulcerative colitis

    PubMed Central

    Kedia, Saurabh; Ahuja, Vineet; Tandon, Rakesh

    2014-01-01

    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 naïve 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

  16. [Comparative experimental study of antioxidant efficiency in treatment of acute pancreatitis].

    PubMed

    Kliu?ko, D A; Korik, V E; Zhidkov, S A

    2011-01-01

    The aims of our experiments on animals were (i) to evaluate by direct oximery the efficiency of various antioxidant drugs in a complex treatment of acute pancreatitis and (ii) to determine the diagnostic value of the direct oximetry method for estimation of the efficiency of medical treatment. The article presents data obtained in a group 75 outbred Guinea with a model acute pancreatitis, which were treated with mexibel (group 1), emoxipin (group 2), end cytoflavin (group 3), with subsequent investigation of the pancreatic tissues by the direct oximetry method. The obtained results confirmed that the intraperitoneal injection of cytoflavin to animals stimulates tissue respiration, improves metabolism, promotes pancreas recovery, and also improves the prognosis and reduces the lethal outcome. The efficiency of cytoflavin within the complex therapy exceeds the effect of other antioxidants (mexibel and emoxipin) under otherwise equal conditions. PMID:22164440

  17. Acute pancreatitis complicating the insertion of a self-expandable biliary metal stent.

    PubMed

    van Steenbergen, W; van Aken, L; Ponette, E

    1992-06-01

    A patient is reported who developed acute pancreatitis complicated by pseudocyst formation immediately after the insertion of a self-expanding metallic biliary stent via the percutaneous route. The distal end of the stent was positioned into the duodenum. Endoscopists should be aware of this potential complication of metallic biliary stents. PMID:1505495

  18. Anti-inflammatory effects of melatonin in a rat model of caerulein-induced acute pancreatitis.

    PubMed

    Carrasco, Cristina; Marchena, Ana M; Holguín-Arévalo, María S; Martín-Partido, Gervasio; Rodríguez, Ana B; Paredes, Sergio D; Pariente, José A

    2013-10-01

    The purpose of our study was to evaluate the protective effect of melatonin in a rat model of caerulein-induced acute pancreatitis. For the induction of experimental acute pancreatitis, four subcutaneous injections of caerulein (20 mgkg–1 body weight) were given to Wistar rats at 2-h intervals. Melatonin was injected intraperitoneally (25 mg kg–1 body weight) 30 min before each caerulein injection. After 12 h, rats were sacrificed by decapitation. Blood and pancreas samples were collected and processed for serological and histopathological studies,respectively. Lipase, a-amylase, corticosterone, total antioxidant power and cytokines interleukin (IL)-1b, IL-4 and tumour necrosis factor(TNF)-a were determined using commercial kits. ANOVA and Tukey tests (P<0.05) were performed for the statistical analysis of the results.Results showed that the administration of melatonin reduced histological damage induced by caerulein treatment as well as the hyperamylasemia and hyperlipidemia. Corticosterone and antioxidant total power were also reverted to basal activities. Furthermore, melatonin pre-treatment reduced pro-inflammatory cytokines IL-1b and TNF-a and increased the serum levels of anti-inflammatory cytokine IL-4. In conclusion,the findings suggest that the protective effect of melatonin in caerulein-induced acute pancreatitis is mediated by the anti-inflammatory ability of this indolamine. Thus, melatonin may have a protective effect against acute pancreatitis. PMID:24779037

  19. Early Crystalloid Fluid Volume Management in Acute Pancreatitis: Association with Mortality and Organ Failure

    Microsoft Academic Search

    Kazuaki Kuwabara; Shinya Matsuda; Kiyohide Fushimi; Koichi B. Ishikawa; Hiromasa Horiguchi; Kenji Fujimori

    2011-01-01

    Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and\\/or critical care. Methods: 9,489 AP patients aged ?18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We

  20. Acute Pancreatitis after Embolization of Liver Tumors: Frequency and Associated Risk Factors

    Microsoft Academic Search

    R. López-Benítez; B. A. Radeleff; H. M. Barragán-Campos; G. Noeldge; L. Grenacher; G. M. Richter; P. Sauer; M. Büchler; G. Kauffmann; P. J. Hallscheidt

    2007-01-01

    Introduction: Acute pancreatitis (AP) is a rare complication after liver embolization (LE) of primary and secondary liver tumors (approximately 1.7%), but it has a significant morbidity and mortality potential if associated with other complications. It usually develops early within 24 h after the LE procedure. Study Purpose: To calculate the frequency of AP after LE in our institution and to

  1. PRSS1 and SPINK1 mutations in idiopathic chronic and recurrent acute pancreatitis

    PubMed Central

    Pelaez-Luna, Mario; Robles-Diaz, Guillermo; Canizales-Quinteros, Samuel; Tusié-Luna, Maria T

    2014-01-01

    AIM: To identify gene mutations in PRSS1 and SPINK1 in individuals with early onset idiopathic chronic or recurrent acute pancreatitis. METHODS: The cationic trypsinogen gene (PRSS1; exons 2 and 3) and the serine protease inhibitor Kazal 1 gene (SPINK1; exon 3) were selectively amplified and sequenced from blood samples of 19 patients admitted to the Pancreas Clinic at our institution with chronic pancreatitis and/or idiopathic recurrent acute pancreatitis that were diagnosed or with onset before age 35. Fifty healthy volunteers served as controls. Whole blood samples were collected and gene specific sequences were amplified by polymerase chain reaction (PCR). All PCR products were subsequently sequenced in order to identify the presence of any mutations. RESULTS: Nineteen patients with pancreatitis (14 males; median age 24 years, range 15-48 years) were included in this study, of which five showed the presence of gene mutations. Direct sequencing results indicated the presence of two previously unidentified mutations in exon 2 of PRSS1 (V39E and N42S) in two patients with recurrent acute pancreatitis. Two cases had the N34S SPINK1 mutation. Analysis of the relatives of one patient homozygous for this mutation showed that five of the six family members carried the N34S SPINK1 mutation. Of these members, three were healthy heterozygous carriers and two were homozygotes (one sibling had diabetes, the other was healthy). Another patient was heterozygous for a novel SPINK1 mutation located on exon 3 (V46D). All members from this patient’s family had normal genotypes, indicating that it was a de novo mutation. No mutations in either gene were present in the control subjects. CONCLUSION: Two novel PRSS1 mutations and one novel SPINK1 mutation were identified in Mexican patients with early onset idiopathic recurrent acute pancreatitis. PMID:25206283

  2. A Preliminary Investigation of Normal Pancreas and Acute Pancreatitis Elasticity Using Virtual Touch Tissue Quantification (VTQ) Imaging

    PubMed Central

    Xie, Juan; Zou, Liling; Yao, Minghua; Xu, Guang; Zhao, Lixia; Xu, Huixiong; Wu, Rong

    2015-01-01

    Background The aim of this study was to prospectively evaluate the use of elastometry in healthy volunteers and patients with acute pancreatitis using virtual touch tissue quantification (VTQ) imaging technology performed on the pancreas. Material/Methods We enrolled 210 healthy volunteers and 44 acute pancreatitis patients in the study between March 2012 and June 2013. Healthy subjects were divided into 3 groups: young (18–30 years), middle-aged (30–50 years), and elderly (>50 years). VTQ was performed on the pancreatic head and body regions to obtain shear wave velocity (SWV) measurements, which were used to evaluate the elasticity values of tissues. Results The pancreatic head SWV value in the whole healthy group was 1.18±0.23 m/s, and that in the pancreatic body was 1.21±0.20 m/s. In patients with acute pancreatitis, the mean SWV measurements at the head were 1.18±0.20 m/s, compared to 1.25±0.19 m/s in the pancreatic body. There was no statistically significant difference between whole healthy volunteers and the acute pancreatitis group. Conclusions VTQ is a new method that shows promise for the quantification of pancreatic elasticity, but further studies are warranted. PMID:26062803

  3. Relative quantification of albumin and fibrinogen modifications by liquid chromatography tandem mass spectrometry in the diagnosis and monitoring of acute pancreatitis.

    PubMed

    Lankes, Ulrich; Brennan, Stephen O; Walmsley, Trevor A; George, Peter M

    2015-04-15

    The increasing availability of liquid chromatography tandem mass spectrometry (LC-MS/MS) in clinical laboratories provides the opportunity to replace or complement present underperforming immuno- and chemometric assays. Amylase and lipase show limited specificity and sensitivity for pancreatic inflammation and lack the capacity of monitoring the disease due to their short half-lives. Previous findings suggested that cleavage products of the pancreatic enzyme carboxypeptidase A could be a more suitable indicator for defining and classifying pancreatic inflammation. The plasma proteins albumin and ?-fibrinogen were digested with trypsin and truncated forms (des-Leu-albumin, and des-Gln-?-fibrinogen) quantified against their non-truncated forms by LC-MS/MS. Four hundred fifty eight samples from 83 patients were used to evaluate the novel method and affirm its suitability for detecting acute pancreatitis. A robust, selective, precise and accurate LC-MS/MS method was set up to measure the proportion of truncated proteins. Reference ranges for the proportion of the truncated albumin and ?-fibrinogen were from 2% to 9% and 3% to 25%, respectively. Acute pancreatitis patients had values above these ranges and were distinctly separated from reference control individuals. The longer circulating half-lives of albumin and fibrinogen compared to pancreatic enzymes themselves provide the potential to diagnose pancreatitis more specifically over a longer time period, to monitor the course of the disease, and to track recurrent complications. The wide range of the proportion and the differential half-life of both truncated proteins could also be used for assessing the severity of pancreatitis. PMID:25770789

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

    PubMed Central

    Worthington, K. J.; Cuschieri, A.

    1976-01-01

    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

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

    SciTech Connect

    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

    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.

  6. Recurrent Acute Pancreatitis Secondary to Graft Pancreas Divisum in a Patient with Modified Multi-Visceral Transplant

    PubMed Central

    Nawaz, Haq; Slivka, Adam

    2014-01-01

    A patient with modified multivisceral transplant developed recurrent acute pancreatitis (RAP) 1 year after transplant and was found to have graft pancreas divisum with otherwise negative work-up for identifying the etiology of RAP. Endoscopic retrograde cholangiopancreatography was performed with minor papilla sphincterotomy and pancreatic duct stent placement of the graft pancreas. The patient's symptoms resolved following endotherapy for a follow-up period of 2 years. This is a unique case of graft pancreatitis secondary to pancreas divisum.

  7. Chemopreventive effects of resveratrol in a rat model of cerulein-induced acute pancreatitis.

    PubMed

    Carrasco, Cristina; Holguín-Arévalo, María S; Martín-Partido, Gervasio; Rodríguez, Ana B; Pariente, José A

    2014-02-01

    In the past decades, a greater understanding of acute pancreatitis has led to improvement in mortality rates. Nevertheless, this disease continues to be a health care system problem due to its economical costs. Future strategies such as antioxidant supplementation could be very promising, regarding to beginning and progression of the disease. For this reason, this study was aimed at assessing the effect of exogenous administration of resveratrol during the induction process of acute pancreatitis caused by the cholecystokinin analog cerulein in rats. Resveratrol pretreatment reduced histological damage induced by cerulein treatment, as well as hyperamylasemia and hyperlipidemia. Altered levels of corticosterone, total antioxidant status, and glutathione peroxidase were significantly reverted to control levels by the administration of resveratrol. Lipid peroxidation was also counteracted; nevertheless, superoxide dismutase enzyme was overexpressed due to resveratrol pretreatment. Related to immune response, resveratrol pretreatment reduced pro-inflammatory cytokine IL-1? levels and increased anti-inflammatory cytokine IL-10 levels. In addition, pretreatment with resveratrol in cerulein-induced pancreatitis rats was able to reverse, at least partially, the abnormal calcium signal induced by treatment with cerulein. In conclusion, this study confirms antioxidant and immunomodulatory properties of resveratrol as chemopreventive in cerulein-induced acute pancreatitis. PMID:24234420

  8. Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

    PubMed Central

    Bruennler, T; Langgartner, J; Lang, S; Wrede, CE; Klebl, F; Zierhut, S; Siebig, S; Mandraka, F; Rockmann, F; Salzberger, B; Feuerbach, S; Schoelmerich, J; Hamer, OW

    2008-01-01

    AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS: We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS: Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION: Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis. Large bore drainages did not prove to be more effective in controlling the septic focus. PMID:18205262

  9. The role of oxygen-derived free radicals in the pathogenesis of acute pancreatitis.

    PubMed Central

    Sanfey, H; Bulkley, G B; Cameron, J L

    1984-01-01

    Acute pancreatitis may be initiated in the ex vivo, perfused canine pancreas preparation by a variety of stimuli. These include oleic acid infusion (FFA), partial duct obstruction with secretin stimulation (POSS), and a 2-hour period of ischemia (ISCH). In each model, pancreatitis is characterized by weight gain, edema, and hyperamylasemia. Oxygen-derived free radicals such as superoxide, hydrogen peroxide, and the hydroxyl radical are highly reactive toxic substances that are normally produced in small amounts during oxidative metabolism. Ordinarily, these substances are detoxified by endogenous intracellular enzymes called free radical scavengers (FRS), such as superoxide dismutase (SOD) and catalase (CAT). These studies were undertaken to evaluate the possible role of oxygen-derived free radicals in the initiation of acute pancreatitis in the isolated canine model. All preparations were perfused for 4 hours with autologous blood. Controls (N = 6): these glands remained normal in appearance, gained minimal weight (6 +/- 1 g), and serum amylase remained normal (less than 1000 u/dl). FFA pancreatitis, FFA alone (N = 6): these glands became edematous, gained weight (113.5 +/- 27.0 g), and developed hyperamylasemia (2087 +/- 387 u/dl). FFA + FRS (N = 6), SOD (50 mg) and CAT (50 mg) were added to the perfusate at time zero: these glands became only minimally edematous, gained less weight (31.8 +/- 10.1 g, p less than 0.05), and amylase remained normal (p less than 0.05). POSS pancreatitis, POSS alone (N = 8): these glands became edematous, gained weight (38.6 +/- 4.6 g), and developed marked hyperamylasemia (9522 +/- 3226 u/dl). POSS + FRS (N = 6): these glands did not develop edema, gained less weight (15.1 +/- 2.6 g, p less than 0.05), and serum amylase only increased to 1815 +/- 343 u/dl, (p less than 0.05). ISCH pancreatitis, ISCH alone (N = 6): these glands became edematous, gained weight (75.8 +/- 25 g), and developed hyperamylasemia (1679 +/- 439 u/dl). ISCH + FRS (N = 6): these glands did not develop edema, gained only 18.3 +/- 9.0 g (p less than 0.005), and serum amylase remained normal (p less than 0.05). These studies demonstrate that, in this canine preparation, acute pancreatitis is significantly ameliorated by oxygen-free radical scavengers. Since this was true whether the pancreatitis was produced by FFA infusion, POSS, or ischemia, it suggests that oxygen-derived free radicals may mediate a common essential step in the pathogenesis of all forms of pancreatitis. PMID:6207783

  10. Pancreatitis after sphincter of Oddi manometry.

    PubMed Central

    Rolny, P; Anderberg, B; Ihse, I; Lindström, E; Olaison, G; Arvill, A

    1990-01-01

    The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure. PMID:2370018

  11. Effect of endogenous cholecystokinin on the course of acute pancreatitis in rats

    PubMed Central

    Jia, Dongmei; Yamamoto, Mitsuyoshi; Otsuki, Makoto

    2015-01-01

    AIM: To examine the effects of pancreatic rest, stimulation and rest/stimulation on the natural course of recovery after acute pancreatitis. METHODS: Acute hemorrhagic pancreatitis (AP) was induced in male rats by intraductal infusion of 40 ?L/100 g body weight of 3% sodium taurocholate. All rats took food ad libitum. At 24 h after induction of AP, rats were divided into four groups: control (AP-C), pancreas rest (AP-R), stimulation (AP-S), and rest/stimulation (AP-R/S). Rats in the AP-C, AP-R and AP-S groups received oral administration of 2 mL/kg body weight saline, cholecystokinin (CCK)-1 receptor antagonist, and endogenous CCK release stimulant, respectively, twice daily for 10 d, while those in the AP-R/S group received twice daily CCK-1 receptor antagonist for the first 5 d followed by twice daily CCK release stimulant for 5 d. Rats without any treatment were used as control group (Control). Biochemical and histological changes in the pancreas, and secretory function were evaluated on day 12 at 24 h after the last treatment. RESULTS: Feeding ad libitum (AP-C) delayed biochemical, histological and functional recovery from AP. In AP-C rats, bombesin-stimulated pancreatic secretory function and HOMA-?-cell score were significantly lower than those in other groups of rats. In AP-R rats, protein per DNA ratio and pancreatic exocrine secretory function were significantly low compared with those in Control rats. In AP-S and AP-R/S rats, the above parameters recovered to the Control levels. Bombesin-stimulated pancreatic exocrine response in AP-R/S rats was higher than in AP-S rats and almost returned to control levels. In the pancreas of AP-C rats, destruction of pancreatic acini, marked infiltration of inflammatory cells, and strong expression of ?-smooth muscle actin, tumor necrosis factor-? and interleukin-1? were seen. Pancreatic rest reversed these histological alterations, but not atrophy of pancreatic acini and mild infiltration of inflammatory cells. In AP-S and AP-R/S rats, the pancreas showed almost normal architecture. CONCLUSION: The favorable treatment strategy for AP is to keep the pancreas at rest during an early stage followed by pancreatic stimulation by promoting endogenous CCK release.

  12. Ibuprofen reduces energy expenditure and acute-phase protein production compared with placebo in pancreatic cancer patients

    Microsoft Academic Search

    SJ Wigmore; JS Falconer; CE Plester; JA Ross; JP Maingay; DC Carter; KCH Fearon

    1995-01-01

    The aim of this study was to investigate the effect of the cyclo-oxygenase inhibitor ibuprofen on the acute-phase protein response and resting energy expenditure (REE) of weight-losing patients with pancreatic cancer. Patients with irresectable pancreatic cancer (n = 16) were treated with either ibuprofen (1200 mg day-1 for 7 days (n = 10) or placebo (n = 6). A group

  13. Effects of Salvia miltiorrhizae on ICAM-1, TLR4, NF-kappaB and Bax proteins expression in multiple organs of rats with severe acute pancreatitis or obstructive jaundice.

    PubMed

    Xiping, Zhang; Dijiong, Wu; Jianfeng, Liang; Qihui, Cheng; Jing, Ye; Penghui, Jia; Meijuan, Yuan; Ninni, Zhou

    2009-08-01

    To observe the protective effects of Salvia miltiorrhizae injection on multiple organs of rats with SAP or OJ. Two hundred eighty-eight rats were used for SAP-associated experiments and OJ-associated experiments. The rats were randomly divided into sham-operated, model control and treated group. According to the different time points after operation, the SAP rats in each group were subdivided into 3, 6 and 12 h groups while the OJ rats were divided into 7, 14, 21 and 28 days groups. The mortality rates, pathological changes and ICAM-1 (only in lung), TLR4 (only in liver), Bax and NF-kappaB proteins expression in multiple organs (liver, kidney, lung, intestinal mucosa, spleen, thymus and lymph nodes) were observed, respectively. The mortality rates of treated groups decreased in both SAP and OJ experiments. Compared to model control group, the pathological changes can be seen in treated groups including; (1) the pathological changes of multiple organs in SAP and OJ experiments were improved, the pathological severity scores of kidney (at 6 h), intestinal mucosa (at 12 h), spleen (at 6 and 12 h), thymus (at 3 and 6 h) and lymph nodes (at 3 and 6 h) in SAP experiment and of liver (on 21 and 28 days), lung (21 days), intestinal mucosa (on 21 and 28 days) and spleen (on 21 and 28 days) in OJ experiment significantly declined (P < 0.05 or P < 0.01); (2) the positive rate of Bax protein in pancreas (at 3 h) and liver (on 6 and 12 h) in SAP experiment and in liver (on 28 days), kidney (on 21 days), and thymus (on 28 days) in OJ experiment were significantly lower (P < 0.05 or P < 0.01); (3) the positive rate of NF-kappaB in liver (at 12 h) and kidney (at 6 h) in SAP experiment and in liver (on 21 days), kidney (on 28 days), intestinal mucosa (on 28 days) and thymus (on 14 days) in OJ experiment significantly decreased (P < 0.05). (4) the positive rate of ICAM-1 in lungs (at 12 h) in SAP experiment was significantly less (P < 0.05). Salvia miltiorrhizae injection can protect multiple organs of SAP or OJ rats and inhibit the expression of ICAM-1, TLR4, NF-kappaB and regulate Bax proteins. Salvia miltiorrhizae may relieve the inflammation response and enhance the immunity function of SAP and OJ rats. PMID:19434485

  14. High risk of acute pancreatitis after endoscopic ultrasound-guided fine needle aspiration of side branch intraductal papillary mucinous neoplasms

    PubMed Central

    Siddiqui, Ali A.; Shahid, Haroon; Shah, Apeksha; Khurana, Tanvi; Huntington, William; Ghumman, Saad S.; Loren, David E.; Kowalski, Thomas E.; Laique, Sobia; Hayat, Umar; Eloubeidi, Mohamad A.

    2015-01-01

    Background and Objectives: Data on the risk of acute pancreatitis following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions are limited. The aim of our study was to evaluate the frequency of acute pancreatitis after EUS-FNA of pancreatic cysts and solid lesions, and determine whether there was a difference in pancreatitis risk in patients with side branch intraductal papillary mucinous neoplasms (SB-IPMN). Patients and Methods: A retrospective review of patients who underwent EUS-FNA of pancreatic cysts and solid lesions was performed. The primary outcome measure was development of acute pancreatitis after EUS-FNA. Factors associated with acute pancreatitis were examined by statistical analysis to determine independent predictors of acute pancreatitis. Statistical significance was determined at a P ? 0.05. Results: We identified 186 patients with pancreatic cystic lesions and 557 with solid lesions in which EUS-FNA was performed. The median size of the cysts was 19 mm (range: 10-66 mm). There were 37 IPMNs, 33 mucinous cystic neoplasms, 58 serous cysts and 46 pseudocysts and 12 solid-cystic ductal carcinomas. The majority of patients (75%) with solid lesions were diagnosed with adenocarcinoma. Patients with pancreatic cysts had a statistically greater frequency of developing pancreatitis after EUS-FNA when compared to those with solid lesions (2.6% vs. 0.36% respectively; P = 0.13). In patients with cysts, there were no statistically significant differences between the two groups (with and without pancreatitis) with regard to a cyst location, size of the cyst, and number of needle passes or trainee involvement. Patients with SB-IPMN had a statistically higher frequency of pancreatitis after EUS-FNA compared to those with other cyst types (8% vs. 1.3% respectively; odds ratio = 6.4, 95% confidence intervals = 1.0-40.3, P = 0.05). Discussion: Patients with SB-IPMN are at a higher risk of developing acute pancreatitis after a EUS-FNA. Alternative means of diagnosis such as magnetic resonance cholangiopancreatogram might be necessary to avoid risk of EUS-FNA. PMID:26020044

  15. Alterations of Toll-like Receptor 4 Expression on Peripheral Blood Monocytes During the Early Stage of Human Acute Pancreatitis

    Microsoft Academic Search

    Hong-Guang Li; Zong-Guang Zhou; Yuan Li; Xue-Lian Zheng; Song Lei; Lin Zhu; Yong Wang

    2007-01-01

    We sought to study Toll-like receptor 4 (TLR4) expression on peripheral blood mononuclear cells (PBMCs) during the early stage\\u000a of human acute pancreatitis (AP). Thirty consecutive patients with acute pancreatitis admitted within 24 hr of onset of abdominal\\u000a pain were enrolled prospectively in this study. Blood samples were taken by venipuncture at admission and on the third and\\u000a seventh days

  16. Systemic-Lupus-Erythematosus-Related Acute Pancreatitis: A Cohort from South China

    PubMed Central

    Yang, Yanlong; Ye, Yujin; Liang, Liuqin; Wu, Tianfu; Zhan, Zhongping; Yang, Xiuyan; Xu, Hanshi

    2012-01-01

    Acute pancreatitis (AP) is a rare but life-threatening complication of SLE. The current study evaluated the clinical characteristics and risk factors for the mortality of patients with SLE-related AP in a cohort of South China. Methods. Inpatient medical records of SLE-related AP were retrospectively reviewed. Results. 27 out of 4053 SLE patients were diagnosed as SLE-related AP, with an overall prevalence of 0.67%, annual incidence of 0.56‰ and mortality of 37.04%. SLE patients with AP presented with higher SLEDAI score (21.70 ± 10.32 versus 16.17 ± 7.51, P = 0.03), more organ systems involvement (5.70 ± 1.56 versus 3.96 ± 1.15, P = 0.001), and higher mortality (37.04% versus 0, P = 0.001), compared to patients without AP. Severe AP (SAP) patients had a significant higher mortality rate compared to mild AP (MAP) (75% versus 21.05%, P = 0.014). 16 SLE-related AP patients received intensive GC treatment, 75% of them exhibited favorable prognosis. Conclusion. SLE-related AP is rare but concomitant with high mortality in South Chinese people, especially in those SAP patients. Activity of SLE, multiple-organ systems involvement may attribute to the severity and mortality of AP. Appropriate glucocorticosteroid (GC) treatment leads to better prognosis in majority of SLE patients with AP. PMID:22761631

  17. Phospholipase A2 mediates nitric oxide production by alveolar macrophages and acute lung injury in pancreatitis.

    PubMed Central

    Tsukahara, Y; Morisaki, T; Horita, Y; Torisu, M; Tanaka, M

    1999-01-01

    OBJECTIVE: Reportedly, nitric oxide (NO) derived from alveolar macrophages (AMs) and increased serum phospholipase A2 (PLA2) activity are associated with the pathogenesis of lung injury in acute pancreatitis. The authors examined the possibility that PLA2 causes, in part, the induction of NO production by AMs in pancreatitis. METHODS: Pancreatitis was induced in rats by selective pancreatic duct ligation (SPL). AMs were stimulated with PLA2 or SPL rat serum, with or without administration of the PLA2 inhibitor quinacrine. Then NO production from the AMs was measured by the Griess method, inducible NO synthase mRNA expression of AMs was analyzed by the reverse transcription-polymerase chain reaction, and cytotoxic effects of AMs on human umbilical vein endothelial cells was examined by a 51Cr release assay. In vivo, the effect of quinacrine on lung injury was determined by measuring the arterial blood oxygen pressure (PaO2), lung weight, and lung permeability using Evans blue dye concentration of SPL rat. RESULTS: In vitro, the serum with high PLA2 activity induced NO production by rat AMs. PLA2 (50 ng/ml) induced significant amounts of NO production, inducible NO synthase mRNA expression, and cytotoxicity toward the human umbilical vein endothelial cells in normal rat AMs, and these activities were significantly inhibited by quinacrine. In vivo, rats with pancreatitis that were given quinacrine showed decreased concentrations of NO2- and NO3- in the bronchoalveolar lavage fluid, and the PaO2, lung edema, and lung permeability were improved significantly. CONCLUSION: PLA2 induces AMs to release NO, which contributes to lung injury in acute pancreatitis. This lung injury was prevented by the administration of the PLA2 inhibitor quinacrine. Images Figure 4. PMID:10077051

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

    PubMed Central

    2011-01-01

    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

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

    PubMed

    Zhang, Jun; Rouse, Rodney L

    2014-09-01

    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

  20. A child with acute pancreatitis and recurrent hypoglycemia due to 3-hydroxy-3-methylglutaryl-CoA lyase deficiency.

    PubMed

    Wilson, W G; Cass, M B; Søvik, O; Gibson, K M; Sweetman, L

    1984-09-01

    A five-year-old-girl with a history of recurrent hypoglycemia presented with acidosis, intractable vomiting, and abdominal tenderness; the diagnosis of acute pancreatitis was made by abdominal ultrasonography and supportive biochemical studies. Urinary organic acid analysis revealed metabolites suggestive of HMG-CoA lyase deficiency, and subsequent enzyme assays of lymphocytes and fibroblasts confirmed this diagnosis. Acute pancreatitis, an uncommon condition in childhood, is seen with increased frequency in patients with Reye syndrome, a metabolic disorder with which HMG-CoA lyase deficiency may be confused. The pathogenesis of pancreatitis in Reye syndrome or in HMG-CoA lyase deficiency has not been determined. PMID:6489380

  1. Dynamics of molecular responses to coxsackievirus B4 infection differentiate between resolution and progression of acute pancreatitis

    PubMed Central

    Gu, Rui; Shampang, Anae; Reilly, Andrew; Fisher, Dusti; Glass, William; Ramsingh, Arlene I.

    2012-01-01

    A coxsackievirus B4 induces acute pancreatitis with different outcomes. The study utilized a systems biology approach to identify molecular immune responses that differentiate between disease resolution and disease progression. The data establish a temporal pattern of host responses that differentiate the resolution of acute pancreatitis from the progression to chronic pancreatitis. A group of twenty-five genes exhibited characteristic expression profiles that were observed during the development of chronic pancreatitis but not during the resolution of disease. We postulate that the temporal dynamics of the twenty-five genes influence the development of pathogenic immune responses associated with chronic pancreatitis. Furthermore, a subset of eleven genes exhibited increased expression as viral titers waned. Of the eleven gene products, five are secreted molecules, TNF-?, IFN-?, CXCL10, IL-10, and IL-22b, and represent novel potential therapeutic targets since they can be readily modulated with antibodies against the specific cytokine/chemokine or with antibodies against the corresponding receptors. PMID:22414343

  2. Metastasis-Induced Acute Pancreatitis Successfully Treated with Chemotherapy and Radiotherapy in a Patient with Small Cell Lung Cancer

    PubMed Central

    Okutur, Kerem; Bozkurt, Mustafa; Korkmaz, Taner; Karaaslan, Ercan; Guner, Levent; Goksel, Suha; Demir, Gokhan

    2015-01-01

    Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare. A 50-year-old female with SCLC who had limited disease and achieved full response after treatment presented with acute pancreatitis during her follow-up. The radiologic studies revealed a small area causing obliteration of the pancreatic duct without mass in the pancreatic neck, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the metastasis of SCLC. The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field. In SCLC, cases of MIAP can be encountered with conventional computed tomography with no mass image, and positron emission tomography and EUS-FNA can be useful for diagnosis of such cases. Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.

  3. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis

    PubMed Central

    Jiang, Hong-Li; Xue, Wu-Jun; Li, Da-Qing; Yin, Ai-Ping; Xin, Xia; Li, Chun-Mei; Gao, Ju-Lin

    2005-01-01

    AIM: To investigate whether continuous veno-venous hemofiltration (CVVH) in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CVVH could influence the survival of acute pancreatitis. METHODS: Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain (early CVVH, n = 9). Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain (late CVVH, n = 10). Group 3 underwent high-volume CVVH within 48 h of the onset of abdominal pain (early CVVH, n = 9). Group 4 received high-volume CVVH after 96 h of the onset of abdominal pain (late CVVH, n = 9). CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CVVH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-?, IL-1? and IL-6. The concentrations of TNF-?, IL-1? and IL-6 were measured by swine-specific ELISA. The Solartron 1 255 B frequency response analyzer (British) was used to observe the resistance of filter membrane. RESULTS: The survival rate had a significant difference (94.44% vs 68.42%, P<0.01) high-volume and low-volume CVVH patients. The survival rate had also a significant difference (88.89% vs 73.68%, P<0.05) between early and late CVVH patients. The hemodynamic deterioration (MAP, HR, CVP) was less severe in groups 4 and 1 than that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed, serum TNF-? concentrations had a negative correlation with resistance (r: -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2; -0.88, -0.92, and -0.82, respectively in group 3; -0.84, -0.87, and -0.79, respectively in group 4). The decreasing extent of TNF-?, IL-1? and IL-6 was significantly different between group 3 and group 1 (TNF-? P<0.05, IL-1? P<0.05, IL-6 P<0.01), between group 4 and group 2 (TNF-? P<0.05, IL-1? P<0.05, IL-6 P<0.01), between group 1 and group 2 (TNF-? P<0.05, IL-1? P<0.05, IL-6 P<0.05), and between group 3 and group 4 (TNF-? P<0.01, IL-1? P<0.01, IL-6 P<0.05), respectively during CVVH period. The decreasing extent of TNF-? and IL-1? was also significantly different between survival patients and dead patients (TNF-? P<0.05, IL-1? P<0.05). In survival patients, serum concentration of TNF-? and IL-1? decreased more significantly than that in dead patients. CONCLUSION: High-volume and early CVVH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more efficiently than low-volume CVVH. The survival rate is related to the decrease extent of TNF-? and IL-1?. The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated. PMID:16097050

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

    PubMed

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

    1998-11-01

    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

  5. Oxidative stress in severe acute illness

    PubMed Central

    Bar-Or, David; Bar-Or, Raphael; Rael, Leonard T.; Brody, Edward N.

    2015-01-01

    The overall redox potential of a cell is primarily determined by oxidizable/reducible chemical pairs, including glutathione–glutathione disulfide, reduced thioredoxin–oxidized thioredoxin, and NAD+–NADH (and NADP–NADPH). Current methods for evaluating oxidative stress rely on detecting levels of individual byproducts of oxidative damage or by determining the total levels or activity of individual antioxidant enzymes. Oxidation–reduction potential (ORP), on the other hand, is an integrated, comprehensive measure of the balance between total (known and unknown) pro-oxidant and antioxidant components in a biological system. Much emphasis has been placed on the role of oxidative stress in chronic diseases, such as Alzheimer's disease and atherosclerosis. The role of oxidative stress in acute diseases often seen in the emergency room and intensive care unit is considerable. New tools for the rapid, inexpensive measurement of both redox potential and total redox capacity should aid in introducing a new body of literature on the role of oxidative stress in acute illness and how to screen and monitor for potentially beneficial pharmacologic agents. PMID:25644686

  6. Taraxacum officinale protects against cholecystokinin-induced acute pancreatitis in rats

    Microsoft Academic Search

    Sang-wan Seo; Hyun-na Koo; An Hyo-jin; Kang-beom Kwon; Byung-cheal Lim; Eun-a Seo; Do-gon Ryu; Goo Moon; Hong-yeoul Kim; Hyung-min Kim; Seung-heon Hong

    2005-01-01

    Abstract AIM: Taraxacum,officinale (TO) has been frequently used as a remedy,for inflammatory,diseases. The aim of this study was to investigate the effect of TO on cholecystokinin (CCK)-octapeptide-induced acute pancreatitis in rats. METHODS: TO at 10 mg\\/kg was orally administered, followed by 75 µg\\/kg CCK octapeptide injected subcutaneously,three times after 1, 3 and 5 h. This whole procedure was repeated

  7. Chaiqin Chengqi Decoction decreases IL-6 levels in patients with acute pancreatitis*

    PubMed Central

    Wang, Ling; Li, Yuan; Ma, Qin; Liu, Yong; Rui, Yuan-yi; Xue, Ping; Zhou, Zong-guang

    2011-01-01

    Objective: In this paper, we investigated the effect of the traditional Chinese medicine Chaiqin Chengqi Decoction (CQCQD) on serum cytokines in acute pancreatitis (AP) patients. Methods: Peripheral blood samples from 107 AP patients were collected within the first 48 h of AP onset and on the 10th day of CQCQD treatment. Control samples were collected from 20 healthy individuals. Serum proinflammatory cytokines tumor necrosis factor-? (TNF-?) and interleukin-6 (IL-6), and anti-inflammatory cytokines IL-10 and IL-1? receptor antagonist (IL-1ra) were examined using the Luminex 100 system. Results: Within the first 48 h of AP onset, IL-6 and IL-1ra levels in severe AP (SAP) patients were significantly higher than those in mild AP (MAP) patients, but IL-10 levels in SAP patients were significantly lower than those in MAP patients. Proinflammatory cytokine IL-6 was significantly decreased after CQCQD treatment (P<0.05), especially in SAP patients (n=25 of 36, P<0.05). The hospitalization time of SAP patients was shortened significantly when serum IL-6 decreased after CQCQD treatment (P<0.05). Conclusions: CQCQD decreased proinflammatory cytokine IL-6 levels in AP patients. PMID:22135153

  8. Roles of Cav3.2 and TRPA1 channels targeted by hydrogen sulfide in pancreatic nociceptive processing in mice with or without acute pancreatitis.

    PubMed

    Terada, Yuka; Fujimura, Mayuko; Nishimura, Sachiyo; Tsubota, Maho; Sekiguchi, Fumiko; Kawabata, Atsufumi

    2015-02-01

    Hydrogen sulfide (H(2)S), formed by multiple enzymes, including cystathionine-?-lyase (CSE), targets Ca(v)3.2 T-type Ca(2+) channels (T channels) and transient receptor potential ankyrin-1 (TRPA1), facilitating somatic pain. Pancreatitis-related pain also appears to involve activation of T channels by H(2)S formed by the upregulated CSE. Therefore, this study investigates the roles of the Ca(v)3.2 isoform and/or TRPA1 in pancreatic nociception in the absence and presence of pancreatitis. In anesthetized mice, AP18, a TRPA1 inhibitor, abolished the Fos expression in the spinal dorsal horn caused by injection of a TRPA1 agonist into the pancreatic duct. As did mibefradil, a T-channel inhibitor, in our previous report, AP18 prevented the Fos expression following ductal NaHS, an H(2)S donor. In the mice with cerulein-induced acute pancreatitis, the referred hyperalgesia was suppressed by NNC 55-0396 (NNC), a selective T-channel inhibitor; zinc chloride; or ascorbic acid, known to inhibit Ca(v)3.2 selectively among three T-channel isoforms; and knockdown of Ca(v)3.2. In contrast, AP18 and knockdown of TRPA1 had no significant effect on the cerulein-induced referred hyperalgesia, although they significantly potentiated the antihyperalgesic effect of NNC at a subeffective dose. TRPA1 but not Ca(v)3.2 in the dorsal root ganglia was downregulated at a protein level in mice with cerulein-induced pancreatitis. The data indicate that TRPA1 and Ca(v)3.2 mediate the exogenous H(2)S-induced pancreatic nociception in naïve mice and suggest that, in the mice with pancreatitis, Ca(v)3.2 targeted by H(2)S primarily participates in the pancreatic pain, whereas TRPA1 is downregulated and plays a secondary role in pancreatic nociceptive signaling. PMID:25267397

  9. Up-regulation of Toll-like receptor 4 was suppressed by emodin and baicalin in the setting of acute pancreatitis

    Microsoft Academic Search

    Zongfang Li; Xianming Xia; Shu Zhang; Aijun Zhang; Wangjun Bo; Rui Zhou

    2009-01-01

    Acute pancreatitis (AP) activates the systemic inflammatory response and is potentially lethal. Recent studies demonstrated that pancreatic enzymes could induce cytokine expression via Toll-like receptor 4 (TLR4) signal pathway, indicating a possible role of TLR4 in local pancreatic injury and systemic inflammatory response. Emodin, an anthraquinone derivative from Radix et Rhizoma Rhei, and baicalin, a flavone from Scutellaria baicalensis Georgi,

  10. Antibiotics as Part of the Management of Severe Acute Malnutrition

    PubMed Central

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

    2013-01-01

    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

  11. Therapeutic effect of caffeic acid phenethyl ester on cerulein-induced acute pancreatitis

    PubMed Central

    Buyukberber, Mehmet; Sava?, M Cemil; Bagci, Cahit; Koruk, Mehmet; Gulsen, Murat T; Tutar, Ediz; Bilgic, Tugba; Ceylan, Nurdan Ö

    2009-01-01

    AIM: To evaluate the therapeutic role of caffeic acid phenethyl ester (CAPE) in a rat model of cerulean-induced acute pancreatitis (AP). METHODS: Seventy male Wistar albino rats were divided into seven groups. Acute edematous pancreatitis was induced by subcutaneous cerulein injection (20 ?g/kg) four times at 1-h intervals. CAPE (30 mg/kg) was given by subcutaneous injection at the beginning (CAPE 1 group) and 12 h after the last cerulein injection (CAPE 2 group). Serum amylase, lipase, white blood cell count, and tumor necrosis factor (TNF)-? levels were measured, and pancreatic histopathology was assessed. RESULTS: In the AP group, amylase and lipase levels were found to be elevated and the histopathological evaluation showed massive edema and inflammation of the pancreas, with less fatty necrosis when compared with sham and control groups. Amylase and lipase levels and edema formation decreased significantly in the CAPE therapy groups (P < 0001); especially in the CAPE 2 group, edema was improved nearly completely (P = 0001). Inflammation and fatty necrosis were partially recovered by CAPE treatment. The pathological results and amylase level in the placebo groups were similar to those in the AP group. White blood cell count and TNF-? concentration was nearly the same in the CAPE and placebo groups. CONCLUSION: CAPE may be useful agent in treatment of AP but more experimental and clinical studies are needed to support our observation of beneficial effects of CAPE before clinical usage of this agent. PMID:19891017

  12. Effects of the Mitochondria-Targeted Antioxidant Mitoquinone in Murine Acute Pancreatitis

    PubMed Central

    Wen, Li; Szatmary, Peter; Mukherjee, Rajarshi; Armstrong, Jane; Chvanov, Michael; Tepikin, Alexei V.; Murphy, Michael P.; Sutton, Robert; Criddle, David N.

    2015-01-01

    Although oxidative stress has been strongly implicated in the development of acute pancreatitis (AP), antioxidant therapy in patients has so far been discouraging. The aim of this study was to assess potential protective effects of a mitochondria-targeted antioxidant, MitoQ, in experimental AP using in vitro and in vivo approaches. MitoQ blocked H2O2-induced intracellular ROS responses in murine pancreatic acinar cells, an action not shared by the control analogue dTPP. MitoQ did not reduce mitochondrial depolarisation induced by either cholecystokinin (CCK) or bile acid TLCS, and at 10?µM caused depolarisation per se. Both MitoQ and dTPP increased basal and CCK-induced cell death in a plate-reader assay. In a TLCS-induced AP model MitoQ treatment was not protective. In AP induced by caerulein hyperstimulation (CER-AP), MitoQ exerted mixed effects. Thus, partial amelioration of histopathology scores was observed, actions shared by dTPP, but without reduction of the biochemical markers pancreatic trypsin or serum amylase. Interestingly, lung myeloperoxidase and interleukin-6 were concurrently increased by MitoQ in CER-AP. MitoQ caused biphasic effects on ROS production in isolated polymorphonuclear leukocytes, inhibiting an acute increase but elevating later levels. Our results suggest that MitoQ would be inappropriate for AP therapy, consistent with prior antioxidant evaluations in this disease. PMID:25878403

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

    PubMed Central

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

    2014-01-01

    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

  14. Lethal cardiotoxicity, steatohepatitis, chronic pancreatitis, and acute enteritis induced by capecitabine and oxaliplatin in a 36-year-old woman

    PubMed Central

    2013-01-01

    Abstract A 36-year-old female was hospitalized with symptoms suggesting intestinal occlusion. She was diagnosed with adenocarcinoma of the ampulla of Vater (pT4N0 stage) and underwent cephalic duodenopancreatectomy 8 months ago. Five cycles of postoperative chemotherapy were administrated using capecitabine and oxaliplatin (CAPOX or XELOX), the last one being completed 1 month ago. During the present hospitalization, because of normal computed tomography and ultrasound abdominal examination, rehydration and antibiotherapy were administrated. However, 4 days after hospital admission, the patient died. At autopsy and histological examination, we found a severe myocardial sclerosis with large scarring areas, severe steatohepatitis, chronic pancreatitis with large fibrotic areas, and acute enteritis. Alcohol consumption was denied. The patient died due to associated heart, liver and pancreatic failure. This multiorgan toxicity and death following CAPOX regimen had not yet been reported in the literature. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6472150549833105 PMID:24041405

  15. [The function of the hydrokinetic and ekbolic pancreas after acute pancreatitis].

    PubMed

    Tympner, F; Domschke, W; Rösch, W; Koch, H; Demling, L

    1976-11-01

    Thirteen patients were investigated 3-4 weeks (I. examination) and 3-5 months (II. examination) after the ceasing of the signs symptoms of an acute pancreatitis concerning their hydrokinetic and ekbolic pancreas-functions. In addition, the pancreatic ducts were demonstrated by ERCP. Reduction of the secretion were shown in 31% at the I. examination and in 23% at the II. examination. There were significant differences in the outputs of bicarbonate, trypsine and chymotrypsine compared to healthy test persons at the I. examination. At the II. examination, however, no significant differences could be observed compared to healthy test persons. The exocrine function of the pancreas was getting worse during the interval between the I. and II. examination in 2 cases but it became normal in 5 cases. Pathological alterations at the pancreativ-duct-system were not demonstrable shown at all. PMID:1007339

  16. Acute necrotising pancreatitis derived from low-dose corticosteroid use: an important reminder of clinical management.

    PubMed

    Sabre, Alexander; Guthrie, Morgan Mary; Maleknia, Reza

    2015-01-01

    Although the exact mechanism is unknown, incidence of drug-induced pancreatitis from corticosteroids is well established in the medical literature. Commonly reported in chronic steroid-dependent individuals who require large doses for a wide array of pathologies, the incidence of damage to the pancreas from low-doses have not been well described. We report a case of a 68-year-old woman who presented with severe abdominal pain, nausea and vomiting, 3?days after the initiation of low-dose methylprednisolone for osteoarthritis. Inpatient laboratory analysis revealed an elevated lipase of 1770?U/L and CT scan showing extensive necrotising pancreatitis involving the head, body and tail. Cessation of the causative medication and conservative treatment successfully led to resolution of symptoms. We present this case to inform clinicians of the precipitance of pancreatitis from modest strength corticosteroid management, so that more accurate and improved performance in pharmacological decisions can be made for patient care. PMID:26150628

  17. Arterial pH, bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis: a single-centre prospective study

    PubMed Central

    Sharma, Vishal; Shanti Devi, Thingbaijam; Sharma, Ravi; Chhabra, Puneet; Gupta, Rajesh; Rana, Surinder S.; Bhasin, Deepak K.

    2014-01-01

    Background. Arterial blood gas (ABG) parameters such as pH form part of multi-parameter scoring systems for predicting severe acute pancreatitis; however, literature on detailed evaluation of ABG alone in this context is scarce. Methods. Patients with acute pancreatitis presenting to our unit between January 2012 and November 2013 were prospectively studied. ABG analysis was done at admission and development of organ failure, any need for intervention, and mortality were noted. The association between various parameters of ABG analysis and the development of organ failure or local complications, need for interventions (endoscopic/radiological/surgical) and mortality were analysed. Results. Two hundred and five patients (mean age: 39.33 ± 13.85 years; 61.0% males) were prospectively studied. The aetiology of acute pancreatitis was alcohol in 93 patients (45.4%) and gall stone disease in 73 (35.6%). Organ failure developed in 71.2% patients and 83.9% had local complications. In 18% of patients, endoscopic/radiological/surgical interventions were needed and 14.6% died. The patients (n = 35) with metabolic acidosis (pH <7.35) suffered higher frequency of organ failure, need for interventions and mortality. Patients with low arterial bicarbonate levels, as well as higher base deficit, also displayed higher frequency of organ failure, need for interventions and mortality. The receiver operating characteristic (ROC) curves for pH <7.35, bicarbonate <22 meq/L and base deficit of >?4 meq/L for prediction of mortality were 0.771 (95% CI: 0.664–0.878), 0.707 (95% CI: 0.622–0.791) and 0.780 (95% CI: 0.693–0.867), respectively. Conclusion. Arterial pH, bicarbonate levels, and base deficit at presentation are useful early markers for predicting adverse outcome in acute pancreatitis. PMID:24994834

  18. Thrombotic thrombocytopenic purpura precipitated by acute pancreatitis: a report of seven cases from a regional UK TTP registry.

    PubMed

    McDonald, V; Laffan, M; Benjamin, S; Bevan, D; Machin, S; Scully, M A

    2009-02-01

    Thrombotic thrombocytopenic purpura (TTP) may be idiopathic or secondary. We report seven TTP cases precipitated by pancreatitis. The patients were admitted with acute pancreatitis and at that time had no clinical or laboratory features of TTP. The median time to develop TTP after pancreatitis was 3 d. The patients had moderately reduced ADAMTS13 activity (mean activity 49%; normal range 66-126%) with no evidence of anti-ADAMTS13 inhibitory autoantibodies. The median number of plasma exchanges to remission was 10 (range 7-14) and no additional treatment with immunosuppression was required to maintain remission. There have been no relapses to date. PMID:19036107

  19. Lack of association between CD14-159 C/T polymorphism and acute pancreatitis: a meta-analysis

    PubMed Central

    Yuan, Xiaoping; Wang, Huiling

    2015-01-01

    The CD14-159 C/T polymorphism has been implicated in susceptibility to acute pancreatitis (AP), but the results were inconclusive. The present meta-analysis aimed to explore the correlation between CD14-159 C/T polymorphism and AP risk. All eligible case-control studies published up to November 10th, 2014 were identified by searching PubMed, Web of Science, CNKI, and WanFang databases. Two reviewers independently identified the literature according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.2 and Stata 12.0 software. A total of five studies comprising 1211 cases and 932 controls were included. Overall, no significant association between CD14-159 C/T polymorphism and AP risk was found under all four genetic models [CT + TT vs CC: OR = 1.09, 95% CI (0.91, 1.31); TT vs CT + CC: OR = 1.04, 95% CI (0.83, 1.29); CT vs CC: OR = 1.08, 95% CI (0.89, 1.32); TT vs CC: OR = 1.15, 95% CI (0.88, 1.49)]; In stratification analysis by disease severity, we also failed to detect any association between CD14-159C/T polymorphism and the risk of mild AP (MAP) or severe AP (SAP); In subgroup analysis by ethnicity, similar results were observed in Asian and European populations. This meta-analysis suggested that the CD14-159C/T polymorphism is not associated with the susceptibility of acute pancreatitis.

  20. Biliary Cystadenoma: An Unusual Cause of Acute Pancreatitis and Indication for Mesohepatectomy

    PubMed Central

    Munir, Bilal; Meschino, Michael; Mercado, Ashley; Hernandez-Alejandro, Roberto

    2014-01-01

    The classic presentation of cystic hepatobiliary lesions is usually nonspecific and often identified incidentally. Here we describe the case of a patient presenting with acute pancreatitis resulting from a large centrally located biliary cystadenoma compressing the pancreas. Determination of the origin of the cystic lesion was difficult on imaging studies. Due to the difficult location of the lesion, a complete surgical resection was achieved with mesohepatectomy and the suspected diagnosis confirmed by pathology. The patient continues to do well 2 years post-op with no signs of recurrence. PMID:25506000

  1. Are gastric mucosal macrophages responsible for gastric injury in acute pancreatitis?

    PubMed Central

    Dang, Sheng-Chun; Wang, Hao; Zhang, Jian-Xin; Cui, Lei; Jiang, De-Li; Chen, Rong-Fang; Qu, Jian-Guo; Shen, Xiang-Qian; Chen, Min; Gu, Min

    2015-01-01

    AIM: To investigate the protective effect of clodronate-containing liposomes against severe acute pancreatitis (SAP)-triggered acute gastric mucosal injury (AGMI) in rats. METHODS: Clodronate- and phosphate-buffered saline (PBS)-containing liposomes were prepared by reverse-phase evaporation. The SAP rat model was established by injecting sodium taurocholate into the pancreatic subcapsular space. Sprague-Dawley rats were randomly divided into three groups: control (C), SAP plus PBS-containing liposome (P) and SAP plus clodronate-containing liposome (T). Serum tumor necrosis factor (TNF)-? levels were estimated by ELISA. Pathological changes in the gastric mucosa and pancreas were observed by hematoxylin and eosin (HE) staining. Apoptotic cells were detected by terminal deoxynucleotidyl transferase dUTP nick end labeling staining. The numbers of macrophages in the gastric mucosa were analyzed by CD68 immunohistochemical staining. RESULTS: The liposomes had a mean diameter of 150 ± 30 nm. The TNF-? levels were significantly higher in the P group than that in the C group (2 h, 145.13 ± 11.50 vs 23.2 ± 2.03; 6 h, 245.06 ± 12.11 vs 30.28 ± 6.07, P < 0.05), and they were significantly lower in the T group than that in the P group (2 h, 93.24 ± 23.11 vs 145.13 ± 11.50; 6 h, 135.18 ± 13.10 vs 245.06 ± 12.11, P < 0.05). The pathological scores of the pancreas were lower in the T group than in the P group (2 h, 1.88 ± 0.83 vs 4.13 ± 0.83; 6 h, 2.87 ± 0.64 vs 6.25 ± 0.88, P < 0.01). The pathological scores of the gastric mucosa were also lower in the T group than in the P group (2 h, 1.12 ± 0.64 vs 2 ± 0.75; 6 h, 1.58 ± 0.53 vs 3 ± 1.31, P < 0.05). In addition, increased CD68 levels were observed in the gastric mucosa of the P group compared with the C group. Clodronate-containing liposomes decreased the CD68 levels in the mucosa of the T group. The apoptotic indexes of the gastric mucosa were higher in the T group than in the P group (2 h, 15.7 ± 0.92 vs 11.5 ± 1.64; 6 h, 21.12 ± 1.06 vs 12.6 ± 2.44, P < 0.01). CONCLUSION: Gastric macrophages contribute to the pathogenesis of gastric injury in SAP. Clodronate-containing liposomes have protective effects against AGMI in rats with SAP. PMID:25759533

  2. Carbon monoxide–based therapy ameliorates acute pancreatitis via TLR4 inhibition

    PubMed Central

    Xue, Jing; Habtezion, Aida

    2013-01-01

    The protective role of hemeoxygenase-1 (HO-1) in various inflammatory conditions is mediated in part by its products, carbon monoxide (CO) and biliverdin. Here we investigated a therapeutic role for CO and CO-primed cells in acute pancreatitis (AP). In a mouse model of AP, treatment with CO-releasing molecule–2 (CORM-2) decreased mortality, pancreatic damage, and lung injury. CORM-2 decreased systemic inflammatory cytokines, suppressed systemic and pancreatic macrophage TNF-? secretion, and inhibited macrophage TLR4 receptor complex expression. In both human and mouse cells, CORM-2 inhibited endogenous and exogenous ligand-dependent TLR4 activation, which indicates that CORM-2 could be therapeutic for both early and late stages of AP, which involve sterile- and endotoxin-mediated inflammation, respectively. Mice engrafted with TLR4-deficient hematopoietic cells were protected against caerulein-induced AP. In the absence of leukocyte TLR4 expression, CORM-2 did not confer additional protection, which indicates that CORM-2–dependent effects are mediated via suppression of macrophage TLR4 activation. We determined that CO was directly responsible for the protective effects of CORM-2 in AP, as inactive forms of CORM-2 were ineffective. Importantly, adoptive transfer of CORM-2–primed cells reduced AP. Such a therapeutic approach would translate the beneficial effects of CO-based therapies, avoiding CO- or CO-RM–mediated toxicities in AP and a wide range of diseases. PMID:24334457

  3. Quantitative organellar proteomics analysis of rough endoplasmic reticulum from normal and acute pancreatitis rat pancreas

    PubMed Central

    Chen, Xuequn; Sans, Maria Dolors; Strahler, John R.; Karnovsky, Alla; Ernst, Stephen A.; Michailidis, George; Andrews, Philip C.; Williams, John A.

    2010-01-01

    Summary The rough endoplasmic reticulum (RER) is a central organelle for synthesizing and processing digestive enzymes and alteration of ER functions may participate in the pathogenesis of acute pancreatitis (AP). To comprehensively characterize the normal and diseased RER subproteome, this study quantitatively compared the protein compositions of pancreatic RER between normal and AP animals using isobaric tags (iTRAQ) and 2D LC-MALDI-MS/MS. A total of 469 unique proteins were revealed from four independent experiments using two different AP models. These proteins belong to a large number of functional categories including ribosomal proteins, translocon subunits, chaperones, secretory proteins, and glyco- and lipid-processing enzymes. 37 RER proteins (25 unique in arginine-induced, 6 unique in caerulein-induced and 6 common in both models of AP) showed significant changes during AP including translational regulators and digestive enzymes whereas only mild changes were found in some ER chaperones. The six proteins common to both AP models including a decrease in pancreatic triacylglycerol lipase precursor, Erp27, and prolyl 4-hydroxylase beta polypeptide as well as a dramatic increase in fibrinogen alpha, beta and gamma chains. These results suggest that the early stages of AP involve changes of multiple RER proteins that may affect the synthesis and processing of digestive enzymes. PMID:19954227

  4. Extracorporeal membrane oxygenation for severe acute respiratory failure

    Microsoft Academic Search

    Klaus Lewandowski

    2000-01-01

    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

  5. Severe Acute Respiratory Syndrome (SARS) Prevention in Taiwan

    ERIC Educational Resources Information Center

    Liu, Hsueh-Erh

    2004-01-01

    Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B…

  6. Lung pathology of fatal severe acute respiratory syndrome

    Microsoft Academic Search

    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

    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

  7. Transmission Dynamics and Control of Severe Acute Respiratory Syndrome

    Microsoft Academic Search

    Marc Lipsitch; Ted Cohen; Ben Cooper; James M. Robins; Stefan Ma; Lyn James; Gowri Gopalakrishna; Suok Kai Chew; Chorh Chuan Tan; Matthew H. Samore; David Fisman; Megan Murray

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and epidemic curves from other settings, we estimated the reproductive number for SARS in the absence of interventions and in the presence of control efforts. We estimate that a single

  8. A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome

    Microsoft Academic Search

    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

    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,

  9. Laparoscopic Common Bile Duct Exploration in Pregnancy With Acute Gallstone Pancreatitis

    PubMed Central

    Kim, Young W.; Chung, Mathew H.

    2006-01-01

    Background: We present a case in which a laparoscopic common bile duct exploration was performed safely in a pregnant patient with acute gallstone pancreatitis. Case Report: A 25-year-old female, gravida 4 para 3, at 14-weeks gestation presented to her obstetrician with complaints of epigastric pain radiating to the back. She was otherwise healthy with no past medical or surgical history. A physical examination revealed a healthy young female with no evidence of jaundice and in no acute distress. An abdominal examination was remarkable for a gravid abdomen with mild tenderness to palpation in her epigastrium and negative Murphy's sign. The patient safely underwent a laparoscopic common bile duct exploration after a laparoscopic cholecystectomy was performed. Conclusion: This case illustrates the role of laparoscopic common bile duct exploration in the diagnosis and treatment of possible choledocholithiasis in a pregnant patient. PMID:16709365

  10. Surgical management of necrotizing pancreatitis.

    PubMed

    Beger, H G

    1989-06-01

    The most important diagnostic step in the management of patients with severe acute pancreatitis is the discrimination between acute interstitial and necrotizing pancreatitis. Measurement of C-reactive protein, lactic acid dehydrogenase, alpha-1-antitrypsin, and alpha-2-macroglobulin and contrast-enhanced CT are useful in detecting the necrotizing course of acute pancreatitis. C-reactive protein, lactic acid dehydrogenase, and contrast-enhanced CT offer detection rates of 85 per cent to more than 90 per cent for pancreatic necrosis. Surgical decision-making in necrotizing pancreatitis should be based on clinical, morphologic, and bacteriologic data. Patients with focal pancreatic necrosis, in general, respond well to medical treatment and do not need surgery. Extended (50 per cent or more) pancreatic necroses, infected necroses, and intrapancreatic parenchymal necroses plus extrapancreatic fatty tissue necroses are indicators for surgical management. The decision for the timing of operation in patients with proved necrotizing pancreatitis should be based on clinical criteria: the development of an acute surgical abdomen, generalized sepsis, shock, persisting or increasing organ dysfunction, or some combination thereof despite maximum intensive care treatment for at least 3 days. Major pancreatic resection for the treatment of necrotizing pancreatitis appears disadvantageous. Necrosectomy and continuous local lavage allow debridement of devitalized tissue and preservation of vital pancreatic tissue. Postoperative local lavage thus results in an atraumatic evacuation of necrotic tissue, the bacterial material, and biologically active substances. The hospital mortality rate of patients treated with necrosectomy and continuous local lavage (the Ulm protocol) is below 10 per cent. Nevertheless, controlled prospective clinical trials should be performed in order to bring more precision to our clinical decisions in respect to the role of surgery for this disease. PMID:2658162

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

    SciTech Connect

    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

    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.

  12. [Mechanisms for cell damage in acute pancreatitis using isolated acinar cells].

    PubMed

    Schulz, H U; Letko, G

    1994-11-01

    Due to the complexity of interacting organ systems, in vivo the interpretation of results obtained from whole-animal experiments of acute pancreatitis remains difficult. To enlighten cause-and-effect-relationships, functional isolated parts of the pancreas are applied increasingly in research into the pathogenesis of the disease, therefore. By means of a collagenase digestion technique, intact acinar cells from normal as well as from pretreated rat pancreas could reproducibly be obtained in high yield. Animals were pretreated in situ by induction of either mesenteric ischemia/reperfusion, juice edema, or acute pancreatitis (AP). Pancreatic acinar cells isolated from these pretreated rats consumed oxygen at comparable rates under resting conditions throughout all experimental groups. A reduced stress capacity of cell respiration as well as a preterm decline in short-term culture was observed in the cells of the AP group, however. These results demonstrate that the induction of AP has found its reflection within the acinar cells themselves. Interestingly, these effects were not clouded by the isolation procedure. The manner of in-situ pretreatment of the respective animal proved to be decisive for later viability of isolated acinar cells in short-term culture. Uncoupling of oxidative phosphorylation by 2,4-dinitrophenol (DNP) lead to an accelerated decline of the acinar cells in all groups. The intactness of cellular energy metabolism seems to play a crucial role in maintaining cellular integrity, therefore. In additional experiments in vitro, the intracellularly mediated cell damage by DNP was compared with one induced from the extracellular environment of isolated cells by antibodies directed against cell surface antigens plus complement.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7845169

  13. Pancreatic lipase-related protein 1 (PLRP1) is present in the pancreatic juice of several species

    Microsoft Academic Search

    Josiane De Caro; Frédéric Carrière; Paola Barboni; Thomas Giller; Robert Verger; Alain De Caro

    1998-01-01

    Pancreatic lipase-related protein 1 (PLRP1) was purified from human, canine, porcine and rat pancreatic juices. The four PLRP1s were identified using microsequencing methods after performing gel filtration on Ultrogel AcA-54 followed by chromatography on Heparin–Sepharose cation-exchanger. Polyclonal antibodies specific to human PLRP1 (HPLRP1) were raised in the rabbit using a synthetic decapeptide from HPLRP1. The results of Western blotting analysis

  14. Differential Distribution of Fibroblast Growth Factor (FGF)-7 and FGF10 in l-Arginine-Induced Acute Pancreatitis

    Microsoft Academic Search

    Toshiyuki Ishiwata; Zenya Naito; Yue Ping Lu; Kiyoko Kawahara; Takenori Fujii; Yoko Kawamoto; Kiyoshi Teduka; Yuichi Sugisaki

    2002-01-01

    There generative process of the pancreas after acute pancreatitis (AP) is characterized by acinar and ductal cell proliferation with synthesis and transient deposition of extracellular matrices. Various growth factors were reported to be highly expressed in AP, but their regulation has not yet been clarified. Fibroblast growth factor (FGF)-7, also known as keratinocyte growth factor (KGF), and FGF-10 are members

  15. Clinical and virological characteristics associated with severe acute hepatitis B.

    PubMed

    Coppola, N; Sagnelli, C; Pisaturo, M; Minichini, C; Messina, V; Alessio, L; Starace, M; Signoriello, G; Gentile, I; Filippini, P; Sagnelli, E

    2014-12-01

    To identify early predictors of a severe or fulminant course in patients with acute viral hepatitis B (AVH-B). One hundred and thirty-eight patients with symptomatic acute hepatitis B observed from 1999 to 2012 were enrolled. For each patient, the demographics, risk factors for the acquisition of hepatitis B virus (HBV) infection, clinical, biochemical and virological data (HBV DNA, HBV DNA sequences) were recorded and analysed. The HBV mutants in the polymerase region were sought in 110 (87%) patients by direct sequencing, and the rtM204V/I mutations also by an allele-specific PCR. AVH-B was severe in 13 (9.4%) of the 138 patients enrolled, fulminant in 6 (4.3%) and with a normal clinical course in 119. The 19 patients with severe or fulminant AVH-B more frequently than the 119 with a normal course stated intravenous drug use (63.2% versus 36.1%, p 0.04) and were HBV-DNA negative (31.6% versus 11.8%, p 0.03) and anti-hepatitis C virus (HCV) positive (57.9% versus 19.3%, p 0.0008); the prevalences of different HBV genotypes and of the rtM204V/I mutant were similar in these three forms of AVH-B. A multivariate logistic regression analysis identified a pre-existing HCV chronic infection as the only factor independently associated with a severe or fulminant clinical course of AVH-B (OR 4.89, 95% CI 1.5-15.94, p 0.01). A pre-existing HCV chronic infection was identified as the only factor independently associated with a severe clinical presentation of acute hepatitis B, an association most probably due to the combination of the liver lesions caused by acute hepatitis B and the pre-existing histological abnormalities related to HCV chronic infection. PMID:24930916

  16. [Assessment and treatment of acute pancreatitis. Position document of the Catalan Society of Gastroenterology, Catalan Society of Surgery and Catalan Society of the Pancreas].

    PubMed

    Boadas, Jaume; Balsells, Joaquin; Busquets, Juli; Codina-B, Antoni; Darnell, Anna; Garcia-Borobia, Francisco; Ginés, Àngels; Gornals, Joan; Gruartmoner, Guillem; Ilzarbe, Lucas; Merino, Xavier; Oms, Lluís; Puig, Ignasi; Puig-Diví, Valentí; Vaquero, Eva; Vida, Francesc; Molero, Xavier

    2015-02-01

    The incidence of acute pancreatitis (AP) is increasing. AP is one of the gastrointestinal diseases that most frequently requires hospital admission in affected individuals. In the last few years, considerable scientific evidence has led to substantial changes in the medical and surgical treatment of this disease. New knowledge of the physiopathology of AP indicates that its severity is influenced by its systemic effects (organ failure), especially if the disease is persistent, and also by local complications (fluid collections or necrosis), especially if these become infected. Treatment should be personalized and depends on the patient's clinical status, the location of the necrosis, and disease stage. PMID:25458544

  17. Hepatitis E virus in patients with acute severe liver injury

    PubMed Central

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

    2014-01-01

    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

  18. Effect of interleukin-10 on pancreatic damage caused by organophosphate poisoning

    Microsoft Academic Search

    I. Ikizceli; Y. Yurumez; L. Avsaro?ullari; C. Kucuk; E. M. Sozuer; I. Soyuer; Y. Yavuz; S. Muhtaroglu

    2005-01-01

    Organophosphate poisoning is a common cause of severe morbidity and mortality in emergency departments. Acute pancreatitis is a frequently reported consequence of organophosphate poisoning, but preventing this potentially severe complication has not been the subject of much research. We tested whether interleukin-10, a cytoprotective agent, could prevent or diminish pathological signs of acute pancreatitis caused by organophosphate poisoning. Thirty rats

  19. Severe Acute Orthopnea: Ipilimumab-Induced Bilateral Phrenic Nerve Neuropathy.

    PubMed

    Jinnur, Praveen; Lim, Kaiser G

    2015-08-01

    Ipilimumab is a monoclonal antibody used in the treatment of unresectable or metastatic melanoma. Several immune-related adverse events including potential fatal events have been reported following its use. We report a case of a 66-year-old man who presented with severe acute exertional dyspnea and orthopnea following administration of ipilimumab for metastatic melanoma. Although various peripheral neuropathy syndromes associated with ipilimumab have been reported, bilateral phrenic nerve paralysis has not been previously reported. This case also highlights the clinical features of bilateral phrenic nerve neuropathy. Pulmonologists have to be aware of these unusual immune-related respiratory adverse events in patients being treated with monoclonal antibodies. PMID:25956728

  20. Acute pancreatitis

    MedlinePLUS

    ... the United States are heavy alcohol use and gallstones. Alcohol use is responsible for up to 70% ... drinks per day for 5 or more years. Gallstones are the next most common cause. The condition ...

  1. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN38327949

    PubMed Central

    Besselink, Marc GH; van Santvoort, Hjalmar C; Nieuwenhuijs, Vincent B; Boermeester, Marja A; Bollen, Thomas L; Buskens, Erik; Dejong, Cornelis HC; van Eijck, Casper HJ; van Goor, Harry; Hofker, Sijbrand S; Lameris, Johan S; van Leeuwen, Maarten S; Ploeg, Rutger J; van Ramshorst, Bert; Schaapherder, Alexander FM; Cuesta, Miguel A; Consten, Esther CJ; Gouma, Dirk J; van der Harst, Erwin; Hesselink, Eric J; Houdijk, Lex PJ; Karsten, Tom M; van Laarhoven, Cees JHM; Pierie, Jean-Pierre EN; Rosman, Camiel; Bilgen, Ernst Jan Spillenaar; Timmer, Robin; van der Tweel, Ingeborg; de Wit, Ralph J; Witteman, Ben JM; Gooszen, Hein G

    2006-01-01

    Background The initial treatment of acute necrotizing pancreatitis is conservative. Intervention is indicated in patients with (suspected) infected necrotizing pancreatitis. In the Netherlands, the standard intervention is necrosectomy by laparotomy followed by continuous postoperative lavage (CPL). In recent years several minimally invasive strategies have been introduced. So far, these strategies have never been compared in a randomised controlled trial. The PANTER study (PAncreatitis, Necrosectomy versus sTEp up appRoach) was conceived to yield the evidence needed for a considered policy decision. Methods/design 88 patients with (suspected) infected necrotizing pancreatitis will be randomly allocated to either group A) minimally invasive 'step-up approach' starting with drainage followed, if necessary, by videoscopic assisted retroperitoneal debridement (VARD) or group B) maximal necrosectomy by laparotomy. Both procedures are followed by CPL. Patients will be recruited from 20 hospitals, including all Dutch university medical centres, over a 3-year period. The primary endpoint is the proportion of patients suffering from postoperative major morbidity and mortality. Secondary endpoints are complications, new onset sepsis, length of hospital and intensive care stay, quality of life and total (direct and indirect) costs. To demonstrate that the 'step-up approach' can reduce the major morbidity and mortality rate from 45 to 16%, with 80% power at 5% alpha, a total sample size of 88 patients was calculated. Discussion The PANTER-study is a randomised controlled trial that will provide evidence on the merits of a minimally invasive 'step-up approach' in patients with (suspected) infected necrotizing pancreatitis. PMID:16606471

  2. Effects of Soluble Epoxide Hydrolase Deficiency on Acute Pancreatitis in Mice

    PubMed Central

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

    2014-01-01

    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

  3. Pancreatic Volvulus with Wandering Spleen and Gastric Volvulus: An Unusual Triad for Acute Abdomen in a Surgical Emergency

    PubMed Central

    Gorsi, Ujjwal; Bhatia, Anmol; Gupta, Rajesh; Bharathi, Saranga; Khandelwal, Niranjan

    2014-01-01

    Wandering spleen is a rare clinical condition which occurs due to laxity or absence of the normal intraperitoneal ligaments that hold the spleen in place. Gastric volvulus and wandering spleen share a common etiology of absence or laxity of intraperitoneal ligaments. The occurrence of simultaneous pancreatic volvulus has never been described before in adolescence. Herein, we report a case having wandering spleen with torsion, and gastric and distal pancreatic volvulus, an unusual triad in acute abdomen in an emergency setting, which has never been described before to the best of our knowledge. PMID:24976284

  4. Isolated acinar cells from rat pancreas in pathogenic studies on acute pancreatitis.

    PubMed

    Letko, G; Falkenberg, B; Matthias, R

    1989-01-01

    In the pathogenesis of acute pancreatitis the events and mechanisms increasing the digestibility of the acinar cells are widely unknown. To study these processes at cellular level, isolated exocrine cells from rat pancreas were utilized as experimental tool. The investigations revealed that extracellularly acting noxae seem to be of less importance to triggering autodigestion. The plasma membrane of the acinar cells was relatively resistant to extracellular trypsin, while anoxia or uncoupling of oxidative phosphorylation obviously reduced the survival of these cells. Combined action of small amounts of trypsin and partial uncoupling resulted in a potentiated cell destruction. The findings presented stress the importance of a well-functioning energy metabolism for the protective potential of acinar cells to further harmful conditions. PMID:2781834

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

    SciTech Connect

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

    1988-01-01

    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.

  6. Potential Influence of Intravenous Lipids on the Outcomes of Acute Pancreatitis

    PubMed Central

    Patel, Krutika S.; Noel, Pawan; Singh, Vijay P.

    2014-01-01

    Parenteral nutrition (PN) has been associated with a higher rate of adverse outcomes compared with enteral feeding in patients with acute pancreatitis (AP). However, PN may be necessary when feeding via the enteral route is poorly tolerated or impossible, and PN is recommended as a second-line nutrition therapy in AP. Intravenous (IV) lipids are commonly used as a part of PN in patients with AP. While the adverse outcomes related to the use of PN in AP have commonly been attributed to infectious complications, data suggest that the unsaturated fatty acids in the triglycerides used in IV lipids may contribute to the development of organ failure. We discuss the clinical and experimental data on this issue and the alternative lipid emulsions that are being studied. PMID:24687866

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

    PubMed Central

    Hung, Whitney Y; Abreu Lanfranco, Odaliz

    2014-01-01

    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

  8. Blockade of Multidrug Resistance-Associated Proteins Aggravates Acute Pancreatitis and Blunts Atrial Natriuretic Factor’s Beneficial Effect in Rats: Role of MRP4 (ABCC4)

    PubMed Central

    Ventimiglia, María Silvia; Najenson, Ana Clara; Perazzo, Juan Carlos; Carozzo, Alejandro; Vatta, Marcelo S; Davio, Carlos A; Bianciotti, Liliana G

    2015-01-01

    We previously reported that atrial natriuretic factor (ANF) stimulates secretin-evoked cAMP efflux through multidrug resistance-associated protein 4 (MRP4) in the exocrine pancreas. Here we sought to establish in vivo whether this mechanism was involved in acute pancreatitis onset in the rat. Rats pretreated with or without probenecid (MRPs general inhibitor) were infused with secretin alone or with ANF. A set of these animals were given repetitive cerulein injections to induce acute pancreatitis. Plasma amylase and intrapancreatic trypsin activities were measured and histological examination of the pancreas performed. Secretin alone activated trypsinogen but induced no pancreatic histological changes. Blockade by probenecid in secretin-treated rats increased trypsin and also induced vacuolization, a hallmark of acute pancreatitis. ANF prevented the secretin response but in the absence of probenecid. In rats with acute pancreatitis, pretreatment with secretin aggravated the disease, but ANF prevented secretin-induced changes. Blockade of MRPs in rats with acute pancreatitis induced trypsinogen activation and larger cytoplasmic vacuoles as well as larger areas of necrosis and edema that were aggravated by secretin but not prevented by ANF. The temporal resolution of intracellular cAMP levels seems critical in the onset of acute pancreatitis, since secretin-evoked cAMP in a context of MRP inhibition makes the pancreas prone to injury in normal rats and aggravates the onset of acute pancreatitis. Present findings support a protective role for ANF mediated by cAMP extrusion through MRP4 and further suggest that the regulation of MRP4 by ANF would be relevant to maintain pancreatic acinar cell homeostasis. PMID:25569802

  9. Temporary Pancreatic Duct Occlusion by Ethibloc: Cause of Microcirculatory Shutdown, Acute Inflammation, and Pancreas Necrosis

    Microsoft Academic Search

    Thorsten Plusczyk; Simone Westermann; Björn Bersal; Michael Menger; Gernot Feifel

    2001-01-01

    .   Temporary obliteration of the pancreatic duct has been suggested to be beneficial in chronic pancreatitis, segmental pancreatic\\u000a transplantation, and following Roux-Y pancreaticojejunostomy. Little is known, however, as to whether obliteration of the\\u000a duct alters exocrine pancreatic physiology. Therefore we studied in male inbred Lewis rats the immediate effects of Ethibloc-induced\\u000a duct obliteration (Ethibloc: Ethicon, Norderstedt, Germany) on pancreatic microcirculation,

  10. Astragaloside IV ameliorates acute pancreatitis in rats by inhibiting the activation of nuclear factor-?B.

    PubMed

    Qiu, Lei; Yin, Guojian; Cheng, Li; Fan, Yuting; Xiao, Wenqin; Yu, Ge; Xing, Miao; Jia, Rongrong; Sun, Ruiqing; Ma, Xiuying; Hu, Guoyong; Wang, Xingpeng; Tang, Maochun; Zhao, Yan

    2015-03-01

    This study aimed to investigate the effects of astragaloside IV (AS-IV; 3-O-?-D-xylopyranosyl-6-O??-D-glucopyranosylcycloastragenol), which has been reported to have comprehensive pharmacological functions, on sodium taurocholate (NaTc)/L-arginine (L-Arg)-induced acute pancreatitis (AP) in rats in vivo and in rat pancreatic acinar cells in vitro. NaTc-induced experimental AP was induced in rats by injecting 4% NaTc (0.1 ml/100 g) in the retrograde direction of the biliopancreatic duct. L-Arg-induced experimental AP was induced in rats by 2 intraperitoneal injections of 20% L-arg (3 g/kg), with an interval of 1 h between the injections. The rats were pre-treated AS-IV (50 mg/kg) or the vehicle (DMSO) 2 h prior to the induction of AP. Enzyme-linked immunosorbent assay, H&E staining, myeloperoxidase (MPO) activity, reverse transcription-quantitative PCR, western blot analysis and immunohistochemistry were used to evaluate the effects of AS-IV on AP. The results revealed that treatment with AS-IV significantly reduced serum amylase and lipase levels, pancreatic pathological alterations, the secretion of pro-inflammatory cytokines, MPO activity, and the protein expression of nuclear factor-?B (NF-?B) in vivo. Moreover, pre-treatment with AS-IV significantly increased the expression levels of manganese superoxide dismutase and cuprum/zinc superoxide dismutase. In the in vitro experiment, treatment of the cells with AS-IV aslo reduced rat pancreatic acinar cell necrosis and nuclear NF-?B activity, and enhanced the protein expression of superoxide dismutase. In conclusion, this study indicates that the protective effects of AS-IV on experimental AP in rats may be closely related to the inhibition of NF-?B. In addition, our results indicate that AS-IV may exert potential antioxidant effects on AP. Therefore, AS-IV may be an effective therapeutic agent for AP. PMID:25604657

  11. Management of acute severe upper airway obstruction in children.

    PubMed

    Pfleger, Andreas; Eber, Ernst

    2013-06-01

    There are many causes of acute severe upper airway obstruction (UAO) in children. The timing of symptom onset and the presence of fever will help to distinguish infectious from non-infectious conditions. Signs and symptoms from congenital malformations often present at birth but may also develop over time. The most common cause of UAO in children is croup. Choking on a foreign body also occurs relatively frequently. Evaluation of the child with UAO starts with a detailed history followed by a thorough physical examination, including an assessment of severity. Severe airway obstruction will result in respiratory failure. This situation requires an immediate response. A child with partial airway obstruction may initially have an adequate airway. However, this situation can deteriorate rapidly. Therefore, providing supportive care and mobilizing resources for definitive airway management may be the most appropriate interventions. PMID:23598067

  12. Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury.

    PubMed

    Heilman, R L; Smith, M L; Kurian, S M; Huskey, J; Batra, R K; Chakkera, H A; Katariya, N N; Khamash, H; Moss, A; Salomon, D R; Reddy, K S

    2015-08-01

    Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ?2.0?mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes. PMID:25808278

  13. Transmission Dynamics and Control of Severe Acute Respiratory Syndrome

    NASA Astrophysics Data System (ADS)

    Lipsitch, Marc; Cohen, Ted; Cooper, Ben; Robins, James M.; Ma, Stefan; James, Lyn; Gopalakrishna, Gowri; Chew, Suok Kai; Tan, Chorh Chuan; Samore, Matthew H.; Fisman, David; Murray, Megan

    2003-06-01

    Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and epidemic curves from other settings, we estimated the reproductive number for SARS in the absence of interventions and in the presence of control efforts. We estimate that a single infectious case of SARS will infect about three secondary cases in a population that has not yet instituted control measures. Public-health efforts to reduce transmission are expected to have a substantial impact on reducing the size of the epidemic.

  14. Centers for Disease Control: Severe Acute Respiratory Syndrome

    NSDL National Science Digital Library

    Visitors to this Web site from the Centers for Disease Control (CDC) will find a current and reliable source of information about Severe Acute Respiratory Syndrome (SARS). The FAQs section offers a general overview of the disease and recent outbreak -- a good starting point for finding the facts behind the headline news. The site also offers recent CDC guidelines and recommendations geared toward medical professionals, travel advisories and related concerns, and links to World Health Organization and other international resources (WHO is coordinating the international investigation of the SARS outbreak).

  15. NIV-Helmet in Severe Hypoxemic Acute Respiratory Failure

    PubMed Central

    Martins, Joana; Nunes, P.; Silvestre, C.; Abadesso, C.; Loureiro, H.; Almeida, H.

    2015-01-01

    Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the possibility of avoiding tracheal intubation and conventional ventilation. A previous healthy 5-month-old boy developed low-grade intermittent fever, flu-like symptoms, and dry cough for 3 days. On admission, he showed severe respiratory distress with SpO2/FiO2 ratio of 94. Subsequent evaluation identified an RSV infection complicated with an increase of inflammatory parameters (reactive C protein 15?mg/dL). Within the first hour after NIV-helmet CPAP SpO2/FiO2 ratio increased to 157. This sustained improvement allowed the continuing of this strategy. After 102?h, he was disconnected from the helmet CPAP device. The NIV use in severe hypoxemic acute respiratory failure should be carefully monitored as the absence of clinical improvement has a predictive value in the need to resume to intubation and mechanical ventilation. We emphasize that SpO2/FiO2 ratio is a valuable monitoring instrument. Helmet interface use represents a more comfortable alternative for providing ventilatory support, particularly to small infants, which constitute a sensitive group within pediatric patients. PMID:26000189

  16. Comparative Study of Serum Pancreatic Isoamylase, Lipase, and Trypsin-Like Immunoreactivity in Pancreatic Disease

    Microsoft Academic Search

    M. Ventrucci; L. Gullo; C. Daniele; C. Bartolucci; P. Priori; L. Platé; G. Bonora; G. Labò

    1983-01-01

    Serum total amylase, pancreatic and salivary isoamylase, lipase and trypsin-like immunoreactivity (TLI) were measured in 16 patients with acute pancreatitis, 37 patients with chronic pancreatitis, 11 patients with pancreatic cancer, and 53 control subjects in order to evaluate the relative value of these tests in the diagnosis of pancreatic disease. In acute pancreatitis patients studied within 2 days from the

  17. Mechanisms of Severe Acute Respiratory Syndrome Coronavirus-Induced Acute Lung Injury

    PubMed Central

    Gralinski, Lisa E.; Bankhead, Armand; Jeng, Sophia; Menachery, Vineet D.; Proll, Sean; Belisle, Sarah E.; Matzke, Melissa; Webb-Robertson, Bobbie-Jo M.; Luna, Maria L.; Shukla, Anil K.; Ferris, Martin T.; Bolles, Meagan; Chang, Jean; Aicher, Lauri; Waters, Katrina M.; Smith, Richard D.; Metz, Thomas O.; Law, G. Lynn; Katze, Michael G.; McWeeney, Shannon; Baric, Ralph S.

    2013-01-01

    ABSTRACT Systems biology offers considerable promise in uncovering novel pathways by which viruses and other microbial pathogens interact with host signaling and expression networks to mediate disease severity. In this study, we have developed an unbiased modeling approach to identify new pathways and network connections mediating acute lung injury, using severe acute respiratory syndrome coronavirus (SARS-CoV) as a model pathogen. We utilized a time course of matched virologic, pathological, and transcriptomic data within a novel methodological framework that can detect pathway enrichment among key highly connected network genes. This unbiased approach produced a high-priority list of 4 genes in one pathway out of over 3,500 genes that were differentially expressed following SARS-CoV infection. With these data, we predicted that the urokinase and other wound repair pathways would regulate lethal versus sublethal disease following SARS-CoV infection in mice. We validated the importance of the urokinase pathway for SARS-CoV disease severity using genetically defined knockout mice, proteomic correlates of pathway activation, and pathological disease severity. The results of these studies demonstrate that a fine balance exists between host coagulation and fibrinolysin pathways regulating pathological disease outcomes, including diffuse alveolar damage and acute lung injury, following infection with highly pathogenic respiratory viruses, such as SARS-CoV. PMID:23919993

  18. A case of valproic acid-induced acute pancreatitis in tuberous sclerosis coexisting with end-stage renal disease.

    PubMed

    Capolongo, Giovanna; Zacchia, Miriam; Pollastro, Rosa Maria; Radice, Leonardo; Anastasio, Pietro

    2013-01-01

    Tuberous sclerosis complex (TCS) is a genetic disorder with a variable clinical presentation. It is commonly characterized by seizures, mental retardation and cutaneous angiofibromas. Renal manifestations frequently include angiomyolipomas and cysts which lead to chronic kidney disease. We report a case of valproic acid-induced acute pancreatitis in a dialysis patient affected by TCS. The case demonstrates the importance of assessing antiepileptic drug treatment in dialysis patients. PMID:22322816

  19. Use of Angiotensin II Receptor Blockers and the Risk of Acute Pancreatitis: A Nested Case-Control Study

    Microsoft Academic Search

    Tomas Sjöberg Bexelius; Luis A. García Rodríguez; Mats Lindblad

    2009-01-01

    Background: There is no specific treatment against acute pancreatitis (AP). A protective effect by angiotensin II receptor blockers (ARB) on AP has been suggested experimentally, but clinical evidence is scarce. Methods: We conducted a population-based case-control study using The Health Improvement Network in the United Kingdom, comprising about 167,000 hypertensive patients in the study period 1996–2005. In multivariate logistic regression

  20. Pancreatitis Associated with Pancreatic Carcinoma

    Microsoft Academic Search

    E. J. Balthazar

    2005-01-01

    The combined occurrence of pancreatic carcinoma with acute or chronic pancreatitis is seldom seen in medical practice, but when present it is a challenging dilemma, plagued by confusing overlapping clinical findings and pitfalls in diagnostic imaging tests. This article reviews the presumptive pathophysiological aspects of this relationship, the perplexing clinical presentations and the advantages and limitations of the noninvasive imaging

  1. Influence of trypsin-induced acute pancreatitis on survival and energy state of isolated acinar cells from rat pancreas.

    PubMed

    Letko, G; Richter, F; Matthias, R

    1992-02-01

    To study the development of acute pancreatitis after intraductal trypsin instillation, at 4 hours, 1, 2, 4 and 6 days after this treatment and after instillation of physiologic saline viable acinar cells were isolated from rat pancreas. Gross anatomic and histologic findings were used to evaluate the time course of pathomorphologic changes. The isolated cells were incubated at 37 degrees C in Eagle's medium in a shaking water bath and the time course of their damage was studied. Additionally, by means of the active accumulation of the fluorophore rhodamine 6 G alterations of the mitochondrial membrane potential, an important parameter of the cellular energy metabolism was evaluated. The most severe histological damage was seen 1 and 2 days after trypsin instillation. At the same time yield and survivability of cells isolated, and their mitochondrial membrane potential reached a minimum. In the controls the time course of these parameters was very similar, but their decrease was less pronounced. Since a direct action of trypsin on acinar cells cannot be responsible for the findings presented a possible involvement of inflammatory cells and their products in the alteration of the cells and of their energy metabolism must be considered. PMID:1594492

  2. Risk Factors for Acute Kidney Injury in Severe Rhabdomyolysis

    PubMed Central

    Rodríguez, Eva; Soler, María J.; Rap, Oana; Barrios, Clara; Orfila, María A.; Pascual, Julio

    2013-01-01

    Background Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. Methods Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. Results The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p?=?0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001). Conclusions The identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures. PMID:24367578

  3. [Acute severe asthma: emergency diagnostic and therapeutic measures].

    PubMed

    Bolliger, C T; Perruchoud, A P

    1992-11-28

    There is growing evidence that the prevalence and the severity of bronchial asthma are rising in the industrialized countries despite a marked increase in the sale of antiasthmatic drugs. Non-diagnosis and undertreatment of patients with asthma may be causative factors. Identification of acute severe asthma by the physician and early hospitalization of patients at risk are important factors in lowering morbidity and mortality. Indicators of severe asthma on initial assessment are a history of poor long-term control (previous hospital admissions, regular use of inhaled beta agonists, maintenance oral corticosteroid treatment, prolonged current attack and low or greatly varying peak flow values) and clinical examination with spirometry as the most objective tool. A peak expiratory flow (PEF) of < 30% pred. (< 100-120 l/min) and a forced expiratory volume in the first second (FEV1) of < 25% pred. (< 0.7-1.01) indicate severe asthma. The physical signs and symptoms correlate well with the spirometric values but show too much variability to be used alone. A PaCO2 value of > or = 45 mm Hg (6 kPa) is very specific for severe asthma. Patients whose asthma is considered severe on initial assessment must be referred to a hospital. In the emergency ward the documented response to treatment, i.e. the speed of recovery, is the most important parameter for discharge or admission to hospital. Only patients who improve within a few hours, who remain clinically stable and who have a PEF > 75% pred. or an FEV1 > 50% pred. should be discharged. PMID:1462142

  4. Fatty acid ethyl ester synthase inhibition ameliorates ethanol-induced Ca2+-dependent mitochondrial dysfunction and acute pancreatitis

    PubMed Central

    Huang, Wei; Booth, David M; Cane, Matthew C; Chvanov, Michael; Javed, Muhammad A; Elliott, Victoria L; Armstrong, Jane A; Dingsdale, Hayley; Cash, Nicole; Li, Yan; Greenhalf, William; Mukherjee, Rajarshi; Kaphalia, Bhupendra S; Jaffar, Mohammed; Petersen, Ole H; Tepikin, Alexei V; Sutton, Robert; Criddle, David N

    2014-01-01

    Objective Non-oxidative metabolism of ethanol (NOME) produces fatty acid ethyl esters (FAEEs) via carboxylester lipase (CEL) and other enzyme action implicated in mitochondrial injury and acute pancreatitis (AP). This study investigated the relative importance of oxidative and non-oxidative pathways in mitochondrial dysfunction, pancreatic damage and development of alcoholic AP, and whether deleterious effects of NOME are preventable. Design Intracellular calcium ([Ca2+]C), NAD(P)H, mitochondrial membrane potential and activation of apoptotic and necrotic cell death pathways were examined in isolated pancreatic acinar cells in response to ethanol and/or palmitoleic acid (POA) in the presence or absence of 4-methylpyrazole (4-MP) to inhibit oxidative metabolism. A novel in vivo model of alcoholic AP induced by intraperitoneal administration of ethanol and POA was developed to assess the effects of manipulating alcohol metabolism. Results Inhibition of OME with 4-MP converted predominantly transient [Ca2+]C rises induced by low ethanol/POA combination to sustained elevations, with concurrent mitochondrial depolarisation, fall of NAD(P)H and cellular necrosis in vitro. All effects were prevented by 3-benzyl-6-chloro-2-pyrone (3-BCP), a CEL inhibitor. 3-BCP also significantly inhibited rises of pancreatic FAEE in vivo and ameliorated acute pancreatic damage and inflammation induced by administration of ethanol and POA to mice. Conclusions A combination of low ethanol and fatty acid that did not exert deleterious effects per se became toxic when oxidative metabolism was inhibited. The in vitro and in vivo damage was markedly inhibited by blockade of CEL, indicating the potential for development of specific therapy for treatment of alcoholic AP via inhibition of FAEE generation. PMID:24162590

  5. Ultrasound Echo-Intensity Predicts Severe Pancreatic Affection in Cystic Fibrosis Patients

    PubMed Central

    Engjom, Trond; Erchinger, Friedemann; Lærum, Birger N.; Tjora, Erling; Gilja, Odd H.; Dimcevski, Georg

    2015-01-01

    Background Pancreatic destruction affects the majority of patients with cystic fibrosis. We aimed to relate ultrasound findings to exocrine pancreatic function and cystic fibrosis genotype. Methods Patients with cystic fibrosis and a matched group of healthy controls were included. We performed transabdominal ultrasound, and recorded echo intensities of the pancreas and parenchymal characteristics according to endoscopic ultrasound based Rosemont criteria. Results We included 39 patients and 29 healthy controls. The cystic fibrosis patients were grouped according to exocrine pancreatic function; Cystic fibrosis, insufficient (n = 20) and sufficient (n = 19). Echo intensity measures and visual score demonstrated hyper-echogenicity in the pancreas insufficient group compared to the pancreas sufficient groups (p<0.001). Ductal and parenchymal changes were not prevalent in any of the groups. Conclusion The hyper-echoic pancreas was the most frequent ultrasonographic finding in exocrine pancreas insufficient cystic fibrosis patients. Pancreatic echo levels correlated to pancreatic phenotype. PMID:25803445

  6. Calcium and Reactive Oxygen Species in Acute Pancreatitis: Friend or Foe?

    PubMed Central

    Booth, David M.; Mukherjee, Rajarshi; Sutton, Robert

    2011-01-01

    Abstract Significance Acute pancreatitis (AP) is a debilitating and, at times, lethal inflammatory disease, the causes and progression of which are incompletely understood. Disruption of Ca2+ homeostasis in response to precipitants of AP leads to loss of mitochondrial integrity and cellular necrosis. Recent Advances While oxidative stress has been implicated as a major player in the pathogenesis of this disease, its precise roles remain to be defined. Recent developments are challenging the perception of reactive oxygen species (ROS) as nonspecific cytotoxic agents, suggesting that ROS promote apoptosis that may play a vital protective role in cellular stress since necrosis is avoided. Critical Issues Fresh clinical findings have indicated that antioxidant treatment does not ameliorate AP and may actually worsen the outcome. This review explores the complex links between cellular Ca2+ signaling and the intracellular redox environment, with particular relevance to AP. Future Directions Recent publications have underlined the importance of both Ca2+ and ROS within the pathogenesis of AP, particularly in the determination of cell fate. Future research should elucidate the subtle interplay between Ca2+ and redox mechanisms that operate to modulate mitochondrial function, with a view to devising strategies for the preservation of organellar function. Antioxid. Redox Signal. 15, 2683–2698. PMID:21861696

  7. Integrated traditional Chinese medicine improves acute pancreatitis via the downregulation of PRSS1 and SPINK1

    PubMed Central

    GAO, QIANG; LIANG, NUSHENG

    2015-01-01

    Integrated traditional Chinese medicine (ITCM) is known to improve health in patients with acute pancreatitis (AP); however, the molecular mechanisms underlying this effect are unknown. AP is associated with the expression of PRSS1 and SPINK1. Thus, the present study aimed to investigate whether ITCM was able to ameliorate AP by regulating the expression levels of protein, serine 1 (PRSS1) and serine peptidase inhibitor, Kazal type 1 (SPINK1). A total of 100 AP patients were divided at random into two groups. The treatment group were treated externally with a herbal ITCM preparation, while the control group received a routine placebo treatment. The mRNA and protein expression levels of PRSS1 and SPINK1 were subsequently compared between the two groups. The results revealed that the health of the patients who had received ITCM improved significantly when compared with the control group patients (P<0.05). In addition, the expression levels of PRSS1 and SPINK1 were found to be lower in the treatment group when compared with the control group (P<0.05). Therefore, ITCM exhibited a significant therapeutic effect on AP and produced no side effects since the treatment was applied externally. ITCM may ameliorate AP by downregulating the expression of PRSS1 and SPINK1; thus, should be considered as a potential therapy for the development of drugs against AP. PMID:25667658

  8. Ibuprofen reduces energy expenditure and acute-phase protein production compared with placebo in pancreatic cancer patients.

    PubMed Central

    Wigmore, S. J.; Falconer, J. S.; Plester, C. E.; Ross, J. A.; Maingay, J. P.; Carter, D. C.; Fearon, K. C.

    1995-01-01

    The aim of this study was to investigate the effect of the cyclo-oxygenase inhibitor ibuprofen on the acute-phase protein response and resting energy expenditure (REE) of weight-losing patients with pancreatic cancer. Patients with irresectable pancreatic cancer (n = 16) were treated with either ibuprofen (1200 mg day-1 for 7 days (n = 10) or placebo (n = 6). A group of 17 age-related non-cancer subjects were also studied. Indirect calorimetry, anthropometry, multifrequency bioelectrical impedence analysis and serum C-reactive protein (CRP) estimation were performed immediately before and after treatment. Before treatment, total REE was significantly elevated in the pancreatic cancer patients compared with healthy controls (1499 +/- 71 vs 1377 +/- 58 kcal) (P < 0.02). Following treatment the mean REE of the ibuprofen group fell significantly (1386 +/- 89 kcal) compared with pretreatment values (1468 +/- 99 kcal) (P < 0.02), whereas no change was observed in the placebo group. Serum CRP concentration was also reduced in the ibuprofen-treated group (pre-ibuprofen, 51 mg l-1; post-ibuprofen, 29 mg l-1; P < 0.05). These results suggest that ibuprofen may have a role in abrogating the catabolic processes which contribute to weight loss in patients with pancreatic cancer. PMID:7541236

  9. Ifitm3 Limits the Severity of Acute Influenza in Mice

    PubMed Central

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

    2012-01-01

    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

  10. [Hypertriglyceridemia-induced pancreatitis].

    PubMed

    Nagayama, Daiji; Shirai, Kohji

    2013-09-01

    In Japan, the frequency of acute pancreatitis is 27.7 per 100,000, which includes 1.4 % of hypertriglyceridemia-induced pancreatitis(HTGP). Severity and complication rates with HTGP have been reported as higher in comparison to acute pancreatitis from other etiologies. Havel has suggested that hydrolysis of excessive triglyceride-rich lipoproteins releases high concentrations of free fatty acid(FFA). The FFA micelles injure the vascular endothelium and acinar cells of the pancreas, producing a self-perpetuating ischemic and acidic environment with resultant toxicity. Lipoprotein lipase (LPL) abnormality has been reported to contribute to severe hypertriglyceridemia. However, patients without any LPL abnormality are often encountered clinically, suggesting that other factors may be involved in the development of severe hypertriglyceridemia. In 21 patients with HTGP, 9 patients(42.9 %) with apolipoprotein AV (ApoAV) Gly185-Cys polymorphism were observed, whereas 14.3 % with LPL gene variants. No patient had ApoCII deficiency. These results suggest that in addition to LPL gene variants, ApoAV variant may be numerously involved in HTGP. It is important for clinicians to routinely investigate pathogenesis of hypertriglyceridemia in case with pancreatitis because specific management may be needed. PMID:24205721

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

    PubMed Central

    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

    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

  12. The pathogenesis of acute pancreatitis. The source and role of oxygen-derived free radicals in three different experimental models.

    PubMed Central

    Sanfey, H; Bulkley, G B; Cameron, J L

    1985-01-01

    Recent experimental work has suggested that oxygen-derived free radicals may play an important role in initiating the early capillary injury in acute pancreatitis. Data from models of ischemic injury in other organs have suggested the enzyme xanthine oxidase is important in generating oxygen-derived free radicals. The present study was performed to determine whether xanthine oxidase is the source of free radical production in experimental pancreatitis. Utilizing the isolated, perfused, ex vivo canine pancreas preparation, three models of pancreatitis were initiated with (1) free fatty acid infusion (FFA), (2) partial duct obstruction and secretin stimulation (POSS), and (3) ischemia (ISCH). In each model, during a 4-hour perfusion, edema developed, weight gain occurred (FFA 120.6 +/- 21.1 gm; POSS 44.5 +/- 6.9 gm; ISCH 63.3 +/- 14.0 gm), and the serum amylase became elevated (FFA 1827 +/- 397 u/dl; POSS 10,171 +/- 1487 u/dl; ISCH 1860 +/- 365 u/dl). When the xanthine oxidase enzyme inhibitor allopurinol was added to the perfusate prior to the 4-hour perfusion, edema formation was absent or minimal, weight gain was significantly less (FFA 15.2 +/- 2.5 gm p less than 0.05; POSS 8.8 +/- 2.7 gm p less than 0.001; ISCH 12.3 +/- 2.8 gm p less than 0.01), and the amylase remained normal or the elevation was significantly decreased (FFA 996 +/- 189 u/dl p less than 0.05; POSS 3021 +/- 1074 u/dl p less than 0.001; ISCH 993 +/- 214 u/dl p less than 0.002). These data confirm that oxygen-derived free radicals play an important role in the pathogenesis of experimental acute pancreatitis, and suggest that the enzyme xanthine oxidase may well be the source of their production. PMID:2581519

  13. The severe acute respiratory syndrome epidemic in mainland China dissected.

    PubMed

    Cao, Wu-Chun; de Vlas, Sake J; Richardus, Jan Hendrik

    2011-03-01

    This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS) epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR) of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteonecrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nationwide internet-based disease reporting system was established. PMID:24470901

  14. Goal-related outcome after acute alcohol-pancreatitis -- a two-year follow-up study.

    PubMed

    Lappalainen-Lehto, Riitta; Koistinen, Noora; Aalto, Mauri; Huhtala, Heini; Sand, Juhani; Nordback, Isto; Seppä, Kaija

    2013-12-01

    The aim of this study was to find out if an acute pancreatitis leads the patients to reduce their alcohol consumption and if there are factors predicting the outcome. We also observed which factors affected the choice of patient's personal drinking goal, e.g., abstinence or moderate drinking, how this goal changed during the follow-up and how the goal affected the change in drinking habits. In 2001-2005, 120 patients treated in Tampere University Hospital for their first alcohol-related acute pancreatitis were interviewed before discharge from the hospital and at the two-year follow-up. All patients had at least one intervention session for their alcohol use. Of the patients 87 (72.5%) completed the study. The alcohol consumption level and its changes, personal drinking goal of the patients, the factors affecting the choice and the changes of the goal were observed. Most (96.4%) of the patients were willing to reduce their drinking. At follow-up, 34 (40.5%) patients succeeded in reducing their alcohol consumption under the pre-set moderate drinking level. The only factor predicting alcohol use was the number of hospitalization days due to the acute alcohol-related pancreatitis (p=0.015). Those who chose abstinence seemed to succeed more often in stopping drinking or reducing their drinking below risk levels as compared to those with moderation goal (47.9% vs. 28.6%, p=0.075). The only abstinence-goal predicting factor was the concern of the relatives, friends or doctors (p=0.001). All 6 patients who needed intensive care chose abstinence-goal. During the follow-up period the goal changed. At baseline, the majority chose abstinence but two years after pancreatitis, the majority was striving for moderate drinking. A serious illness seems to be a good opportunity to change and to motivate patients. Even if abstinence is recommended to patients with alcohol-related pancreatitis, communication of individual goals is important in the motivation process of the patients. PMID:24018221

  15. Protein Kinase D Regulates Cell Death Pathways in Experimental Pancreatitis

    PubMed Central

    Yuan, Jingzhen; Liu, Yannan; Tan, Tanya; Guha, Sushovan; Gukovsky, Ilya; Gukovskaya, Anna; Pandol, Stephen J.

    2012-01-01

    Inflammation and acinar cell necrosis are two major pathological responses of acute pancreatitis, a serious disorder with no current therapies directed to its molecular pathogenesis. Serine/threonine protein kinase D family, which includes PKD/PKD1, PKD2, and PKD3, has been increasingly implicated in the regulation of multiple physiological and pathophysiological effects. We recently reported that PKD/PKD1, the predominant PKD isoform expressed in rat pancreatic acinar cells, mediates early events of pancreatitis including NF-?B activation and inappropriate intracellular digestive enzyme activation. In current studies, we investigated the role and mechanisms of PKD/PKD1 in the regulation of necrosis in pancreatic acinar cells by using two novel small molecule PKD inhibitors CID755673 and CRT0066101 and molecular approaches in in vitro and in vivo experimental models of acute pancreatitis. Our results demonstrated that both CID755673 and CRT0066101 are PKD-specific inhibitors and that PKD/PKD1 inhibition by either the chemical inhibitors or specific PKD/PKD1 siRNAs attenuated necrosis while promoting apoptosis induced by pathological doses of cholecystokinin-octapeptide (CCK) in pancreatic acinar cells. Conversely, up-regulation of PKD expression in pancreatic acinar cells increased necrosis and decreased apoptosis. We further showed that PKD/PKD1 regulated several key cell death signals including inhibitors of apoptotic proteins, caspases, receptor-interacting protein kinase 1 to promote necrosis. PKD/PKD1 inhibition by CID755673 significantly ameliorated necrosis and severity of pancreatitis in an in vivo experimental model of acute pancreatitis. Thus, our studies indicate that PKD/PKD1 is a key mediator of necrosis in acute pancreatitis and that PKD/PKD1 may represent a potential therapeutic target in acute pancreatitis. PMID:22470346

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

    PubMed Central

    Yao, Jinmei; Lv, Guocai

    2014-01-01

    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

  17. The Reduction of Peripheral Blood CD4+ T Cell Indicates Persistent Organ Failure in Acute Pancreatitis

    PubMed Central

    Dong, Liming; Yang, Chong; Gou, Shanmiao; Yin, Tao; Wu, Heshui; Wang, Chunyou

    2015-01-01

    Objective Few data are available on the potential role of inflammatory mediators and T lymphocytes in persistent organ failure (POF) in acute pancreatitis (AP). We conducted a retrospective study to characterize their role in the progression of POF in AP. Methods A total of 69 AP patients presented within 24 hours from symptom onset developing organ failure (OF) on admission were included in our study. There were 39 patients suffering from POF and 30 from transient OF (TOF). On the 1st, 3rd and 7th days after admission, blood samples were collected for biochemical concentration monitoring including serum IL-1?, IL-6, TNF-? and high-sensitivity C-reactive protein (hs-CRP). The proportions of peripheral CD4+ and CD8+ T lymphocytes were assessed based on flow cytometry simultaneously. Results Patients with POF showed a significantly higher value of IL-1? and hs-CRP on day 7 compared with the group of TOF (P < 0.05). Proportions of CD4+ T cells on days 1, 3, 7 and CD4+ / CD8+ ratio on day 1 were statistically lower in the group of POF patients (P < 0.05). A CD4+ T cell proportion of 30.34% on day 1 predicted POF with an area under the curve (AUC) of 0.798, a sensitivity with 61.54% and specificity with 90.00%, respectively. Conclusions The reduction of peripheral blood CD4+ T lymphocytes is associated with POF in AP, and may act as a potential predictor. PMID:25938229

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

    PubMed Central

    Akta?, Bora; Ba?ar, Ömer; Y?lmaz, Bar??; Ekiz, Fuat; Alt?nba?, Akif; Çoban, ?ahin; Büyükçam, Fatih; Albayrak, Aynur; Gini?, Zeynep; Yüksel, Osman; Deliba??, Tuncay

    2014-01-01

    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

  19. Dantrolene mitigates caerulein-induced pancreatitis in vivo in mice

    PubMed Central

    Orabi, Abrahim I.; Shah, Ahsan U.; Ahmad, Mahwish U.; Choo-Wing, Rayman; Parness, Jerome; Jain, Dhanpat; Bhandari, Vineet

    2010-01-01

    Acute pancreatitis is a painful, inflammatory disorder for which adequate treatments are lacking. An early, critical step in its development is the aberrant signaling of Ca2+ within the pancreatic acinar cell. This Ca2+ release is modulated by the intracellular Ca2+ channel the ryanodine receptor (RYR). We have previously shown that RYR inhibition reduces pathological intra-acinar protease activation, an early marker of pancreatitis. In this study, we examined whether pretreatment with the RYR inhibitor dantrolene attenuates the severity of caerulein-induced pancreatitis in mice. Immunofluorescent labeling for RYR from mouse pancreatic sections showed localization to the basolateral region of the acinar cell. After 1 h of caerulein hyperstimulation in vivo, dantrolene 1) reduced pancreatic trypsin activity by 59% (P < 0.05) and 2) mitigated early ultrastructural derangements within the acinar cell. Eight hours after pancreatitis induction, dantrolene reduced pancreatic trypsin activity and serum amylase by 61 and 32%, respectively (P < 0.05). At this later time point, overall histological severity of pancreatitis was reduced by 63% with dantrolene pretreatment (P < 0.05). TUNEL-positive cells were reduced by 58% (P < 0.05). These data suggest that the RYR plays an important role in mediating early acinar cell events during in vivo pancreatitis and contributes to disease severity. Blockade of Ca2+ signals and particularly RYR-Ca2+ may be useful as prophylactic treatment for this disease in high-risk settings for pancreatitis. PMID:20448143

  20. Acute pancreatitis in six non-transplanted uraemic children. A co-operative study from the French Society of Paediatric Nephrology.

    PubMed

    Boudailliez, B; André, J L; Broyer, M; Davin, J C; Landthaler, G; Palcoux, J B

    1988-10-01

    Ten clinical episodes of acute pancreatitis (AP) occurred in six patients (mean age 10 years, range 3-15 years) with chronic renal failure (CRF) during a 9-year period (1977-1986). The underlying cause of CRF was vesicoureteral reflux (2); urethral valves (1); ureterohydronephrosis (1); nephronopthisis (1) and a haemolytic uraemic syndrome which occurred 12 years before (1). In all patients a diagnosis of AP was established both on clinical grounds and with a serum amylase level of greater than 600 IU/l. In 3 patients laparotomy was performed because of suspected appendicitis. All patients required exclusive parenteral feeding (mean duration 25 days) and 2 patients had a partial pancreatectomy. No patient developed pancreatic pseudocysts, 2 patients experienced one relapse (3 and 21 months later) and 1 patient had two relapses and died. Mean duration of follow up was 3 years (range 1-10 years). Possible aetiological factors were: choledochal cyst (1); parotitis without a rise in mumps antibodies (1); familial dyslipidaemia but without AP in other family members (1), and aluminium intoxication with hypercalcaemia and convulsive encephalopathy treated with valproic acid in 1 patient. Severe hyperparathyroidism with radiological signs was absent in all patients. Transplantation had been performed either before AP in 2 patients (1 and 3 years before AP) or had followed AP in 1 patient (7 years after) without occurrence or relapse of AP. PMID:2484654

  1. Overexpression of Pancreatitis-Associated Protein (PAP) in Human Pancreatic Ductal Adenocarcinoma

    Microsoft Academic Search

    Min-Jue Xie; Yoshiharu Motoo; Juan Lucio Iovanna; Shi-Bing Su; Koushiro Ohtsubo; Fujitsugu Matsubara; Norio Sawabu

    2003-01-01

    Pancreatitis-associated protein (PAP) is almost absent in normal pancreas, but is strongly induced in acute pancreatitis. PAP mRNA is also expressed in cancer cells, including pancreatic ductal adenocarcinoma. However, the clinicopathological significance of PAP in human pancreatic cancer is not clear. We examined PAP expression in pancreatic tissues from individuals with pancreatic ductal adenocarcinoma using immunohistochemistry. PAP was overexpressed in

  2. Acute liver failure caused by severe acute hepatitis B: a case series from a multi-center investigation

    PubMed Central

    2014-01-01

    Background Few data can be available regarding acute liver failure (ALF) caused by severe acute hepatitis B up to now. This study aims to report such cases from China. Findings We conducted a multi-center investigation on ALF from 7 tertiary hospitals in different areas of China. A total of 11 patients with ALF caused by severe acute hepatitis B were finally identified. In these patients, there were 10 male and 1 female patients. As a serious complication, apparent hemorrhage occurred in 9 patients. Eventually, in these 11 patients, 4 survived and 7 died. 4 died of heavy bleeding, 2 died of systemic inflammatory response syndrome and 1 died of irreversible coma. No patients received liver transplantation. Conclusions ALF caused by severe acute hepatitis B is worthy of formal studies based on its rarity and severity. PMID:24958233

  3. The glucocorticoid-induced TNF receptor family-related protein (GITR) is critical to the development of acute pancreatitis in mice

    PubMed Central

    Galuppo, M; Nocentini, G; Mazzon, E; Ronchetti, S; Esposito, E; Riccardi, L; Sportoletti, P; Di Paola, R; Bruscoli, S; Riccardi, C; Cuzzocrea, S

    2011-01-01

    BACKGROUND AND PURPOSE Pancreatitis represents a life-threatening inflammatory condition where leucocytes, cytokines and vascular endothelium contribute to the development of the inflammatory disease. The glucocorticoid-induced tumour necrosis factor (TNF) receptor family-related protein (GITR) is a costimulatory molecule for T lymphocytes, modulates innate and adaptive immune system and has been found to participate in a variety of immune responses and inflammatory processes. Our purpose was to verify whether inhibition of GITR triggering results in a better outcome in experimental pancreatitis. EXPERIMENTAL APPROACH In male GITR knock-out (GITR?/?) and GITR+/+ mice on Sv129 background, acute pancreatitis was induced after i.p. administration of cerulein. Other experimental groups of GITR+/+ mice were also treated with different doses of Fc-GITR fusion protein (up to 6.25 µg·mouse?1), given by implanted mini-osmotic pump. Clinical score and pro-inflammatory parameters were evaluated. KEY RESULTS A less acute pancreatitis was found in GITR?/? mice than in GITR+/+ mice, with marked differences in oedema, neutrophil infiltration, pancreatic dysfunction and injury. Co-treatment of GITR+/+ mice with cerulein and Fc-GITR fusion protein (6.25 µg·mouse?1) decreased the inflammatory response and tissue injury, compared with treatment with cerulein alone. Inhibition of GITR triggering was found to modulate activation of nuclear factor ?B as well as the production of TNF-?, interleukin-1?, inducible nitric oxide synthase, nitrotyrosine, poly-ADP-ribose, intercellular adhesion molecule-1 and P-selectin. CONCLUSIONS AND IMPLICATIONS The GITR-GITR ligand system is crucial to the development of acute pancreatitis in mice. Our results also suggest that the Fc-GITR fusion protein could be useful in the treatment of acute pancreatitis. PMID:21091650

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

    PubMed

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

    2013-12-01

    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

  5. Control of the 20022003 severe acute respiratory syndrome (SARS) outbreak was based on rapid diagnosis

    E-print Network

    Hyman, James "Mac"

    Control of the 2002­2003 severe acute respiratory syndrome (SARS) outbreak was based on rapid diagnosis coupled with effective patient isolation. We used uncertain- ty and sensitivity analysis to simultaneously apply more than one method of control. Severe acute respiratory syndrome (SARS), a viral res

  6. Prior cholecystectomy predisposes to acute pancreatitis in codeine-prescribed patients

    PubMed Central

    Turkmen, Serdar; Buyukhatipoglu, Hakan; Suner, Ali; Apucu, Haci Gokhan; Ulas, Turgay

    2015-01-01

    In this paper, we report a case of drug-induced pancreatitis just after taking a pain pill including a low-dose combination of acetaminophen and codeine. Codeine-induced pancreatitis has been rarely reported, however, well-established. The proposed mechanism for codeine-induced pancreatitis is by increasing Oddi sphincter pressure. However, the clinically important point is that the codeine-induced pancreatitis is seen almost only in the cholecystectomized patients due to lacking of its reservoir capacity. Codeine is commonly used alone or in combination in pain medicine. Therefore, it is fairly important to question whether a patient underwent cholecystectomy when a physician decides to prescribe codeine-included preparations.

  7. Oral poly(ADP-ribose) polymerase-1 inhibitor BSI-401 has antitumor activity and synergizes with oxaliplatin against pancreatic cancer, preventing acute neurotoxicity

    PubMed Central

    Melisi, Davide; Ossovskaya, Valeria; Zhu, Cihui; Rosa, Roberta; Ling, Jianhua; Dougherty, Patrick M.; Sherman, Barry M.; Abbruzzese, James L.; Chiao, Paul J.

    2010-01-01

    Purpose Development of novel agents and drug combinations are urgently needed for treatment of pancreatic cancer. Oxaliplatin belongs to an important class of DNA-damaging organoplatinum agents, useful in pancreatic cancer therapy. However, increased ability of cancer cells to recognize and repair DNA damage enables resistance to these agents. PARP-1 is a sensor of DNA damage with key roles in DNA repair. Here we report the therapeutic activity of the PARP-1 inhibitor BSI-401, as a single agent and in combination with oxaliplatin in orthotopic nude mouse models of pancreatic cancer, and its effect on oxaliplatin-induced acute neurotoxicity. Experimental Design We determined in vitro the effect of BSI-401 and its synergism with oxaliplatin on the growth of pancreatic cancer cells. Activity of different dosages of parenteral and oral BSI-401, alone and in combination with oxaliplatin, was evaluated in orthotopic nude mouse models with luciferase-expressing pancreatic cancer cells. The effect of BSI-401 in preventing oxaliplatin-induced acute cold allodynia was measured in rats using a temperature-controlled plate. Results BSI-401 alone and in synergism with oxaliplatin significantly inhibited the growth of pancreatic cancer cells in vitro. In nude mice, intraperitoneal (200 mg/kg QW×4) and oral (400 mg/kg [QD5+R2]×4) administration of BSI-401 significantly reduced tumor burden and prolonged survival (46 vs. 144 days, P = 0.0018; 73 vs. 194 days, P= 0.0017) compared with no treatment. BSI-401 combined with oxaliplatin had potent synergistic antitumor activity (46 vs. 132 days, P = 0.0063), and significantly (P= 0.0148) prevented acute oxaliplatin-induced neurotoxicity. Conclusions BSI-401, alone or in combination with oxaliplatin, is a promising new therapeutic agent that warrants further evaluation for treatment of pancreatic cancer. PMID:19808866

  8. Root of the superior mesenteric artery in pancreatitis and pancreatic carcinoma: evaluation with CT.

    PubMed

    Schulte, S J; Baron, R L; Freeny, P C; Patten, R M; Gorell, H A; Maclin, M L

    1991-09-01

    To determine if changes involving the root of the superior mesenteric artery are specific for neoplasm, the authors retrospectively reviewed 173 computed tomographic (CT) examinations of patients with proved pancreatitis (103 examinations) and pancreatic ductal adenocarcinoma (70 examinations). Streaky infiltration of the fat surrounding the root was seen in 27 of 56 examinations of acute pancreatitis, in four of 24 examinations of chronic pancreatitis, in 12 of 23 examinations of pancreatitis complicated by abscess, and in 25 of 70 examinations of pancreatic carcinoma. Periarterial lymph nodes were visible in 14 with acute pancreatitis, in three with chronic pancreatitis, in six with pancreatic abscess, and in 11 with pancreatic carcinoma. A focal mass extended to within 1 cm of the root in 10 with acute pancreatitis, in two with chronic pancreatitis, in four with pancreatic abscess, and in 24 with pancreatic carcinoma; the mass obliterated the periarterial fat in seven with acute pancreatitis, in one with pancreatic abscess, and in 18 with pancreatic carcinoma. Circumferential encasement occurred in one with chronic pancreatitis, in four with pancreatic abscess, in 14 with pancreatic carcinoma, and in none with acute pancreatitis; nearly all cases of encasement revealed loss of periarterial fat. Thus, these indicators are not specific for neoplasm. PMID:1871275

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

    Microsoft Academic Search

    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

    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.

  10. Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome

    Microsoft Academic Search

    Jesus Villar; L. Pérez-Méndez; R. M. Kacmarek

    1999-01-01

    Background: Despite intensive research, there are no universally accepted clinical definitions for acute lung injury (ALI) or the acute\\u000a respiratory distress syndrome (ARDS). A recent joint American-European Consensus Conference on ARDS formally defined the difference\\u000a between ALI and ARDS based on the degree of oxygenation impairment. However, this definition may not reflect the true prevalence,\\u000a severity and prognosis of these

  11. Levetiracetam-induced severe acute granulomatous interstitial nephritis

    PubMed Central

    Yong, Jim; Ismail, Kasim; Griffith, Neil; Liu, Michael; Makris, Angela

    2012-01-01

    Granulomatous interstitial nephritis (GIN) is an uncommon cause of renal failure, which may be caused by drugs. Levetiracetam is an increasingly used anti-epileptic medication that is not known to cause renal toxicity in adults. To our knowledge, levetiracetam has not previously been reported as a cause of GIN. We report the case of a 69-year-old woman who developed haemodialysis-requiring acute renal failure after commencement of treatment with levetiracetam, which was shown to be GIN by renal biopsy. She made a complete recovery with cessation of levetiracetam and treatment with steroids.

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

    PubMed Central

    Etienne, Denzil; Reda, Yousef

    2014-01-01

    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

  13. Prevention of hyperlipidemic acute pancreatitis during pregnancy with medium-chain triglyceride nutritional support

    Microsoft Academic Search

    Takaaki Mizushima; Koji Ochi; Naoki Matsumura; Mitsuko Ichimura; Tadaaki Ishibashi; Keiich Tsuboi; Hideo Harada

    1998-01-01

    Summary\\u000a Conclusion  \\u000a A combination of diet therapy, nutritional support with medium-chain triglycerides (MCT), and well-planned preterm Cesarean\\u000a delivery on demand is an effective measure to prevent gestational hyperlipidemic pancreatitis and leads to successful childbirth.\\u000a \\u000a \\u000a \\u000a Background  Prevention and therapy of gestational hyperlipidemic pancreatitis are important, although difficult, because the condition\\u000a carries a high maternal and fetal morbidity and mortality.\\u000a \\u000a \\u000a \\u000a Results  We describe a

  14. Decision trees for the severity and recurrence of acute splenic sequestration in sickle cell disease

    E-print Network

    Emilion, Richard

    - 1 - Decision trees for the severity and recurrence of acute splenic sequestration in sickle cell Background Acute splenic sequestration is one of the major clinical forms of sickle cell disease. This potentially life-threatening complication is defined by a rapid sequestration of sickle red blood cells

  15. [The possibilities of modern prophylaxis of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP)].

    PubMed

    Tarasov, A N; Vasil'ev, A V; Olevskaia, E R; Deriabina, E A; Mashkovski?, A M

    2014-01-01

    The paper presents the results of the 1778 performed ERCP on patients with benign bile duct occlusion. Father was given evaluation of the effectiveness of using ksifokam, and usage of preventive and therapeutic stenting of the main pancreatic duct in 31 patients. PMID:25842666

  16. Protective Role of Nuclear Factor E2-Related Factor 2 against Acute Oxidative Stress-Induced Pancreatic ? -Cell Damage.

    PubMed

    Fu, Jingqi; Zheng, Hongzhi; Wang, Huihui; Yang, Bei; Zhao, Rui; Lu, Chunwei; Liu, Zhiyuan; Hou, Yongyong; Xu, Yuanyuan; Zhang, Qiang; Qu, Weidong; Pi, Jingbo

    2015-01-01

    Oxidative stress is implicated in the pathogenesis of pancreatic ?-cell dysfunction that occurs in both type 1 and type 2 diabetes. Nuclear factor E2-related factor 2 (NRF2) is a master regulator in the cellular adaptive response to oxidative stress. The present study found that MIN6 ?-cells with stable knockdown of Nrf2 (Nrf2-KD) and islets isolated from Nrf2-knockout mice expressed substantially reduced levels of antioxidant enzymes in response to a variety of stressors. In scramble MIN6 cells or wild-type islets, acute exposure to oxidative stressors, including hydrogen peroxide (H2O2) and S-nitroso-N-acetylpenicillamine, resulted in cell damage as determined by decrease in cell viability, reduced ATP content, morphology changes of islets, and/or alterations of apoptotic biomarkers in a concentration- and/or time-dependent manner. In contrast, silencing of Nrf2 sensitized MIN6 cells or islets to the damage. In addition, pretreatment of MIN6 ?-cells with NRF2 activators, including CDDO-Im, dimethyl fumarate (DMF), and tert-butylhydroquinone (tBHQ), protected the cells from high levels of H2O2-induced cell damage. Given that reactive oxygen species (ROS) are involved in regulating glucose-stimulated insulin secretion (GSIS) and persistent activation of NRF2 blunts glucose-triggered ROS signaling and GSIS, the present study highlights the distinct roles that NRF2 may play in pancreatic ?-cell dysfunction that occurs in different stages of diabetes. PMID:25949772

  17. Protective Role of Nuclear Factor E2-Related Factor 2 against Acute Oxidative Stress-Induced Pancreatic ?-Cell Damage

    PubMed Central

    Fu, Jingqi; Zheng, Hongzhi; Wang, Huihui; Yang, Bei; Zhao, Rui; Lu, Chunwei; Liu, Zhiyuan; Hou, Yongyong; Xu, Yuanyuan; Zhang, Qiang; Qu, Weidong; Pi, Jingbo

    2015-01-01

    Oxidative stress is implicated in the pathogenesis of pancreatic ?-cell dysfunction that occurs in both type 1 and type 2 diabetes. Nuclear factor E2-related factor 2 (NRF2) is a master regulator in the cellular adaptive response to oxidative stress. The present study found that MIN6 ?-cells with stable knockdown of Nrf2 (Nrf2-KD) and islets isolated from Nrf2-knockout mice expressed substantially reduced levels of antioxidant enzymes in response to a variety of stressors. In scramble MIN6 cells or wild-type islets, acute exposure to oxidative stressors, including hydrogen peroxide (H2O2) and S-nitroso-N-acetylpenicillamine, resulted in cell damage as determined by decrease in cell viability, reduced ATP content, morphology changes of islets, and/or alterations of apoptotic biomarkers in a concentration- and/or time-dependent manner. In contrast, silencing of Nrf2 sensitized MIN6 cells or islets to the damage. In addition, pretreatment of MIN6 ?-cells with NRF2 activators, including CDDO-Im, dimethyl fumarate (DMF), and tert-butylhydroquinone (tBHQ), protected the cells from high levels of H2O2-induced cell damage. Given that reactive oxygen species (ROS) are involved in regulating glucose-stimulated insulin secretion (GSIS) and persistent activation of NRF2 blunts glucose-triggered ROS signaling and GSIS, the present study highlights the distinct roles that NRF2 may play in pancreatic ?-cell dysfunction that occurs in different stages of diabetes. PMID:25949772

  18. SITE DIRECTED MUTAGENESIS OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) CORONAVIRUS NSP 15 ENDORIBONUCLEASE 

    E-print Network

    Baig, Kimberlyn Maravet

    2006-08-16

    ABSTRACT Site Directed Mutagenesis of Severe Acute Respiratory Syndrome (SARS) Cornavirus Nsp 15 Endoribonuclease (April 2006) K. Maravet Baig Department of Biology Texas A&M University Fellows Advisor: Dr. Linda A Guarino...

  19. Absence of ATM truncations in patients with severe acute radiation reactions

    Microsoft Academic Search

    Raymond A Clarke; Gary R Goozee; Geoff Birrell; Zhi Ming Fang; Homa Hasnain; Martin Lavin; John H Kearsley

    1998-01-01

    Purpose: Severe acute toxicity limits the effective use of radiotherapy in patients who are radiosensitive, and it is not usually possible to identify these radiohypersensitive (R-H) individuals before treatment commences. Five such R-H patients were detected over a 3-year period. We undertook this study to determine whether the severe acute radiohypersensitivity of these five individuals showed any correlation with cellular

  20. Pancreatic stellate cells respond to inflammatory cytokines: potential role in chronic pancreatitis

    Microsoft Academic Search

    P Mews; P Phillips; R Fahmy; M Korsten; R Pirola; J Wilson; M Apte

    2002-01-01

    Background: It is now generally accepted that chronic pancreatic injury and fibrosis may result from repeated episodes of acute pancreatic necroinflammation (the necrosis-fibrosis sequence). Recent stud- ies suggest that pancreatic stellate cells (PSCs), when activated, may play an important role in the development of pancreatic fibrosis. Factors that may influence PSC activation during pancreatic necroinflammation include cytokines known to be

  1. Pancreatic cancer

    PubMed Central

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

    2011-01-01

    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

  2. Hereditary pancreatitis for the endoscopist.

    PubMed

    Patel, Milan R; Eppolito, Amanda L; Willingham, Field F

    2013-03-01

    Hereditary pancreatitis shares a majority of clinical and morphologic features with chronic alcoholic pancreatitis, but may present at an earlier age. The term hereditary pancreatitis has primarily been associated with mutations in the serine protease 1 gene (PRSS1) which encodes for cationic trypsinogen. PRSS1 mutations account for approximately 68-81% of hereditary pancreatitis. Mutations in other genes, primarily serine protease inhibitor Kazal type 1 (SPINK1) and the cystic fibrosis transmembrane conductance regulator (CFTR) are also associated with hereditary pancreatitis. While chronic alcoholic pancreatitis may develop in the fourth or fifth decades, patients with hereditary pancreatitis may develop symptoms in the first or second decades of life. Hereditary pancreatitis is diagnosed either by detecting a causative gene mutation or by the presence of chronic pancreatitis in two first-degree or three second-degree relatives, in two or more generations, without precipitating factors and with a negative workup for known causes. Patients with hereditary pancreatitis may have recurrent acute pancreatitis and may develop pancreatic exocrine and endocrine insufficiency. Hereditary pancreatitis may involve premature trypsinogen activation or decreased control of trypsin. Recurrent inflammation can lead to acute pancreatitis and subsequently to chronic pancreatitis with parenchymal calcification. There is a markedly increased risk of pancreatic carcinoma compared with the general population. Patients are often referred for evaluation of pancreatitis, biliary or pancreatic ductal dilatation, jaundice, biliary obstruction, pancreatic duct stone or stricture, pancreatic pseudocysts, and for evaluation for malignancy. Medical treatment includes pancreatic enzyme supplementation, nutritional supplementation, diabetes management, and palliation of pain. Patients should avoid tobacco use and alcohol exposure. Hereditary pancreatitis is reviewed and recommendations for genetic testing are discussed. PMID:23503650

  3. Indications for surgery in necrotizing pancreatitis.

    PubMed Central

    Reber, H A; McFadden, D W

    1993-01-01

    The decision to operate on a patient with severe acute pancreatitis is often difficult and requires mature clinical judgment. Indications that are widely accepted include to establish the differential diagnosis, when the surgeon is concerned that the symptoms are due to a disease other than pancreatitis for which an operation is mandatory; in persistent and severe biliary pancreatitis, when an obstructing gallstone is lodged in the ampulla of Vater and cannot be managed endoscopically; in the presence of infected pancreatic necrosis; and to drain a pancreatic abscess, if percutaneous drainage does not produce the desired result. Other indications that are less well defined and somewhat controversial are the presence of sterile pancreatic necrosis involving 50% or more of the pancreas, when the pancreatitis persists despite maximal medical therapy, and when a patient's condition deteriorates. For these last three indications, guidelines have been presented that permit a logical approach to management, although uncertainty remains. Surgeons should strive to describe in detail and precisely the clinical state of their patients at the time that an operation is done, as well as the findings and technical details of the operation. This should allow further refinement in the management of this vexing problem. PMID:8128695

  4. Pancreatitis - discharge

    MedlinePLUS

    Chronic pancreatitis - discharge; Pancreatitis - chronic - discharge; Pancreatic insufficiency - discharge ... You were in the hospital because you have pancreatitis, or swelling of the pancreas You may have ...

  5. Biological therapy in acute severe ulcerative colitis: Indian experience.

    PubMed

    Sood, Ajit; Midha, Vandana; Singh, Arshdeep

    2014-08-01

    Biologicals have a well established role as rescue therapy in management of steroid refractory cases of Ulcerative colitis and Crohn's disease. However, high cost and potential risk of infections like tuberculosis limits their use in developing countries. As there is paucity of data on the use of various biological agents from developing countries like India, we are reporting the limited Indian experience with the available agents. Infliximab has been used as a rescue therapy for severe refractory Ulcerative colitis while other agents have been used as a part of multicentre clinical trials. PMID:25735124

  6. Does early ED CT scanning of afebrile patients with first episodes of acute pancreatitis ever change management?

    PubMed

    Dachs, Robert J; Sullivan, Luke; Shanmugathasan, Preshanthini

    2015-06-01

    Rising utilization of computed tomography (CT) imaging early in the course of acute pancreatitis (AP) has been recently reported. However, radiographic demonstration of the degree of necrosis or the presence of complications is not fully apparent within the first days of an acute attack. The objective of this study was to examine if CT scanning early in the course of disease (<48 h of symptoms) in afebrile patients with an emergency department (ED) diagnosis of first episode of AP revealed any unanticipated pathology that altered clinical management. A retrospective chart review of all adult patients with a first episode of AP without fever admitted to the medical ward through the ED of our community hospital from January 1, 2011 to May 31, 2012 was performed. In cases in which CT scans were performed, the record was reviewed to determine if any unexpected findings were uncovered or if patient care was altered by the CT report. Two hundred forty-eight patients were admitted with an ED diagnosis of AP; 26.2 % (n?=?65) met inclusion criteria; 70.8 % (n?=?46) received a CT scan within 48 h of symptom onset. No patient that underwent CT scanning had an unexpected finding (95 % CI, 0.923-1.0). Our results demonstrate that afebrile patients with first episodes of AP do not benefit from early abdominal CT imaging. These results support the ACR Appropriateness Criteria recommendation that CT is not indicated in the first 48 h after symptom onset in unequivocal cases of AP. PMID:25239388

  7. The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity

    PubMed Central

    Göya, Cemil; Hamidi, Cihad; Okur, Mehmet Hanifi; ?çer, Mustafa; O?uz, Abdullah; Hattapo?lu, Salih; Çetinçakmak, Mehmet Güli; Teke, Memik

    2014-01-01

    PURPOSE The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis. METHODS Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis. RESULTS The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6–1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37–4.78 m/s) for acute appendicitis. CONCLUSION ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation. PMID:25323836

  8. [Carrión's disease complicated with severe acute leptospirosis: a case report].

    PubMed

    Huerta, Anderson; Salas, Marcia; Yarinsueca, Jorge; Maguiña, Ciro

    2014-04-01

    The case of an adult, 56 year old male is reported, from Sihuas (Ancash) who presented at Hospital Nacional Dos de Mayo with fever, jaundice and anemia. In three days of hospitalization, he developed severe anemia (Hb: 11.8 to 6.7 g / dL) and generalized myalgias associated with a sudden worsening jaundice correlated with elevated bilirubin (TB 3.2 to 19.6 mg / dL direct dominance) and general deterioration. Microbiological smear and culture were positive for Bartonella bacilliformis. Subsequent serology (microagglutination) was positive for Lesptospira serovar Pomona. The patient was given specific antibiotic therapy (ceftriaxone and ciprofloxacin), transfused two units of packed red blood cells, improved clinically and was discharged. PMID:25123883

  9. [VRS bronchiolitis with severe hyponatremia leading to acute seizures: a report of three cases].

    PubMed

    Pop Jora, D; de Suremain, N; Arnaud, C; Gréteau, S; Guellec, I; Renolleau, S; Carbajal, R

    2014-12-01

    Acute bronchiolitis due to respiratory syncytial virus (RSV) can present with extrapulmonary manifestations, notably severe hyponatremia. Hyponatremia is caused by excess secretion of antidiuretic hormone and can be exacerbated by intravenous infusion of hypotonic solutions. We report three cases of infants admitted for acute bronchiolitis and hyponatremia leading to acute seizures. We describe how hyponatremia was corrected and analyze the management aspects that might have worsened the magnitude of hyponatremia. We underline the basic principles of water and electrolyte management of bronchiolitis. PMID:25445128

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

    Microsoft Academic Search

    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

    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

  11. Acute severe back pain radiating to the whole body during intravenous administration of amiodarone.

    PubMed

    Yan, Yiwen; Shen, Hua

    2015-07-01

    Amiodarone represents an effective antiarrhythmic drug for cardioversion of recent-onset atrial fibrillation (AF) and maintenance of sinus rhythm. Acute low back and/or epigastric pain has been reported in the medical literature as a rare side effect of amiodarone, but most cases were Europeans, one was Chinese. We present the case of a Japanese patient who experienced acute severe back pain radiating to the whole body a few minutes after intravenous (IV) infusion of amiodarone. PMID:25907175

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

    PubMed Central

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

    2014-01-01

    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

  13. Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices

    Microsoft Academic Search

    M. J. Peters; R. C. Tasker; K. M. Kiff; R. Yates; D. J. Hatch

    1998-01-01

    Objective: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment\\u000a of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical\\u000a trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with\\u000a those who

  14. [Management of acute and severe complications in adults with cystic fibrosis].

    PubMed

    Chapron, J; Zuber, B; Kanaan, R; Hubert, D; Desmazes-Dufeu, N; Mira, J-P; Dusser, D; Burgel, P-R

    2011-04-01

    The natural history of cystic fibrosis (CF) may be associated both with acute respiratory complications (respiratory exacerbations, haemoptysis, pneumothorax) and with non-respiratory complications (distal intestinal obstruction syndrome, dehydration) that may result in hospitalizations. The aim of this article is to describe the main therapeutic approaches that are adopted in the management of acute complications occurring in CF adults, and to discuss indications for admission of these patients to intensive care units. Adult CF patients admitted to intensive care unit often benefit from antibiotic courses adapted to their chronic bronchial infection, especially when the hospitalization is related to respiratory disease (including haemoptysis and pneumothorax). Nutritional support, including hypercaloric diet, control of hyperglycemia and pancreatic enzyme supplementation is warranted. The recommended therapy for major haemoptysis is bronchial artery embolization. Patient with significant pneumothorax should have a chest tube inserted, while the treatment of distal intestinal obstruction syndrome will most often be medical. In case of respiratory failure, non-invasive ventilation is the preferred mode of ventilatory support because invasive ventilation is associated with poor outcomes. Therapeutic options should always have been discussed between the patient, family members and the CF medical team to allow for informed decision making. PMID:21549905

  15. Issues in Hypertriglyceridemic Pancreatitis - An Update

    PubMed Central

    Scherer, John; Singh, Vijay; Pitchumoni, C. S; Yadav, Dhiraj

    2014-01-01

    Hypertriglyceridemia (HTG) is a well established but underestimated cause of acute (AP) and recurrent AP (RAP). The clinical presentation of HTG-induced pancreatitis (HTG pancreatitis) is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, medications, pregnancy) in a patient with an underlying common genetic abnormality of lipoprotein metabolism (Familial combined hyperlipidemia or Familial HTG). Less commonly, a patient with rare genetic abnormality (Familial chylomicronemic syndrome) with or without an additional secondary factor is encountered. The risk of AP in patients with serum triglycerides >1000 mg/dl and >2000 mg/dl is ?5% and 10-20% respectively. It is not clear whether HTG pancreatitis is more severe than when it is due to other causes. Clinical management of HTG pancreatitis is similar to that of other causes. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride levels. Use of apheresis is still experimental and better designed studies are needed to clarify its role in management of HTG pancreatitis. Diet, lifestyle changes, control of secondary factors are key to the treatment and medications are useful adjuncts to long term management of triglyceride levels. Control of triglyceride levels to well below 500 mg/dl can effectively prevent recurrences of pancreatitis. PMID:24172179

  16. Outcome of acute kidney injury in severe burns: a systematic review and meta-analysis

    Microsoft Academic Search

    Nele Brusselaers; Stan Monstrey; Kirsten Colpaert; Johan Decruyenaere; Stijn I. Blot; Eric A. J. Hoste

    2010-01-01

    Purpose  The main objective of this review was to analyse the prevalence and outcome of acute kidney injury (AKI) in patients with\\u000a severe burn injury. AKI is a common complication in patients with severe burn injury and one of the major causes of death\\u000a (often combined with other organ dysfunctions). Several definitions of AKI have been used, but the RIFLE ‘consensus’

  17. Treatment of pain in chronic pancreatitis by inhibition of pancreatic secretion with octreotide

    Microsoft Academic Search

    P Malfertheiner; D Mayer; M Büchler; J E Domínguez-Muñoz; B Schiefer; H Ditschuneit

    1995-01-01

    It has been suggested that pancreatic ductal hypertension, secondary to pancreatic outflow obstruction, is a cause of pain in chronic pancreatitis. This study investigated the effect of inhibiting pancreatic secretion with octreotide in chronic pancreatitis pain. Ten patients with chronic alcoholic pancreatitis and severe daily pain were included in an intraindividual double blind crossover study. All patients received octreotide (3

  18. Current knowledge of hypertriglyceridemic pancreatitis.

    PubMed

    Valdivielso, Pedro; Ramírez-Bueno, Alba; Ewald, Nils

    2014-10-01

    Severe hypertriglyceridemia (HTG) is a well established and the most common cause of acute pancreatitis (AP) after alcohol and gall stone disease. It is alleged to account for up to 10% of all pancreatitis episodes. Studies suggest that in patients with triglyceride (TG) levels>1000 mg/dL (>11.3 mmol/L), hypertriglyceridemia-induced acute pancreatitis (HTGP-AP) occurs in approximately 15-20% of all subjects referred to Lipid Clinics. Until now, there is no clear evidence which patients with severe HTG will develop pancreatitis and which will not. Underlying pathophysiological concepts include hydrolysis of TG by pancreatic lipase and excessive formation of free fatty acids with inflammatory changes and capillary injury. Additionally hyperviscosity and ischemia may play a decisive role. The clinical features of HTG-AP patients are supposed to be no different from patients with AP of other etiologies. Yet, there are well-conducted studies suggesting that HTG-AP is associated with a higher severity and complication rate. Therapeutic measurements in HTG-AP include dietary modifications, different antihyperlipidemic agents, insulin and/or heparin treatment. The beneficial use of plasmapheresis is repeatedly reported and suggested in many studies. Yet, due to the lack of randomized and controlled trials, it is currently unknown if plasmapheresis may improve morbidity and mortality in the clinical setting of HTG-AP. Since there are no commonly accepted clinical guidelines in the management of HTG-AP, there is a definite need for an international, multicenter approach to this important subject. PMID:25269432

  19. A Study of Oxidative Stress Biomarkers and Effect of Oral Antioxidant Supplementation in Severe Acute Malnutrition

    PubMed Central

    Ghone, Rahul A.; Suryakar, Adinath N.; Kulhalli, P. M.; Bhagat, Sonali S.; Padalkar, Ramchandra K.; Karnik, Aarti C.; Hundekar, Prakash S.; Sangle, D. A.

    2013-01-01

    Background: Malnutrition represents one of the most severe health problems in India. Free radicals play an important role in immunological response, which induces the oxidative surplus in severe acute malnutrition. Severe dietary deficiency of nutrients leads to increased oxidative stress in cellular compartments. Aim: The goal of this study was to inspect impact of oxidative stress in the form of serum malondialdehyde as product of lipid peroxidation, vitamin E, zinc and erythrocyte superoxide dismutase in patients with severe acute malnutrition. Material and Methods: Sixty severe acute malnutrition patients were studied before and after supplementation of antioxidants for one month, and their status were compared with those of 60 age and sex matched healthy controls. The level of serum MDA was analyzed by the Kei Satoh method, serum vitamin E concentration was measured by Baker and Frank Method, serum zinc was measured by using Atomic Absorption Spectrophotometer (AAS) and erythrocyte superoxide dismutase was measured by Kajari Das Method. Results: Significantly increased levels of serum malondialdehyde (p<0.001) were found in the patients as compared to those in controls, and significant depletions were found in the levels of serum vitamin E, zinc and erythrocyte superoxide dismutase in patients with severe acute malnutrition as compared to those in controls. After supplementation of antioxidants for one month, the levels of malondialdehyde were found to be decreased significantly (p<0.001) and zinc and erythrocyte superoxide dismutase capacity levels were increased significantly (p<0.05). Also, there was a non–significant (p>0.05) increase in vitamin E levels as compared to those before supplementation results. Conclusion: Harsh deficiency of various nutrients in severe acute malnutrition leads to generation of heavy oxidative stress. These effects may be minimized with supplementation of antioxidants. PMID:24298460

  20. Decision trees for the severity and recurrence of acute splenic sequestration in sickle cell disease

    E-print Network

    Paris-Sud XI, Université de

    - 1 - Decision trees for the severity and recurrence of acute splenic sequestration in sickle cell of sickle cell disease. This potentially life-threatening complication is defined by a rapid sequestration of sickle red blood cells in the spleen. Approximately 30% of young patients will develop this complication

  1. Ultrastructure and Origin of Membrane Vesicles Associated with the Severe Acute Respiratory Syndrome Coronavirus Replication Complex

    Microsoft Academic Search

    Eric J. Snijder; Yvonne van der Meer; Jessika Zevenhoven-Dobbe; Jos J. M. Onderwater; Jannes van der Meulen; Henk K. Koerten; A. Mieke Mommaas

    2006-01-01

    The RNA replication complexes of mammalian positive-stranded RNA viruses are generally associated with (modified) intracellular membranes, a feature thought to be important for creating an environment suitable for viral RNA synthesis, recruitment of host components, and possibly evasion of host defense mechanisms. Here, using a panel of replicase-specific antisera, we have analyzed the earlier stages of severe acute respiratory syndrome

  2. The use of proteomics in the discovery of serum biomarkers from patients with severe acute respiratory

    E-print Network

    Fan, Jianqing

    respiratory syndrome Yi Ren1*, Qing-Yu He2, 3*= , Jianqing Fan4 , Brian Jones5 , Yuan Zhou6 , Yi Xie1 , Chung Research centre, The University of Hong Kong, Hong Kong, China Severe acute respiratory syndrome (SARS showed a sensitivity of 100% for SARS patients and a specificity of 92.8% for controls. Fur- thermore

  3. Fear of Severe Acute Respiratory Syndrome (SARS) among Health Care Workers

    ERIC Educational Resources Information Center

    Ho, Samuel M. Y.; Kwong-Lo, Rosalie S. Y.; Mak, Christine W. Y.; Wong, Joe S.

    2005-01-01

    In this study, the authors examined fear related to severe acute respiratory syndrome (SARS) among 2 samples of hospital staff in Hong Kong. Sample 1 included health care workers (n = 82) and was assessed during the peak of the SARS epidemic. Sample 2 included hospital staff who recovered from SARS (n = 97). The results show that participants in…

  4. Cross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human

    Microsoft Academic Search

    Huai-Dong Song; Chang-Chun Tu; Guo-Wei Zhang; Sheng-Yue Wang; Kui Zheng; Lian-Cheng Lei; Qiu-Xia Chen; Yu-Wei Gao; Hui-Qiong Zhou; Hua Xiang; Hua-Jun Zheng; Shur-Wern Wang Chern; Feng Cheng; Chun-Ming Pan; Hua Xuan; Sai-Juan Chen; Hui-Ming Luo; Duan-Hua Zhou; Yu-Fei Liu; Jian-Feng He; Peng-Zhe Qin; Ling-Hui Li; Yu-Qi Ren; Wen-Jia Liang; Ye-Dong Yu; Larry Anderson; Ming Wang; Rui-Heng Xu; Xin-Wei Wu; Huan-Ying Zheng; Jin-Ding Chen; Guodong Liang; Yang Gao; Ming Liao; Ling Fang; Li-Yun Jiang; Hui Li; Fang Chen; Biao di; Li-Juan He; Jin-Yan Lin; Suxiang Tong; Xiangang Kong; Lin Du; Pei Hao; Hua Tang; Andrea Bernini; Xiao-Jing Yu; Ottavia Spiga; Zong-Ming Guo; Hai-Yan Pan; Wei-Zhong He; Jean-Claude Manuguerra; Arnaud Fontanet; Antoine Danchin; Neri Niccolai; Yi-Xue Li; Chung-I. Wu; Guo-Ping Zhao

    2005-01-01

    The genomic sequences of severe acute respiratory syndrome coronaviruses from human and palm civet of the 2003\\/2004 outbreak in the city of Guangzhou, China, were nearly identical. Phylogenetic analysis suggested an independent viral invasion from animal to human in this new episode. Combining all existing data but excluding singletons, we identified 202 single-nucleotide variations. Among them, 17 are polymorphic in

  5. Evasion of antibody neutralization in emerging severe acute respiratory syndrome coronaviruses

    Microsoft Academic Search

    Zhi-Yong Yang; Heidi C. Werner; Wing-Pui Kong; Kwanyee Leung; Elisabetta Traggiai; Antonio Lanzavecchia; Gary J. Nabel

    2005-01-01

    Molecular characterization of the severe acute respiratory syndrome coronavirus has revealed genetic diversity among isolates. The spike (S) glycoprotein, the major target for vaccine and immune therapy, shows up to 17 substitutions in its 1,255-aa sequence; however, the biologic significance of these changes is unknown. Here, the functional effects of S mutations have been determined by analyzing their affinity for

  6. High-Dose Pulse Versus Nonpulse Corticosteroid Regimens in Severe Acute Respiratory Syndrome

    Microsoft Academic Search

    James C. Ho; Gaik C. Ooi; Thomas Y. Mok; Johnny W. Chan; Ivan Hung; Bing Lam; Poon C. Wong; Patrick C. Li; Pak L. Ho; Wah K. Lam; Chun K. Ng; Mary S. Ip; Kar N. Lai; Moira Chan-Yeung; Kenneth W. Tsang

    2003-01-01

    The treatment of atypical pneumonia, subsequently termed severe acute respiratory syndrome (SARS), is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 patients with probable SARS (me- dian age 37 years, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to

  7. Abstract --Highly infectious diseases such as SARS (Severe Acute Respiratory Syndrome), Avian Influenza (Bird Flu),

    E-print Network

    Si, Yain Whar "Lawrence"

    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

  8. The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS) shows

    E-print Network

    The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS (Mills and Childs 1998). Monkeypox, hantavirus pulmonary syndrome (HPS), Lassa fever, Argentine evidence for top-down regulation of zoonotic disease reservoirs Richard S Ostfeld1 and Robert D Holt2

  9. Comparing continuous hemofiltration with hemodialysis in patients with severe acute renal failure

    Microsoft Academic Search

    Richard D. Swartz; Joseph M. Messana; Sean Orzol; Friedrich K. Port

    1999-01-01

    Continuous venovenous hemofiltration (CVVH) or CVVH with additional diffusive dialysis (CVVH-D) has theoretical advantages in treating severe acute renal failure (ARF), but no prospective clinical trials or restrospective comparison studies have clearly shown its superiority over intermittent hemodialysis (HD). To evaluate this question, all 349 adult patients with ARF receiving renal replacement therapy (RRT) at our medical center during 1995

  10. Virus Research 120 (2006) 146155 Inhibition of severe acute respiratory syndrome-associated coronavirus

    E-print Network

    Wimley, William C.

    2006-01-01

    ; Peptide inhibitor; Murine hepatitis virus; Six-helix bundle; Anti-viral 1. Introduction Severe acute-associated coronavirus (SARS-CoV) infectivity by peptides analogous to the viral spike protein Bruno Sainz Jr.a,, Eric C that affected Asia, North America and Europe in 2002­2003. The viral spike (S) glycoprotein is responsible

  11. A case of severe thrombocytopaenia associated with acute HIV-1 infection.

    PubMed

    Aoki, Ami; Moro, Hiroshi; Watanabe, Takayuki; Asakawa, Katsuaki; Miura, Satoru; Moriyama, Masato; Tanabe, Yoshinari; Kagamu, Hiroshi; Narita, Ichiei

    2015-03-01

    A 23-year-old man was admitted to our hospital with severe thrombocytopaenia. He had unprotected sexual contact 6 weeks earlier. He was diagnosed with acute HIV infection by means of HIV RNA viral load testing and HIV-associated thrombocytopaenia. Although his thrombocytopaenia improved immediately with short-term dexamethasone therapy, this effect was not sustained after cessation of therapy. Antiretroviral therapy including raltegravir was initiated, and the patient recovered from severe thrombocytopaenia within several days. The findings from this case suggest that acute HIV infection should be suspected with unexplained thrombocytopaenia, and that antiretroviral therapy is the treatment of choice for severe HIV-associated thrombocytopaenia, even when in the early period following acquisition of the virus. PMID:24737880

  12. Interaction of severe acute respiratory syndrome-associated coronavirus with dendritic cells

    Microsoft Academic Search

    Martin Spiegel; Kerstin Schneider; Friedemann Weber; Manfred Weidmann; Frank T. Hufert

    2006-01-01

    Severe acute respiratory syndrome (SARS) of humans is caused by a novel coronavirus of zoonotic origin termed SARS-associated coronavirus (SARS-CoV). The virus induces severe injury of lung tissue, as well as lymphopenia and destruction of the architecture of lymphatic tissue by as-yet-unknown mechanisms. In this study, the interaction of SARS-CoV with dendritic cells(DCs), the key regulators of immune responses, was

  13. The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

    PubMed Central

    Aji, Budi; Yamamoto, Shelby Suzanne; Sauerborn, Rainer

    2014-01-01

    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

  14. Association of Interleukin-8 and Neutrophils with Nasal Symptom Severity During Acute Respiratory Infection

    PubMed Central

    Henriquez, Kelsey M.; Hayney, Mary S.; Xie, Yaoguo; Zhang, Zhengjun; Barrett, Bruce

    2015-01-01

    Using a large data set (n = 811), the relationship between acute respiratory infection illness severity and inflammatory biomarkers was investigated to determine whether certain symptoms are correlated more closely than others with the inflammatory biomarkers, interleukin-8 (IL-8) and nasal neutrophils. Participants with community acquired acute respiratory infection underwent nasal lavage for IL-8 and neutrophil testing, in addition to multiplex polymerase chain reaction (PCR) methods for the detection and identification of respiratory viruses. Information about symptoms was obtained throughout the duration of the illness episode using the well-validated Wisconsin Upper Respiratory Symptom Survey (WURSS-21). Global symptom severity was calculated by the area under the curve (AUC) plotting duration versus WURSS total. Of the specimens tested, 56% were positively identified for one or more of nine different respiratory viruses. During acute respiratory infection illness, both IL-8 and neutrophils positively correlate with AUC (rs = 0.082, P = 0.022; rs = 0.080, P = 0.030). IL-8 and neutrophils correlate with nasal symptom severity: runny nose (r = 0.13, P = <0.00001; r = 0.18, P = <0.003), plugged nose (r = 0.045, P = 0.003; r = 0.14, P = 0.058), and sneezing (r = ?0.02, P = <0.0001; r = ?0.0055, P = 0.31). Neutrophils correlate with some quality of life measures such as sleeping well (r = 0.15, P = 0.026). Thus, the study demonstrates that IL-8 and neutrophils are correlated with severity of nasal symptoms during acute respiratory infection. Further research is necessary to determine if the concentration of these or other biomarkers can predict the overall duration and severity of acute respiratory infection illness. PMID:25132248

  15. A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis

    PubMed Central

    Sharma, Vishal; Rana, Surinder S.; Sharma, Ravi K.; Kang, Mandeep; Gupta, Rajesh; Bhasin, Deepak K.

    2015-01-01

    Background A number of scoring systems are available to predict prognosis in acute pancreatitis (AP). The aim of the study was to compare extra-pancreatic inflammation on computed tomography (CT) (EPIC score) and renal rim sign with clinical scores (BISAP, SIRS) and conventional CT severity index (CTSI) and modified CTSI (MCTSI) in predicting persistent organ failure (POF), intervention and mortality. Methods The demographic, clinical and radiographic data from patients with AP were retrospectively evaluated. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and area under the ROC (AUROC). Results Of the 105 patients (65 males; mean age 40.6±12.9 years) included, 8 died, 71 developed POF, and 16 needed intervention. The mean CTSI, MCTSI and EPIC scores were 5.8±3.0, 7.1±2.6 and 4.0±1.9 respectively. The AUROC for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (95%CI 0.53-0.78), 0.75 (95%CI 0.65-0.86), 0.66 (95%CI 0.54-0.78), 0.70 (95%CI 0.58-0.81), 0.64 (95%CI 0.52-0.76), 0.71 (95%CI 0.60-0.83), for radiological/endoscopic intervention were 0.50 (95%CI 0.35-0.65), 0.64 (95%CI 0.49-0.78), 0.51 (95%CI 0.36-0.66), 0.55 (95%CI 0.41-0.70), 0.51 (95%CI 0.36-0.67), 0.66 (95%CI 0.52-0.81), and for mortality 0.57 (95%CI 0.38-0.75), 0.90 (95%CI 0.83-0.97), 0.67 (95%CI 0.50-0.83), 0.68 (95%CI 0.51-0.85), 0.73 (95%CI 0.57-0.89) and 0.77 (95%CI 0.64-0.90) respectively. Conclusion The prognostic performance of various clinical and radiological scoring systems in AP is comparable with BISAP having the highest accuracy for predicting POF and mortality.

  16. Management of severe acute malnutrition in low-income and middle-income countries.

    PubMed

    Trehan, Indi; Manary, Mark J

    2015-03-01

    Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5?years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods. PMID:25421910

  17. IMPACT OF OBESITY SEVERITY AND DURATION ON PANCREATIC ?-AND ?-CELLS DYNAMICS IN NORMOGLYCEMIC NON-HUMAN PRIMATES

    PubMed Central

    Guardado-Mendoza, Rodolfo; Jimenez-Ceja, Lilia; Majluf-Cruz, Abraham; Kamath, Subhash; Fiorentino, Teresa Vanessa; Casiraghi, Francesca; Velazquez, Alberto Omar Chavez; DeFronzo, Ralph Anthony; Dick, Edward; Davalli, Alberto; Folli, Franco

    2012-01-01

    Objective Obesity is associated to high insulin and glucagon plasma levels. Enhanced ?–cell function and ?–cell expansion are responsible for insulin hypersecretion. It is unknown whether hyperglucagonemia is due to ?-cell hypersecretion or to an increase in ?-cell mass. In this study, we investigated the dynamics of the ?-cell and ?-cell function and mass in pancreas of obese normoglycemic baboons. Methods Pancreatic ?- and ?-cell volumes were measured in 51 normoglycemic baboons divided into 6 groups according to overweight severity or duration. Islets morphometric parameters were correlated to overweight and to diverse metabolic and laboratory parameters. Results Relative ?-cell volume (R?V) and relative islet ?-cell volume (RI?V) increased significantly with both overweight duration and severity. Conversely, in spite of the induction of insulin resistance, overweight produced only modest effects on relative ?-cell volume (R?V) and relative islet ?-cell volume (RI?V). Of note, RI?V did not increase neither with overweight duration nor with overweight severity, supposedly because of the concomitant, greater, increase in RI?V. Baboons' body weights correlated with serum levels of Interleukin-6 and Tumour Necrosis Factor-? soluble Receptors (IL-6sR and sTNF-R1), demonstrating that overweight induces abnormal activation of the signaling of two cytokines known to impact differently ?- and ?-cell viability and replication. Conclusion In conclusion, overweight and insulin resistance induce in baboons a significant increase in ?-cell volumes (R?V, RI?V) while have minimal effects on the ?-cells. This study suggests that an increase in the ?-cell mass may precede the loss of ?-cells and the transition to overt hyperglycemia and diabetes. PMID:23229736

  18. Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality

    PubMed Central

    Martin, Paul J.; Storb, Rainer F.; Bhatia, Smita; Maziarz, Richard T.; Pulsipher, Michael A.; Maris, Michael B.; Davis, Christopher; Deeg, H. Joachim; Lee, Stephanie J.; Maloney, David G.; Sandmaier, Brenda M.; Appelbaum, Frederick R.; Gooley, Theodore A.

    2014-01-01

    Whether the hematopoietic cell transplantation comorbidity index (HCT-CI) can provide prognostic information about development of acute graft-versus-host disease (GVHD) and subsequent mortality is unknown. Five institutions contributed information on 2985 patients given human leukocyte antigen-matched grafts to address this question. Proportional hazards models were used to estimate the hazards of acute GVHD and post-GVHD mortality after adjustment for known risk variables. Higher HCT-CI scores predicted increased risk of grades 3 to 4 acute GVHD (P < .0001 and c-statistic of 0.64), and tests of interaction suggested that this association was consistent among different conditioning intensities, donor types, and stem cell sources. Probabilities of grades 3 to 4 GVHD were 13%, 18%, and 24% for HCT-CI risk groups of 0, 1 to 4, and ?5. The HCT-CI was statistically significantly associated with mortality rates following diagnosis of grade 2 (hazard ratio [HR] = 1.24; P < .0001) or grades 3 to 4 acute GVHD (HR = 1.19; P < .0001). Patients with HCT-CI scores of ?3 who developed grades 3 to 4 acute GVHD had a 2.63-fold higher risk of mortality than those with scores of 0 to 2 and did not develop acute GVHD. Thus, pretransplant comorbidities are associated with the development and severity of acute GVHD and with post-GVHD mortality. The HCT-CI could be useful in designing trials for GVHD prevention and could inform expectations for GVHD treatment trials. PMID:24797298

  19. Relation of severe deficiency of vitamin D to cardiovascular mortality during acute coronary syndromes.

    PubMed

    Correia, Luis C L; Sodré, Fábio; Garcia, Guilherme; Sabino, Michael; Brito, Mariana; Kalil, Felipe; Barreto, Bruno; Lima, José C; Noya-Rabelo, Márcia M

    2013-02-01

    Vitamin D deficiency is associated with risk for a first cardiovascular event in the general population, possibly because of inflammation, insulin resistance, and neurohumoral activation. However, its relation with outcomes in acute coronary syndromes has not been reported. To test the hypothesis that severe deficiency of vitamin D is independently associated with cardiovascular mortality during ACS, 206 patients admitted for unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation acute myocardial infarction had 25-hydroxyvitamin D serum levels measured at admission. Severe vitamin D deficiency was defined a priori as a value ?10 ng/ml. The average concentration of vitamin D was 20 ± 8.2 ng/ml, and 10% of patients were severely deficient (95% confidence interval 6.6% to 15%). Cardiovascular mortality during hospitalization took place in 14 patients, an incidence of 6.8%. Patients with severe vitamin D deficiency had in-hospital cardiovascular mortality of 24%, significantly higher than the 4.9% observed in the remaining patients (relative risk 4.3, 95% confidence interval 1.8 to 10, p = 0.001). After adjustment for Global Registry of Acute Coronary Events (GRACE) score, Gensini angiographic score, and potential confounding variables, severe deficiency of vitamin D remained an independent predictor of in-hospital cardiovascular mortality (odds ratio 14, 95% confidence interval 1.2 to 158, p = 0.03). In conclusion, severe vitamin D deficiency is independently associated with in-hospital cardiovascular mortality in patients with acute coronary syndromes. PMID:23174181

  20. Severe Hypercalcemia: A Rare and Unusual Presentation of Childhood Acute Lymphoblastic Leukemia

    PubMed Central

    Bahoush, Gholamreza

    2014-01-01

    Hypercalcemia in children is a medical emergency and often manifests as nonspecific symptoms such as nausea, vomiting, weight loss, and anorexia. Severe hypercalcemia is a rare complication of malignancy in children, while it can be seen in various types of malignant tumors. It is usually associated with significant morbidity and may be severe enough to threaten life. Incidence of hypercalcemia in hematopoietic malignancies including acute lymphoblastic leukemia (ALL) is very rare and unusual, especially as the initial manifestation of the disease. In this paper a 6-year-old boy who had severe hypercalcemia and gastrointestinal symptoms before the onset of common and usual manifestations of ALL is introduced. PMID:24800038

  1. Minimally invasive treatment of infected pancreatic necrosis

    PubMed Central

    Cebulski, W?odzimierz; S?odkowski, Maciej; Krasnod?bski, Ireneusz W.

    2014-01-01

    Infected pancreatic necrosis is a challenging complication that worsens prognosis in acute pancreatitis. For years, open necrosectomy has been the mainstay treatment option in infected pancreatic necrosis, although surgical debridement still results in high morbidity and mortality rates. Recently, many reports on minimally invasive treatment in infected pancreatic necrosis have been published. This paper presents a review of minimally invasive techniques and attempts to define their role in the management of infected pancreatic necrosis. PMID:25653725

  2. Early Upregulation of Acute Respiratory Distress Syndrome-Associated Cytokines Promotes Lethal Disease in an Aged-Mouse Model of Severe Acute Respiratory Syndrome Coronavirus Infection

    Microsoft Academic Search

    Barry Rockx; Tracey Baas; Gregory A. Zornetzer; Bart Haagmans; Timothy Sheahan; Matthew Frieman; Matthew D. Dyer; Thomas H. Teal; Sean Proll; Judith van den Brand; Ralph Baric; Michael G. Katze

    2009-01-01

    Several respiratory viruses, including influenza virus and severe acute respiratory syndrome coronavirus (SARS-CoV), produce more severe disease in the elderly, yet the molecular mechanisms governing age-related susceptibility remain poorly studied. Advanced age was significantly associated with increased SARS-related deaths, primarily due to the onset of early- and late-stage acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. Infection of aged, but

  3. Anatomic Pathways of Peripancreatic Fluid Draining to Mediastinum in Recurrent Acute Pancreatitis: Visible Human Project and CT Study

    PubMed Central

    Xu, Haotong; Zhang, Xiaoming; Christe, Andreas; Ebner, Lukas; Zhang, Shaoxiang; Luo, Zhulin; Wu, Yi; Li, Yin; Tian, Fuzhou

    2013-01-01

    Background In past reports, researchers have seldom attached importance to achievements in transforming digital anatomy to radiological diagnosis. However, investigators have been able to illustrate communication relationships in the retroperitoneal space by drawing potential routes in computerized tomography (CT) images or a virtual anatomical atlas. We established a new imaging anatomy research method for comparisons of the communication relationships of the retroperitoneal space in combination with the Visible Human Project and CT images. Specifically, the anatomic pathways of peripancreatic fluid extension to the mediastinum that may potentially transform into fistulas were studied. Methods We explored potential pathways to the mediastinum based on American and Chinese Visible Human Project datasets. These drainage pathways to the mediastinum were confirmed or corrected in CT images of 51 patients with recurrent acute pancreatitis in 2011. We also investigated whether additional routes to the mediastinum were displayed in CT images that were not in Visible Human Project images. Principal Findings All hypothesized routes to the mediastinum displayed in Visible Human Project images, except for routes from the retromesenteric plane to the bilateral retrorenal plane across the bilateral fascial trifurcation and further to the retrocrural space via the aortic hiatus, were confirmed in CT images. In addition, route 13 via the narrow space between the left costal and crural diaphragm into the retrocrural space was demonstrated for the first time in CT images. Conclusion This type of exploration model related to imaging anatomy may be used to support research on the communication relationships of abdominal spaces, mediastinal spaces, cervical fascial spaces and other areas of the body. PMID:23614005

  4. Cross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human

    PubMed Central

    Song, Huai-Dong; Tu, Chang-Chun; Zhang, Guo-Wei; Wang, Sheng-Yue; Zheng, Kui; Lei, Lian-Cheng; Chen, Qiu-Xia; Gao, Yu-Wei; Zhou, Hui-Qiong; Xiang, Hua; Zheng, Hua-Jun; Chern, Shur-Wern Wang; Cheng, Feng; Pan, Chun-Ming; Xuan, Hua; Chen, Sai-Juan; Luo, Hui-Ming; Zhou, Duan-Hua; Liu, Yu-Fei; He, Jian-Feng; Qin, Peng-Zhe; Li, Ling-Hui; Ren, Yu-Qi; Liang, Wen-Jia; Yu, Ye-Dong; Anderson, Larry; Wang, Ming; Xu, Rui-Heng; Wu, Xin-Wei; Zheng, Huan-Ying; Chen, Jin-Ding; Liang, Guodong; Gao, Yang; Liao, Ming; Fang, Ling; Jiang, Li-Yun; Li, Hui; Chen, Fang; Di, Biao; He, Li-Juan; Lin, Jin-Yan; Tong, Suxiang; Kong, Xiangang; Du, Lin; Hao, Pei; Tang, Hua; Bernini, Andrea; Yu, Xiao-Jing; Spiga, Ottavia; Guo, Zong-Ming; Pan, Hai-Yan; He, Wei-Zhong; Manuguerra, Jean-Claude; Fontanet, Arnaud; Danchin, Antoine; Niccolai, Neri; Li, Yi-Xue; Wu, Chung-I; Zhao, Guo-Ping

    2005-01-01

    The genomic sequences of severe acute respiratory syndrome coronaviruses from human and palm civet of the 2003/2004 outbreak in the city of Guangzhou, China, were nearly identical. Phylogenetic analysis suggested an independent viral invasion from animal to human in this new episode. Combining all existing data but excluding singletons, we identified 202 single-nucleotide variations. Among them, 17 are polymorphic in palm civets only. The ratio of nonsynonymous/synonymous nucleotide substitution in palm civets collected 1 yr apart from different geographic locations is very high, suggesting a rapid evolving process of viral proteins in civet as well, much like their adaptation in the human host in the early 2002–2003 epidemic. Major genetic variations in some critical genes, particularly the Spike gene, seemed essential for the transition from animal-to-human transmission to human-to-human transmission, which eventually caused the first severe acute respiratory syndrome outbreak of 2002/2003. PMID:15695582

  5. Fatal hemorrhagic-necrotizing pancreatitis associated with pancreatic and hepatic lipidosis in an obese Asian palm civet (Paradoxurus hermaphroditus)

    PubMed Central

    Laura, Bongiovanni; Nicola, Di Girolamo; Alessandro, Montani; Leonardo, Della Salda; Paolo, Selleri

    2014-01-01

    Asian palm civets (Paradoxurus hermaphroditus), or toddy cats, belong to the family Viverridae. Little is known about the pathology of these animals and few articles have been published, mainly concerning their important role as wild reservoir hosts for severe infectious diseases of domestic animals and human beings. A 4-year-old, female Asian palm civet was found dead by the owner. At necropsy, large amount of adipose tissue was found in the subcutis and in the peritoneal cavity. Most of the pancreas appeared red, translucent. Hepatomegaly, discoloration of the liver were evident, with multifocal areas of degeneration, characterized by white nodular lesions. Histologically, the pancreas showed severe interstitial and perilobular necrosis and extensive haemorrhages, with separation of the interstitium, mild reactive inflammation at the periphery of the pancreatic lobules. Liver showed multifocal foci of vacuolar degeneration, lipidic accumulation, sometimes associated to hepatocyte necrosis. A diagnosis of acute severe hemorrhagic-necrotizing pancreatitis (or acute pancreatic necrosis) associated with pancreatic and hepatic lipidosis was made. To the best of our knowledge, this represents the first case report of acute lethal pancreatitis in an Asian palm civet. Although the exact cause of the disease remains undetermined, a hypothesis of the cause and pathogenesis is discussed, pointing out dietary indiscretion and consequent overweight as possible important risk factors. PMID:25183148

  6. Acute Toxicity of Zinc to Several Aquatic Species Native to the Rocky Mountains

    Microsoft Academic Search

    Stephen F. BrinkmanWalter; Walter D. Johnston

    National water-quality criteria for the protection of aquatic life are based on toxicity tests, often using organisms that\\u000a are easy to culture in the laboratory. Species native to the Rocky Mountains are poorly represented in data sets used to derive\\u000a national water-quality criteria. To provide additional data on the toxicity of zinc, several laboratory acute-toxicity tests\\u000a were conducted with a

  7. Isolation of inhibitory RNA aptamers against severe acute respiratory syndrome (SARS) coronavirus NTPase\\/Helicase

    Microsoft Academic Search

    Kyoung Jin Jang; Na-Ra Lee; Woon-Seok Yeo; Yong-Joo Jeong; Dong-Eun Kim

    2008-01-01

    Recent outbreak of Severe Acute Respiratory Syndrome (SARS) that caused almost 800 victims requires a development of efficient inhibitor against SARS coronavirus (SCV). In this study, RNA aptamers against SCV NTPase\\/Helicase (nsP10) were isolated from RNA library containing random sequences of 40 nts using in vitro selection technique. Nucleotide sequences of enriched RNA aptamer pool (ES15 RNA) contain AG-rich conserved

  8. Inhaled iloprost is a potent acute pulmonary vasodilator in HIV-related severe pulmonary hypertension

    Microsoft Academic Search

    H. A. Ghofrani; G. Friese; T. Discher; H. Olschewski; R. T. Schermuly; N. Weissmann; W. Seeger; F. Grimminger; J. Lohmeyer

    2004-01-01

    Inhaled iloprost is a potent acute pulmonary vasodilator in HIV-related severe pulmonary hypertension. H.A. Ghofrani, G. Friese, T. Discher, H. Olschewski, R.T. Schermuly, N. Weissmann, W. Seeger, F. Grimminger, J. Lohmeyer. #ERS Journals Ltd 2004. ABSTRACT: As antiretroviral therapy has improved life expectancy in human immunodeficiency virus (HIV) infection, the life-limiting complication of HIV-related pulmonary hypertension has come into focus.

  9. SITE DIRECTED MUTAGENESIS OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) CORONAVIRUS NSP 15 ENDORIBONUCLEASE

    E-print Network

    Baig, Kimberlyn Maravet

    2006-08-16

    SITE DIRECTED MUTAGENESIS OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) CORONAVIRUS NSP 15 ENDORIBONUCLEASE A Senior Honors Thesis by K. Maravet Baig Submitted to the Office of Honors Programs & Academic Scholarships Texas A... SYNDROME (SARS) CORONAVIRUS NSP 15 ENDORIBONUCLEASE A Senior Honors Thesis by K. Maravet Baig Submitted to the Office of Honors Programs & Academic Scholarships Texas A&M University in partial fulfillment of the requirements...

  10. Severe acute respiratory syndrome coronavirus spike protein expressed by attenuated vaccinia virus protectively immunizes mice

    Microsoft Academic Search

    Himani Bisht; Anjeanette Roberts; Leatrice Vogel; Alexander Bukreyev; Peter L. Collins; Brian R. Murphy; Kanta Subbarao; Bernard Moss

    2004-01-01

    The spike protein (S), a membrane component of severe acute respiratory syndrome coronavirus (SARS-CoV) is anticipated to be an important component of candidate vaccines. We constructed recombinant forms of the highly attenuated modified vaccinia virus Ankara (MVA) containing the gene encoding full-length SARS-CoV S with and without a C-terminal epitope tag called MVA\\/S-HA and MVA\\/S, respectively. Cells infected with MVA\\/Sor

  11. Severe acute respiratory syndrome caused by the influenza A (H1N1) virus.

    PubMed

    Ribeiro, Sandra Aparecida; Brasileiro, Graziela Sgreccia; Soleiman, Luciana Novaes Campello; Silva, Cristiano Cruz; Kavaguti, Cláudio Shoki

    2010-01-01

    In view of the pandemic caused by a new virus, influenza A (H1N1), we report the case of a 56-year-old patient without relevant risk factors and with severe acute respiratory syndrome resulting from infection with this virus. We present the results of laboratory tests and the imaging findings (chest X-ray and CT scans). The evolution was favorable, and the patient was discharged after 14 days. PMID:20625677

  12. Clinical Factors and Viral Load Influencing Severity of Acute Hepatitis A

    PubMed Central

    Lee, Hyun Woong; Chang, Dong-Yeop; Moon, Hong Ju; Chang, Hye Young; Shin, Eui-Cheol; Lee, June Sung; Kim, Kyung-Ah; Kim, Hyung Joon

    2015-01-01

    Background and Aims Clinical manifestations of hepatitis A virus (HAV) infection vary from mild to fulminant hepatic failure (FHF) in adults. We investigated the relationship between laboratory findings, including viral load, and clinical outcomes in patients with acute hepatitis A (AHA) and evaluated predictive factors for severe acute hepatitis (s-AH). Methods We analyzed the clinical manifestations of AHA in 770 patients. Patients with a prothrombin time (PT) of less than 40% of normal were classified as s-AH and included 4 patients with FHF, 11 patients with acute renal failure, and 3 patients with prolonged jaundice (n = 128). Other patients were defined as mild acute hepatitis (m-AH) (n = 642). Serum samples were obtained from 48 patients with acute hepatitis A. Among them, 20 with s-AH, and 28 with m-AH, were tested for HAV RNA titer. Results In a multivariate analysis, age (HR = 1.042, P = 0.041), peak creatinine (HR = 4.014, P = 0.001), bilirubin (HR = 1.153, P = 0.003), alanine aminotransferase (ALT) (HR = 1.001, P<0.001), initial lactate dehydrogenase (LDH) (HR = 1.000, P = 0.045) and total cholesterol (HR = 0.978, P<0.001) were independent factors for s-AH. Serum HAV RNA was detected in 20/20 (100%) patients with s-AH and 22/28 (78.6%) patients with m-AH. In a multivariate analysis of the 48 patients who were tested for HAV RNA, peak ALT (HR = 1.001, P = 0.004) and HAV RNA titer (HR = 2.076, P = 0.012) were independent factors for s-AH. Conclusions Clinical factors including age, peak creatinine, bilirubin, ALT, initial LDH and total cholesterol were independent factors for s-AH in a multivariate analysis. In particular, HAV load strongly correlated with the severity of hepatitis A. PMID:26090677

  13. Tapentadol immediate release for the relief of moderate-to-severe acute pain.

    PubMed

    Hartrick, Craig T

    2009-11-01

    Tapentadol is a novel, centrally acting analgesic with two mechanisms of action: micro-opioid receptor agonism and norepinephrine reuptake inhibition. It has demonstrated broad analgesic efficacy across multiple pain models. This article reviews the clinical development of tapentadol immediate release (IR), including results from Phase II and III clinical trials that evaluated the efficacy and safety of tapentadol IR in patients with moderate-to-severe acute pain. In clinical studies in patients with moderate-to-severe acute postoperative pain, osteoarthritis pain and/or low back pain, tapentadol IR 50, 75 or 100 mg every 4 - 6 h has demonstrated analgesic efficacy similar to that observed with the micro-opioid receptor agonist oxycodone HCl IR 10 or 15 mg every 4 - 6 h. However, at doses providing comparable analgesic efficacy, tapentadol IR has been associated with significantly lower incidences of nausea and/or vomiting and constipation, and a significantly lower rate of treatment discontinuation compared with oxycodone IR. The observed efficacy across different pain models and favorable gastrointestinal tolerability profile associated with tapentadol IR indicate that this novel analgesic is an attractive treatment option for the relief of moderate-to-severe acute pain. PMID:19795998

  14. Acute-phase proteins in pregnant Sudanese women with severe Plasmodium falciparum malaria.

    PubMed

    Saad, Alfarazdeg A; Mohamed, Omar E; Ali, Abdelaziem A; Bashir, Ahmed M; Ali, Naji I; Elbashir, Mustafa I; Adam, Ishag

    2012-09-01

    A case-control study was carried out in Kassala and Medani Maternity Hospitals in Sudan to investigate acute-phase proteins [haptoglobin, C-reactive protein (CRP), ferritin and albumin] in three groups of pregnant women (32 in each arm) comprising those with severe Plasmodium falciparum malaria or uncomplicated P. falciparum malaria and healthy controls. Whilst there was no significant difference in the levels of albumin and haptoglobin, ferritin and CRP levels were significantly higher in pregnant women with severe P. falciparum malaria. There were significant positive correlations between parasite count and haptoglobin, and medium positive correlations between parasite count and CRP. PMID:22818740

  15. Descriptive review of geographic mapping of severe acute respiratory syndrome (SARS) on the Internet

    PubMed Central

    Boulos, Maged N Kamel

    2004-01-01

    From geographic mapping at different scales to location-based alerting services, geoinformatics plays an important role in the study and control of global outbreaks like severe acute respiratory syndrome (SARS). This paper reviews several geographic mapping efforts of SARS on the Internet that employ a variety of techniques like choropleth rendering, graduated circles, graduated pie charts, buffering, overlay analysis and animation. The aim of these mapping services is to educate the public (especially travellers to potentially at-risk areas) and assist public health authorities in analysing the spatial and temporal trends and patterns of SARS and in assessing/revising current control measures. PMID:14748926

  16. Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after 'magic mushroom' abuse.

    PubMed

    Bickel, Markus; Ditting, Tilmann; Watz, Henrik; Roesler, Alexander; Weidauer, Stefan; Jacobi, Volkmar; Gueller, Saskia; Betz, Christoph; Fichtlscherer, Stephan; Stein, Juergen

    2005-12-01

    We report the case of a 25-year-old, hepatitis C-infected man, who presented with severe rhabdomyolysis and acute renal failure, and later developed posterior encephalopathy with cortical blindness after the ingestion of magic mushrooms. Conventional respiratory and cardiovascular support including mechanical ventilation, continuous veno-venous hemodialysis and corticosteroids led to improvement and the patient recovered completely over the following months. Magic mushrooms are becoming increasingly fashionable among drug users, as they are believed to be more harmless than other hallucinogenic designer drugs. So far, little is known about their possible severe side effects. PMID:16276262

  17. Major histocompatibility complex gene product expression on pancreatic beta cells in acutely diabetic BB rats.

    PubMed Central

    Issa-Chergui, B.; Yale, J. F.; Vigeant, C.; Seemayer, T. A.

    1988-01-01

    Type I diabetes mellitus was induced in young, diabetes-prone BB rats by the passive transfer of concanavalin A-activated T lymphocytes from the spleens of acutely diabetic BB rats. The pancreas of the recipients was examined 1-2 days after the onset of glycosuria by immunocytochemistry by means of monoclonal antibodies for determining whether 1) Class I and/or II major histocompatibility gene complex (MHC) products were expressed on beta cells and 2) the mononuclear cell infiltrates were represented by T cells. Marked expression of Class I MHC gene products was evident on beta cells. In contrast, Class II MHC gene products were not identified on normal-appearing beta cells. Dendritic cells dispersed throughout the acinar and interstitial pancreas were markedly increased in number. The mononuclear cell infiltrate contained few cells (1-15%) recognized by a pan-T cell marker. Although it is possible that this passive transfer model might differ considerably from the spontaneously occurring diabetic state in the rat, this study suggests that 1) Class I, rather than Class II, MHC gene expression may be pivotal to beta-cell injury in diabetic rats, and 2) non-T cells may constitute an effector cell population central to beta-cell necrosis in Type I diabetes mellitus. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:3276208

  18. Does virus-bacteria coinfection increase the clinical severity of acute respiratory infection?

    PubMed

    Damasio, Guilherme A C; Pereira, Luciane A; Moreira, Suzana D R; Duarte Dos Santos, Claudia N; Dalla-Costa, Libera M; Raboni, Sonia M

    2015-09-01

    This retrospective cohort study investigated the presence of bacteria in respiratory secretions of patients hospitalized with acute respiratory infections and analyzed the impact of viral and bacterial coinfection on severity and the mortality rate. A total of 169 patients with acute respiratory infections were included, viruses and bacteria in respiratory samples were detected using molecular methods. Among all samples, 73.3% and 59.7% were positive for viruses and bacteria, respectively; 45% contained both virus and bacteria. Bacterial coinfection was more frequent in patients infected by community respiratory viruses than influenza A H1N1pdm (83.3% vs. 40.6%). The most frequently bacteria detected were Streptococcus pneumoniae and Haemophilus influenzae. Both species were co-detected in 54 patients and identified alone in 22 and 21 patients, respectively. Overall, there were no significant differences in the period of hospitalization, severity, or mortality rate between patients infected with respiratory viruses alone and those coinfected by viruses and bacteria. The detection of mixed respiratory pathogens is frequent in hospitalized patients with acute respiratory infections, but its impact on the clinical outcome does not appear substantial. However, it should be noted that most of the patients received broad-spectrum antibiotic therapy, which may have contributed to this favorable outcome. J. Med. Virol. 87:1456-1461, 2015. © 2015 Wiley Periodicals, Inc. PMID:25976175

  19. Magnetic resonance imaging of pancreatitis: An update

    PubMed Central

    Manikkavasakar, Sriluxayini; AlObaidy, Mamdoh; Busireddy, Kiran K; Ramalho, Miguel; Nilmini, Viragi; Alagiyawanna, Madhavi; Semelka, Richard C

    2014-01-01

    Magnetic resonance (MR) imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as non-ionizing nature and higher safety profile of intravascular contrast media, making it particularly valuable in radiosensitive populations such as pregnant patients, and patients with recurrent pancreatitis requiring multiple follow-up examinations. Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis. This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis, pancreatitis complications and other important differential diagnoses that mimic pancreatitis. PMID:25356038

  20. Cyclophosphamide-Induced Severe Acute Hyponatremic Encephalopathy in Patients with Breast Cancer: Report of Two Cases

    PubMed Central

    Baker, Michelle; Markman, Maurie; Niu, Jiaxin

    2014-01-01

    Abstract Background Cyclophosphamide is an alkylating agent widely used in antineoplastic and immunosuppressive therapies. Symptomatic hyponatremia can be a rare but life-threatening complication in patients treated with cyclophosphamide. Case Presentations We report 2 patients who presented with severe acute hyponatremic encephalopathy after receiving their first cycles of a low-dose cyclophosphamide-containing regimen for breast cancer. In case 1, a 58-year-old female received the combination of docetaxel and cyclophosphamide, and in case 2, a 56-year-old female received the combination of doxorubicin and cyclophosphamide. Both patients recovered after correction of their serum sodium concentration without neurological deficits. Future cycles of chemotherapy were well tolerated without recurrence of hyponatremia after cyclophosphamide was discontinued from the respective regimens. Conclusion Clinicians must always keep in mind that acute hyponatremic encephalopathy can be induced by low-dose cyclophosphamide. PMID:25232325

  1. A Case of Severe Acute Kidney Injury by Near-Drowning

    PubMed Central

    Rhee, Harin; Lee, Naria; Lee, Sung Jun; Song, Sang Heon; Lee, Dong Won; Lee, Soo Bong; Sol, Mee Young; Kwak, Ihm Soo

    2012-01-01

    Acute kidney injury (AKI) secondary to near-drowning is rarely described and poorly understood. Only few cases of severe isolated AKI resulting from near-drowning exist in the literature. We report a case of near-drowning who developed to isolated AKI due to acute tubular necrosis (ATN) requiring dialysis. A 21-yr-old man who recovered from near-drowning in freshwater 3 days earlier was admitted to our hospital with anuria and elevated level of serum creatinine. He needed five sessions of hemodialysis and then renal function recovered spontaneously. Renal biopsy confirmed ATN. We review the existing literature on near-drowning-induced AKI and discuss the possible pathogenesis. PMID:22323873

  2. Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis.

    PubMed

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative. PMID:25215245

  3. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    PubMed Central

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative. PMID:25215245

  4. Hypertriglyceridaemia and abnormalities of triglyceride catabolism persisting after pancreatitis

    Microsoft Academic Search

    P. N. Durrington; O. P. Twentyman; J. M. Braganza; J. P. Miller

    1986-01-01

    Thirty-three patients referred consecutively following an attack of pancreatitis at least six weeks earlier (acute pancreatitis\\u000a in 10 patients and chronic pancreatitis in 23 patients) had an intravenous fat tolerance test to determine their capacity\\u000a to catabolise circulating triglycerides. Hypertriglyceridaemia was present in 14 patients (42%), including 5 with acute pancreatitis\\u000a and 9 with chronic pancreatitis. the highest serum triglyceride

  5. Urgent transcatheter aortic valve replacement for severe aortic valve stenosis with acute decompensated heart failure: report of a case.

    PubMed

    Kashiyama, Noriyuki; Kuratani, Toru; Torikai, Kei; Maeda, Koichi; Toda, Koichi; Miyagawa, Shigeru; Nishi, Hiroyuki; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Saito, Tetsuya; Sawa, Yoshiki

    2015-07-01

    Recent evidence suggests that transcatheter aortic valve replacement (TAVR) is feasible for treating severe aortic valve stenosis (AS) in patients who are considered high risk for elective surgery. However, it is still unclear whether TAVR is a better option than surgical aortic valve replacement for severe AS with acute decompensated heart failure. We report a case of severe AS with acute heart failure, which was treated successfully by urgent TAVR, with cardiopulmonary support. PMID:25358893

  6. Short Communication: Is Ethanol-Based Hand Sanitizer Involved in Acute Pancreatitis after Excessive Disinfection?—An Evaluation with the Use of PBPK Model

    PubMed Central

    Huynh-Delerme, Céline; Artigou, Catherine; Bodin, Laurent; Tardif, Robert; Charest-Tardif, Ginette; Verdier, Cécile; Sater, Nessryne; Ould-Elhkim, Mostafa; Desmares, Catherine

    2012-01-01

    An occupational physician reported to the French Health Products Safety Agency (Afssaps) a case of adverse effect of acute pancreatitis (AP) in a teaching nurse, after multiple demonstrations with ethanol-based hand sanitizers (EBHSs) used in a classroom with defective mechanical ventilation. It was suggested by the occupational physician that the exposure to ethanol may have produced a significant blood ethanol concentration and subsequently the AP. In order to verify if the confinement situation due to defective mechanical ventilation could increase the systemic exposure to ethanol via inhalation route, a physiologically based pharmacokinetic (PBPK) modeling was used to predict ethanol blood levels. Under the worst case scenario, the simulation by PBPK modeling showed that the maximum blood ethanol concentration which can be predicted of 5.9?mg/l is of the same order of magnitude to endogenous ethanol concentration (mean = 1.1?mg/L; median = 0.4?mg/L; range = 0–35?mg/L) in nondrinker humans (Al-Awadhi et al., 2004). The present study does not support the likelihood that EBHS leads to an increase in systemic ethanol concentration high enough to provoke an acute pancreatitis. PMID:22577377

  7. Severity of psychotic episodes in predicting concurrent depressive and anxiety features in acute phase schizophrenia

    PubMed Central

    2014-01-01

    Background Considering that depressive and anxiety symptoms are common in schizophrenia, this study investigated whether the severity of a psychotic episode in an acute phase schizophrenia cohort is predictive of concurrent depressive and anxiety features. Method Fifty one recently hospitalised patients suffering from acute phase schizophrenia participated prospectively in a cross-sectional study. The severity of the psychotic episode, the depressive features and the anxiety features were measured by the Structured Clinical Interview for Positive and Negative Syndrome Scale (SCI-PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Anxiety Rating Scale (HAM-A) and the Staden Schizophrenia Anxiety Rating Scale (S-SARS). The total SCI-PANSS-scores were adjusted to exclude appropriately the depression or anxiety items contained therein. To examine akathisia as potential confounder, the Barnes Akathisia Scale was also applied. The relationships were examined using linear regressions and paired t-tests were performed between lower and higher scores on the SCI-PANSS. Results A higher adjusted total SCI-PANSS-score predicted statistically significantly higher scores for depressive features on the CDSS (p?severity of a psychotic episode in acute phase schizophrenia predicts the severity of concurrent depressive and anxiety features respectively. PMID:24903304

  8. PANCREATIC CANCER 14. PANCREATIC CANCER

    E-print Network

    Paxton, Anthony T.

    PANCREATIC CANCER 125 14. PANCREATIC CANCER 14.1. SUMMARY Pancreatic cancer was the eleventh most increase of approximately 4% per annum. The risk of developing pancreatic cancer up to the age of 74 was 1 their pancreatic cancer diagnosis. Table 14.1 Summary information for pancreatic cancer in Ireland, 1995

  9. Intrapancreatic communication of bile and pancreatic ducts secondary to pancreatic necrosis.

    PubMed

    Miller, B M; Traverso, L W; Freeny, P C

    1988-08-01

    An unusual complication of acute necrotizing pancreatitis occurred in which erosion of the intrapancreatic common bile duct and cephalic pancreatic duct formed a pancreaticobiliary cavity. This pancreatic process was observed to enhance during contrast computed tomography and was hypervascular during angiography, making preoperative diagnosis difficult. To our knowledge, the spontaneous development of such a cavity as a complication of acute pancreatitis has not been reported. The patient was successfully treated with pancreaticoduodenectomy. PMID:3395229

  10. Lamivudine treatment failure in preventing fatal outcome of de novo severe acute hepatitis B in patients with haematological diseases

    Microsoft Academic Search

    Enzo Petrelli; Maria Balducci; Carlo Pieretti; Marco B. Luigi Rocchi; Massimo Clementi; Aldo Manzin

    2001-01-01

    Background: Patients with malignant haematological diseases administered or no longer receiving immunosuppressive therapy are at high risk of reactivation or de novo hepatitis B infection and fulminant hepatitis. Despite promising results in the treatment of chronic hepatitis and its use in selected patients with acute hepatitis B, there is no consensus on lamivudine treatment in severe acute hepatitis portending a

  11. Vaccines to prevent severe acute respiratory syndrome coronavirus-induced disease

    PubMed Central

    Enjuanes, Luis; DeDiego, Marta L.; Álvarez, Enrique; Deming, Damon; Sheahan, Tim; Baric, Ralph

    2009-01-01

    An important effort has been performed after the emergence of severe acute respiratory syndrome (SARS) epidemic in 2003 to diagnose and prevent virus spreading. Several types of vaccines have been developed including inactivated viruses, subunit vaccines, virus-like particles (VLPs), DNA vaccines, heterologous expression systems, and vaccines derived from SARS-CoV genome by reverse genetics. This review describes several aspects essential to develop SARS-CoV vaccines, such as the correlates of protection, virus serotypes, vaccination side effects, and bio-safeguards that can be engineered into recombinant vaccine approaches based on the SARS-CoV genome. The production of effective and safe vaccines to prevent SARS has led to the development of promising vaccine candidates, in contrast to the design of vaccines for other coronaviruses, that in general has been less successful. After preclinical trials in animal models, efficacy and safety evaluation of the most promising vaccine candidates described has to be performed in humans. PMID:17416434

  12. Managing severe acute respiratory syndrome (SARS) intellectual property rights: the possible role of patent pooling.

    PubMed Central

    Simon, James H. M.; Claassen, Eric; Correa, Carmen E.; Osterhaus, Albert D. M. E.

    2005-01-01

    Patent applications that incorporate the genomic sequence of the severe acute respiratory syndrome (SARS) coronavirus, have been filed by a number of organizations. This is likely to result in a fragmentation of intellectual property (IP) rights which in turn may adversely affect the development of products, such as vaccines, to combat SARS. Placing these patent rights into a patent pool to be licensed on a non-exclusive basis may circumvent these difficulties and set a key precedent for the use of this form of mechanism in other areas of health care, leading to benefits to public health. PMID:16211163

  13. Emerging infections and pregnancy: West Nile virus, monkeypox, severe acute respiratory syndrome, and bioterrorism.

    PubMed

    Jamieson, Denise J; Jernigan, Daniel B; Ellis, Jane E; Treadwell, Tracee A

    2005-09-01

    As new infectious diseases, such as West Nile virus, monkeypox, and severe acute respiratory syndrome (SARS) are recognized in the United States, there are critical questions about how these infectious diseases will affect pregnant women and their infants. In addition, the implications of bioterrorist attacks for exposed pregnant women need to be considered. In this article, the authors address the following questions for a number of infectious disease threats: (1) does pregnancy affect the clinical course of these novel infectious diseases?, (2) what are the implications for prophylaxis and treatment of exposed or infected pregnant women?, and (3) are these novel infectious diseases transmitted during pregnancy, labor and delivery, or breastfeeding? PMID:16085032

  14. Severe Hypercalcemia and Acute Renal Failure: An Unusual Presentation of Sarcoidosis

    PubMed Central

    Karnchanasorn, Rudruidee; Sarikonda, Molly; Aldasouqi, Saleh; Gossain, Ved V.

    2010-01-01

    Although hypercalcemia is a known metabolic complication of sarcoidosis, it is rarely a presenting manifestation. Long-standing hypercalcemia and hypercalciuria can cause nephrocalcinosis and chronic renal failure. Acute renal failure, although described, is also a rare presentation of patients with sarcoidosis. We describe two patients with sarcoidosis, who presented with severe hypercalcemia and worsening renal function. Parathyroid hormone levels were appropriately suppressed. This led to an extensive search for the cause of hypercalcemia. Finally, after a lymph node biopsy in both cases, a diagnosis of sarcoidosis was established, hypercalcemia resolved, and r