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1

Acute Pancreatitis Complicating Severe Dengue  

PubMed Central

Dengue is an arthropod borne viral infection endemic in tropical and subtropical continent. Severe dengue is life threatening. Various atypical presentations of dengue have been documented. But we present a rare and fatal complication of severe dengue in form of acute pancreatitis. A 27-year-old male had presented with severe dengue in decompensated shock and with pain in abdomen due to pancreatitis. The pathogenesis of acute pancreatitis in dengue is not clearly understood, but various mechanisms are postulated. The awareness and timely recognition of this complication is very important for proper management.

Jain, Vishakha; Gupta, OP; Rao, Tarun; Rao, Siddharth

2014-01-01

2

[Sepsis in acute severe pancreatitis].  

PubMed

Retrospective analysis of 99 consecutive cases of acute severe pancreatitis established presence of systemic inflammation in all patients. Magnitude of acute phase response was characterised by C-reactive protein and Interleukin-6 values. Progression to multiple organ failure raised considerably lethality. Failure developed more frequently in respiratory system, liver and kidneys. General mortality was 38,4%. PMID:16927913

Hotineanu, V F; Balica, I M; Bogdan, V I

2006-01-01

3

Intensive medical treatment of severe acute pancreatitis  

Microsoft Academic Search

Therapeutic measurements for acute pancreatitis depend on the severity of the disease and its complications. Since complications of acute pancreatitis may develop at any time, patients should be admitted to an intensive care unit for assessment (and frequent reassessment) of the severity of the disease and of the development of complications; they should remain in the intensive care unit for

Werner Creutzfeldt; Paul G. Lankisch

1981-01-01

4

Metabolic Management of Severe Acute Pancreatitis  

Microsoft Academic Search

.   The metabolic management of severe acute pancreatitis involves early identification of patients with severe pancreatitis,\\u000a aggressive fluid resuscitation, organ support, and careful monitoring in an intensive care environment. Recent evidence has\\u000a helped to define the roles of enteral feeding, prophylactic antibiotics, endoscopic retrograde cholangiopancreatography, computed\\u000a tomography, and fine-needle aspiration for bacteriology. The most difficult decision in the management of

John A. Windsor; Hisham Hammodat

2000-01-01

5

Octreotide Treatment in Patients with Severe Acute Pancreatitis  

Microsoft Academic Search

We investigated the effect of octreotide in the treatment of severe acute pancreatitis in a case–control study. Experimental and clinical studies on the effect of octreotide in the treatment of acute pancreatitis have shown controversial results. Since January 1992, we have been conducting a prospective randomized study on the effect of octreotide in severe acute pancreatitis, in three hospitals in

Haim Paran; Ami Mayo; Daphna Paran; David Neufeld; Ivan Shwartz; Rika Zissin; Pierre Singer; Ofer Kaplan; Yehuda Skornik; Uri Freund

2000-01-01

6

Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis  

PubMed Central

Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early stage of SAP.

Tsuji, Yoshihisa; Takahashi, Naoki; Tsutomu, Chiba

2012-01-01

7

Severe Acute Pancreatitis: Case-Oriented Discussion of Interdisciplinary Management  

Microsoft Academic Search

The clinical course of an episode of acute pancreatitis varies from a mild, transitory illness to a severe often necrotizing form with distant organ failure and a mortality rate of 20–40%. Patients with severe pancreatitis, representing about 15–20% of all patients with acute pancreatitis, need to be identified as early as possible after onset of symptoms allowing starting intensive care

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

2005-01-01

8

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

Microsoft Academic Search

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

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

2007-01-01

9

[Selenium supplementation in patients with severe acute pancreatitis].  

PubMed

Selenium supplementation improves antioxidant status in critically ill patients with severe acute pancreatitis. It depends on quantum of dosage and supplementation time. The aim of this analysis is point out on benefit of antioxidant therapy by supplementing selenium. Methods: Patient with severe acute pancreatitis and developing septic shock was admitted on anesthesiology and intensive care department. Adjuvant supplementation therapy with selenium was started in continual infusion 750 mg/24 h during next six days. Activity of antioxidant enzyme glutathione peroxidase and others inflammatory markers were decrease. A case report presents the possibility to affect on systemic inflammatory response syndrome pathogenesis in initial phase. It has to improve therapeutic progress in patients with severe acute pancreatitis. PMID:21121149

Kocan, L; Firment, J; Simonová, J; Vasková, J; Guzy, J

2010-08-01

10

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

Microsoft Academic Search

BACKGROUND: Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis. METHODS: In this multicentre randomised, double-blind, placebo-controlled trial, 298 patients with predicted severe acute pancreatitis (Acute Physiology

Marc GH Besselink; Hjalmar C van Santvoort; Erik Buskens; Marja A Boermeester; Harry van Goor; Harro M Timmerman; Vincent B Nieuwenhuijs; Thomas L Bollen; Bert van Ramshorst; Ben JM Witteman; Camiel Rosman; Rutger J Ploeg; Menno A Brink; Alexander FM Schaapherder; Cornelis HC Dejong; Peter J Wahab; Cees JHM van Laarhoven; Erwin van der Harst; Casper HJ van Eijck; Miguel A Cuesta; Louis MA Akkermans; Hein G Gooszen

2008-01-01

11

Treatment in severe acute pancreatitis - still a reason of debate  

PubMed Central

Abstract Surgical therapy in severe acute pancreatitis significantly evolved in the last 10 to 20 years. The aim was to present the experience of the First Surgery Clinic within the University Emergency Hospital Bucharest, in the management of severe acute pancreatitis, following major etiopathogenic, diagnostic and treatment aspects. Our study was retrospective, longitudinal and descriptive, including a seven years period, between 2004 and 2010. 42 patients diagnosed with severe acute pancreatitis have been admitted and operated. 25 were male, representing 59,52% and 17 female, respectively 40,47%. 55% of the patients were operated more than 11 days after the hospitalization, 25% were operated in the 4 to 10 days interval and 20% were operated in emergency conditions: immediate emergency (first 24 hours) or delayed emergency (24–72 hours). Mortality reported to the moment of surgery was 60% for the patients operated in the first 24 hours, 66,67% for the 24-72 hours operation interval, 30% for the patients operated between 4-10 days from the admission and 18,18% for operations performed after more than 11 days . Conclusion: mortality significantly decreased when the surgical moment was postponed by using intensive therapy, over 11 days from admission. We reconfirm the optimal temporization attitude of surgery, until the infection of necrosis or appearance of pancreatic abscess.

Popa, D

2013-01-01

12

Effect of resveratrol on pancreatic oxygen free radicals in rats with severe acute pancreatitis  

PubMed Central

AIM: To investigate the therapeutic effects of resveratrol (RESV) as a free radical scavenger on experimental severe acute pancreatitis (SAP). METHODS: Seventy-two male Sprague–Dawley rats were divided randomly into sham operation group, SAP group, and resveratrol-treated group. Pancreatitis was induced by intraductal administration of 0.1 mL/kg 4% sodium taurocholate. RESV was given intravenously at a dose of 20 mg/kg body weight. All animals were killed at 3, 6, 12 h after induction of the model. Serum amylase, pancreatic superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO) were determined. Pathologic changes of the pancreas were observed under optical microscope. RESULTS: The serum amylase, pancreatic MPO and the score of pathologic damage increased after the induction of pancreatitis, early (3, 6 h) SAP samples were characterized by decreased pancreatic SOD and increased pancreatic MDA. Resveratrol exhibited a protective effect against lipid peroxidation in cell membrane caused by oxygen free radicals in the early stage of SAP. This attenuation of the redox state impairment reduced cellular oxidative damage, as reflected by lower serum amylase, less severe pancreatic lesions, normal pancreatic MDA levels, as well as diminished neutrophil infiltration in pancreas. CONCLUSION: RESV may exert its therapeutic effect on SAP by lowering pancreatic oxidative free radicals and reducing pancreatic tissue infiltration of neutrophils.

Li, Zhen-Dong; Ma, Qing-Yong; Wang, Chang-An

2006-01-01

13

A randomised, double blind, multicentre trial of octreotide in moderate to severe acute pancreatitis  

Microsoft Academic Search

BACKGROUNDThe pharmacological inhibition of exocrine pancreatic secretion with the somatostatin analogue octreotide has been advocated as a specific treatment of acute pancreatitis.AIMTo investigate the efficacy of octreotide in acute pancreatitis in a randomised, placebo controlled trial.METHODS302 patients from 32 hospitals, fulfilling the criteria for moderate to severe acute pancreatitis within 96 hours of the onset of symptoms, were randomly assigned

W Uhl; M W Büchler; P Malfertheiner; H G Beger; G Adler; W Gaus

1999-01-01

14

The impact of oral feeding on the severity of acute pancreatitis  

Microsoft Academic Search

Background: In the management of acute pancreatitis, oral feeding is prohibited and either enteral or parenteral feeding is commenced for the patients in an effort to not increase the secretion of the pancreatic enzymes.Purpose: This study was undertaken in an attempt to determine the impact of oral feeding on the severity of acute pancreatitis and to compare this impact with

Mustafa ?ahin; ?ükrü Özer; Celalettin Vatansev; Mehmet Aköz; Hüsamettin Vatansev; Faruk Aksoy; Alaattin Dilsiz; Osman Yilmaz; Mehmet Karademir; Murat Aktan

1999-01-01

15

Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report  

PubMed Central

Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

de Oliveira, Cassio Vieira; Moreira, Alecsandro; Baima, Julio P; Franzoni, Leticia de C; Lima, Talles B; Yamashiro, Fabio da S; Coelho, Kunie Yabuki Rabelo; Sassaki, Ligia Y; Caramori, Carlos Antonio; Romeiro, Fernando G; Silva, Giovanni F

2014-01-01

16

Survival after profound hypocalcaemia with tetany complicating severe haemorrhagic acute pancreatitis.  

PubMed Central

A patient is reported who developed severe haemorrhagic pancreatitis, without hyperamylasemia, which was complicated by gross hypocalcaemia presenting as tetany. Tetany is very uncommon in acute pancreatitis and is a grave prognostic indicator, recovery being exceptionally rare. The mechanisms responsible for disordered calcium homeostasis associated with acute pancreatitis are reviewed. CT scanning was an important feature of this patient's management and its role in severe pancreatitis is discussed. Images Figure 1

Jones, P. A.

1985-01-01

17

Effect of IL4 on altered expression of complement activation regulators in rat pancreatic cells during severe acute pancreatitis  

Microsoft Academic Search

AIM: To investigate the effect of IL-4 on the altered ex- pression of complement activation regulators in pancreas and pancreatic necrosis during experimental severe acute pancreatitis (SAP). METHODS: SAP model of rats was established by ret- rograde injection of 5% sodium taurocholate (1 mL\\/kg) into the pancreatic duct. We immunohistochemically assayed the expression of three complement activation regulators: decay accelerating

Cheng Zhang; Chun-Lin Ge; Ren-Xuan Guo; San-Guang He

18

A Prospective Evaluation of the Bedside Index for Severity in Acute Pancreatitis Score in Assessing Mortality and Intermediate Markers of Severity in Acute Pancreatitis  

Microsoft Academic Search

OBJECTIVES:Our aim was to prospectively evaluate the ability of the bedside index for severity in acute pancreatitis (BISAP) score to predict mortality as well as intermediate markers of severity in a tertiary center.METHODS:The BISAP score was evaluated among 397 consecutive cases of acute pancreatitis admitted to our institution between June 2005 and December 2007. BISAP scores were calculated on all

Vikesh K Singh; Bechien U Wu; Thomas L Bollen; Kathryn Repas; Rie Maurer; Richard S Johannes; Koenraad J Mortele; Darwin L Conwell; Peter A Banks

2009-01-01

19

Health insurance and payment systems for severe acute pancreatitis.  

PubMed

The medical insurance system of Japan is based on the Universal Medical Care System guaranteed by the provision of the Article 25 of the Constitution of Japan, which states that "All the people shall have the right to live a healthy, cultural and minimum standard of life." The health insurance system of Japan comprises the medical insurance system and the health care system for the long-lived. Medical care insurance includes the employees' health insurance (Social Insurance) that covers employees of private companies and their families and community insurance (National Health Insurance) that covers the self-employed. Each medical insurance system has its own medical care system for the retired and their families. The health care system for the long-lived covers people of over 75 years of age (over 65 years in people with a certain handicap). There is also a system under which all or part of the medical expenses is reimbursed by public expenditure or the cost of medical care not covered by health insurance is paid by the government. This system is referred to collectively as the "the public payment system of medical expenses." To support the realization of the purpose of this system, there is a treatment research enterprise for specified diseases (intractable diseases). Because of the high mortality rate, acute pancreatitis is specified as an intractable disease for the purpose of reducing its mortality rate, and treatment expenses of patients are paid in full by the government dating back to the day when the application was made for a certificate verifying that he or she has severe acute pancreatitis. PMID:20012327

Yoshida, Masahiro; Takada, Tadahiro; Hirata, Koichi; Mayumi, Toshihiko; Shikata, Satoru; Shirai, Kunihiro; Kimura, Yasutoshi; Wada, Keita; Amano, Hodaka; Arata, Shinju; Hirota, Masahiko; Takeda, Kazunori; Gabata, Toshifumi; Hirota, Morihisa; Yokoe, Masamichi; Kiriyama, Seiki; Sekimoto, Miho

2010-01-01

20

Use of endoscopic naso-pancreatic drainage in the treatment of severe acute pancreatitis  

Microsoft Academic Search

AIM: To review the experience on the use of endoscopic nasopancreatic drainage (ENPD) in the treatment of severe acute pancreatitis (SAP). METHODS: Since March 1998, under the regular management of SAP with non-operative method, ENPD has been randomly used in 14 patients. The average age of the patients was 41.3±15.9 (years), with 8 males and 6 females. The time from

Zhu-Fu Quan; Zhi-Ming Wang; Wei-Qin Li; Jie-Shou Li

21

Effects of disease severity and necrosis on pancreatic dysfunction after acute pancreatitis  

PubMed Central

AIM: To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis (AP). METHODS: One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo follow-up were included. Patients were classified according to severity of the disease, necrosis ratio and localization. Subjective clinical evaluation and fecal pancreatic elastase-I (FPE-I) were used for exocrine dysfunction evaluation, and oral glucose tolerance test was completed for endocrine dysfunction. The correlation of disease severity, necrosis ratio and localization with exocrine and endocrine dysfunction were investigated. RESULTS: There were 58 male and 51 female patients, and mean age was 56.5 ± 15.7. Of the patients, 35.8% had severe AP (SAP) and 27.5% had pancreatic necrosis. Exocrine dysfunction was identified in 13.7% of the patients [17.9% were in SAP, 11.4% were in mild AP (MAP)] and 34.7% of all of the patients had endocrine dysfunction (56.4% in SAP and 23.2% in MAP). In patients with SAP and necrotizing AP (NAP), FPE-Ilevels were lower than the others (P < 0.05 and 0.001 respectively) and in patients having pancreatic head necrosis or near total necrosis, FPE-1 levels were lower than 200 ?g/g stool. Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP (P < 0.001). All of the patients in the necrosectomy group had endocrine dysfunction. CONCLUSION: Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.

Garip, Gokhan; Sarandol, Emre; Kaya, Ekrem

2013-01-01

22

(Non)Compliance with Guidelines for the Management of Severe Acute Pancreatitis among German Surgeons  

Microsoft Academic Search

Background: Implementation of guidelines for the therapy of acute pancreatitis (e.g. those of the International Association of Pancreatology, IAP) into clinical practice has been assumed but not been evaluated. Aim: To verify the knowledge and acceptance of guidelines for the management of severe acute pancreatitis among German surgeons. Methods: A questionnaire consisting of five short questions concerning key points in

T. Foitzik; E. Klar

2007-01-01

23

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

PubMed

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

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

2014-06-01

24

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

PubMed Central

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

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

2014-01-01

25

Circulating cytokines in predicting development of severe acute pancreatitis  

PubMed Central

Introduction Severe acute pancreatitis (AP) is associated with high morbidity and mortality. Early prediction of severe AP is needed to improve patient outcomes. The aim of the present study was to find novel cytokines or combinations of cytokines that can be used for the early identification of patients with AP at risk for severe disease. Methods We performed a prospective study of 163 nonconsecutive patients with AP, of whom 25 had severe AP according to the revised Atlanta criteria. Admission serum levels of 48 cytokines and growth factors were determined using Bio-Plex Pro Human Cytokine Assay 21-plex and 27-plex magnetic bead suspension panels. Admission plasma levels of C-reactive protein (CRP), creatinine and calcium were measured for comparison. In subgroup analyses, we assessed the cytokine profiles of patients with severe AP (n = 14) who did not have organ dysfunction (OD) upon admission (modified Marshall score <2). Results Of 14 cytokines elevated in the severe AP group, interleukin 6 (IL-6) and hepatocyte growth factor (HGF) levels were independent prognostic markers of severe AP. IL-6, HGF and a combination of them predicted severe AP with sensitivities of 56.0%, 60.0% and 72.0%, respectively, and specificities of 90.6%, 92.8% and 89.9%, respectively. The corresponding positive likelihood ratio (LR+) values were 5.9, 8.3 and 7.1, respectively. The predictive values of CRP, creatinine and calcium were comparable to those of the cytokines. In subgroup analyses of patients with severe AP and without OD upon admission, we found that IL-8, HGF and granulocyte colony-stimulating factor (G-CSF) levels predicted the development of severe AP, with G-CSF being the most accurate cytokine at a sensitivity of 35.7%, a specificity of 96.1% and a LR+ of 9.1. Conclusions IL-6 and HGF levels upon admission have prognostic value for severe AP which is similar to levels of CRP, creatinine and calcium. Although IL-6 and HGF, as either single or combined markers, were not perfect in identifying patients at risk for severe AP, the possibility that combining them with novel prognostic markers other than cytokines might improve prognostic accuracy needs to be studied. The accuracy of IL-8, HGF and G-CSF levels in predicting severe AP in patients without clinical signs of OD upon admission warrants larger studies.

2014-01-01

26

A case of severe acute pancreatitis and ischemic gastropathy caused by acute aortic dissection.  

PubMed

A 49-year-old man presented with chest pain and was given a diagnosis of aortic dissection based on computed tomography (CT) findings. Two days later the dissection reached the origin of the celiac artery and there was poor blood flow from the body to the tail of the pancreas and fundus of the stomach wall. Severe acute pancreatitis developed. Endoscopy showed a near-circumferential gastric ulcer in the gastric cardia and we diagnosed ischemic gastropathy. A fistula between the area of infected pancreatic necrosis and the stomach had formed spontaneously and the necrotic tissue was draining into the stomach. His recovery was uneventful. PMID:21212601

Umeda, Ikumi; Hayashi, Tsuyoshi; Ishiwatari, Hirotoshi; Yoshida, Makoto; Miyanishi, Kouji; Sato, Yasushi; Kofune, Masayoshi; Takimoto, Risyu; Kato, Junji; Meguro, Makoto; Hirata, Kouichi

2011-01-01

27

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 ...

28

Early Nasogastric Feeding in Predicted Severe Acute Pancreatitis  

PubMed Central

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

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

2006-01-01

29

[Analysis of selected inflammatory markers for early prediction of severe clinical course of acute pancreatitis].  

PubMed

Despite new diagnostic methods, including novel laboratory parameters and imaging techniques, and growing knowledge on pathogenesis of acute pancreatitis, early assessment of severity remains the main factor influencing prognosis in the disease. The aim of the study was the evaluation of diagnostic accuracy of interleukins (IL): 6 and 18 and acute phase proteins: C-reactive protein (CRP) and serum amyloid A (SAA), together with Glasgow prognostic score during first 48 hours after diagnosing acute pancreatitis in a group of 40 patients treated in the I-st Department of General and Gastrointestinal Surgery University Hospital in Cracow. All the studied inflammatory markers were significantly higher in patients with moderate and severe acute pancreatitis versus patients with mild form of the disease on the first 48 hours of the disease. Expanding Glasgow score with IL-6, IL-18, SAA or CRP determinations resulted in better accuracy for diagnosing severe clinical course of acute pancreatitis. PMID:24052976

Ku?nierz-Cabala, Beata; Gurda-Duda, Anna; Dumnicka, Paulina; Ku?niewski, Marek; Kulig, Jan; Panek, Józefa; Solnica, Bogdan

2013-01-01

30

Acute lipotoxicity regulates severity of biliary acute pancreatitis without affecting its initiation.  

PubMed

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

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

2014-06-01

31

Effects of different resuscitation fluid on severe acute pancreatitis  

PubMed Central

AIM: To compare effects of different resuscitation fluid on microcirculation, inflammation, intestinal barrier and clinical results in severe acute pancreatitis (SAP). METHODS: One hundred and twenty patients with SAP were enrolled at the Pancreatic Disease Institute between January 2007 and March 2010. The patients were randomly treated with normal saline (NS group), combination of normal saline and hydroxyethyl starch (HES) (SH group), combination of normal saline, hydroxyethyl starch and glutamine (SHG group) in resuscitation. The ratio of normal saline to HES in the SH and SHG groups was 3:1. The glutamine (20% glutamine dipeptide, 100 mL/d) was supplemented into the resuscitation liquid in the SHG group. Complications and outcomes including respiratory and abdominal infection, sepsis, abdominal hemorrhage, intra-abdominal hypertension, abdominal compartment syndrome (ACS), renal failure, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), operation intervention, length of intensive care unit stay, length of hospital stay, and mortality at 60 d were compared. Moreover, blood oxygen saturation (SpO2), gastric intramucosal pH value (pHi), intra-abdominal pressure (IAP), inflammation cytokines, urine lactulose/mannitol (L/M) ratio, and serum endotoxin were investigated to evaluate the inflammatory reaction and gut barrier. RESULTS: Compared to the NS group, patients in the SH and SHG groups accessed the endpoint more quickly (3.9 ± 0.23 d and 4.1 ± 0.21 d vs 5.8 ± 0.25 d, P < 0.05) with less fluid volume (67.26 ± 28.53 mL/kg/d, 61.79 ± 27.61 mL/kg per day vs 85.23 ± 21.27 mL/kg per day, P < 0.05). Compared to the NS group, incidence of renal dysfunction, ARDS, MODS and ACS in the SH and SHG groups was obviously lower. Furthermore, incidence of respiratory and abdominal infection was significantly decreased in the SH and SHG groups, while no significant difference in sepsis was seen. Moreover, less operation time was needed in the SH and SHG group than the NS group, but the difference was not significant. The mortality did not differ significantly among these groups. Blood SpO2 and gastric mucosal pHi in the SH and SHG groups increased more quickly than in the NS group, while IAP was significantly decreased in the SH and SHG group. Moreover, the serum tumor necrosis factor-?, interleukin-8 and C-reactive protein levels in the SH and SHG groups were obviously lower than in the NS group at each time point. Furthermore, urine L/M ratio and serum endotoxin were significantly lower in the SH group and further decreased in the SHG group. CONCLUSION: Results indicated that combination of normal saline, HES and glutamine are more efficient in resuscitation of SAP by relieving inflammation and sustaining the intestinal barrier.

Zhao, Gang; Zhang, Jun-Gang; Wu, He-Shui; Tao, Jin; Qin, Qi; Deng, Shi-Chang; Liu, Yang; Liu, Lin; Wang, Bo; Tian, Kui; Li, Xiang; Zhu, Shuai; Wang, Chun-You

2013-01-01

32

Acute Pancreatitis (Beyond the Basics)  

MedlinePLUS

... WHERE TO GET MORE INFORMATION REFERENCES GRAPHICS FIGURES Pancreas anatomy PANCREATITIS OVERVIEW Acute pancreatitis refers to inflammation of the pancreas, causing sudden and severe abdominal pain. The pancreas ...

33

Effects of carbon monoxide releasing molecule-liberated CO on severe acute pancreatitis in rats  

Microsoft Academic Search

Recent studies have suggested that exogenously administered carbon monoxide (CO) is beneficial for resolution of acute inflammation. Severe acute pancreatitis (SAP) is an inflammatory condition which leads to a systemic inflammatory response syndrome (SIRS). In this study, we investigated the role of CO liberated from carbon monoxide releasing molecule-2 (CORM-2) in rats with SAP. SAP was induced by retrograde infusion

Ping Chen; Bei Sun; Hua Chen; Gang Wang; Shangha Pan; Rui Kong; Xuewei Bai; Shuangjia Wang

2010-01-01

34

Therapeutic effects of Caspase-1 inhibitors on acute lung injury in experimental severe acute pancreatitis  

PubMed Central

AIM: To assess the therapeutic effect of Caspase-1 inhibitors (ICE-I) on acute lung injury (ALI) in experimental severe acute pancreatitis (SAP). METHODS: Forty-two SD rats were randomly divided into 3 groups: healthy controls (HC, n = 6); SAP-S group (n = 18); SAP-ICE-I group (n = 18). SAP was induced by retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. HC rats underwent the same surgical procedures and duct cannulation without sodium taurocholate infusion. In SAP-S group, rats received the first intraperitoneal injection of isotonic saline 2 h after induction of acute pancreatitis and a repeated injection after 12 h. In SAP-ICE-I group, the rats were firstly given ICE inhibitors intraperitoneally 2 h after induction of pancreatitis. As in SAP-S group, the injection was repeated at 12 h. Serum IL-1? was measured by ELISA. Intrapulmonary expression of Caspase-1, IL-1? and IL-18 mRNA were detected by semi-quantitative RT-PCR. The wet/dry weight ratios and histopathological changes of the lungs were also evaluated. RESULTS: Serum IL-1? levels in SAP-S group were 276.77 ± 44.92 pg/mL at 6 h, 308.99 ± 34.95 pg/mL at 12 h, and 311.60 ± 46.51 pg/mL at 18 h, which were increased significantly (P < 0.01, vs HC). In SAP-ICE-I group, those values were decreased significantly (P < 0.01, vs SAP-S). Intrapulmonary expression of Caspase-1, IL-1? and IL-18 mRNA were observed in the HC group, while they were increased significantly in the SAP-S group (P < 0.01, vs HC). The expression of IL-1? and IL-18 mRNA were decreased significantly in the SAP-ICE-I group (P < 0.01, vs SAP-S), whereas Caspase-1 mRNA expression had no significant difference (P > 0.05). The wet/dry weight ratios of the lungs in the SAP-S group were increased significantly (P < 0.05 at 6 h, P < 0.01 at 12 h and 18 h, vs HC) and they were decreased significantly in the SAP-ICE-I group (P < 0.05, vs SAP-S). Caspase-1 inhibitors ameliorated the severity of ALI in SAP. CONCLUSION: Caspase-1 activation, and overproduction of IL-1? and IL-18 play an important role in the course of ALI, and Caspase-1 inhibition is effective for the treatment of ALI in experimental SAP.

Zhang, Xiao-Hua; Zhu, Ren-Min; Xu, Wen-An; Wan, Hai-Jun; Lu, Heng

2007-01-01

35

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

PubMed Central

Background—In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis. ?Aims—To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis. ?Methods—Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated. ?Results—SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p<0.005; APACHE II scores 8 (6-10) to 6 (4-8), p<0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC. ?Conclusion—TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial. ?? Keywords: acute pancreatitis; enteral nutrition; bacterial translocation; oxidative stress

Windsor, A; Kanwar, S; Li, A; Barnes, E; Guthrie, J; Spark, J; Welsh, F; Guillou, P; Reynolds, J

1998-01-01

36

Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis.  

PubMed

Abstract This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the ? (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients. PMID:24833148

Zhao, Jg; Liao, Q; Zhao, Yp; Hu, Y

2014-01-01

37

Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis  

PubMed Central

AIM: To investigate the effect of epidural anaesthesia (EA) on pancreatic microcirculation during acute pancreatitis (AP). METHODS: AP was induced by injection of sodium taurocholate into the pancreatic duct of Sprague-Dawley rats. To realize EA, a catheter was introduced into the epidural space between T7 and T9 and bupivacaine was injected. Microcirculatory flow was measured by laser Doppler flowmetry. Arterial blood gas analyses were performed. At the end of the experiment (??5 h), pancreas was removed for histology. The animals were divided into three groups: Group 1 (n?=?9), AP without EA; Group 2 (n?=?4), EA without AP; and Group 3 (n?=?6), AP treated by EA. RESULTS: In Group 1, pancreatic microcirculatory flow prior to AP was 141?±?39 perfusion units (PU). After AP, microcirculatory flow obviously decreased to 9?±?6 PU (P?pancreatic tissue. In Group 3, AP initially caused a significant decrease in microcirculatory flow from 155?±?25 to 11?±?7 PU (P?pancreatic tissue in Group 3 than that in Group 1. CONCLUSION: AP caused dramatic microcirculatory changes within the pancreas, with development of metabolic acidosis and tissue necrosis. EA allowed partial restoration of microcirculatory flow and prevented development of tissue necrosis and systemic complications. Therefore, EA should be considered as therapeutic option to prevent evolution from edematous to necrotic AP.

Demirag, Alp; Pastor, Catherine M; Morel, Philippe; Jean-Christophe, Copin; Sielenkamper, Andreas W; Guvener, Nilgun; Mai, Gang; Berney, Thierry; Frossard, Jean-Louis; Buhler, Leo H

2006-01-01

38

Endoscopic management of acute biliary pancreatitis.  

PubMed

Acute pancreatitis represents numerous unique challenges to the practicing digestive disease specialist. Clinical presentations of acute pancreatitis vary from trivial pain to severe acute illness with a significant risk of death. Urgent endoscopic treatment of acute pancreatitis is considered when there is causal evidence of biliary pancreatitis. This article focuses on the diagnosis and endoscopic treatment of acute biliary pancreatitis. PMID:24079788

Kuo, Vincent C; Tarnasky, Paul R

2013-10-01

39

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

Microsoft Academic Search

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

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

2009-01-01

40

Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?  

Microsoft Academic Search

Background: The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome

Gary Gecelter; Bashar Fahoum; Syed Gardezi; Moshe Schein

2002-01-01

41

Pyrrolidine dithiocarbamate reduces the severity of cerulein-induced murine acute pancreatitis.  

PubMed

The nuclear factor-kappaB (NF-kappaB) is a transcription factor that plays a pivotal role in the induction of genes involved in the response to injury and inflammation. Dithiocarbamates are antioxidants that are potent inhibitors of NF-kappaB. This study tested the hypothesis that pyrrolidine dithiocarbamate (PDTC) attenuates experimental acute pancreatitis. Intraperitoneal injection of cerulein in mice resulted in severe, acute pancreatitis characterized by edema, neutrophil infiltration, tissue hemorrhage and necrosis, and elevated serum levels of amylase and lipase. Infiltration of pancreatic and lung tissue with neutrophils (measured as increase in myeloperoxidase activity) was associated with enhanced lipid peroxidation (increased tissue levels of malondialdehyde). Immunohistochemical examination demonstrated a marked increase in immunoreactivity for nitrotyrosine and intracellular adhesion molecule-1 in the pancreas and lung of cerulein-treated mice. In contrast, the degree of 1) pancreas and lung injury, 2) upregulation/expression of intracellular adhesion molecule-1, 3) staining for nitrotyrosine, and 4) lipid peroxidation was markedly reduced by pretreatment with PDTC. This study demonstrates that prevention of the activation of NF-kappaB by PDTC ameliorates the tissue injury associated with experimental murine acute pancreatitis and provides an important insight into the molecular biology of acute pancreatitis. PMID:14625479

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

2003-12-01

42

Combined effects of sivelestat and resveratrol on severe acute pancreatitis-associated lung injury in rats.  

PubMed

ABSTRACT Despite extensive research and clinical efforts made in the management of acute pancre-atitis during the past few decades, to date no effective cure is available and the mortality from severe acute pancre-atitis remains high. Given that lung is the primary cause of early death in acute pancreatitis patients, novel therapeutic approaches aiming to prevent lung injury have become a subject of intensive investigation. In a previous study, we demonstrated that sivelestat, a specific inhibitor of neutrophil elastase, is effective in protecting against lung failure in rats with taurocholate-induced acute pancreatitis. As part of the analyses extended from that study, the present study aimed to evaluate the role of sivelestat and/or resveratrol in the protection against acute pancreatitis-associated lung injury. The extended analyses demonstrated the following: (1) sodium taurocholate induced apparent lung injury and dysfunction manifested by histological anomalies, including vacuolization and apoptosis of the cells in the lung, as well as biochemical aberrations in the blood (an increase in amylase concentration and a decrease in partial arterial oxygen pressure) and increases in activities of reactive oxygen species, interleukin 6, myeloperoxidase, neutrophil elastase, lung edema, bronchotracho alveolar lavage protein concentration, and bronchotracho alveolar lavage cell infiltration in the lung; and (2) in lung tissues, either sivelestat or resveratrol treatment effectively attenuated the taurocholate-induced abnormalities in all parameters analyzed except for serum amylase concentration. In addition, combined treatment with both sivelestat and resveratrol demonstrated additive protective effects on pancreatitis-associated lung injury compared with single treatment. PMID:24785170

Wang, Houhong; Wang, Shuai; Tang, Amao; Gong, Huihui; Ma, Panpan; Chen, Li

2014-08-01

43

Rational Therapy of Acute Pancreatitis  

Microsoft Academic Search

Management of acute pancreatitis represents a challenging aspect of everyday clinical practice that requires a multimodal and interdisciplinary approach. Mild cases of acute pancreatitis are usually self-limitating and treated with fluid resuscitation, analgesics, oxygen administration, and antiemetics. In addition to this, the role of nutritional support has been established for patients with severe acute pancreatitis with more evidence demonstrating its

D. Štimac; G. Poropat

2010-01-01

44

Value of adipokines in predicting the severity of acute pancreatitis: Comprehensive review  

PubMed Central

AIM: To analyze the prognostic value of adipokines in predicting the course, complications and fatal outcome of acute pancreatitis (AP). METHODS: We performed the search of PubMed database and the systemic analysis of the literature for both experimental and human studies on prognostic value of adipokines in AP for period 2002-2012. Only the papers that described the use of adipokines for prediction of severity and/or complications of AP were selected for further analysis. Each article had to contain information about the levels of measured adipokines, diagnosis and verification of AP, to specify presence of pancreatic necrosis, organ dysfunction and/or mortality rates. From the very beginning, study was carried out adhering to the PRISMA checklist and flowchart for systemic reviews. To assess quality of all included human studies, the Quality Assessment of Diagnostic Accuracy Studies tool was used. Because of the high heterogeneity between the studies, it was decided to refrain from the statistical processing or meta-analysis of the available data. RESULTS: Nine human and three experimental studies were included into review. In experimental studies significant differences between leptin concentrations at 24 and 48 h in control, acute edematous and acute necrotizing pancreatitis groups were found (P = 0.027 and P < 0.001). In human studies significant differences between leptin and resitin concentrations in control and acute pancreatitis groups were found. 1-3 d serum adiponectin threshold of 4.5 ?g/mL correctly classified the severity of 81% of patients with AP. This threshold yielded a sensitivity of 70%, specificity 85%, positive predictive value 64%, negative predictive value88% (area under curve 0.75). Resistin and visfatin concentrations differ significantly between mild and severe acute pancreatitis groups, they correlate with severity of disease, need for interventions and outcome. Both adipokines are good markers for parapancreatic necrosis and the cut-off values of 11.9 ng/mL and 1.8 ng/mL respectively predict the high ranges of radiological scores. However, the review revealed that all nine human studies with adipokines are very different in terms of methodology and objectives, so it is difficult to generalize their results. It seems that concentrations of the leptin and resistin increases significantly in patients with acute pancreatitis compared with controls. Serum levels of adiponectin, visfatin and especially resitin (positive correlation with Acute Physiology and Chronic Health Evaluation?II, Ranson and C-reactive protein) are significantly different in mild acute pancreatitis and severe acute pancreatitis patients, so, they can serve as a markers for the disease severity prediction. Resistin and visfatin can also be used for pancreatic and parapancreatic necrosis prediction, interventions needs and possible, outcome. CONCLUSION: High levels of adipokines could allow for prediction of a severe disease course and outcome even in small pancreatic lesions on computed tomography scans.

Karpavicius, Andrius; Dambrauskas, Zilvinas; Sileikis, Audrius; Vitkus, Dalius; Strupas, Kestutis

2012-01-01

45

[The usefulness and limitations of the new Japanese criteria for severity assessment in acute pancreatitis].  

PubMed

New Japanese criteria for severity assessment in acute pancreatitis were introduced in October 2008. The new criteria are simpler than the previous ones, and are also expected to be more useful for the severity assessment. We retrospectively analyzed the clinical factors in our patients to predict prognosis, and evaluated the usefulness and limitations of the new criteria. There were few missing data in the new criteria compared with the previous criteria. The areas under the receiver operating characteristic (ROC) curves for mortality prediction were 0.870 for the new criteria and 0.884 for the previous criteria. However, there were more patients whose disease severity on admission were underestimated using the new criteria and who finally progressed to worse stages including death. This evidence strongly suggests the lower sensitivity of the new criteria in mortality prediction. Repeated assessment of severity after admission will be indispensable in the proper treatment of patients with acute pancreatitis. PMID:20057183

Shirai, Kiyokazu; Sako, Akahito; Asayama, Naoki; Ogami, Toshiko; Nakajima, Ryo; Nishimura, So; Fujiya, Keiichi; Yada, Tomoyuki; Yamada, Akihiro; Akazawa, Naoki; Sakurai, Toshiyuki; Oshima, Takao; Nagata, Naoyoshi; Yago, Yuzo; Sasajima, Keita; Kobayakawa, Masao; Akiyama, Junichi; Yanase, Mikio; Masaki, Naohiko; Uemura, Naomi

2010-01-01

46

The Isolated Perfused Liver Response to a ‘Second Hit’ of Portal Endotoxin during Severe Acute Pancreatitis  

Microsoft Academic Search

Background\\/Aim: During severe acute pancreatitis (AP), the liver may show an exaggerated response to the inflammatory products of gut injury transported in the portal vein. Our aim was to explore liver proinflammatory mediator production after a ‘second hit’ of portal lipopolysaccharide (LPS) during AP. Methods: Twenty-four rats underwent one of three ‘first-hit’ scenarios: (1) severe AP induced by intraductal glycodeoxycholic

Damian J. Mole; Mark A. Taylor; Neil V. McFerran; Thomas Diamond

2005-01-01

47

CD64 Expression Is Increased in Patients with Severe Acute Pancreatitis: Clinical Significance  

PubMed Central

Background/Aims Upregulated CD64 expression on neutrophils is the most useful marker for acute bacterial infections and systemic inflammation. However, it is unknown whether CD64 is involved in the pathogenesis of acute pancreatitis (AP). This study was designed to determine whether CD64 is implicated in severe acute pancreatitis (SAP), and thus, is a suitable marker for SAP. Methods SAP was induced in rats with an intraperitoneal injection of L-arginine. CD64 expression in the rat pancreas was determined by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry. Additionally, the CD64 mRNA expression in peripheral blood leukocytes from 21 patients with mild acute pancreatitis (MAP) and 10 patients with SAP was investigated at the time of admission and during remission by qRT-PCR. Results CD64 mRNA and protein expression in the pancreas was significantly higher in rats with SAP, compared to the controls. The CD64 expression was higher in the patients with SAP than in the patients with MAP. During remission, CD64 mRNA decreased in both the MAP and SAP patients. The area under the curve of CD64 expression for the detection of SAP was superior to both the Ranson and the Acute Physiology and Chronic Health Evaluation II scores. Conclusions The CD64 level was significantly increased in correlation with the disease severity in SAP and may act as a useful marker for predicting the development of SAP.

Zhang, Hao; Ling, Xian-Long; Wu, Yu-Yun; Lu, Mu-Han; Guo, Hong; Zhang, Peng-Bin; Zhao, Xiao-Yan; Yang, Shi-Ming

2014-01-01

48

A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis.  

PubMed

Obesity is clearly an independent risk factor for increased severity of acute pancreatitis (AP), although the mechanisms underlying this association are unknown. Adipokines (including leptin and adiponectin) are pleiotropic molecules produced by adipocytes that are important regulators of the inflammatory response. We hypothesized that the altered adipokine milieu observed in obesity contributes to the increased severity of pancreatitis. Lean (C57BL/6J), obese leptin-deficient (LepOb), and obese hyperleptinemic (LepDb) mice were subjected to AP by six hourly intraperitoneal injections of cerulein (50 microg/kg). Severity of AP was assessed by histology and by measuring pancreatic concentration of the proinflammatory cytokines IL-1beta and IL-6, the chemokine MCP-1, and the marker of neutrophil activation MPO. Both congenitally obese strains of mice developed significantly more severe AP than wild-type lean animals. Severity of AP was not solely related to adipose tissue volume: LepOb mice were heaviest; however, LepDb mice developed the most severe AP both histologically and biochemically. Circulating adiponectin concentrations inversely mirrored the severity of pancreatitis. These data demonstrate that congenitally obese mice develop more severe AP than lean animals when challenged by cerulein hyperstimulation and suggest that alteration of the adipokine milieu exacerbates the severity of AP in obesity. PMID:18583460

Zyromski, Nicholas J; Mathur, Abhishek; Pitt, Henry A; Lu, Debao; Gripe, John T; Walker, Julia J; Yancey, Kyle; Wade, Terence E; Swartz-Basile, Deborah A

2008-09-01

49

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

PubMed Central

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.

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

1992-01-01

50

Continuous Regional Arterial Infusion with Fluorouracil and Octreotide Attenuates Severe Acute Pancreatitis in a Canine Model  

Microsoft Academic Search

AimTo investigate the therapeutic effects of fluorouracil (5-Fu) and octreotide (Oct) continuous regional arterial infusion (CRAI,) alone or in combination, was administered in a canine model of severe acute pancreatitis (SAP).Materials and MethodsThe animals were divided into five groups; group A (Sham), group B (SAP), group C (SAP and 5-Fu), group D (SAP and Oct), and group E (SAP and

Meng Tao Zhou; Bi Cheng Chen; Hong Wei Sun; Yue Peng Jin; Fa Jing Yang; Xing Zhang; Roland Andersson; Qi Yu Zhang

2012-01-01

51

Effect of melatonin on the severity of L-arginine-induced experimental acute pancreatitis in rats  

PubMed Central

AIM: To determine the effect of melatonin pre- and post-treatment on the severity of L-arginine (L-Arg) -induced experimental pancreatitis in rats. METHODS: Male Wistar rats (25) were divided into five groups. Those in group A received two injections of 3.2 g/kg body weight L-Arg i.p. at an interval of 1 h. In group MA, the rats were treated with 50 mg/kg body weight melatonin i.p. 30 min prior to L-Arg administration. In group AM, the rats received the same dose of melatonin 1 h after L-Arg was given. In group M, a single dose of melatonin was administered as described previously. In group C the control animals received physiological saline injections i.p. All rats were exsanguinated 24 h after the second L-Arg injection. RESULTS: L-Arg administration caused severe necrotizing pancreatitis confirmed by the significant elevations in the serum amylase level, the pancreatic weight/body weight ratio (pw/bw), the pancreatic IL-6 content and the myeloperoxidase activity, relative to the control values. Elevation of the serum amylase level was significantly reduced in rats given melatonin following L-Arg compared to rats injected with L-Arg only. The activities of the pancreatic antioxidant enzymes (Cu/Zn-superoxide dismutase (Cu/Zn-SOD) and catalase (CAT)) were significantly increased 24 h after pancreatitis induction. Melatonin given in advance of L-Arg significantly reduced the pancreatic CAT activity relative to that in the rats treated with L-Arg alone. In the liver, L-Arg significantly increased the lipid peroxidation level, and the glutathione peroxidase and Cu/Zn-SOD activities, whereas the Mn-SOD activity was reduced as compared to the control rats. Melatonin pre-treatment prevented these changes. CONCLUSION: Melatonin is an antioxidant that is able to counteract some of the L-Arg-induced changes during acute pancreatitis, and may therefore be helpful in the supportive therapy of patients with acute necrotizing pancreatitis.

Szabolcs, Annamaria; Reiter, Russel J; Letoha, Tamas; Hegyi, Peter; Papai, Gabor; Varga, Ilona; Jarmay, Katalin; Kaszaki, Jozsef; Sari, Reka; Jr, Zoltan Rakonczay; Lonovics, Janos; Takacs, Tamas

2006-01-01

52

Study progress in therapeutic effects of traditional Chinese medicine monomer in severe acute pancreatitis*  

PubMed Central

Severe acute pancreatitis (SAP) is a common acute abdomen clinical problem characterized by high mortality, multiple complications, complicated pathogenesis and difficult treatment. Recent studies found traditional Chinese medicine (TCM) monomers have markedly good effect for treating SAP. Many TCM monomers can inhibit pancreatin, resist inflammation, improve microcirculation and immunoloregulation, etc. to block the pathological progress of SAP in multiple ways, reduce complications and lower mortality with rapid effects. It is significant for enhancing SAP treatment to deeply understand the current situation in TCM monomers for treating SAP and take precious references therein. This article summarizes the treating effects and mechanisms of TCM monomers for SAP in recent years.

Zhang, Xi-ping; Liu, Da-ren; Shi, Yan

2007-01-01

53

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

PubMed Central

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

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

2014-01-01

54

Effect of emodin on endoplasmic reticulum stress in rats with severe acute pancreatitis.  

PubMed

This study aimed to investigate the protective effect of emodin on endoplasmic reticulum (ER) stress in rats with severe acute pancreatitis (SAP) and the underlying molecular mechanism. Sprague-Dawley male rats were randomly divided into sham operation group, SAP model group, and emodin treatment group. SAP was constructed through injecting sodium taurocholate into pancreatic and biliary duct in rats. Half an hour before establishing the animal model, emodin or sodium carboxymethylcellulose was intragastrically administrated to the rats in respective group. Rats were killed at 3, 6, and 12 h postdisease induction. The amylase, tumor necrosis factor-alpha (TNF-?) and interleukin-6 (IL-6) levels in serum, pancreatic histopathology, acinar ER ultrastructure, protein expression of Bip, IRE1?,TRAF2, ASK1, p-JNK, and p-p38 MAPK in pancreas were examined. Sodium taurocholate induced pancreatic injury and ER lumen dilated in exocrine pancreas in rats at 3-, 6-, and 12-h time points. ER stress transducers Bip, IRE1?, and their downstream molecules TRAF2, ASK1 in pancreatitis were upregulated. Furthermore, phosphorylation of JNK and p38MAPK in pancreas was increased, which induced high expression level of inflammatory cytokines such as TNF-? and IL-6. Treatment with emodin obviously ameliorated pancreatic injury and decreased the release of amylase and inflammatory cytokines. Further studies showed that emodin significantly decreased the expression of Bip, IRE1?, TRAF2, and ASK1, inhibited phosphorylation of JNK and p38 MAPK in pancreas in rats at all time points. Emodin could reduce pancreatic injury and restrain inflammatory reaction in SAP rats partly via inhibiting ER stress transducers IRE1? and its downstream molecules. PMID:23605470

Wu, Li; Cai, Baochang; Zheng, Shizhong; Liu, Xiao; Cai, Hao; Li, Huan

2013-10-01

55

[Hot issues on the treatment of severe acute pancreatitis by Integrated Traditional Chinese and Western Medicine].  

PubMed

Severe acute pancreatitis (SAP) is recognized as critical refractory disease. The case fatality rate of SAP is as high as 36%-50%. Although significant progress has been achieved on the treatment of severe acute pancreatitis (SAP) by Integrated Traditional Chinese Medicine (TCM) and Western Medicine (WM), there still exist some difficulties hindering the further improvement of therapeutic efficacy. The hot issues includes: unconfirmative curative effects and diverse treatment principles, complicated predictive scoring systems and inaccurate markers for the severity stratification, unproved new therapeutic tools and controversial methods waiting more high qualified evidence, unclarified mechanism of Integrated TCM and WM. In order to overcome the difficulties, we aim to launch the clinical pathway of Integrated TCM and WM, to strengthen the unity of multidisciplinary cooperation. We also need to keep the efforts on screening the markers for early evaluation and prediction of disease severity, improving the diagnosis and treatment, exploring the mechanism of Traditional Chinese Medicine in treating SAP with more high quality basic and clinical research. Based on these efforts, we could provide better treatments and prognosis for SAP patients. PMID:24490512

Xia, Qing; Deng, Li-Hui

2013-11-01

56

Effect of BN52021 on NF?-Bp65 expression in pancreatic tissues of rats with severe acute pancreatitis  

PubMed Central

AIM: To investigate dynamic changes and significance of expression of NF-?Bp65 in pancreatic tissues of rats with severe acute pancreatitis (SAP), as well as BN52021 effects. METHODS: Wistar male rats were randomly divided into negative control group (NC group, n = 60), SAP-model group (SAP group, n = 60), and BN52021-treated group (BN group, n = 60), and each of the above groups was respectively divided into 6 subgroups at different time points after operation (1 h, 2 h, 3 h, 6 h, 12 h, and 24 h) (n = 10). By RT-PCR and Western blot, NF-?Bp65 mRNA and its protein expression in pancreatic tissues of rats were detected respectively. RESULTS: The expression of NF-?Bp65 mRNA dynamically changed in both SAP groups and BN groups. The mRNA level was higher in SAP groups than NC groups at 2 h, 3 h, 12 h, and 24 h after operation (P < 0.05), higher in BN groups than NC groups at all time points (P < 0.05), and higher in BN groups than SAP group at 1 h (P < 0.05). The NF-?Bp65 protein level was higher in SAP groups than NC groups at 1 h, 3 h, and 6 h (P < 0.01), and 2 h, 12 h, and 24 h (P < 0.05), higher in BN groups than NC groups at all time points (P < 0.05), and lower in BN groups than SAP groups at 1 h, 3 h, and 6 h (P < 0.05). CONCLUSION: The expression of NF-?Bp65 in pancreatic tissues is dynamically changed and the changes play an important role in pathogenesis of SAP. BN52021 exerts therapeutic effects through reducing the expression level of NF-?Bp65 protein in the early stage of SAP.

Xia, Shi-Hai; Fang, Dian-Chun; Hu, Chun-Xiu; Bi, Hui-Ying; Yang, Yin-Zhi; Di, Yao

2007-01-01

57

Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report  

Microsoft Academic Search

Severe acute pancreatitis is a common critical disease, which may cause severe complications such as sepsis and multiple organ\\u000a dysfunction syndrome (MODS), and has a high mortality. A 31-year-old woman with 25-weeks pregnancy presented with hyperlipidemic\\u000a pancreatitis, sepsis and MODS. Based on conventional treatment, 125 h of continuous veno-venous hemofiltration (CVVH) and\\u000a 3 sessions of hemoperfusion (HP) were carried out. The

Yi Tang; Ling Zhang; Ping Fu; Yan Kang; Fang Liu

58

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

SciTech Connect

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

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

2010-03-05

59

Severity Scoring for Prognostication in Patients With Severe Acute Pancreatitis: Comparative Analysis of the Ranson Score and the APACHE III Score  

Microsoft Academic Search

Background: Despite a paucity of validation, the Ran- son score is still the most popular method for gauging the severity of pancreatitis. Hypotheses: The Ranson score more accurately pre- dicts outcomes in patients with severe acute pancreati- tis (SAP) when compared with APACHE (Acute Physi- ology and Chronic Health Evaluation) III scores, and the individual components of the Ranson score

Soumitra R. Eachempati; Lynn J. Hydo; Philip S. Barie

2002-01-01

60

Early management of acute pancreatitis.  

PubMed

Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis. PMID:24160930

Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

2013-10-01

61

Perirenal space blocking restores gastrointestinal function in patients with severe acute pancreatitis  

PubMed Central

AIM: To investigate effects of perirenal space blocking (PSB) on gastrointestinal function in patients with severe acute pancreatitis (SAP). METHODS: Forty patients with SAP were randomly allocated to receive PSB or no PSB (NPSB). All the SAP patients received specialized medical therapy (SMT). Patients in the PSB group received PSB + SMT when hospitalized and after diagnosis, whereas patients in the NPSB group only received SMT. A modi?ed gastrointestinal failure (GIF) scoring system was used to assess the gastrointestinal function in SAP patients after admission. Pain severity (visual analog scale, 0 to 100) was monitored every 24 h for 72 h. RESULTS: Modified GIF score decreased in both groups during the 10-d study period. The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was performed. During the 72-h study period, pain intensity decreased in both groups. The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points. Patients in the PSB group had significantly lower incidences of hospital mortality, multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection, and stayed in the intensive care unit for a shorter duration. However, no difference in terms of operation incidence was found between the two groups. CONCLUSION: PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP. Moreover, PSB administration could improve prognosis and decrease the mortality of SAP patients.

Sun, Jun-Jun; Chu, Zhi-Jie; Liu, Wei-Feng; Qi, Shi-Fang; Yang, Yan-Hui; Ge, Peng-Lei; Zhang, Xiao-Hui; Li, Wen-Sheng; Yang, Cheng; Zhang, Yu-Ming

2013-01-01

62

[Hypertriglyceridemia and acute pancreatitis].  

PubMed

Data of 26 patients suffering from severe pancreatitis, who were treated at the anesthesiologic intensive care unit during the years 1991 and 1992, were evaluated with respect to etiologic factors, especially hypertriglyceridemia, stage of the disease and clinical outcome. Hypertriglyceridemia was found in 13 cases (11 men, 2 women, mean age 42 +/- 9 years) with values between 330 mg/dl and 4000 mg/dl. Lipid electrophoresis revealed a pattern typical for type IV hyperlipidemia. Insulin dependent diabetes was present in 4 patients and 5 reported about an unusual high alcohol intake preceding pancreatitis. Beside surgical approaches, including drainage and lavage, and basic intensive care treatment plasmapheresis was performed in 8 patients with hypertriglyceridemia. 5 patients with pancreatitis and hypertriglyceridemia died out of multiorganic failure, and so the mortality rate was 38%. The group of patients with pancreatitis caused by cholelithiasis or chronic alcohol consumption showed a mortality rate of 46%. The poor outcome of pancreatitis associated with hypertriglyceridemia demonstrates the importance of the treatment of hypertriglyceridemia in order to prevent the development of pancreatitis. The determination of plasma triglyceride values should belong to the routine diagnostic procedures in acute pancreatitis. PMID:7709709

Lechleitner, M; Ladner, E; Seyr, M; Hoppichler, F; Föger, B; Hackl, J M

1994-01-01

63

Acute Pancreatitis in the Guangdong Province, China  

Microsoft Academic Search

Background\\/Aims: Many studies have recently been published on acute pancreatitis; however, few large-sample studies have been focused on the risk factors for deaths in severe acute pancreatitis. To address this issue, the present study was intended to assess etiology, severity, and mortality of acute pancreatitis in the Guangdong Province (Guangdong), China, and to analyze the risk factors responsible for deaths

Yu Bai; Lin Jia; Bingsheng Wang; Bihui Yang; Liping Wang; Xingang Shi; Wenjun Zhang; Yan Liu; Duowu Zou; Zhaoshen Li

2007-01-01

64

Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP  

Microsoft Academic Search

OBJECTIVES:Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Many medications have been used to prevent this complication. We aimed to evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis.METHODS:During 18 months, all eligible patients who underwent ERCP were enrolled in this study. In a double-blind randomized trial, patients received a suppository containing

Rasoul Sotoudehmanesh; Morteza Khatibian; Shadi Kolahdoozan; Sanaz Ainechi; Ramin Malboosbaf; Mehdi Nouraie

2007-01-01

65

Acute pancreatitis: the stress factor.  

PubMed

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

Binker, Marcelo G; Cosen-Binker, Laura I

2014-05-21

66

Acute pancreatitis: The stress factor  

PubMed Central

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

Binker, Marcelo G; Cosen-Binker, Laura I

2014-01-01

67

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

Microsoft Academic Search

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

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

68

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

PubMed

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

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

2013-09-01

69

Nutrition Support in Acute Pancreatitis  

Microsoft Academic Search

Summary In the majority (80%) of patients with acute pancreatitis, the disease is self limiting and, after a few days of withholding feeding and intravenous administration of fluids, patients can again be normally fed orally. In a small percentage of patients, the disease progresses to severe necrotic pancreatitis, with an intense systemic inflammatory response and often with multiple organ dysfunction

Orestis Ioannidis; Athina Lavrentieva; Dimitrios Botsios

70

Management of acute pancreatitis.  

PubMed

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

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

2014-08-01

71

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

PubMed Central

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

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

2013-01-01

72

Involvement of interstitial cells of Cajal in experimental severe acute pancreatitis in rats  

PubMed Central

AIM: To observe the changes in interstitial cells of Cajal (ICC) in rats with experimental severe acute pancreatitis (SAP). METHODS: A total of twenty-four SD rats were randomly divided into two groups (n = 12), namely the sham (S) group and the SAP group; the SAP rat model was established by retrograde injection of 5% sodium taurocholate (1.0 mL/kg) into the pancreatic duct. Twenty-four hours later intestinal motility was assessed by testing small intestinal propulsion rate, and then the rats were sacrificed. The pancreas and jejunum were resected and underwent routine pathologic examination. Immunohistochemical staining was used to detect c-kit-positive cells in the jejunum. Expression of c-kit mRNA was detected by real-time polymerase chain reaction, and the expression of c-kit protein was evaluated by Western blotting. Ultrastructure of ICC was evaluated by transmission electron microscopy. RESULTS: There was bleeding, necrosis and a large amount of inflammatory cell infiltration in pancreatic tissue in the SAP group, while in jejunal tissue we observed a markedly denuded mucosal layer, loss of villous tissue and a slightly dilated muscular layer. The small intestinal propulsion rate was 68.66% ± 2.66% in the S group and 41.55% ± 3.85% in the SAP group. Compared with the S group, the rate of the SAP group decreased sharply. The density of c-kit-positive cells in the SAP group was significantly lower than in the S group; the respective mean densities were 88.47 ± 10.49 in the S group and 56.11 ± 7.09 in the SAP group. The levels of c-kit protein and mRNA were 0.36 ± 0.04 and 1.29 ± 0.91 in the SAP group, respectively, which were significantly lower than those in the S group (0.53 ± 0.06, 0.64 ± 0.33, respectively). In the SAP group, ICC profiles showed the same change tendency, such as vacuolation of mitochondria, irregular vacuoles and loosened desmosome-like junctions. CONCLUSION: Decreased c-kit-positive cells and ultrastructural changes in ICC resulting from blockade of the c-kit signaling pathway are involved in the intestinal dysmotility associated with SAP.

Shi, Liang-Liang; Liu, Ming-Dong; Chen, Min; Zou, Xiao-Ping

2013-01-01

73

Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome  

PubMed Central

AIM: To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion (CRAI) via a drug delivery system (DDS) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). METHODS: We presented our recent experience in 8 patients with SAP. The patients developed clinical ACS, which required abdominal decompression. During the operation, a DDS was inserted into the peripancreatic artery (the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery). Through this DDS, a protease inhibitor, antibiotics and octreotide were infused continuously. The duration of the regional artery infusion ranged from 8 to 41 d. The outcomes and the changes in the APACHE II score, computed tomography (CT) severity index and intra-abdominal pressure (IAP) of the patients were retrospectively evaluated. RESULTS: Eight patients with an initial APACHE IIscore of 18.9 (range, 13-27) and a Balthazar CT severity index of 9.1 (range, 7-10) developed severe local and systemic complications. These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension (IAH). After a mean interval of 131.9 ± 72.3 d hospitalization, 7 patients recovered with decreased APACHE II scores, CT severity indexes and IAP. The mean APACHE II score was 5.4 (range, 4-8), the CT severity index was 2.3 (range, 1-3), and IAP decreased to 7.7 mmHg (range, 6-11 mmHg) 60 d after operation. One patient died of multiple organ failure 1 wk after surgery. CONCLUSION: CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

Deng, Zhi-Gang; Zhou, Jian-Yin; Yin, Zhen-Yu; Peng, You-Yuan; Wang, Fu-Qiang; Wang, Xiao-Min

2011-01-01

74

Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial  

PubMed Central

Introduction Severe acute pancreatitis is still a potentially life threatening disease with high mortality. The aim of this study was to evaluate the therapeutic effect of thoracic epidural anaesthesia (TEA) on survival, microcirculation, tissue oxygenation and histopathologic damage in an experimental animal model of severe acute pancreatitis in a prospective animal study. Methods In this study, 34 pigs were randomly assigned into 2 treatment groups. After severe acute pancreatitis was induced by intraductal injection of glycodesoxycholic acid in Group 1 (n?=?17) bupivacaine (0.5%; bolus injection 2 ml, continuous infusion 4 ml/h) was applied via TEA. In Group 2 (n?=?17) no TEA was applied. During a period of 6 hours after induction, tissue oxygen tension (tpO2) in the pancreas and pancreatic microcirculation was assessed. Thereafter animals were observed for 7 days followed by sacrification and histopathologic examination. Results Survival rate after 7 days was 82% in Group 1 (TEA) versus 29% in Group 2: (Control) (P <0.05). Group 1 (TEA) also showed a significantly superior microcirculation (1,608?±?374 AU versus 1,121?±?510 AU; P <0.05) and tissue oxygenation (215?±?64 mmHg versus 138?±?90 mmHG; P <0.05) as compared to Group 2 (Control). Consecutively, tissue damage in Group 1 was reduced in the histopathologic scoring (5.5 (3 to 8) versus 8 (5.5 to 10); P <0.05). Conclusions TEA led to improved survival, enhanced microcirculatory perfusion and tissue oxygenation and resulted in less histopathologic tissue-damage in an experimental animal model of severe acute pancreatitis.

2013-01-01

75

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China  

PubMed Central

AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CVVH/LVVH), short-term veno-venous hemofiltration (SVVH), SVVH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS: The SVVH only technique was the least costly modality, $5809 (44 449 RMB), and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CVVH/LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION: The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

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

2008-01-01

76

Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage  

PubMed Central

AIM: To evaluate the therapeutic effect of alanyl-glutamine dipeptide (AGD) in the treatment of severe acute pancreatitis (SAP) in early and advanced stage. METHODS: Eighty patients with SAP were randomized and received 100 mL/d of 20% AGD intravenously for 10 d starting either on the day of (early treatment group) or 5 d after (late treatment group) admission. Groups had similar demographics, underlying diseases, Ranson score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Balthazar’s computed tomography (CT) score at the beginning of the study and underwent similar other medical and nutritional management. RESULTS: The duration of acute respiratory distress syndrome (2.7 ± 3.3 d vs 12.7 ± 21.0 d, P < 0.01), renal failure (1.3 ± 0.5 d vs 5.3 ± 7.3 d, P < 0.01), acute hepatitis (3.2 ± 2.3 d vs 7.0 ± 7.1 d, P < 0.01), shock (1.7 ± 0.4 d vs 4.8 ± 3.1 d, P < 0.05), encephalopathy (2.3 ± 1.9 d vs 9.5 ± 11.0 d, P < 0.01) and enteroparalysis (2.2 ± 1.4 d vs 3.5 ± 2.2 d, P < 0.01) and hospital stay (28.8 ± 9.4 d vs 45.2 ± 27.1 d, P < 0.01) were shorter in the early treatment group than in the late treatment group. The 15-d APACHE II score was lower in the early treatment group than in the late treatment group (5.0 ± 2.4 vs 8.6 ± 3.6, P < 0.01). The infection rate (7.9% vs 26.3%, P < 0.05), operation rate (13.2% vs 34.2%, P < 0.05) and mortality (5.3% vs 21.1%, P < 0.05) in the early treatment group were lower than in the late treatment group. CONCLUSION: Early treatment with AGD achieved a better clinical outcome in SAP patients.

Xue, Ping; Deng, Li-Hui; Xia, Qing; Zhang, Zhao-Da; Hu, Wei-Ming; Yang, Xiao-Nan; Song, Bing; Huang, Zong-Wen

2008-01-01

77

[Prolonged acute pancreatitis after bone marrow transplantation].  

PubMed

Acute pancreatitis is not infrequent after allogenic marrow transplantation. Several causes can predispose to pancreatitis, including Graft-Versus-Host Disease (GVHD), a condition which is probably underestimated. In the literature, few description of pancreatic GVHD can be found. Pancreatic GVHD diagnosis can be difficult if pancreatic involvement occurs without other typical manifestations of GVHD. We report the case of a woman, 54 years old, suffering from prolonged, painful pancreatitis two months after allogenic bone marrow transplantation for acute myeloid leucemia. Pancreatic GVHD diagnosis was performed after five weeks on duodenal biopsies despite the absence of diarrheoa. The patient dramatically improved within few days on corticosteroids. PMID:18378104

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

2008-04-01

78

Adjuvant treatment of severe acute pancreatitis with C1 esterase inhibitor concentrate after haematopoietic stem cell transplantation  

Microsoft Academic Search

BACKGROUNDWith an incidence of 4%, acute pancreatitis is a common complication of bone marrow or peripheral haematopoietic stem cell transplantation, which contributes significantly to morbidity and mortality in these patients. In most cases, the pathogenesis of acute pancreatitis cannot be attributed to a single pathogenetic factor, as treatment toxicity, acute graft versus host disease, infection, and cholestasis may all contribute.

D T Schneider; W Nürnberger; H Stannigel; H Bönig; U Göbel

1999-01-01

79

Nutrition, Inflammation, and Acute Pancreatitis  

PubMed Central

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

Petrov, Max

2013-01-01

80

Inhibition of poly(ADP-ribose) polymerase attenuates the severity of acute pancreatitis and associated lung injury  

Microsoft Academic Search

The severity of acute pancreatitis results from the transmigration and activation of leukocytes within the pancreas and the local synthesis and release of proinflammatory-soluble mediators that transform a local injury into a systemic inflammatory response. Poly(ADP-ribose)polymerase-1 (PARP-1) is a nuclear DNA-binding protein that has been shown to play a relevant role in cell necrosis and organ failure in various diseases

Ruben A Mota; Francisco Sánchez-Bueno; Luis Saenz; David Hernández-Espinosa; Jaime Jimeno; Pedro L Tornel; Alejandro Martínez-Torrano; Pablo Ramírez; Pascual Parrilla; José Yélamos

2005-01-01

81

Zinc supplement modulates oxidative stress and antioxidant values in rats with severe acute pancreatitis.  

PubMed

Oxidative stress is a main factor in the pathogenesis of severe acute pancreatitis (SAP). The ability of zinc (Zn) to retard oxidative processes has been recognized for many years. This study aims to examine the levels of free oxygen radicals and antioxidant enzyme in SAP rats and know the effect of Zn supplementation on free oxygen radicals and antioxidant system in rats with SAP. Forty-five male Wistar rats were divided into three groups-the SAP group (n=15), the Zn-treated group (n=15), and the controlled group (n=15). For the SAP group, sodium taurocholate is injected into the pancreatic duct to induce SAP; for the Zn-treated group, Zn (5 mg/kg) is subcutaneously injected immediately after injection of 5% sodium taurocholate. Firstly, the activity of erythrocyte glutathione peroxidase (GSH-Px), erythrocyte superoxide dismutase (SOD), and the content of plasma malondialdehyde (MDA), which are the toxic products of oxidative stress, is measured. Secondly, the levels of free oxygen radicals in the liver and kidney are detected. The result showed that the activity of GSH-Px and SOD was lower in the SAP group than that in the controlled group, although the content of plasma MDA increased. However, the activity of SOD and GSH-Px in the Zn-treated group was not significantly decreased after comparing with the controlled group; in the mean time, the content of MDA was not significantly increased either. Moreover, the content of free radical in liver and kidney was higher in the SAP group compared with the controlled group, but the content of free radical in the Zn-treated group was not higher than that in the controlled group (p>0.05). All of the above indicated that Zn may recover the activity of free radical-scavenging enzymes and decrease the content of free radical for the SAP group rats. In conclusion, the content of free radical increase may be one of the reasons that SAP rats are injured, and it is possible for Zn to be used to treat SAP through scavenging free radical and increasing the activity of SOD and GSH-Px of erythrocyte. PMID:24771310

Tang, Qin-qing; Su, Shi-yue; Fang, Mao-yong

2014-06-01

82

Deletion of TRPC3 in mice reduces Store-Operated Ca2+ influx and the severity of acute pancreatitis  

PubMed Central

Background and Aims Receptor–stimulated Ca2+ influx is a critical component of the Ca2+ signal and mediates all cellular functions regulated by Ca2+. However, excessive Ca2+ influx is highly toxic resulting in cell death, which is the nodal point in all forms of pancreatitis. Ca2+ influx is mediated by store-operated channels (SOCs). The identity and function of the native SOCs in most cells is unknown. Methods Here, we determine the role of deletion of Trpc3 in mice on Ca2+ signaling, exocytosis, intracellular trypsin activation and pancreatitis. Results Deletion of TRPC3 reduced the receptor-stimulated and SOCs-mediated Ca2+ influx by about 50%, indicating that TRPC3 functions as SOC in vivo. The reduced Ca2+ influx in TRPC3?/? acini resulted in reduced frequency of the physiological Ca2+ oscillations and of the pathological sustained [Ca2+]i increase caused by supramaximal stimulation and by the toxins bile acids and palmitoleic acid ethyl ester. Consequently, deletion of TRPC3 shifted the dose response for receptor-stimulated exocytosis, and prevented the pathological inhibition of digestive enzyme secretion at supramaximal agonist concentrations. Accordingly, deletion of TRPC3 markedly reduced intracellular trypsin activation and excessive actin depolymerization in vitro and the severity of pancreatitis in vivo. Conclusions These findings establish the native TRPC3 as a SOC in vivo and a role for TRPC3-mediated Ca2+ influx in the pathogenesis of acute pancreatitis and suggest that TRPC3 should be considered a target for prevention of the pancreatic damage in acute pancreatitis.

Kim, Min Seuk; Hong, Jeong Hee; Li, Qin; Shin, Dong Min; Abramowitz, Joel; Birnbaumer, Lutz; Muallem, Shmuel

2009-01-01

83

Assessment and Treatment of Severe Pancreatitis  

Microsoft Academic Search

From the theoretical point of view, antiproteolytic therapy would seem to be the rationale for acute pancreatitis management. Unfortunately, clinical human trials studying the role of antiproteases in the treatment of acute pancreatitis differ in several respects in terms of their basic design. As a consequence, any form of homogeneous analysis of the reported data as a whole is impossible.

Claudio Bassi; Massimo Falconi; Erminia Caldiron; Roberto Salvia; Nora Sartori; Giovanni Butturini; Conrado Contro; Stefano Marcucci; Luca Casetti; Paolo Pederzoli

1999-01-01

84

Severe Acute Pancreatitis with Complicating Colonic Fistula Successfully Closed Using the Over-the-Scope Clip System  

PubMed Central

A 44-year-old man presenting to our hospital emergency room with abdominal pain was hospitalized for hyperlipidemic acute pancreatitis. A pig-tail catheter was placed percutaneously to drain an abscess on day 22. Although the abscess improved gradually and good clinical progress was seen, pancreatic duct disruption was strongly suspected and endoscopic retrograde cholangiopancreatography was performed on day 90. An endoscopic nasopancreatic drainage tube was placed, but even with concurrent use of a somatostatin analogue, treatment was ineffective. Surgical treatment was elected, but was subsequently postponed as the abscess culture was positive for extended-spectrum ?-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus aureus. Drainage tubography showed a small fistula of the colon at the splenic flexure on day 140. Colonoscopy was performed on day 148. After indigo carmine had been injected, a fistula into the splenic flexure of the colon showed blue staining. The over-the-scope clip (OTSC) system was used to seal the fistula and complete closure was shown. A liquid diet was started on day 159 and was smoothly upgraded to a full diet. Following removal of the pancreatic stent on day 180, drainage volume immediately decreased and the percutaneous drain was removed. On day 189, computed tomography showed no exacerbation of the abscess and the patient was discharged on day 194. This case of colonic fistula caused by severe acute pancreatitis was successfully treated using the OTSC system, avoiding the need for an open procedure.

Ito, Ken; Igarashi, Yoshinori; Mimura, Takahiko; Kishimoto, Yui; Kamata, Itaru; Kobayashi, Shunsuke; Yoshimoto, Kensuke; Okano, Naoki

2013-01-01

85

Overexpression of Fas and FasL Is Associated with Infectious Complications and Severity of Experimental Severe Acute Pancreatitis by Promoting Apoptosis of Lymphocytes.  

PubMed

This study investigated the relationship of Fas and Fas ligand (FasL) expression and apoptosis of lymphocytes in relation to the pathogenic immune response and infectious complications observed in experimental severe acute pancreatitis in mice. Forty male Balb/c mice were randomly divided into control, mild (MAP), and severe acute pancreatitis (SAP) groups. Overexpression of Fas/FasL messenger ribonucleic acid (mRNA) and protein was observed in spleen-derived lymphocytes in SAP (p?severity of experimental severe acute pancreatitis by promoting apoptosis of lymphocytes. PMID:24566874

Pinhu, Liao; Qin, Yueqiu; Xiong, Bin; You, Yanwu; Li, Jun; Sooranna, Suren R

2014-08-01

86

Infective severe acute pancreatitis: A comparison of 99mTc-ciprofloxacin scintigraphy and computed tomography  

PubMed Central

AIM: To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography (CT) for detecting secondary infections associated with severe acute pancreatitis (SAP) in swine. METHODS: Six healthy swine were assigned to a normal control group (group A, n = 6). SAP was induced in group B (n = 9) and C (n = 18), followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli (E. coli) (group B) and active E. coli (group C), respectively. At 7 d after inoculation, a CT scan and a series of analyses using infecton imaging (at 0.5, 1, 2, 3, 4 and 6 h after the administration of 370 MBq of intravenous infecton) were performed. The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments. The differences in infecton uptake and changes in the lesion-background radioactive count ratios (L/B) in the 3 groups were recorded and compared. After imaging detection, histopathology and bacterial examinations were performed, and infected SAP was regarded as positive. The imaging findings were compared with histopathological and bacteriological results. RESULTS: In group A, 6 animals survived without infection in the pancreas. In group B, 7/9 swine survived and one suffered from infection. In group C, 15/18 animals survived with infection. Hence, the number of normal, non-infected and infected SAP swine was 6, 6 and 16, respectively. The sensitivity, speci?city, accuracy, positive predictive value and negative predictive value of the infecton method were 93.8% (15/16), 91.7% (11/12), 92.9% (26/28), 93.8% (15/16) and 91.7% (11/12), whereas these values for CT were 12.5% (2/16), 100.0% (12/12), 50.0% (14/28), 100.0% (2/2) and 46.2% (12/26), respectively. The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine (P < 0.001). The mean L/B of the infectious foci at 0.5, 1, 2, 3, 4 and 6 h was 1.17 ± 0.10, 1.71 ± 0.30, 2.46 ± 0.45, 3.36 ± 0.33, 2.04 ± 0.37 and 1.1988 ± 0.09, respectively. At 3 h, the radioactive counts (2350.25 ± 602.35 k) and the mean L/B of the infectious foci were significantly higher than that at 0.5 h (P = 0.000), 1 h (P = 0.000), 2 h (P = 0.04), 4 h (P = 0.000) and 6 h (P = 0.000). CONCLUSION: 99mTc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.

Wang, Jian-Hua; Sun, Gao-Feng; Zhang, Jian; Shao, Cheng-Wei; Zuo, Chang-Jing; Hao, Jun; Zheng, Jian-Ming; Feng, Xiao-Yuan

2013-01-01

87

Experimental study of therapeutic efficacy of Baicalin in rats with severe acute pancreatitis  

PubMed Central

AIM: To observe the therapeutic efficacy of Baicalin in rats with severe acute pancreatitis (SAP) and explore its therapeutic mechanisms. METHODS: The SAP rat models were randomly divided into the model control group, Baicalin treatment group, octreotide treatment group and sham operation group. All groups were randomly subdivided into 3 h, 6 h and 12 h groups with 15 rats in each group. The survival, ascites volume and pathological changes of pancreas in all rats were observed at different time points after operation. The plasma amylase content and serum TNF-?, IL-6, malonaldehyde (MDA) and PLA2 contents were also determined. RESULTS: The survival was not obviously different between the treated groups, and was significantly higher in treated groups at 12 h compared to the model control group (P < 0.05, 15 vs 10). The ascites/body weight ratio at 3 h and 6 h was significantly lower in Baicalin treatment group compared to the model control group and octreotide treatment group (P < 0.05, 1.00 vs 2.02 and 1.43 and P < 0.001, 2.29 (1.21) vs 2.70 (0.80) and 2.08 (2.21), respectively). The contents of amylase, TNF-?, IL-6, MDA and PLA2 were significantly lower in the treated groups than in the model control group (P < 0.05, 4342 vs 5303, 5058 vs 6272 in amylase, P < 0.01, 21.90 vs 36.30, 23.80 vs 39.70, 36 vs 54.35 in MDA and 56.25 vs 76.10 in PlA2, or P < 0.001, 65.10 and 47.60 vs 92.15 in TNF-?, 3.03 vs 5.44, 2.88 vs 6.82, 2.83 vs 5.36 in IL-6, respectively). The pathological scores of pancreas in the treated groups were significantly lower than that in the model control group (P < 0.05, 9.00 vs 10.05, 6.00 vs 9.00, 8.00 vs 10.05), but no marked difference was found between the treated groups. CONCLUSION: The Baicalin injection has significant therapeutic effects on SAP rats, its effects are similar to those of octreotide. The Baicalin injection is also cheap and has a big application range, quite hopefully to be used in clinical treatment of SAP.

Zhang, Xi-Ping; Zhang, Ling; He, Jin-Xian; Zhang, Rui-Ping; Cheng, Qi-Hui; Zhou, Yi-Feng; Lu, Bei

2007-01-01

88

Effects of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis*  

PubMed Central

Objective: To investigate the protective effects and mechanisms of action of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis (SAP). Methods: The rats were divided into sham-operated, model control, dexamethasone treated, and Salvia miltiorrhiza treated groups. At 3, 6, and 12 h after operation, the mortality rate of different groups, pathological changes, Bcl-2-associated X protein (Bax) and nuclear factor-?B (NF-?B) protein expression levels in multiple organs (the pancreas, liver, kidneys, and lungs), toll-like receptor 4 (TLR-4) protein levels (only in the liver), intercellular adhesion molecule 1 (ICAM-1) protein levels (only in the lung), and terminal deoxynucleotidy transferase mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) staining expression levels, as well as the serum contents of amylase, glutamate-pyruvate transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), blood urea nitrogen (BUN), and creatinine (CREA) were observed. Results: The mortality rate of the dexamethasone treated group was significantly lower than that of the model control group (P<0.05). The pathological changes in multiple organs in the two treated groups were relieved to different degrees (P<0.05 and P<0.01, respectively), the expression levels of Bax and NF-?B proteins, and apoptotic indexes of multiple organs were reduced (P<0.05 and P<0.01, respectively). The contents of amylase, GPT, GOT, BUN, and CREA in the two treated groups were significantly lower than those in model control groups (P<0.05 and P<0.01, respectively). The expression level of ICAM-1 protein in the lungs (at 3 and 12 h) in the dexamethasone treated group was significantly lower than that in the Salvia miltiorrhiza treated group (P<0.05). The serum contents of CREA (at 12 h) and BUN (at 6 h) of the Salvia miltiorrhiza treated group were significantly lower than those in the dexamethasone treated group (P<0.05). Conclusions: Both dexamethasone and Salvia miltiorrhiza can reduce the inflammatory reaction, regulate apoptosis, and thus protect multiple organs of rats with SAP.

Ou, Jing-min; Zhang, Xi-ping; Wu, Cheng-jun; Wu, Di-jiong; Yan, Ping

2012-01-01

89

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

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

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

90

Circulating Cytokine Levels in Acute Pancreatitis—Model of SIRS\\/CARS Can Help in the Clinical Assessment of Disease Severity  

Microsoft Academic Search

The aim of our study was to evaluate the pro- and anti-inflammatory cytokine response during acute pancreatitis and its predictive\\u000a value on severity of disease. A hospital-based prospective clinical study was conducted. Twenty patients with acute pancreatitis\\u000a were enrolled during a 12-month period. Plasma concentrations of TNF-?, IL-1?, IL-6, and IL-10 were determined at days 1,\\u000a 2, 3, 6, and

Ivan Gunjaca; Josip Zunic; Mihaela Gunjaca; Zdenko Kovac

91

Severe hemorrhagic complications in pancreatitis.  

PubMed

Severe bleeding may complicate the course of either acute or chronic pancreatitis, the latter being more frequently involved. Pseudocysts, severe inflammation, regional necrosis and infection may cause major vessel erosion with or without pseudoaneurysm formation which eventually may result in severe bleeding into the gastrointestinal tract, retroperitoneum and peritoneal cavity. The AA report their experience on 8 cases and analyze the data of a comprehensive review of 389 cases of massive bleeding reported in the literature during the last 100 years until December 1993. Mortality rate seems to be related to the etiology of the bleeding along with its localization and the underlying anatomo-pathologic findings. In patients with chronic pancreatitis it is 22% while in patients with acute pancreatitis or chronic pancreatitis with acute exacerbation it is 60.4% and 57.1% respectively. Splenic, gastroduodenal and superior pancreaticoduodenal arteries are the most commonly involved vessels being associated respectively with a mortality rate of 20.5%, 27.9% and 46.1%. Massive haemorrhage complicating infected necrosis or abscesses implies a worse prognosis when compared to severe bleeding associated with pseudocyst with or without pseudoaneurysm. The increasing use of diagnostic and interventional radiology appears to be the way forward to improve survival rates. Awareness of high risk predisposing condition, activism in achieving an early identification of the bleeding sources, and eventually its angiographic control are essential guidelines for successful approach to the most unpredictable complication of pancreatitis. When embolization fails or is followed by recurrence of hemorrhage, definitive surgical procedures should be immediately instituted. PMID:7668500

Flati, G; Salvatori, F; Porowska, B; Talarico, C; Flati, D; Proposito, D; Talarico, E; Carboni, M

1995-01-01

92

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy  

PubMed Central

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

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

2014-01-01

93

Loperamide-Induced Acute Pancreatitis  

PubMed Central

Acute pancreatitis is a common disease leading to hospitalizations, most often caused by gallstones or alcohol. We present a case of a patient diagnosed with acute pancreatitis considered to be due to loperamide treatment for diarrhea.

Vidarsdottir, Hanna; Moller, Pall Helgi; Bjornsson, Einar Stefan

2013-01-01

94

Compatibility of carbapenem antibiotics with nafamostat mesilate in arterial infusion therapy for severe acute pancreatitis: stabilities of carbapenem antibiotics.  

PubMed

The effectiveness of continuous regional arterial infusion therapy using protease inhibitors and antibiotics for severe acute pancreatitis has been previously reported. Carbapenem antibiotics, which have a broad antibacterial spectrum, and nafamostat mesilate are often used for this therapeutic approach. We investigated the compatibility of various carbapenem antibiotics with nafamostat mesilate. Carbapenem antibiotics were dissolved in 30 mL of saline or 5% glucose and the appearance, pH, and stability of the solutions were determined. The changes in each carbapenem antibiotic solution after mixing with nafamostat mesilate were then investigated. Biapenem and doripenem showed a residual rate of > or = 90% at 8 hours after dissolution in saline or 5% glucose and exhibited an appropriate appearance and residual rate (> or = 90%). After mixing with nafamostat mesilate, biapenem maintained a residual rate of > or = 90% for the longest time period (8 hours) and exhibited a slight coloration, followed by doripenem (6 hours) and meropenem dissolved in saline. The other carbapenem antibiotics that were tested exhibited changes in appearance or their residual rate. Biapenem and doripenem, which exert their effects in a time-dependent manner, can be infused for prolonged periods for the treatment of not only severe acute pancreatitis, but also other severe infections. PMID:23259254

Hamada, Yukihiro; Imaizumi, Hiroshi; Miyazawa, Shirou; Kida, Mitsuhiro; Souma, Kazui; Koizumi, Wasaburou; Sunakawa, Keisuke; Kuroyama, Masakazu

2012-08-01

95

Gadolinium induced recurrent acute pancreatitis.  

PubMed

Acute pancreatitis is a sudden swelling and inflammation of the pancreas. The two most common causes are alcohol use and biliary stones. Drug-induced acute pancreatitis are rare (1.4-2%). In this present study, we present a case of recurrent acute pancreatitis induced by a specific magnetic-resonance-imaging (MRI) contrast agent called gadobenate dimeglumine. PMID:23395575

Blasco-Perrin, H; Glaser, B; Pienkowski, M; Peron, J M; Payen, J L

2013-01-01

96

Role of interleukin-6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis.  

PubMed Central

A number of laboratory and clinical studies have shown that interleukin-6 is the principal mediator of the acute phase protein response. In this study the relationship between serum concentrations of interleukin-6 and C-reactive protein in acute pancreatitis are examined and the ability of interleukin-6 to discriminate between severe and mild attacks is assessed. We have studied 24 patients (10 severe and 14 mild). Serum samples were collected on admission, six hourly for 48 hours and then 12 hourly for a further three days. When the areas under the curves of individual patients were compared there was a strong correlation between the total production of interleukin-6 and C-reactive protein (r = 0.73) (Spearman rank correlation) and peak interleukin-6 and C-reactive protein concentrations (r = 0.75), suggesting a close relationship between interleukin-6 and C-reactive protein production. Both on admission and peak interleukin-6 concentrations were significantly higher in patients with severe than mild disease. There was no significant difference in on admission C-reactive protein concentrations, although significant differences were seen when peak concentrations were considered. Utilising a peak interleukin-6 concentration of > 130 u/ml, we were able to distinguish between severe and mild attacks of acute pancreatitis with a sensitivity of 100% and specificity of 71%. These figures were comparable with those for peak C-reactive protein, a C-reactive protein of > 150 mg/l detecting severe attacks of acute pancreatitis with a sensitivity of 90% and specificity of 79%. In view of the fact that interleukin-6 concentrations peaked earlier than those of C-reactive protein, interleukin-6 is capable of providing comparable, but earlier severity prediction than C-reactive protein.

Heath, D I; Cruickshank, A; Gudgeon, M; Jehanli, A; Shenkin, A; Imrie, C W

1993-01-01

97

Valsartan-induced acute pancreatitis.  

PubMed

Gastrointestinal toxicity is uncommon among patients treated with angiotensin II receptor antagonists. A 58-year-old man presented with nausea, vomiting and constant pain in the epigastrium that radiated to the flanks. He received treatment with valsartan (160 mg daily) for hypertension. The clinical, biochemical and radiological findings were compatible with a diagnosis of acute pancreatitis. After the patient achieved a clinical and biochemical recovery, the valsartan therapy was started again. Six weeks later, he returned to the hospital with an attack of pancreatitis. Subsequently, he returned with repeated attacks of pancreatitis twice, and the valsartan was discontinued. Ten months after the treatment, the patient had no complaints. When severe abdominal symptoms occur for no apparent reason during treatment with valsartan, a diagnosis of pancreatitis should be considered. PMID:24694480

Can, Burak; Sali, Mursel; Batman, Adnan; Yilmaz, Hasan; Korkmaz, Ugur; Celebi, Altay; Senturk, Omer; Hulagu, Sadettin

2014-01-01

98

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage  

PubMed Central

AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ? 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE II scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.

Chen, Hong; Li, Fei; Sun, Jia-Bang; Jia, Jian-Guo

2008-01-01

99

Berberine ameliorates severe acute pancreatitis?induced intestinal barrier dysfunction via a myosin light chain phosphorylation?dependent pathway.  

PubMed

Berberine is a traditional drug used to treat gastrointestinal disorders in China and has been demonstrated to attenuate intestinal barrier dysfunction in certain animal models. However, the effects of berberine on pancreatitis-induced intestinal barrier dysfunction are yet to be fully elucidated. This study aimed to investigate the effect of berberine pretreatment on the attenuation of intestinal barrier dysfunction induced by severe acute pancreatitis (SAP). A total of 36 rats were randomly divided into Sham, SAP and SAP plus berberine groups. Pancreatitis was induced using retrograde injection of 3% Na-taurocholate into the pancreatic duct. Histological examinations of the pancreas were performed and intestinal barrier dysfunction was characterized by histological measurements and the assessment of serum diamine oxidase activity and endotoxin levels. Zonula occludens-1 and occludin mRNA and protein expression, as well as myosin light chain (MLC) phosphorylation, were assessed. SAP rat models were successfully established. Berberine treatment was found to have no significant effect on the histological changes in the pancreas, but was observed to ameliorate the intestinal mucosal barrier damage and membrane permeability associated with SAP. Although berberine exerted minimal effects on tight junction proteins in the ilea of SAP rats, it was observed to significantly inhibit SAP-induced MLC phosphorylation. To the best of our knowledge, this is the first study to demonstrate that berberine attenuates SAP?induced intestinal barrier dysfunction in vivo. In addition, this study shows that the effect of berberine on intestinal barrier function may be associated with the inhibition of SAP?induced upregulation of MLC phosphorylation. PMID:24584406

Liang, Hong-Yin; Chen, Tao; Yan, Hong-Tao; Huang, Zhu; Tang, Li-Jun

2014-05-01

100

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

PubMed Central

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

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

2014-01-01

101

NSAIDs and Acute Pancreatitis: A Systematic Review  

PubMed Central

The resulting pain is the main symptom of acute pancreatitis and it should be alleviated as soon as possible. NSAIDs are the first line therapy for pain and they are generally administered to acute pancreatitis patients upon admission to the hospital. In addition, these drugs have also been used to prevent post-endoscopic cholangiopancreatography (ERCP) acute pancreatitis. On the other hand, there are several reports indicating that NSAIDs may be the actual cause of acute pancreatitis. We carried out a literature search on PubMed/MEDLINE; all full text papers published in from January 1966 to November 2009 on the use of NSAIDs in acute pancreatitis were collected; the literature search was also supplemented by a review of the bibliographies of the papers evaluated. Thus, in this article, we will systematically review the current literature in order to better illustrate the role of NSAIDs in acute pancreatitis, in particular: i) NSAIDs as a cause of acute pancreatitis; ii) their use to prevent post-retrograde ERCP pancreatitis and iii) their efficacy for pain relief in the acute illness of the pancreas.

Pezzilli, Raffaele; Morselli-Labate, Antonio Maria; Corinaldesi, Roberto

2010-01-01

102

Acute pancreatitis after nifedipine and acetaminophen poisoning — case report  

Microsoft Academic Search

The incidence of drug-induced pancreatitis is rare. There have been several reports of acute pancreatitis as a complication\\u000a in acute poisoning with drugs or toxins. We present a case of a young woman with acute pancreatitis secondary to an overdose\\u000a of nifedipine and acetaminophen in a suicide attempt. We excluded other causes of acute pancreatitis by clinical history,\\u000a serum toxicology,

Laurentiu Sorodoc; Catalina Lionte; Cristina Bologa; Ovidiu Petris; Victorita Sorodoc; Carmen Buga

2009-01-01

103

Regulatory Roles of the PI3K/Akt Signaling Pathway in Rats with Severe Acute Pancreatitis  

PubMed Central

The phosphatidylinositol 3-kinase(PI3K)/protein kinase B (Akt) pathway plays a key role in inflammation. However, the regulatory roles of PI3K/Akt in severe acute pancreatitis (SAP) have not been elucidated. The aim of this study was to investigate the impact of wortmannin, a PI3K/Akt inhibitor, on SAP rats through exposure to sodium taurocholate (STC) after 3 h and 6 h. The SAP group was found to have a significant increase in pancreas Akt expression, along with the activation of serum amylase, TNF-?, IL-1?, and IL-6, and pancreas histological aggravation. The administration of wortmannin in SAP rats reduced Akt expression, attenuated the level of serum amylase and inflammation factor, and alleviated the damage of pancreatic tissue. Furthermore, the administration of wortmannin led to an obvious reduction in NF-?B and p38MAPK expression in SAP rats. These findings showed that the PI3K/Akt inhibitor wortmannin decreases inflammatory cytokines in SAP rats and suggests its regulatory mechanisms may occur through the suppression on NF-?B and p38MAPK activity.

Xu, Ping; Wang, Jing; Yang, Zhi-wen; Lou, Xiao-li; Chen, Cheng

2013-01-01

104

Indications for Surgery in Acute Pancreatitis  

Microsoft Academic Search

Infection complicating pancreatic or peripancreatic necrosis is the single most accepted criterion for surgical intervention in severe acute pancreatitis. A failure to improve after 72 h of high-quality intensive care should also stimulate clinicians to reappraise the claims for surgical therapy. It is wise to remove the gallbladder in all cases which come to surgery, whether stones are proven or

C. W. Imrie

1994-01-01

105

L-asparaginase-induced severe acute pancreatitis in an adult with extranodal natural killer/T-cell lymphoma, nasal type: A case report and review of the literature  

PubMed Central

L-asparaginase (L-Asp)-associated pancreatitis (AAP) occurs occasionally; however, this side-effect has predominantly been observed among pediatric patients. Usually, it is not life-threatening and generally responds to intensive medical therapy. The present study presents a rare case of lethal AAP in an adult. The patient was recently diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, and the chronic hepatitis B virus (HBV) infection and was receiving L-Asp as part of a chemotherapy regimen. Severe acute pancreatitis occurred and the patient succumbed 72 h after completion of chemotherapy. The HBV infection and lipid disorders may have been potential risk factors for the development of severe acute pancreatitis in the patient.

WU, FANG; QU, LU; TAN, YAFEN; ZHANG, YUE; HU, CHUNHONG

2014-01-01

106

Fractalkine upregulates inflammation through CX3CR1 and the Jak-Stat pathway in severe acute pancreatitis rat model.  

PubMed

Based on the function of chemokine fractalkine (FKN), acting as both adhesion and chemoattractant, FKN plays a role in acute inflammatory response. In this study, we investigated the mechanism of FKN mediated upregulation inflammation in severe acute pancreatitis (SAP) rat models. Western blot, reverse transcriptase-polymerase chain reaction, and immunofluorescence demonstrated that FKN and its receptor CX3CR1 were overexpressed in cerulein-stimulated AR42J cells. AG490 and FKN-siRNA inhibited activation of Janus kinase/signal transducers and activators of transcription (Jak/Stat) in cerulein-stimulated AR42J cells. Following exposure AG490 and FKN-siRNA inhibited tumor necrosis factor-alpha expression by enzyme-linked immunosorbent assay and immunohistochemistry in vivo the SAP rat models. These results showed FKN and CX3CR1 were involved inflammatory response in cerulein-stimulated AR42J cells. FKN upregulates inflammation through CX3CR1 and the Jak/Stat pathway in SAP rat models. PMID:22213034

Huang, Li-ya; Chen, Ping; Xu, Ling-xiao; Zhou, Yu-fen; Zhang, Yong-ping; Yuan, Yao-zong

2012-06-01

107

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

PubMed Central

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

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

2013-01-01

108

Ascites of severe acute pancreatitis in rats transcriptionally up-regulates expression of interleukin-6 and -8 in vascular endothelium and mononuclear leukocytes.  

PubMed

The molecular mechanisms that link acute pancreatitis and multiple organ failure remain unknown. We examined the effect of ascitic fluids prepared from rats with experimental necrotizing pancreatitis on the expression of interleukin (IL) -6 and IL-8 in human umbilical vein endothelial cells (HUVEC) and human monocytic THP-1 cells. Incubation of HUVEC or THP-1 cells with the ascitic fluids resulted in a concentration-dependent up-regulation of the cytokine expression with comparable mRNA induction. Electrophoretic mobility shift assay revealed that the ascitic fluids increased the nuclear factor-kappaB (NF-kappaB) and NF-IL6 binding activities. Intraperitoneal injection of ascitic fluids into healthy rats induced the activation of NF-kappaB in the infiltrating leukocytes in the lung. Our results suggested that ascitic fluids may play a role in the pathophysiology of severe acute pancreatitis through the activation of transcription factors and consequent cytokine productions in distant organs. PMID:10711463

Masamune, A; Shimosegawa, T; Fujita, M; Satoh, A; Koizumi, M; Toyota, T

2000-02-01

109

Acute pancreatitis induced thrombotic thrombocytopenic purpura  

PubMed Central

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome of unknown cause with an estimated incidence of one case per million. The disease is characterized by a pentad of symptoms: Thrombocytopenia, microangiopathic hemolytic anemia, neurologic changes, renal dysfunction, and fever. It causes thrombosis in the microvasculature of several organs, producing diverse manifestations. Acute pancreatitis (AP) is a well-described consequence of TTP. Acute pancreatitis triggering TTP is uncommon.

Ali, Mohammed Arshad; Shaheen, Jalal Syed Shafiuddin; Khan, Mohammed Ali

2014-01-01

110

Fundamental and intensive care of acute pancreatitis  

Microsoft Academic Search

Patients who have been diagnosed as having acute pancreatitis should be, on principle, hospitalized. Crucial fundamental management\\u000a is required soon after a diagnosis of acute pancreatitis has been made and includes monitoring of the conscious state, the\\u000a respiratory and cardiovascular system, the urinary output, adequate fluid replacement and pain control. Along with such management,\\u000a etiologic diagnosis and severity assessment should

Morihisa HirotaTadahiro; Tadahiro Takada; Nobuya Kitamura; Tetsuhide Ito; Koichi Hirata; Masahiro Yoshida; Toshihiko Mayumi; Keisho Kataoka; Kazunori Takeda; Miho Sekimoto; Masahiko Hirota; Yasutoshi Kimura; Keita Wada; Hodaka Amano; Toshifumi Gabata; Shinju Arata; Masamichi Yokoe; Seiki Kiriyama

2010-01-01

111

Is acute recurrent pancreatitis a chronic disease?  

Microsoft Academic Search

Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis

Alberto Mariani; Pier Alberto Testoni

2008-01-01

112

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

PubMed Central

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

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

2014-01-01

113

Increased proportion of nitric oxide synthase immunoreactive neurons in rat ileal myenteric ganglia after severe acute pancreatitis  

PubMed Central

Background Severe acute pancreatitis (SAP) remains a potentially life-threatening disease. Gastrointestinal motility disturbance such as intestinal ileus is seen in every case. By now, the mechanisms of pancreatitis-induced ileus are largely unknown. The main purpose of the present study was to observe changes of nitric oxide synthase-immunoreactive (NOS-IR) neurons in ileal myenteric ganglia in SAP rats with gastrointestinal dysmotility, trying to explore underlying nervous mechanisms of pancreatitis-induced ileus. Methods Twenty Sprague Dawley rats were randomly divided into sham operated group and SAP group. SAP was induced by retrograde cholangiopancreatic duct injection of 5% sodium taurocholate. Abdominal X-ray and intestinal transit were performed to detect the existence of paralytic ileus and intestinal dysmotility. Pathological damage of pancreas was evaluated. Double-immunolabeling was employed for the whole-mount preparations of ileal myenteric ganglia. The morphology of NOS-IR neurons were observed and the percentage of NOS-IR neurons was calculated based on the total Hu-immunoreactive neurons. Total RNA of ileum was extracted according to Trizol reagent protocol. Neuronal NOS (nNOS) mRNA expression was evaluated by RT-PCR. Results The small intestinal transit index in the SAP group was significantly lower compared with the sham operated group (29.21 ± 3.68% vs 52.48 ± 6.76%, P <0.01). The percentage of NOS-IR neurons in ileal myenteric ganglia in the SAP group was significantly higher than that in the sham operated group (37.5 ± 12.28% vs 26.32 ± 16.15%, P <0.01). nNOS mRNA expression in ileum of SAP group was significantly higher than that in the sham operated group (1.02 ± 0.10 vs 0.70 ± 0.06, P < 0.01). Conclusions The increased quantity of NOS-IR neurons in ileal myenteric ganglia and increased nNOS mRNA expression may suggest nNOS over expression as one of the nervous mechanisms of gastrointestinal dysmotility in SAP rat.

2011-01-01

114

Early classic hemofiltration exhibits no benefits in severe acute pancreatitis with early organ failure: a retrospective case-matched study.  

PubMed

Continuous venovenous hemofiltration (CVVH) is an important organ supportive technique. This study aimed to evaluate the impact of early classic CVVH on the outcomes of severe acute pancreatitis (SAP) patients with early organ failure (EOF). Between 2008 and 2012, a total of 44 SAP patients with EOF were admitted to our department. The 44 patients were classified into two groups according to whether they received early classic CVVH (2?L/h, initiated within 24?h after admission): 25 patients received early CVVH (ECVVH group), and 19 patients did not receive early CVVH (control group). The two groups were matched for age and Acute Physiology and Chronic Health Evaluation II scores. The severity of organ dysfunctions was evaluated by Sequential Organ Failure Assessment (SOFA) scores. Each group included 19 patients. The baseline characters between the two groups were balanced. The SOFA scores in the ECVVH group increased compared with those in the control group. The time to weaning from mechanical ventilation was significantly longer in the ECVVH group (log-rank test: ?(2) ?=?4.007, P?=?0.045). Renal support was also significantly prolonged in the ECVVH group (the number of patients receiving CVVH 72?h after admission: 10 vs. 3, respectively, P?=?0.038). Nine patients died in the ECVVH group versus six patients in the control group (P?=?0.508). In conclusion, our study failed to prove that early classic CVVH had any benefits on the outcomes of SAP patients with EOF. Unexpectedly, early classic CVVH worsened organ functional capacity. However, it is possible that CVVH using advanced techniques may be beneficial in SAP patients with EOF. PMID:24020965

Zhang, Xujie; Sun, Shiren; Li, Shujun; Feng, Xiangying; Wang, Shiqi; Liu, Chaoxu; Hang, Zhenning; Tong, Chao; Zhu, Cailin; Bai, Bin; Xu, Bin; Feng, Quanxin; Zhao, Qingchuan

2014-04-01

115

A Randomized Controlled Trial of Enteral versus Parenteral Feeding in Patients with Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications with Total Enteral Nutrition  

Microsoft Academic Search

Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with

Maxim S. Petrov; Mikhail V. Kukosh; Nikolay V. Emelyanov

2006-01-01

116

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

Microsoft Academic Search

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

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

2004-01-01

117

Prebiotics in ImmunoModulation for Treatment of Acute Pancreatitis  

Microsoft Academic Search

\\u000a Intestinal mucosal immune system plays a significant role in the pathogenesis of severe acute pancreatitis and its associated\\u000a complications. Prebiotics restore intestinal bacteria flora in patients with severe acute pancreatitis. Moreover, they exert\\u000a beneficial anti-infective and metabolic effects. Earlier studies show that prebiotics improve clinical outcome in patients\\u000a with severe acute pancreatitis. More research is warranted to study the effects

Refaat A. Hegazi

118

Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review*  

PubMed Central

Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

2013-01-01

119

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

PubMed Central

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

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

120

Protective Effect of Melatonin on Acute Pancreatitis  

PubMed Central

Melatonin, a product of the pineal gland, is released from the gut mucosa in response to food ingestion. Specific receptors for melatonin have been detected in many gastrointestinal tissues including the pancreas. Melatonin as well as its precursor, L-tryptophan, attenuates the severity of acute pancreatitis and protects the pancreatic tissue from the damage caused by acute inflammation. The beneficial effect of melatonin on acute pancreatitis, which has been reported in many experimental studies and supported by clinical observations, is related to: (1) enhancement of antioxidant defense of the pancreatic tissue, through direct scavenging of toxic radical oxygen (ROS) and nitrogen (RNS) species, (2) preservation of the activity of antioxidant enzymes; such as superoxide dismutase (SOD), catalase (CAT), or glutathione peroxidase (GPx), (3) the decline of pro-inflammatory cytokine tumor necrosis ? (TNF?) production, accompanied by stimulation of an anti-inflammatory IL-10, (4) improvement of pancreatic blood flow and decrease of neutrophil infiltration, (5) reduction of apoptosis and necrosis in the inflamed pancreatic tissue, (6) increased production of chaperon protein (HSP60), and (7) promotion of regenerative process in the pancreas. Conclusion. Endogenous melatonin produced from L-tryptophan could be one of the native mechanisms protecting the pancreas from acute damage and accelerating regeneration of this gland. The beneficial effects of melatonin shown in experimental studies suggest that melatonin ought to be employed in the clinical trials as a supportive therapy in acute pancreatitis and could be used in people at high risk for acute pancreatitis to prevent the development of pancreatic inflammation.

Jaworek, Jolanta; Szklarczyk, Joanna; Jaworek, Andrzej K.; Nawrot-Porabka, Katarzyna; Leja-Szpak, Anna; Bonior, Joanna; Kot, Michalina

2012-01-01

121

Peritoneal Lavage Efficiently Eliminates Protease-Alpha-2Macroglobulin Complexes and Components of the Contact System from the Peritoneal Cavity in Patients with Severe Acute Pancreatitis  

Microsoft Academic Search

Trypsin (Try), plasma kallikrein (KK) and plasmin activities together with coagulation factor XII (F XII, Hageman factor), high-molecular-weight kininogen (HMWK), plasma prekallikrein (PKK), ?2-macroglobulin (c?2-M), C1 inhibitor (C1Inh), and functional plasma kallikrein inhibition (KKI) values were studied in peritoneal fluid and lavage taps of 9 patients with severe acute pancreatitis treated with peritoneal lavage. Both immunochemical methods and functional techniques

A. O. Aasen; T. E. Ruud; O. Roeise; B. N. Bouma; J. O. Stadaas

1989-01-01

122

Practical Guidelines for Acute Pancreatitis  

Microsoft Academic Search

Introduction: The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis. Statements: Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence

R. Pezzilli; A. Zerbi; V. Di Carlo; C. Bassi; G. F. Delle Fave

2010-01-01

123

The Management of Acute and Chronic Pancreatitis  

PubMed Central

Pancreatitis, which is most generally described as any inflammation of the pancreas, is a serious condition that manifests in either acute or chronic forms. Chronic pancreatitis results from irreversible scarring of the pancreas, resulting from prolonged inflammation. Six major etiologies for chronic pancreatitis have been identified: toxic/ metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction. The most common symptom associated with chronic pancreatitis is pain localized to the upper-to-middle abdomen, along with food malabsorption, and eventual development of diabetes. Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases. Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes. Dietary restrictions are recommended, along with enzyme replacement and vitamin supplementation. More definitive outcomes may be achieved with surgical or endoscopic methods, depending on the role of the pancreatic ducts in the manifestation of disease.

Banks, Peter A.; Conwell, Darwin L.; Toskes, Phillip P.

2010-01-01

124

siRNA-based targeting of fractalkine overexpression suppresses inflammation development in a severe acute pancreatitis rat model.  

PubMed

Fractalkine (FKN), a chemokine that acts as both an adhesion molecule and a chemoattractant, is expressed in many inflammatory diseases. Chemokines play a crucial role in severe acute pancreatitis (SAP). This study used adenovirus-mediated siRNA to target FKN overexpression and assessed its ability to suppress inflammation development in a SAP rat model. Adenovirus-mediated FKN siRNA was transfected into cerulein-stimulated AR42J cells. The growth of cerulein-stimulated AR42J cells was determined by colony formation and MTT assays. The inhibitory effect of the FKN siRNA was studied in a SAP rat model in vivo and detected by ELISA, RT-PCR, western blot analysis and immunohistochemistry. FKN, IL-8 and TNF-? were found to be overexpressed in cerulein-stimulated AR42J cells by ELISA and western blot analysis (P<0.05). The animal experiments confirmed that FKN siRNA could inhibit inflammation development in SAP. The values of serum FKN, TNF-? and IL-8 levels were decreased after FKN siRNA treatment (P<0.05). Furthermore, western blotting and RT-PCR analysis showed that FKN protein and mRNA levels were decreased after injection with FKN siRNA (P<0.05). Immunohistochemistry also showed that inflammation was decreased after injection with FKN-siRNA in the SAP rat model. Treatment with siRNA can inhibit FKN overexpression and also suppresses inflammation development in a SAP rat model. More importantly, this study indicated that FKN, which is overexpressed in the SAP rat model, may serve as a novel and effective therapeutic target for SAP. PMID:22751862

Huang, Liya; Ma, Junwen; Tang, Yuming; Chen, Ping; Zhang, Shuxian; Zhang, Yongping; Yuan, Yao Zong

2012-09-01

125

Complicated acute pancreatitis  

Microsoft Academic Search

Opinion statement  The treatment of severe, complicated pancreatitis requires:\\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Rapid assessment and recognition of severity, determined by using APACHE or equivalent scoring systems.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Aggressive resuscitation with crystalloid and colloid solutions using central venous monitoring for guidance, and to help\\u000a identify and treat early organ failure.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Nutritional support including total parenteral feeding, which can assist in maintaining nutrition during

Stephen P. Martin; Charles D. Ulrich

1999-01-01

126

Somatostatin therapy of acute experimental pancreatitis.  

PubMed Central

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.

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

1977-01-01

127

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

PubMed Central

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

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

2007-01-01

128

Acute pancreatitis complicating excessive intake of phenolphthalein.  

PubMed Central

A case is described in which a patient presented with acute pancreatitis following inadvertent ingestion of large quantities of phenolphthalein for the treatment of his chronic constipation. There was complete recovery and no sequelae from the acute attack of pancreatitis.

Lambrianides, A. L.; Rosin, R. D.

1984-01-01

129

Acute hepatitis E complicated by acute pancreatitis and multiorgan dysfunction.  

PubMed

We report this rare case of a 27-year-old man who presented with acute hepatitis E and went on to develop acute epigastric pain. He was diagnosed to have acute severe pancreatitis with shock and acute renal failure due to hepatitis E. Such a phenomenon has rarely been reported in the literature, with patients following a benign course and complete recovery after conservative management and analgesia. Awareness of this potentially life-threatening complication, especially in young men from endemic areas with acute hepatitis E presenting with abdomen pain has been highlighted. PMID:24899005

Karanth, Suman S; Khan, Zohaib; Rau, Nileshwar Radhakrishna; Rao, Karthik

2014-01-01

130

Gallstone pancreatitis: positive correlation between severe pancreatitis and passed stone  

Microsoft Academic Search

Background\\/Purpose. Little is known about whether the severity of pancreatitis depends upon persistent stone impaction or stone passage into the duodenum, and the role of endoscopic sphincterotomy (ES) has remained controversial. Methods. This study reviewed our experience of 183 patients with gallstone pancreatitis, with special attention paid to the relationship between the severity of pancreatitis, the severity of coexisting biliary

Masatoshi Isogai; Akihiro Yamaguchi; Tohru Harada; Yuji Kaneoka; Junji Washizu; Kiyoshi Aikawa

2005-01-01

131

Acute pancreatitis: a multisystem disease.  

PubMed

Proteolytic enzymes, lipase, kinins, and other active peptides liberated from the inflamed pancreas convert inflammation of the pancreas, a single-organ disease of the retroperitoneum, to a multisystem disease. Adult respiratory distress syndrome, in addition to being secondary to microvascular thrombosis, may be the result of active phospholipase A (lecithinase), which digests lecithin, a major component of surfactant. Myocardial depression and shock are suspected to be secondary to vasoactive peptides and a myocardial depressant factor. Coagulation abnormalities may range from scattered intravascular thrombosis to severe disseminated intravascular coagulation. Acute renal failure has been explained on the basis of hypovolemia and hypotension. The renin-angiotensin alterations in acute pancreatitis (AP) as mediators of renal failure need to be studied. Metabolic complications include hypocalcemia, hyperlipemia, hyperglycemia, hypoglycemia, and diabetic ketoacidosis, of which hypocalcemia has been long recognized as an indicator of poor prognosis. The pathogenesis of hypocalcemia is multifactorial and includes calcium-soap formation, hormonal imbalances (e.g., parathyroid hormone, calcitonin, glucagon), binding of calcium by free fatty acid-albumin complexes, and intracellular translocation of calcium. Subcutaneous fat necrosis, arthritis, and Purtscher's retinopathy are rare. The various prognostic criteria of AP and other associated laboratory abnormalities are manifestations of systemic effects. Early recognition and appropriated management of these complications have resulted in improved prognosis of severe AP. PMID:8049885

Agarwal, N; Pitchumoni, C S

1993-06-01

132

[Pancreas. Part I: congenital changes, acute and chronic pancreatitis].  

PubMed

The pancreas develops from ventral and the dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum because of insufficient drainage. MR cholangiopancreatography (MRCP) is the technique of choice for detecting pancreas divisum non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (and sometimes stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. The Atlanta classification differentiates between mild acute and severe acute pancreatitis associated with organ failure and/or local complications such as necrosis, abscess or pseudocyst. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of disease. Balthazar et al.'s CT severity index assesses the risk of mortality and morbidity. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis. PMID:16496105

Schima, W; Ba-Ssalamah, A; Plank, C; Kulinna-Cosentini, C; Püspök, A

2006-04-01

133

Role of endoscopic ultrasonography in the diagnosis of acute and chronic pancreatitis.  

PubMed

Endoscopic ultrasonography (EUS) can be a useful tool for detecting underlying causes of acute pancreatitis and establishing the severity of fibrosis in chronic pancreatitis. Ancillary techniques include fine needle aspiration and core biopsy, bile collection for crystal analysis, pancreatic function testing, and celiac plexus block. This review focuses on the role of EUS in the diagnosis of acute and chronic pancreatitis. PMID:24079787

Stevens, Tyler

2013-10-01

134

Influence of bile flow interruption on acute experimental pancreatitis.  

PubMed

The influence of bile flow interruption on the pathogenesis of acute pancreatitis has been evaluated in the rat. The pancreatitis was induced by Pfeffer's technique and the severity of the disease was assessed by a macroscopic examination of the pancreatic damage and the calculation of amylase-to-creatinine clearance ratio (ACCR) as well. The results showed that the bile reflux into the pancreas made the pancreatic lesions caused by stasis in the gland associated with hyperstimulation of exocrine secretion more severe. On the other hand the bile reflux had no influence when the pancreatitis was due to flowing back of duodenal contents into the pancreas (closed duodenal loop). It was concluded that the bile effect is probably consistent with a pressure mechanism. In addition the reliability of ACCR in the diagnosis of acute pancreatitis was confirmed, and the test was effective in detecting even milder pancreatic damages. PMID:6206023

Sarli, L; Gafŕ, M; Lupi, M; Peracchia, A

1984-01-01

135

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

PubMed Central

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

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

2014-01-01

136

Pathophysiology of Acute Experimental Pancreatitis: Lessons from Genetically Engineered Animal Models and New Molecular Approaches  

Microsoft Academic Search

The incidence of acute pancreatitis is growing and worldwide population-based studies report a doubling or tripling since the 1970s. 25% of acute pancreatitis are severe and associated with histological changes of necrotizing pancreatitis. There is still no specific medical treatment for acute pancreatitis. The average mortality resides around 10%. In order to develop new specific medical treatment strategies for acute

Claus Schäfer; Anne Barbara Tietz; Burkhard Göke

2005-01-01

137

Epidemiological characteristic of acute pancreatitis in Trzebnica district.  

PubMed

Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas. PMID:22487738

Bogdan, Justyna; Elsaftawy, Ahmed; Kaczmarzyk, Janusz; Jab?ecki, Jerzy

2012-02-01

138

Lipase turbidimetric assay and acute pancreatitis.  

PubMed

The simplified turbidimetric assay for lipase activity was used for the differential diagnosis of acute pancreatitis. Serum lipase levels were found to be increased in a group of 17 patients in whom acute pancreatitis was clinically suspected and confirmed by a high ACCR and decreased uptake of the radionuclide in the pancreas scan. The lipase levels were within normal limits in a control group of 14 patients suffering from diseases other than acute pancreatitis. The turbidimetric test was helpful for rapid quantitative determination of serum lipase and thus for the early and accurate diagnosis of acute pancreatitis. PMID:6200277

Orda, R; Orda, S; Baron, J; Wiznitzer, T

1984-04-01

139

Dendritic Cells Promote Pancreatic Viability in Mice with Acute Pancreatitis  

PubMed Central

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

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

2011-01-01

140

Solitary Main Pancreatic Ductal Calculus of Possible Biliary Origin Causing Acute Pancreatitis  

Microsoft Academic Search

Context Pancreatic ductal calculi are most often associated with chronic pancreatitis. Radiological features of chronic pancreatitis are readily evident in the presence of these calculi. However, acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. Case report A 59 -year-old man presented with a first episode of acute pancreatitis. Contrast enhanced computerized tomography (CT)

Ramakrishna Prasad; Chowdary Chaparala; Rafiuddin Patel; James Ahsley Guthrie; Mervyn Huw Davies; Pierre J Guillou; Krishna V Menon

141

Enteral Nutrition and Acute Pancreatitis: A Review  

PubMed Central

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

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

2011-01-01

142

Duodenal perforation due to a kink in a nasojejunal feeding tube in a patient with severe acute pancreatitis: a case report  

PubMed Central

Introduction Nasojejunal feeding tube placement can be achieved by fluoroscopic or endoscopic techniques. Significant complications due to nasojejunal feeding tube placement, such as hydrothorax, duodenal perforation and retroperitoneal emphysema, are very rare. We present a case of massive retroperitoneal emphysema and abscess because of duodenal perforation caused by a kink in a nasojejunal feeding tube. Case presentation A 34-year-old Chinese woman was admitted to our intensive care unit due to hypertriglyceridemia and severe acute pancreatitis. As she suffered from acute respiratory distress syndrome and required mechanical ventilation, a nasojejunal feeding tube was placed by transnasal endoscopic technique. The procedure took place at her bedside. Half a month later, she had a high fever and abdominal distension. An abdominal radiography was performed and showed that the nasojejunal feeding tube was kinking on the third portion of the duodenum and the tip of the nasojejunal feeding tube was inserted into the right retroperitoneum on the second portion of the duodenum. Conclusion When a nasojejunal feeding tube is placed through the transnasal endoscopic technique, an abdominal radiography should be used to confirm the tube's position and indicate if it is kinking or beyond the ligament of Treitz.

2010-01-01

143

[The pathophysiology of acute pancreatitis (author's transl)].  

PubMed

An acute pancreatitis is possible, both in a hitherto healthy organ (mainly together with gallstones) and in a chronically danaged gland (maily together with alcoholism). Toxic damage of the pancreas is found in hypercalcemic states and with drugs. It is unknown what directly induces acute inflammation in the pancreas. The pathophysiological consequences of acute pancreatitis are mainly volume deficiency and shock, renal failure, pulmonary insufficiency, disturbances of carbohydrate metabolism and blood clotting. Prognosis of acute pancreatitis is difficult to evaluate. Clinical findings and laboratory parameters are utilized together to judge the presumable course of the disease. PMID:7001844

Goebell, H

1980-01-01

144

Acute pancreatitis: the substantial human and financial costs.  

PubMed

A greater understanding of the natural history of acute pancreatitis combined with greatly improved radiological imaging has led to improvement in the hospital mortality from acute pancreatitis, from around 25-30% to 6-10% in the past 30 years. Moreover, it is now recognised that the first phase of severe acute phase pancreatitis is a systemic inflammatory response syndrome (SIRS), during which multiple organ failure and death often supervene. Survival into the second phase may be accompanied by local complications, such as infected pancreatic necrosis, which may be prevented by prophylactic antibiotics and treated by judicious surgery. Intensive care unit costs can be substantial, but might be justified because of the excellent quality of life of survivors. Reduction in multiple organ failure by agents such as lexipafant, an antagonist of platelet activating factor (PAF) (which plays a critical role in generating the SIRS), may contribute to intensive care unit cost containment, as well as reducing the incidence of local complications and deaths from acute pancreatitis. A further improvement in the human and financial costs also requires the centralisation of the management of patients with severe acute pancreatitis, to single hospital units whose concentrated expertise equips them to intervene most effectively in what is still recognised as a highly complex disease. PMID:9691932

Neoptolemos, J P; Raraty, M; Finch, M; Sutton, R

1998-06-01

145

Acute idiopathic pancreatitis: clinical and diagnostic contribution.  

PubMed

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

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

1997-01-01

146

A case of montelukast induced hypercholesterolemia, severe hypertriglyceridemia and pancreatitis  

PubMed Central

Montelukast sodium is a leukotriene inhibitor, and competitively antagonizes cys-LT1 receptor and used widely and effectively in treating allergic rhinitis, bronchial asthma and allied respiratory conditions. This case report outlines a rare case of montelukast induced hypercholesterolemia, severe hypertriglyceridemia and acute pancreatitis in a 22 years old male patient. The patient was taking 10 mg oral montelukast daily for allergic rhinitis. Although his symptoms improved considerably, after 2 months of therapy, he experienced unusual weight gain and got admitted with severe pain abdomen. Clinical and other relevant investigation findings revealed the presence of acute pancreatitis with associated hypercholesterolemia and severe hypertriglyceridemia. There were no evidences of any other possible hereditary, surgical, metabolic, infective, organic or other pathologic causes giving rise to these conditions. De-challenge was done and the patient was treated conservatively resulting in reversal of the diseased state. Naranjo adverse drug reaction probability scale suggested that it was 'probable' that oral administration of montelukast was responsible for the acute pancreatitis associated with hypercholesterolemia and severe hypertriglyceridemia. There is only a singular and confirmed reported case of montelukast induced hypertriglyceridemia from India. For patients taking montelukast for a long duration, routine lipid profile monitoring should be done, and if these patients present with symptoms of epigastric and periumbilical pain with vomiting, provisions for screening acute pancreatitis might be warranted.

Das, Saibal; Mondal, Somnath; Dey, Jayanta Kumar; Bandyopadhyay, Sanjib; Saha, Indranil; Tripathi, Santanu Kumar

2013-01-01

147

Why a detailed examination after acute pancreatitis?  

PubMed

During the 1965-9 period, we studied the consequences of acute pancreatitis in a group of 53 patients (1). Using the 1963 Marseille classification of pancreatitis (2), we pointed, inter alia, to the incidence of changes in exocrine and endocrine functions of the pancreas in some patients (something that we would refer to as residua after acute pancreatitis, today), and emphasized the need for a detailed examination of patients, following an attack of acute pancreatitis. In this article we wish to reemphasize the need for such detailed examination, this time in connection with new classifications of pancreatitis, i.e., the Revised Classification of Pancreatitis--Marseille, 1984 (3), and the Pancreatitis Classification of Marseille-Rome 1988 (4,5). The latter classification, based on studies of lesions and causes of pancreatitis, constitutes yet another attempt to integrate pathology into the prerequisites for clear-cut definition of the disease. However, a definition of pancreatitis, based on pathological findings, remains an aim yet to be attained in everyday clinical practice. That is why the clinician will rely on the Marseille classification (1984), taking into account the Marseille-Rome classification (1988). PMID:1946317

Stastná, R

1991-09-01

148

[Pancreas. Congenital changes, acute and chronic pancreatitis].  

PubMed

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis. PMID:17468982

Schima, W; Ba-Ssalamah, A; Plank, C; Kulinna-Cosentini, C; Püspök, A

2007-05-01

149

Endocrine pancreatic secretion in patients after acute pancreatitis.  

PubMed

In 14 nonobese patients after acute pancreatitis and with normal oral glucose tolerance, the response of insulin, C-peptide, and pancreatic glucagon after 100 g of oral glucose was assessed. The curves of insulin and C-peptide were significantly raised compared with those of controls, and no difference was found between the response of patients with a negative (n = 8) and a positive (n = 6) family history of type II diabetes. The curves of pancreatic glucagon did not differ from those found in controls. Our results indicate that a normal response to glucose after recovery from an attack of acute pancreatitis is maintained at the cost of increased insulin secretion. PMID:2188259

Stastná, R; Karasová, L; Svácek, J; Petrásek, R; Winkler, L; Lánská, V; Skála, I; Malý, J

1990-05-01

150

Acute Pancreatitis Associated with Amoebic Liver Abscess  

PubMed Central

We present a rare case of acute pancreatitis in a 50-year-old man with amoebic liver abscess. He had a right lobe liver abscess along with markedly elevated serum lipase and amylase levels and edematous pancreas. Liver abscess was aspirated. The patient was managed conservatively with antibiotics and improved without any complications. Acute pancreatitis associated with ALA is not reported in the literature till date.

Ghosh, Jayant Kumar; Dixit, Vinod Kumar; Lamtha, Sangey Chopel; Goyal, Sundeep Kumar; Kaushik, Pankaj

2013-01-01

151

Acute pancreatitis and amiodarone: A case report  

PubMed Central

Amiodarone, a class III antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.

Chen, Yen-Yuan; Chen, Ching-Yu; Leung, Kai-Kuen

2007-01-01

152

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

PubMed Central

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

2014-01-01

153

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

Microsoft Academic Search

Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a

Pratibha Seshadri; Anand Vimal Dev; Surekha Viggeswarpu; Sowmya Sathyendra; John Victor Peter

2008-01-01

154

Amelioration of experimental acute pancreatitis with Dachengqi Decoction via regulation of necrosis-apoptosis switch in the pancreatic acinar cell.  

PubMed

Severity of acute pancreatitis contributes to the modality of cell death. Pervious studies have demonstrated that the herb medicine formula "Dachengqi Decoction" (DCQD) could ameliorate the severity of acute pancreatitis. However, the biological mechanisms governing its action of most remain unclear. The role of apoptosis/necrosis switch within acute pancreatitis has attracted much interest, because the induction of apoptosis within injured cells might suppress inflammation and ameliorate the disease. In this study, we used cerulein (10(-8) M)-stimulated AR42J cells as an in vitro model of acute pancreatitis and retrograde perfusion into the biliopancreatic duct of 3.5% sodium taurocholate as an in vivo rat model. After the treatment of DCQD, cell viability, levels of apoptosis and necrosis, reactive oxygen species positive cells, serum amylase, concentration of nitric oxide and inducible nitric oxide syntheses, pancreatic tissue pathological score and inflammatory cell infiltration were tested. Pretreatment with DCQD increased cell viability, induced apoptosis, decreased necrosis and reduced the severity of pancreatitis tissue. Moreover, treatment with DCQD reduced the generation of reactive oxygen species in AR42J cells but increased the concentration of nitric oxide of pancreatitis tissues. Therefore, the regulation of apoptosis/necrosis switch by DCQD might contribute to ameliorating the pancreatic inflammation and pathological damage. Further, the different effect on reactive oxygen species and nitric oxide may play an important role in DCQD-regulated apoptosis/necrosis switch in acute pancreatitis. PMID:22768339

Wang, Jia; Chen, Guangyuan; Gong, Hanlin; Huang, Wei; Long, Dan; Tang, Wenfu

2012-01-01

155

Selected biochemical parameters and ultrastructural picture of pancreas due to Ulinastatin treatment of experimental acute pancreatitis  

Microsoft Academic Search

Urinary trypsin inhibitor (UTI, Ulinastatin) is a protease inhibitor that has not been yet used in Europe in any experimental trial of severe acute pancreatitis. We have combined the experimental model of severe, hemorrhagic form of acute pancreatitis, and pharmacological treatment with a protease inhibitor. Male Wistar rats were divided into four experimental groups: healthy controls, operated, operated with experimentally

R. Maciejewski; F. Burdan; K. Burski; B. Madej; R. Ziemiakowicz; A. D?browski; G. Wallner

2005-01-01

156

Effect of Dextran 40 and aprotinin on experimental acute pancreatitis.  

PubMed

This study examines and compares the prophylactic role of aprotinin and Dextran 40 in acute pancreatitis. Experimental acute pancreatitis was induced in 70 male Wistar rats using the closed-duodenal-loop technique. The rats were randomly divided into four groups; sham operation, untreated acute pancreatitis, and therapy with aprotinin or Dextran 40. Samples of blood and urine were collected at the beginning and at the end of the 24-hr period for measurement of amylase and creatinine which allowed calculation of the amylase-creatinine clearance ratio (ACCR). Mortality in the aprotinin group was the same as the untreated rats (20%). Dextran 40 therapy was associated with a lower mortality rate (6.7%). Light microscopic examination confirmed that the histologic changes of acute pancreatitis were less severe in both the aprotinin- and Dextran 40-treated rats. The ACCR was elevated after Dextran 40 therapy, which was due mainly to high urinary amylase levels. These results suggest that Dextran 40 may have a prophylactic role in acute experimental pancreatitis but again emphasizes the high false-positive rate of the ACCR determination. PMID:6199589

Crocket, K V; Reising, J R; Wirman, J A; Gau, N; Joffe, S N

1984-03-01

157

Alterations in intestinal motility and microflora in experimental acute pancreatitis  

Microsoft Academic Search

Summary\\u000a Conclusion  \\u000a A delay in intestinal transit time appears as an early event in acute pancreatitis, preceding intestinal bacterial overgrowth\\u000a and translocation.\\u000a \\u000a \\u000a \\u000a Background  Septic complications, primarily caused by bacteria of enteric origin, are frequent in severe acute pancreatitis. Impairment\\u000a in intestinal motility probably plays a pathophysiological role in the development of bacterial overgrowth and ensuing translocation.\\u000a \\u000a \\u000a \\u000a Methods  In the present study, the

Per Leveau; Xiangdong Wang; Vasile Soltesz; Ingemar Ihse; Roland Andersson

1996-01-01

158

Lanreotide autogel-induced acute pancreatitis in a patient with acromegaly.  

PubMed

Somatostatin and somatostatin analogues are considered very useful for the treatment of hormone producing tumors and acute variceal bleeding. They have also been proposed for the treatment of acute pancreatitis and for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis although clinical trials have failed to show any efficacy. The authors report the case of a 45-year-old man, recently diagnosed of acromegaly, which developed an acute pancreatitis shortly after his first injection of lanreotide autogel. The patient developed a severe dilatation of his hypocontractile gallbladder with distension of the intra and extrahepatic biliary ducts, the choledochus and the main pancreatic duct, without lithiasis or other abnormalities at the papilla, which resolved spontaneously in a month. We consider that lanreotide most likely induced a functional spasm of the Sphincter of Oddi, with impairment of the biliary-pancreatic outflow, leading to an acute pancreatitis, and review the literature concerning this drug related pancreatitis. PMID:22749514

Sequeira Lopes da Silva, José Tiago; González Casas, Olga; Bejarano Moguel, Verónica; Lobo Pascua, Maria; López-Santamaría Redondo, Antonio; Cordero Torres, Remigio

2013-01-01

159

Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis  

Microsoft Academic Search

Background\\/Aim: Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD) in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence

Liliane S. Deeb; Jasmeet Bajaj; Sandeep Bhargava; David Alcid; C. S. Pitchumoni

2008-01-01

160

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

PubMed

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

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

2013-01-01

161

Acute pancreatitis in infants and children.  

PubMed Central

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.

Hillemeier, C.; Gryboski, J. D.

1984-01-01

162

Endoscopic therapy for acute recurrent pancreatitis.  

PubMed

Endoscopy plays an important role in both the diagnosis and the initial management of recurrent acute pancreatitis, as well as the investigation of refractory disease, but it has known limitations and risks. Sound selective use of these therapies, complemented with other lines of investigation such as genetic testing, can dramatically improve frequency of attacks and associated quality of life. Whether endoscopic therapy can reduce progression to chronic pancreatitis, or reduce the risk of malignancy, is debatable, and remains to be proven. PMID:24079791

Roberts, Jason R; Romagnuolo, Joseph

2013-10-01

163

Correlates of morbidity and mortality in severe necrotizing pancreatitis.  

PubMed

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus 40%) was significantly higher in group B. The rate of organ dysfunction also rose along with the rates of other morbidities and variables that were related to a patient's hospital stay. Only APACHE II significantly correlated with the degree of necrosis, wherein the chances of substantial necrosis rose by 20% with each unit increase of APACHE II score. APACHE II Score could be employed and studied further prospectively to help identify patients with pancreatic necrosis. PMID:22844617

Pal, K M; Kasi, Pashtoon Murtaza; Tayyeb, Mohammad; Mosharraf, S M Faisal; Fatmi, Zafar

2012-01-01

164

Correlates of Morbidity and Mortality in Severe Necrotizing Pancreatitis  

PubMed Central

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus 40%) was significantly higher in group B. The rate of organ dysfunction also rose along with the rates of other morbidities and variables that were related to a patient's hospital stay. Only APACHE II significantly correlated with the degree of necrosis, wherein the chances of substantial necrosis rose by 20% with each unit increase of APACHE II score. APACHE II Score could be employed and studied further prospectively to help identify patients with pancreatic necrosis.

Pal, K. M.; Kasi, Pashtoon Murtaza; Tayyeb, Mohammad; Mosharraf, S. M. Faisal; Fatmi, Zafar

2012-01-01

165

[Ehlers-Danlos syndrome associated with acute pancreatitis].  

PubMed

Ehlers-Danlos syndrome is an inherited connective tissue disease characterized by articular laxity, hyperelastic skin and tissue fragility. The syndrome is genetically, biochemically and clinically heterogeneous and several well-defined subtypes have been identified. We describe a patient with the type IV variant of this syndrome who developed acute spontaneous pancreatitis. PMID:11219134

Indart, A; Zugasti, P; Alzate, L F; Arenas, J I

2001-01-01

166

Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years' experience  

PubMed Central

Background Conservative treatment of patients with severe acute pancreatitis (SAP) may be associated with development of intra-abdominal hypertension (IAH), deterioration of visceral perfusion and increased risk of multiple organ dysfunction. Fluid balance is essential for maintenance of adequate organ perfusion and control of the third space. Timely application of continuous veno-venous haemofiltration (CVVH) may help in balancing fluid replacement and removal of cytokines from the blood and tissue compartments. The aim of the present study was to determine whether CVVH can be recommended as a constituent of conservative treatment in patients with SAP who suffer IAH. Methods A retrospective analysis of 10 years' experience with low-flow CVVH application in patients with SAP who develop IAH was. In all patients, measurement of the intra-abdominal pressure (IAP) was done indirectly through the urinary bladder. Sequential organ failure assessment (SOFA) score was calculated for severity assessment, and necrotizing forms were verified by contrast-enhanced computed tomography. Dynamics of IAP were analysed in parallel with signs of systemic inflammation, dynamics of C-reactive protein and cumulative fluid balance. All variables, complication rate and outcomes were analysed in the whole group and in patients with IAH (CVVH and no-CVVH groups). Results From the total of 130 patients, 75 were treated with application of CVVH and 55 without CVVH. Late hospitalization was associated with application of CVVH. Infection was observed in 28.5% of cases regardless of the type of treatment received, with a similar necessity for surgical intervention. IAH was observed in 68.5% of patients, and they had significantly higher SOFA scores compared to patients with normal IAP. CVVH treatment resulted in negative cumulative fluid balance starting from day 5 in patients with IAH, whereas without this treatment, fluid balance remained increasingly positive after a week. Finally, application of CVVH resulted in a lower infection rate and shorter hospital stay, 26.7% vs. 37.9%, and a median of 32 (interquartile range (IQR) = 60 to 12) days vs. 24 (IQR = 34 to 4) days, p = 0.05, comparing CVVH vs. no-CVVH group. Mortality rate reached 11.7% in the CVVH group and 13.8% in the no-CVVH group. Conclusions Early application of CVVH facilitates negative fluid balance and reduction of IAH in patients with SAP; it is not associated with increased infection or mortality rate and may reduce hospital stay.

2012-01-01

167

Acute pancreatitis induced by methimazole therapy.  

PubMed

Among the causative factors for acute pancreatitis, adverse drug reactions are considered to be rare. The diagnosis of drug-induced pancreatitis (DIP) is challenging to establish, and is often underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected agent. We present the case of an 80-year-old woman who presented with complaints of abdominal pain. Her medications included methimazole (MMI) which she had been on for the past 3 months. Computed tomography of her abdomen showed peripancreatic fat stranding with trace amount of surrounding fluid, along with amylase and lipase levels suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to MMI use was made. Withdrawal of the drug from her medication regimen was accompanied by relief of symptoms and resolution of clinical evidence of pancreatitis. The aim of this paper is to report only the fourth case of MMI-induced pancreatitis in the published literature, and to illustrate the significance of an appropriate and timely diagnosis of DIP. PMID:22679409

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

2012-05-01

168

Fatal brain stem event complicating acute pancreatitis.  

PubMed

Acute pancreatitis, developing in a patient with chronic renal failure, was complicated by a fatal neurological illness during which MRI showed pontine and extrapontine changes consistent with pontine and extrapontine myelinolysis. At post mortem, acute pancreatitis was confirmed but the neuropathological findings were more in keeping with an unusual presentation of acute haemorrhagic leucoencephalitis, perhaps even representing a form of 'pancreatic encephalopathy'. Although the development of CT and MRI scanning has greatly increased the resolution of neuroimaging and facilitated diagnosis during life, the value of autopsy examination is confirmed in cases such as this. Sometimes the findings may raise more questions than may have been answered - this too is an important function! PMID:12763345

Chan, C; Fryer, J; Herkes, G; Prelog, K; Harrington, T

2003-05-01

169

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse Outcomes of Acute Pancreatitis  

Microsoft Academic Search

Background: Most acute pancreatitis risk scoring systems use total white blood cell counts (WBC) as one of the risk factors. The value of the neutrophil-lymphocyte ratio (NLR) to predict the severity of acute pancreatitis has not been previously evaluated. Methods:This observational study included 283 patients admitted to a tertiary center between 2004 and 2007. The patients were arranged into tertiles

Basem Azab; Neil Jaglall; Jean Paul Atallah; Ari Lamet; Venkat Raja-Surya; Bachir Farah; Martin Lesser; Warren D. Widmann

2011-01-01

170

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

PubMed Central

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

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

2014-01-01

171

Acute pancreatitis and superior mesenteric artery syndrome.  

PubMed

Superior mesenteric artery syndrome (SMAS) has been proposed as a rare cause of proximal bowel obstruction resulting from compression of the third portion of the duodenum secondary to narrowing of the space between the aorta and superior mesenteric artery. The main risk factors associated with SMAS are significant weight loss, corrective spinal surgery and congenital or acquired anatomic abnormalities. Its association with acute pancreatitis has been reported in very few cases. We present a critical review of this topic, with the report of a patient allegedly diagnosed of SMAS and acute pancreatitis. PMID:24641461

Sihuay-Diburga, Denisse Joan; Accarino-Garaventa, Anna; Vilaseca-Montplet, Jaime; Azpiroz-Vidaur, Fernando

2013-01-01

172

Pioglitazone, a PPAR-? activator, attenuates the severity of cerulein-induced acute pancreatitis by modulating early growth response-1 transcription factor.  

PubMed

The purpose of this study was to test the hypothesis that activation of endogenous peroxisome proliferator-activated receptor (PPAR?) inhibits induction of early growth response factor-1 (Egr-1), which is rapidly induced in the pancreas following cerulein intraperitoneal injection. Acute pancreatitis was induced in mice by hourly intraperitoneal injection of cerulein. Pioglitazone was administered prophylactically and pancreatic inflammation was assessed. AR42J cells were stimulated with caerulein 10?? M co-incubated in presence of different concentration of pioglitazone. The expression of PPAR?, Egr-1, and the target genes of Egr-1 were studied by real-time reverse transcriptase polymerase chain reaction (PCR), Western blot, and immunohistochemistry. In vitro, a PPAR-? activator (pioglitazone) strikingly diminished Egr-1 mRNA and protein expression corresponding to Egr-1. In vivo, treatment with pioglitazone prior to the intraperitoneal injection of cerulein induction of Egr-1 and its target genes such as, monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1 (MIP-1). The inhibitory effect of pioglitazone on Egr-1 expression induced by cerulein was almost fully restored by GW9662. Activation of PPAR-? suppressed the activation of Egr-1 and its inflammatory gene targets and provided potent protection against pancreas injury. These data suggest a new mechanism in which PPAR-? activation may decrease tissue inflammation in response to a cerulein insult. PMID:22677361

Wan, Hongyu; Yuan, Yaozong; Liu, Jiansheng; Chen, Guohong

2012-08-01

173

Alcohol exacerbates LPS-induced fibrosis in subclinical acute pancreatitis.  

PubMed

The role of pancreatic acinar cells in initiating fibrogenic responses during the early stages of alcoholic acute pancreatitis has not been evaluated. We investigated the ability of injured acinar cells to generate pancreatic fibrosis in acute pancreatitis. Rats were fed either an ethanol-containing or control diet over 14 weeks and euthanized 3 or 24 hours after a single lipopolysaccharide injection. Profibrotic transforming growth factor-? of acinar cells and pancreatic fibrosis were assessed by immunofluorescence, histological characteristics, and electron microscopy. Human pancreatic tissues were also evaluated. Periacinar cell fibrosis and collagen were exacerbated 24 hours after endotoxemia in alcohol-fed rats. Alcohol exposure exacerbated acinar cell-specific production of transforming growth factor ? in response to lipopolysaccharide in vivo and in acinar cell-like AR42J cells in vitro. Although a morphological examination showed no visible signs of necrosis, early pancreatic fibrosis can be initiated by little or no pancreatic necrosis. Transforming growth factor ? was also significantly increased in human acinar cells from patients with acute/recurrent pancreatitis compared with chronic pancreatitis tissue. Alcohol exacerbates lipopolysaccharide-induced pancreatic fibrosis during the early onset of mild, subclinical, acute pancreatitis. We suggest that multiple, subclinical, acute pancreatitis episodes can accumulate in fibrosis during the development of chronic pancreatitis, even if there is no history of acute pancreatitis. PMID:24091223

Gu, Haitao; Fortunato, Franco; Bergmann, Frank; Büchler, Markus W; Whitcomb, David C; Werner, Jens

2013-11-01

174

Minute pancreatic carcinoma with initial symptom of acute pancreatitis.  

PubMed

We experienced a case of minute pancreatic carcinoma in a 59-year-old man who complained of upper abdominal pain after drinking alcohol. Abdominal ultrasonography (US) revealed dilatation of the main pancreatic duct (MPD). Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed slight dilatation of the MPD and its obstruction near the portal vein. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated occlusion of the MPD, and cytology of aspirated pancreatic juice was negative for malignancy. With the diagnosis of benign localized obstruction of the MPD, the patient underwent surgery. There was a clear demarcation of hardness and color of the pancreas on the left margin of the superior mesenteric vein, and the caudal pancreas was hard and fibrotic. Intraoperative US revealed slight dilatation of the MPD, and the aspiration cytology result was class IV. First, segmental resection of the pancreas was performed, but pathological examination of frozen section showed neither malignancy nor stenotic lesion. An additional small portion of the proximal pancreas was resected. The specimen included a ductal carcinoma, 5 mm in diameter. Accordingly, a pylorus-preserving pancreatoduodenectomy was performed. Microscopically, the minute carcinoma had already penetrated the duct wall and infiltrated lymph vessels and veins. The patient has been under close observation at our outpatient clinic, and so far there have been no signs of recurrence. To improve the poor prognosis of pancreatic cancer, we should be alert to the occurrence of acute pancreatitis as an initial symptom. PMID:12541052

Imamura, Mikio; Asahi, Shuji; Yamauchi, Hidemi; Tadokoro, Keiichi; Suzuki, Hiroyoshi

2002-01-01

175

Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis  

PubMed Central

We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.

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

2009-01-01

176

Lipotoxicity Causes Multisystem Organ Failure and Exacerbates Acute Pancreatitis in Obesity  

PubMed Central

Obesity increases the risk of adverse outcomes during acute critical illnesses such as burns, severe trauma, and acute pancreatitis. Although individuals with more body fat and higher serum cytokines and lipase are more likely to experience problems, the roles that these characteristics play are not clear. We used severe acute pancreatitis as a representative disease to investigate the effects of obesity on local organ function and systemic processes. In obese humans, we found that an increase in the volume of intrapancreatic adipocytes was associated with more extensive pancreatic necrosis during acute pancreatitis and that acute pancreatitis was associated with multisystem organ failure in obese individuals. In vitro studies of pancreatic acinar cells showed that unsaturated fatty acids were proinflammatory, releasing intracellular calcium, inhibiting mitochondrial complexes I and V, and causing necrosis. Saturated fatty acids had no such effects. Inhibition of lipolysis in obese (ob/ob) mice with induced pancreatitis prevented a rise in serum unsaturated fatty acids and prevented renal injury, lung injury, systemic inflammation, hypocalcemia, reduced pancreatic necrosis, and mortality. Thus, therapeutic approaches that target unsaturated fatty acid–mediated lipotoxicity may reduce adverse outcomes in obese patients with critical illnesses such as severe acute pancreatitis.

Navina, Sarah; Acharya, Chathur; DeLany, James P.; Orlichenko, Lidiya S.; Baty, Catherine J.; Shiva, Sruti S.; Durgampudi, Chandra; Karlsson, Jenny M.; Lee, Kenneth; Bae, Kyongtae T.; Furlan, Alessandro; Behari, Jaideep; Liu, Shiguang; McHale, Teresa; Nichols, Larry; Papachristou, Georgios Ioannis; Yadav, Dhiraj; Singh, Vijay P.

2012-01-01

177

Pancreatic fluid hypersecretion in rats after acute pancreatitis.  

PubMed

Pancreatic exocrine function was examined in rats during the early stage of acute pancreatitis induced by four subcutaneous injections of 20 micrograms/kg body weight of cerulein at hourly intervals. Basal pancreatic fluid secretion at 6 hr after the first of four cerulein injections was significantly elevated (27.6 +/- 3.7 vs 17.4 +/- 2.1 microliters/30 min in control, P < 0.01) and further increased with time, reaching the peak level at 24 hr (105.1 +/- 4.6 microliters/30 min). Intravenous infusion of loxiglumide (50 mg/kg body wt/hr), atropine (100 micrograms/kg body wt/hr), or anti-secretin serum did not modify the fluid hypersecretion observed at 24 hr after induction of acute pancreatitis. Loxiglumide, when given 30 min before the first cerulein injection, markedly reduced fluid secretion, but could not inhibit the fluid hypersecretion when applied after the last cerulein injection. Leakage of Evans blue dye into pancreatic juice was slightly but significantly increased in postpancreatitic rats compared with that in the control rats (1.30 +/- 0.17 vs 0.75 +/- 0.08 micrograms/ml, P < 0.01), whereas that in the pancreas was not different from the control rats. In vivo labeling with 5-bromo-2'-deoxyuridine showed active proliferation of acinar and ductular cells at 6 hr. In addition, the fluid was rich in chloride (137.1 +/- 2.5 at 24 hr vs 92.4 +/- 3.3 meq/liter in control, P < 0.01) but poor in bicarbonate concentration (39.0 +/- 2.0 at 24 hr vs 46.5 +/- 1.9 mmol/liter in control, P < 0.01), indicating acinar cell secretion. These results indicate that pancreatic fluid secretion during the early stage of acute pancreatitis induced by supramaximal doses of cerulein was markedly increased not by CCK-, secretin-, or cholinergic-dependent mechanisms but probably by acinar cell proliferation. PMID:9052504

Czakó, L; Yamamoto, M; Otsuki, M

1997-02-01

178

Antiproteases in Preventing Post-ERCP Acute Pancreatitis  

Microsoft Academic Search

Summary Pancreatitis remains the most common and potentially fatal complication following ERCP. Various pharmacological agents have been used in an attempt to prevent post-ERCP pancreatitis, but most randomized controlled trials have failed to demonstrate their efficacy. Antiproteases, which have been clinically used to manage acute pancreatitis, would theoretically reduce pancreatic injury after ERCP because activation of proteolytic enzymes is considered

Takeshi Tsujino; Takao Kawabe; Masao Omata

179

Gastrostomy tube dislodgment acute pancreatitis.  

PubMed

Percutaneous gastrostomy is well established root for long term feeding of patients who cannot be fed orally. The risks of percutanous gastrostomy insertion are low. Tube related complications often resolved by placing a Foley catheter or other balloon gastrostomy tube as a temporary solution. Gastrostomy tube related gastric, duodenal and billiary obstruction were reported. Gastrostomy tube related pancreatitis is scarcely described. We described a patient who suffered a pancreatitis related to Foley catheter gastrostomy dislodgment. Reviewing all reported cases of gastrostomy related pancreatitis revealed higher incidence in patient with Foley catheter used as gastrostomy and revealed questionable trends in conducting tube replacement. We suggest a proper manner for tube replacement and concluded that should a Foley catheter used as a temporary solution a replacement should be schedule in a timely manner to avoid life threatening complications. PMID:24674106

Brauner, Eran; Kluger, Yoram

2014-01-01

180

Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis  

PubMed Central

Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication, there is a very high mortality. The most common cause of HAP is iatrogenic trauma such as liver biopsy, transhepatic biliary drainage, cholecystectomy and hepatectomy. HAP may also occur with complications such as infections or inflammation associated with septic emboli. HAP has been reported rarely in patients with acute pancreatitis. As far as we are aware, there is no report of a case caused by acute idiopathic pancreatitis, particularly. We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman. The woman initially presented with acute pancreatitis due to unknown cause. After conservative management, her symptoms seemed to have improved. But eight days after admission, abdominal pain abruptly became worse again. Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT. Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain. ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram. Without any particular treatment such as embolization or surgical ligation, HAP thrombosed spontaneously. Three months after discharge, abdominal CT demonstrated that HAP in the left lateral segment had disappeared.

Yu, Yeon Hwa; Sohn, Joo Hyun; Kim, Tae Yeob; Jeong, Jae Yoon; Han, Dong Soo; Jeon, Yong Cheol; Kim, Min Young

2012-01-01

181

Acute Pancreatitis Complicating Intragastric Balloon Insertion  

PubMed Central

We present a case of acute pancreatitis that happened as a complication of intragastric balloon insertion used for weight reduction in a young obese lady. Although many complications can happen with this type of procedure, this presentation is very rare and may not have been reported previously. The patient responded well to removal of the balloon since her pain resolved completely and her serum amylase normalized. She did not have any obvious cause of pancreatitis other than a significant radiologically proven compression of the pancreas by the balloon.

Mohammed, AbdulRahman Elsheikh; Benmousa, Ali

2008-01-01

182

Acute pancreatitis: a rare complication of acute hepatitis E.  

PubMed

Hepatitis E is an emerging imported disease in Europa but autochthonous cases are described for some years. Extra-hepatic associated manifestations are published. We report a case of acute necrotizing pancreatitis associated with imported acute viral E hepatitis (genotype 1a) in a 26 years old French man travelling and originated from Pakistan. The outcome is favourable spontaneously in two months. This life-threatening hepatitis E related complication is unknown in Europa where genotype 3 virus strains prevail. The clinical presentation is stereotyped with the onset of pancreatitis in the second or third weeks of hepatitis evolution in an Indian male in his second or third decade infected with genotype 1 strain. No pancreatitis-related death is reported in the 13 previous reported cases. PMID:21628104

Deniel, Cécile; Coton, Thierry; Brardjanian, Sarah; Guisset, Michel; Nicand, Elisabeth; Simon, Fabrice

2011-07-01

183

Endoscopic clearance of the pancreatic duct in chronic pancreatitis with severe pain  

Microsoft Academic Search

In a phase I study endoscopic removal of pancreatic duct stones and protein plugs was attempted in five patients suffering from chronic pancreatitis with severe chronic pain. The pancreatic duct contents could be extracted after successful sphincterotomy in three patients. Clearance of the pancreatic duct was followed by complete or partial relief of pain. The follow-up period was 17–48 months.

Stefan Linder; Carl-Fredrik Engström; Anette Rosen; Karl-Ludvig Wiechel

1993-01-01

184

Severe acute mountain sickness.  

PubMed Central

The experiences of acute mountain sickness (AMS) as it has presented to a physician working in a general hospital at 1370 m in Kathmandu, nepal, are described. The features of 39 cases are analysed. It is suggested that AMS should be classified into benign and malignant forms.

Dickinson, J. G.

1979-01-01

185

Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever  

PubMed Central

Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated with acute pancreatitis and acute respiratory distress syndrome.

Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

2011-01-01

186

Repetitive Self-Limited Acute Pancreatitis Induces Pancreatic Fibrogenesis in the Mouse  

Microsoft Academic Search

The role of repetitive acute injury in the pathogenesis of chronic pancreatitis remains unknown. To determine if repetitive injury induced by pancreatic hyperstimulation would reproduce the characteristic features of human chronic pancreatitis, acute reversible pancreatic injury was induced in mice by twice weekly cerulein treatment, 50 µg\\/kg\\/hr × 6 hr, for 10 weeks. Procollagen a1(I) mRNA was markedly increased by

Brent A. Neuschwander-Tetri; Frank R. Burton; Michael E. Presti; Robert S. Britton; Christine G. Janney; Paul R. Garvin; Elizabeth M. Brunt; Nancy J. Galvin; John E. Poulos

2000-01-01

187

Activation of Nuclear Factor-?B in Acinar Cells Increases the Severity of Pancreatitis in Mice  

PubMed Central

Background & Aims Nuclear factor (NF)-?B is activated during early stages of pancreatitis. This transcription factor regulates genes that control many cell activities, including inflammation and survival. There is evidence that activation of NF-?B protects against pancreatitis, and in other cases, that it promotes this disease. We compared the effects NF-?B in different mouse models of pancreatitis to understand these complications. Methods To model constitutive activation of NF-?B, we expressed a transgene that encodes its p65 subunit or the inhibitor of ?B kinase (IKK) 2 in pancreatic acinar cells of mice. We analyzed effects on pancreatic tissues and levels of NF-?B target genes in these mice and compared them to mice that did not express transgenic p65 or IKK2 (controls). Results Transgenic expression of p65 led to compensatory expression of the inhibitory subunit IKB-? and therefore, no clear phenotype. However, p65 transgenic mice given injections of caerulein, to induce acute pancreatitis, had higher levels of NF-?B activity in acinar cells, greater levels of inflammation, and more severe outcomes than control mice. In contrast, constitutive expression of IKK2 directly increased the activity of NF-?B in acinar cells and induced pancreatitis. Prolonged activity of IKK2 (3 months) resulted in activation of stellate cells, loss of acinar cells, and fibrosis, which are characteristics of chronic pancreatitis. Co-expression of IKK2 and p65 greatly increased the expression of inflammatory mediators and the severity of pancreatitis, compared with control mice. Conclusions The level of NF-?B activation correlates with the severity of acute pancreatitis in mice. Longer periods of activation (3 months) lead to chronic pancreatitis. These findings indicate that strategies to inactivate NF-?B might be used to treat patients with acute or chronic pancreatitis.

Huang, Haojie; Liu, Yan; Daniluk, Jaroslaw; Gaiser, Sebastian; Chu, Jun; Wang, Huamin; Logsdon, Craig; Ji, Baoan

2013-01-01

188

Relationship between pancreatic enzymes and pathological changes in the pancreas in acute pancreatitis  

Microsoft Academic Search

Summary  To clarify the relationship between changes in serum pancreatic enzymes and pathological changes in pancreatic parenchyma,\\u000a this study was performed by using rat models with acute pancreatitis. The models were rats with edematous and necrotizing\\u000a pancreatitis. Amylase, lipase, ribonuclease (RNase), and deoxyribonuclease (DNase I, II) in the serum were determined for\\u000a 48 h after the development of pancreatitis. Amylase and

Yoshio Kinami; Ichiro Kita

1989-01-01

189

Protective effect of the combined treatment of pancreatic and neutrophil elastase inhibitors on acute pancreatitis elicited by lipopolysaccharide in rats given intraductal injection of taurocholate plus trypsin  

Microsoft Academic Search

A severe acute pancreatitis was produced by intraperitoneal injection of lipopolysaccharide (LPS) in rats with preexisting\\u000a hemorrhagic and necrotizing pancreatitis induced by retrograde injection of a 5% taurocholate plus 1% trypsin solution into\\u000a the pancreatic duct. Mortality and time-course changes in pancreatic, hepatic, renal and pulmonary functions, and organ myeloperoxidase\\u000a (MPO) levels were examined in this model. LPS at an

Mayumi Yamano; Masako Umeda; Keiji Miyata; Toshimitsu Yamada

1998-01-01

190

Continuous Intravenous Octreotide Treatment for Acute Experimental Pancreatitis  

Microsoft Academic Search

Background: The efficacy of octreotide, the synthetic analogue of the hormone somatostatin, for the treatment of acute pancreatitis is controversial. Octreotide has been commonly administered in subcutaneous bolus injections; however, continuous intravenous infusion may be advantageous for acute conditions. Methods: Acute experimental pancreatitis was induced in rats by intraparenchymal injections of 1 ml 10% sodium taurocholate, and octreotide (1 µg\\/kg\\/h,

R. Greenberg; R. Haddad; H. Kashtan; E. Brazowski; E. Graff; Y. Skornick; O. Kaplan

1999-01-01

191

Improvement of Impaired Microcirculation and Tissue Oxygenation by Hemodilution with Hydroxyethyl Starch plus Cell-Free Hemoglobin in Acute Porcine Pancreatitis  

Microsoft Academic Search

Aims: To avoid the progression from mild edematous acute pancreatitis (AP) to the severe necrotizing form, one therapeutic option is to improve pancreatic microcirculation and tissue oxygenation. The aim of the study was to evaluate the influence of improved rheology (isovolemic hemodilution) plus enhanced oxygen supply (bovine hemoglobin HBOC-301) on pancreatic microcirculation, tissue oxygenation and survival in severe acute experimental

Marc Freitag; Thomas G. Standl; Helge Kleinhans; André Gottschalk; Oliver Mann; Christian Rempf; Kai Bachmann; Andreas Gocht; Susan Petri; Jakob R. Izbicki; Tim Strate

2006-01-01

192

A Case of Concomitant Perforated Acute Cholecystitis and Pancreatitis  

PubMed Central

Introduction. Concomitant cholecystitis and gallstone pancreatitis is an infrequent clinical encounter, reported sparsely in the literature. Concurrent acute cholecystitis and pancreatitis complicated by gall bladder perforation has not been reported before. Presentation of Case. We report a 39-year-old female presenting with concomitant cholecystitis and acute pancreatitis, complicated by gallbladder perforation. Discussion. There is much controversy surrounding the timing of cholecystectomy following gallstone pancreatitis, with the recent literature suggesting that “early” operation is safe. In the current case, gallbladder perforation altered the “routine” management of gallstone pancreatitis and posed as a management dilemma. Conclusion. Clinical judgement dictated timing of operative management and ultimately cholecystectomy was performed safely.

Toshniwal, Sumeet; Chan, Steven; Houli, Nezor

2013-01-01

193

Acute pancreatitis with gliptins: Is it a clinical reality?  

PubMed

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

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

2013-10-01

194

Acute pancreatitis with gliptins: Is it a clinical reality?  

PubMed Central

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.

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

2013-01-01

195

Acute Pancreatitis: The Role of Imaging and Interventional Radiology  

SciTech Connect

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

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

2004-09-15

196

Poorly controlled type 2 diabetes complicated by an episode of severe hypertriglyceridaemia-induced pancreatitis.  

PubMed

A 23-year-old woman with a history of type 2 diabetes and non-compliance presented to the emergency department with abdominal epigastric pain and nausea. Laboratory examination revealed a mild ketoacidosis while an abdominal CT scan performed the following day demonstrated a severe acute pancreatitis of the body and tail (Balthazar grade E) despite normal amylase serum levels on admission. The presence of a lactescent serum was the clue to an extremely high triglyceride level (>10 000 mg/dl) causing the pancreatitis. The hypertriglyceridaemia itself was attributed mainly to the diabetic ketoacidosis. There was no family history of hypertriglyceridaemia. The triad consisting of diabetic ketoacidosis, hypertriglyceridaemia and acute pancreatitis is an unusual presentation of poorly controlled diabetes which can occur in type 1 as well as type 2 diabetic adults and children. Treatment with intravenous insulin and hydration successfully resolved the ketoacidosis and hypertriglyceridaemia and reversed the episode of acute pancreatitis. PMID:23632173

Denecker, Nathalie; Decochez, Katelijn

2013-01-01

197

Oxidative stress in acute pancreatitis: lost in translation?  

PubMed

Oxidative stress has been implicated in the pathogenesis of acute pancreatitis, a severe and debilitating inflammation of the pancreas that carries a significant mortality, and which imposes a considerable financial burden on the health system due to patient care. Although extensive efforts have been directed towards the elucidation of critical underlying mechanisms and the identification of novel therapeutic targets, the disease remains without a specific therapy. In experimental animal models of acute pancreatitis, increased oxidative stress and decreased antioxidant defences have been observed, changes also detected in patients clinically. However, despite the promise of studies evaluating the effects of antioxidants in these model systems, translation to the clinic has thus far been disappointing. This may reflect many factors involved in the design of both preclinical and clinical evaluations of antioxidant therapy, not least the fact that most experimental studies have focussed on pre-treatment rather than post-injury assessment. This review has examined evidence relating to the involvement of oxidative stress in the pathophysiology of acute pancreatitis, focussing on experimental models and the clinical experience, including the experimental techniques employed and potential of antioxidant therapy. PMID:23952531

Armstrong, J A; Cash, N; Soares, P M G; Souza, M H L P; Sutton, R; Criddle, D N

2013-11-01

198

Effect of Mycophenolate Mofetil on Cerulein-Induced Acute Pancreatitis  

Microsoft Academic Search

Aim: The aim of this study was to determine the effects of mycophenolate mofetil (MMF) on acute pancreatitis with evaluation of biochemical and histopathological findings. Materials and Methods: Cerulein was administered to induce acute pancreatitis in rats. Three groups of 10 rats each were formed. Animals in group 1 received physiologic saline solution. In group 2 animals received MMF at

B. Tasdogan; H. F. Kucuk; N. Kurt; L. Kaptanoglu; H. Uzun; M. Eser

2010-01-01

199

Towards a Novel Treatment Strategy for Acute Pancreatitis  

Microsoft Academic Search

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

Joan M. Braganza

2001-01-01

200

B Cell Activating Factor of the Tumor Necrosis Factor Family (BAFF) Behaves as an Acute Phase Reactant in Acute Pancreatitis  

PubMed Central

Objective To determine if B cell activating factor of the tumor necrosis factor family (BAFF) acts as an acute phase reactant and predicts severity of acute pancreatitis. Methods 40 patients with acute pancreatitis were included in this single center cohort pilot study. Whole blood and serum was analyzed on day of admission and nine consecutive days for BAFF, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and leucocyte numbers. Different severity Scores (Ranson, APACHE II, SAPS II, SAPS III) and the clinical course of the patient (treatment, duration of stay, duration ICU) were recorded. Results Serum BAFF correlates with CRP, an established marker of severity in acute pancreatitis at day of admission with a timecourse profil similar to IL-6 over the first nine days. Serum BAFF increases with Ranson score (Kruskal-Wallis: Chi2?=?10.8; p?=?0.03) similar to CRP (Kruskal-Wallis: Chi2?=?9.4; p?=?0.05 ). Serum BAFF, IL-6, and CRP levels are elevated in patients that need intensive care for more than seven days and in patients with complicated necrotizing pancreatitis. Discriminant analysis and receiver operator characteristics show that CRP (wilks-lambda?=?0.549; ROC: AUC 0.948) and BAFF (wilks-lambda?=?0.907; ROC: AUC 0.843) serum levels at day of admission best predict severe necrotizing pancreatitis or death, outperforming IL-6, PCT, and number of leucocytes. Conclusion This study establishes for the first time BAFF as an acute phase reactant with predictive value for the course of acute pancreatitis. BAFF outperforms established markers in acute pancreatitis, like IL-6 and PCT underscoring the important role of BAFF in the acute inflammatory response.

Pongratz, Georg; Hochrinner, Hannah; Straub, Rainer H.; Lang, Stefanie; Brunnler, Tanja

2013-01-01

201

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

PubMed

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

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

202

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

PubMed Central

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.

Yilmaz, Baris; Basar, Omer; Aktas, Bora; Altinbas, Akif; Ekiz, Fuat; Buyukcam, Fatih; Albayrak, Aynur; Ginis, Zeynep; Ozturk, Gulfer; Coban, Sahin; Ucar, Engin; Kaya, Oskay; Yuksel, Osman; Caner, Sedat; Delibasi, Tuncay

2014-01-01

203

Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis  

Microsoft Academic Search

Infection of pancreatic necrosis by gut bacteria is a major cause of morbidity and mortality in patients with severe acute pancreatitis. Use of prophylactic antibiotics remains controversial. The aim of this experiment was assess if modification of intestinal flora with specifically designed multispecies probiotics reduces bacterial translocation or improves outcome in a rat model of acute pancreatitis. METHODS: Male Sprague-Dawley

L. Paul van Minnen; Harro M. Timmerman; Femke Lutgendorff; André Verheem; Wil Harmsen; Sergey R. Konstantinov; Hauke Smidt; Maarten R. Visser; Ger T. Rijkers; Hein G. Gooszen; Louis M. A. Akkermans

2007-01-01

204

Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation  

Microsoft Academic Search

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary\\u000a or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but\\u000a serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical\\u000a suspicion of bile duct obstruction and

Zuo-bing Chen; Zhong-yan Liang; Yun Zhang; Shao-yang Zhang; Shu-sen Zheng

2010-01-01

205

Pancreatic Damage after the First Episode of Acute Alcoholic Pancreatitis and Its Association with the Later Recurrence Rate  

Microsoft Academic Search

Background: Acute alcoholic pancreatitis (AAP) recurs in up to half of the patients, continuous alcohol consumption being an important risk factor. Changes in pancreatic function and morphology after acute pancreatitis have been characterized previously, but their association with later recurrences has not been adequately studied. Patients and Methods: In this prospective follow-up study, the pancreatic function of 54 patients (47

Hanna Pelli; Riitta Lappalainen-Lehto; Anneli Piironen; Satu Järvinen; Juhani Sand; Isto Nordback

2009-01-01

206

Pancreatitis  

MedlinePLUS

... the hormones insulin and glucagon into the bloodstream. Pancreatitis is inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself. Pancreatitis can be acute or chronic. Either form is ...

207

Gastric feeding and "gut rousing" in acute pancreatitis.  

PubMed

The "pancreatic rest" concept is entrenched in the management of acute pancreatitis. As a result, "nonstimulatory" feeding has been widely advocated in patients with this disease, being parenteral nutrition 2-3 decades ago and jejunal tube feeding in the past decade. However, accumulating clinical evidence from the fields of acute pancreatitis and critical care medicine suggests that gastric feeding is as safe and effective as jejunal feeding in most patients. This has paved the way for a new conceptual framework called "gut rousing." Acute pancreatitis management now requires consideration of gut function. Enteral nutrition is a gut-directed therapy, and avoiding stimulation of the pancreas in patients with acute pancreatitis need not overshadow the main goal of maintaining or restoring gut function. PMID:24710859

Petrov, Maxim S

2014-06-01

208

Anti-inflammatory effects of PPAR-gamma agonists directly correlate with PPAR-gamma expression during acute pancreatitis.  

PubMed

Peroxisome proliferator-activated receptors (PPARs) are ligand-inducible transcription factors that regulate cellular energy and lipid metabolism. PPAR-gamma agonists also have potent anti-inflammatory properties through down-regulation of early inflammatory response genes. The role of PPAR-gamma in acute pancreatitis has not been adequately examined. In this study, we determined the effect of PPAR-gamma agonists on the severity of pancreatitis and sought to correlate PPAR-gamma expression in pancreatic acinar cells and the severity of acute pancreatitis in vivo. Acute pancreatitis was induced in mice by hyperstimulation with the cholecystokinin analog, cerulein. PPAR-gamma agonists were administered by intraperitoneal injection 15-30 minutes before induction of pancreatitis (pretreatment) or at various times after induction of pancreatitis (treatment). Pancreata and serum were harvested over the course of 24 hours. Serum amylase activity and glucose levels were measured. Pancreata were used for histological evaluation as well as protein and mRNA analysis. Pretreatment of mice with the PPAR-gamma agonists 15-deoxy-Delta12, 14-prostaglandin J(2), or troglitazone significantly reduced the severity of pancreatitis in a dose-dependent manner. This reduction was indicated by reduced serum amylase activity and histological damage (leukocyte infiltration, vacuolization, and necrosis). Although cerulein decreased PPAR-gamma expression in the pancreas, pretreatment with agonists maintained PPAR-gamma expression early in acute pancreatitis. The expression of PPAR-gamma inversely correlated with pancreatitis severity and expression of the proinflammatory cytokines, interleukin-6, and tumor necrosis factor-alpha. Treatment with troglitazone after the induction of pancreatitis reduced serum amylase activity. The results suggest that PPAR-gamma plays a direct role in the inflammatory cascade during the early events of acute pancreatitis. Our data are the first to demonstrate that PPAR-gamma agonists represent a promising therapeutic strategy for acute pancreatitis. PMID:16966031

Rollins, Michael D; Sudarshan, Sharon; Firpo, Matthew A; Etherington, Brooke H; Hart, Brandon J; Jackson, Heidi H; Jackson, Jeffrey D; Emerson, Lyska L; Yang, David T; Mulvihill, Sean J; Glasgow, Robert E

2006-01-01

209

A rare case of perforated caecum after acute pancreatitis.  

PubMed

Isolated caecal perforation following pancreatitis is a rare event. We report a case of severe non-necrotising pancreatitis complicated by caecal perforation that was managed successfully. PMID:22613291

Martin, L C E; Stavrou, M; El-Madani, F; Naik, V; Jain, K; Gupta, S

2012-05-01

210

Hyperlipaemia intensifies the course of acute oedematous and acute necrotising pancreatitis in the rat  

Microsoft Academic Search

BACKGROUND--Serum triglyceride concentrations higher than 10 to 20 mmol\\/l are probably a risk factor for developing acute pancreatitis in humans. AIMS--To therefore analyse the influence of hyperlipaemia on the course of acute oedematous and acute necrotising pancreatitis in rats. SUBJECTS--Male Wistar rats were used in all experiments. METHODS--Six different groups of animals were used: two groups without pancreatitis (controls), two

B Hofbauer; H Friess; A Weber; K Baczako; P Kisling; M Schilling; W Uhl; C Dervenis; M W Büchler

1996-01-01

211

From Acute Pancreatitis to Stage IV Pancreatic Cancer in 12 Weeks  

PubMed Central

Pancreatic cancer is well known to be an aggressive and highly malignant condition with varied ways of presentation. Pancreatic cystic neoplasms are very uncommon causes of pancreatic malignancy and can often be ignored or missed, especially in the early stages. We present the case of a 49-year-old Caucasian male with no past medical history presenting to an outside facility with sudden epigastric pain that was eventually diagnosed as acute pancreatitis. On transfer to our facility, he was eventually found to have metastatic malignant mucinous cystic pancreatic neoplasm. Barely 12 weeks after his initial presentation and following an aggressive hospital course, he passed away.

Enweluzo, Chijioke; Dutta, Simanta; Aziz, Fahad; Lenfest, Stephen

2013-01-01

212

Acute pancreatitis after spine surgery: a case report and review of literature.  

PubMed

Although acute postoperative pancreatitis is a relatively frequent complication after open biliary tract surgery and gastric surgery, acute pancreatitis after spine surgery is a rare complication. We report the first case of acute pancreatitis after posterior lumbar interbody fusion (PLIF) for spondylolisthesis that resolved with conservative treatment. A 53-year-old female patient received a PLIF from L3 to L5. The patient presented with persistent mild abdominal pain, nausea and vomiting several hours after the surgery. An abdominal CT revealed swelling of the head of the pancreas and free fluid around the pancreas. A gastroenterologist diagnosed acute pancreatitis and prescribed nafamostat mesilate, antibiotics and intravenous fluid therapy. The patient recovered gradually, and clinical symptoms disappeared. At 6 months after the operation, she had experienced no recurrence of abdominal symptoms, and solid spinal fusion was achieved. In previous studies, acute pancreatitis was reported as a complication after spine surgery for various spine diseases such as scoliosis and lumbar disorders. The procedures performed included anterior/posterior scoliosis surgery and anterior/posterior lumbar fusion surgery. We must consider the possibility of acute pancreatitis when unusual abdominal symptoms with elevated serum amylase levels occur after spine surgery. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality. PMID:24318308

Tauchi, Ryoji; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Ukai, Junichi; Kobayashi, Kazuyoshi; Shinjo, Ryuichi; Muramoto, Akio; Nakashima, Hiroaki; Matsumoto, Tomohiro; Ishiguro, Naoki

2014-07-01

213

Caerulein-induced acute pancreatitis in mice that constitutively overexpress Reg/PAP genes  

PubMed Central

Background The cystic fibrosis (CF) mouse pancreas has constitutively elevated expression of the Reg/PAP cell stress genes (60-fold greater Reg3?, and 10-fold greater PAP/Reg3? and Reg3?). These genes are suggested to be involved in protection or recovery from pancreatic injury. Methods To test this idea the supramaximal caerulein model was used to induce acute pancreatitis in wild type and CF mice. Serum amylase, pancreatic water content (as a measure of edema), pancreatic myeloperoxidase activity, and Reg/PAP expression were quantified. Results In both wild type and CF mice caerulein induced similar elevations in serum amylase (maximal at 12 h), pancreatic edema (maximal at 7 h), and pancreatic myeloperoxidase activity (MPO, a marker of neutrophil infiltration; maximal at 7 h). By immunohistochemistry, Reg3? was strongly expressed in the untreated CF pancreas but not in wild type. During pancreatitis, Reg3? was intensely expressed in foci of inflamed tissue in both wild type and CF. Conclusion These data demonstrate that the severity of caerulein-induced pancreatitis is not ameliorated in the CF mouse even though the Reg/PAP stress genes are already highly upregulated. While Reg/PAP may be protective they may also have a negative effect during pancreatitis due to their anti-apoptotic activity, which has been shown to increase the severity of pancreatitis.

Norkina, Oxana; Graf, Rolf; Appenzeller, Philippe; De Lisle, Robert C

2006-01-01

214

Pathophysiological role of secretory type I and II phospholipase A2 in acute pancreatitis: an experimental study in rats.  

PubMed Central

BACKGROUND: In human acute pancreatitis two different types of secretory phospholipase A2 (PLA2) have been found. AIM: To analyse the specific pattern of distribution of these PLA2 activities and their pathophysiological role in experimental acute pancreatitis. SUBJECTS AND METHODS: Catalytic activities of secretory type I (pancreatic) and type II (non-pancreatic) PLA2 and the protein concentration of immunoreactive pancreatic PLA2 (IR-PLA2) in serum and pancreatic tissue of rats with cerulein (mild form) and sodium taurocholate (severe form) induced acute pancreatitis were determined. RESULTS: Cerulein infusion caused a significant increase in type I PLA2 activity (p < 0.01) and IR-PLA2 protein concentration (p < 0.01) in serum and pancreas, whereas type II PLA2 activity remained unchanged during the 12 hour observation period. Histology showed no significant tissue destruction. In sodium taurocholate induced acute pancreatitis type II PLA2 activity significantly increased, reaching values over 10-fold higher than controls (p < 0.01), whereas IR-PLA2 protein concentration and type I PLA2 activity were only marginally increased. In this severe model of acute pancreatitis significantly lower values were detected than in the control pancreas (p < 0.002) for PLA2 activity and IR-PLA2 protein concentration. Histology showed parenchymal and fat necroses with haemorrhage, oedema, and inflammatory cell infiltration. CONCLUSIONS: Type I PLA2 activity is dependent on the IR-PLA2 protein concentration in serum and pancreatic tissue. The type II PLA2 activity is not stimulated by cerulein, which indicates an extra-acinar origin of this enzyme. Type II PLA2 activity is significantly increased in sodium taurocholate induced acute pancreatitis indicating its role in the local necrotising process and involvement in the systemic effects in severe acute pancreatitis.

Uhl, W; Schrag, H J; Schmitter, N; Nevalainen, T J; Aufenanger, J; Wheatley, A M; Buchler, M W

1997-01-01

215

The crosstalk between gut inflammation and gastrointestinal disorders during acute pancreatitis.  

PubMed

The intestinal inflammation caused by intestinal ischemia reperfusion during acute pancreatitis (AP) often leads to multiple organ dysfunction and aggravation of acute pancreatitis. This review concerns up-date progress of the pathophysiology and molecular mechanism of the excessive production of gut-derived cytokines. The regulation effects of immuno-neuro-endocrine network for pancreatic necrosis are the basis for pharmacological therapeutic in AP. The translation from basic research to clinical trials for the prevention or treatment of severe acute pancreatitis (SAP) is of great value. Early enteral nutrition is necessary for the restitution, proliferation, and differentiation of the intestinal epithelial cells adjacent to the wounded area. Clearance of the excess intestinal bacteria and supplement of probiotics may be helpful to prevent bacterial translocation and infection of pancreas. PMID:23782148

Guo, Zhen-Zhen; Wang, Pu; Yi, Zhi-Hui; Huang, Zhi-Yin; Tang, Cheng-Wei

2014-01-01

216

A Case of Acute Pancreatitis Associated with Risperidone Treatment  

PubMed Central

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.

Ueno, Shu-ichi

2014-01-01

217

Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis.  

PubMed

Three hundred patients with acute pancreatitis have been studied. Pancreatitis was associated with alcoholism in 207, biliary tract disease in 51 and other conditions in 42. Twenty-two patients died, and an additional 34 patients required more than one week of treatment in the intensive care unit. Retrospective analysis of the first 100 patients identified 11 objective findings which correlated with the occurrence of serious illness or death. They were, on admission, age over 55 years, blood glucose level over 200 milligrams per cent, white blood count over 16,000 per cubic millimeter, serum lactic dehydrogenase level over 350 International units per liter and serum glutamic-oxalacetic transaminase level over 250 Sigma Frankel units per cent. During the initial 48 hours of therapy, the findings were hematocrit value decrease over 10 percentage points, serum calcium level below 8 milligrams per cent, base deficit over 4 milli-equivalents per liter, a blood urea nitrogen level increase over 5 milligrams per cent, estimated fluid sequestration over 6 liters and arterial oxygen tension less than 60 millimeters of mercury. Prospective application of these signs in the latter 200 patients permitted the accurate early identification of those with severe pancreatitis. Only one of 162 patients with fewer than three of these early features was seriously ill or died, while 24 of 38 patients with three or more early positive findings were seriously ill or died. The objective early identification of patients with severe pancreatitis permits more vigorous management of this group and also provides a basis for the selection of patients for the evaluation of proposed improved therapies. Percutaneous peritoneal dialysis in severe pancreatitis was evaluated in ten patients, with three or more positive early signs, who were randomly assigned to dialysis or continued conventional care. Morbidity was strikingly reduced in patients who underwent dialysis, and while death or more than nine days of intensive care occurred in two of five patients who did not receive dialysis, all five patients having dialysis recovered after fewer than nine days of intensive care treatment. Serious illness or death occurred in 31 of the first 100 patients but in only 26 of the more recent 200 patients. There has been a similar fall in mortality from 15.0 to 3.5 per cent. Factors which may contribute to this improvment include the objective early identification of patients with severe disease, the avoidance of early laparotomy whenever practical, the prolongation of nasogastric suction until all evidence of pancreatic inflammation has resolved, careful monitoring of respiratory function and early treatment of pulmonary complications and peritoneal dialysis in patients with severe disease. PMID:941075

Ranson, J H; Rifkind, K M; Turner, J W

1976-08-01

218

Pancreatic enzyme therapy for pancreatic exocrine insufficiency  

Microsoft Academic Search

Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis,\\u000a cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease\\u000a and Crohn’s disease, and gastrointestinal and pancreatic surgical resection. Recognition of this entity is highly relevant\\u000a to avoid malnutrition-related morbidity and mortality. Therapy for pancreatic exocrine insufficiency is based on the

J. Enrique Domínguez-Muńoz

2007-01-01

219

Effects of Delayed Administration of Octreotide in Acute Experimental Pancreatitis  

Microsoft Academic Search

Multiple therapeutic modalities studied for acute pancreatitis often show a poor correlation between results obtained in experimental studies and results of clinical trials. One of the main reasons for this discrepancy is that in most experimental studies the drugs were administered immediately after induction of pancreatitis, whereas in the clinical setting there is almost always a delay between the onset

Ofer Kaplan; Doron Kaplan; Eran Casif; Annette Siegal; Haim Paran; Eran Graf; Yehuda Skornick

1996-01-01

220

Added value of CT criteria compared to the clinical SAP score in patients with acute pancreatitis  

Microsoft Academic Search

.  \\u000a \\u000a Background: To assess the added value of established computed tomography (CT) scores versus the Simplified Acute Physiology (SAP) score\\u000a in predicting outcome in patients with acute pancreatitis.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Contrast-enhanced CT was performed in 45 patients with acute pancreatitis. The Balthazar score, CT severity index (CTSI),\\u000a and Schr?der score were assessed, and the SAP score was calculated. The predictive values

A. R. van den Biezenbos; P. M. Kruyt; K. Bosscha; M. S. van Leeuwen; M. A. M. Feldberg; Y. T. van der Schouw; H. G. Gooszen

1998-01-01

221

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

PubMed Central

Aim: Acute pancreatitis (AP), in particular, severe acute pancreatitis (SAP), is a rare but challenging complication during pregnancy in terms of diagnosis and management. The objective of this paper is to investigate the causes and therapeutic strategies of AP in patients during the third trimester of pregnancy. Methods: We performed a retrospective analysis of the clinical features, laboratory data, and outcomes in 16 patients with acute pancreatitis during the third trimester of pregnancy. Results: Information was collected on admission, management, and outcome. A total 16 patients were diagnosed with acute pancreatitis during pregnancy. In 7 of 9 patients with mild AP, pregnancy was terminated by cesarean section and all 9 cases were cured. In 4 out of 7 patients with SAP, pregnancy was terminated by cesarean section in conjunction with peritoneal irrigation and drainage, and the mothers and infants survived. In the remaining 3 patients with SAP, there was one case of intrauterine death in which Induced labor was performed and 2 patients died of multiple organ failure. Conclusion: A high-fat diet and cholelithiasis are the triggers of AP in pregnancy. Conservative treatment is the preferred therapeutic method; in particular, for mild AP. Endoscopic surgery and peritoneal drainage are effective for acute biliary pancreatitis. Patients with hyperlipidemic pancreatitis should undergo lipid-lowering therapy, and hemofiltration should be done as soon as it becomes necessary. For patients with SAP, termination of pregnancy should be carried out as early as possible.

Sun, Yanmei; Fan, Cuifang; Wang, Suqing

2013-01-01

222

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

SciTech Connect

Purpose: We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. Materials and Methods: A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. Results: After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient's hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Conclusion: Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.

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

2011-02-15

223

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

PubMed

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

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

2011-10-01

224

Reversible gall bladder dysfunction in severe pancreatic insufficiency  

Microsoft Academic Search

The present study was undertaken to examine the intestinal phase of cholecystokinin (CCK) secretion and gall bladder contraction in patients with severe pancreatic insufficiency. Plasma CCK concentrations, measured by radioimmunoassay, and gall bladder contraction by cholescintigraphy were studied in response to intraduodenal fat with and without addition of pancreatic enzymes. Fasting plasma CCK concentrations were in the same range in

A A Masclee; J B Jansen; F H Corstens; C B Lamers

1989-01-01

225

Acute Pancreatitis Secondary to Duodenoduodenal Intussusception in Duodenal Adenoma  

PubMed Central

Duodenoduodenal intussusception is a rare condition that is in general caused by a tumor. We describe duodenoduodenal intussusception secondary to a tubulovillous adenoma that caused acute pancreatitis in a 31-year-old female. We resected a duodenal tumor from the submucosal layer and then simply closed the duodenal wall. To the best of our knowledge, this is the first description of acute pancreatitis secondary to duodenoduodenal intussusception by tubulovillous adenoma in the second part of the duodenum in an adult.

Watanabe, Fumiaki; Noda, Hiroshi; Okamura, Jun; Toyama, Nobuyuki; Konishi, Fumio

2012-01-01

226

siRNA GENE KNOCKDOWN OF PANCREATITIS-ASSOCIATED PROTEINS (PAP) IN RAT ACUTE PANCREATITIS  

PubMed Central

Background The pancreatitis-associated protein (PAP) family of genes is induced in acute pancreatitis. We have previously demonstrated that antisense mediated gene knockdown of PAP in vivo decreased PAP gene expression and worsened pancreatitis. Here we investigated the effect of a more stable inhibition of PAP using siRNA gene knockdown in vitro and in an in vivo model of experimental pancreatitis. Methods In vitro, pancreatic acinar cell line, AR42J, was cultured with Dexamethasone and IL6 (Dex/IL6) to induce expression of PAP with subsequent transfection of siRNA into stimulated AR42J cells. In vivo, acute pancreatitis was induced in Sprague Dawley rats by retrograde infusion of 4% sodium taurocholate (NaT) into the pancreatic duct. PAP-specific siRNA was subsequently administrated, subcapsularly, after infusion of NaT. Controls included administration of scrambled siRNA (SC-RNA) or vehicle alone. After 24hr, pancreata were harvested and assessed for worsening pancreatitis by histopathology; serum was analyzed for PAP, amylase, lipase and cytokines protein levels. In both models endogenous PAP (PAPI, PAPII, PAPIII) gene expression was assessed at 24 hrs using real time RT-PCR. Results In vitro, PAP isoform (PAPI, PAPII, PAPIII) protein and mRNA levels were reduced (PAPI: 76%, PAPII: 8%, PAPIII: 24%) in cells treated with PAP siRNA when compared with control treatment. In vivo, induction of pancreatitis was confirmed by histopathology, serum amylase and lipase levels. PAP isoforms I and III expression were reduced (PAPI: 36%, PAPIII: 66%) in siRNA treated rats, compared with controls; there was no difference in PAP II isoform mRNA expression and serum protein levels. Serum amylase levels decreased after administration of siRNA compared with vehicle control (1583 ±312.U/L vs. 3013±317 U/L; p<0.05). In addition, serum lipase levels decreased after administration of PAP siRNA compared with vehicle control (162 ±42 U/L vs. 478±125 U/L; p<0.05). Serum levels of IL-1?, IL-4 and IL-6 increased (20%, 96.9%, 118%, respectively) while CRP and TNF? decreased (18.8%, and 13.7%, respectively) when compared with vehicle control. Administration of PAP siRNA correlated with worsening leukocytic infiltration and necrosis but not edema. Conclusions siRNA mediated gene knockdown of PAP appeared to worsen pancreatitis severity but demonstrated some different effects when compared to antisense gene knockdown in certain instances. This observed difference may be due to the inhibition profile discrepancy between two knockdown methods and/or different mechanisms of action for siRNA compared with antisense technology.

Lin, Yin-Yao; Viterbo, Domenico; Mueller, Cathy M.; Stanek, Albert E.; Smith-Norowitz, Tamar; Drew, Hazel; Wadgaonkar, Raj; Zenilman, Michael E.; Bluth, Martin H.

2009-01-01

227

Repetitive Acute Pancreatic Injury in the Mouse Induces Procollagen ?1(I) Expression Colocalized to Pancreatic Stellate Cells  

Microsoft Academic Search

Pancreatic stellate cells may be a major source of extracellular matrix deposition during injury. This study was undertaken to establish whether pancreatic stellate cells are a source of Type I collagen in vivo and whether they continue to be a source of matrix production in the post-injury fibrotic pancreas. To induce pancreatic fibrogenesis, acute pancreatic injury was induced in mice

Brent A Neuschwander-Tetri; Kim R Bridle; Lisa D Wells; Marin Marcu; Grant A Ramm

2000-01-01

228

Update on pathogenesis and clinical management of acute pancreatitis  

PubMed Central

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

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

2012-01-01

229

Specific Therapy for Local and Systemic Complications of Acute Pancreatitis With Monoclonal Antibodies Against ICAM-1  

PubMed Central

Objective To analyze the time points and levels of the expression of adhesion molecules in the pancreas and lung in pancreatitis of different severities, and to assess whether treatment with a monoclonal antibody against intercellular adhesion molecule-1 (ICAM-1) can reduce local and systemic complications. Background The outcome of severe acute pancreatitis relates to its pulmonary and septic complications. Leukocyte adhesion and infiltration, both mediated by ICAM-1, are central events in the pathogenesis of necrotizing pancreatitis. Methods Expression of ICAM-1 at different time points was assessed by immunohistochemistry and Western blot analysis in pancreas and lungs from rats with mild edematous or severe necrotizing pancreatitis. ICAM-1 expression was correlated with leukocyte infiltration and histologic changes. The possible therapeutic effect of monoclonal antibodies against ICAM-1 was assessed by measuring pancreatic and lung injury. Results In edematous pancreatitis, increased ICAM-1 expression in pancreas was evident by 6 hours but did not occur in lung. In contrast, ICAM-1 was upregulated at 3 hours in the pancreas and at 12 hours in lung in necrotizing pancreatitis. Increased expression of ICAM-1 preceded leukocyte infiltration. Treatment of severe necrotizing pancreatitis with monoclonal antibodies against ICAM-1 decreased both local pancreatic injury and systemic lung injury compared with untreated controls. Conclusions Upregulation of ICAM-1 and subsequent leukocyte infiltration appear to be significant mediators of pancreatic and pulmonary injury in pancreatitis, and both the onset and extent correlate with severity. The time course should permit effective prevention of tissue damage by treatment with ICAM-1 antibodies.

Werner, Jens; Z'graggen, Kaspar; Fernandez-del Castillo, Carlos; Lewandrowski, Kent B.; Compton, Carolyn C.; Warshaw, Andrew L.

1999-01-01

230

Acute pancreatitis associated with boceprevir: a case report.  

PubMed

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

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

2014-01-01

231

A case of acute pancreatitis following endoscopic biopsy of the ampulla of Vater.  

PubMed

Ampullary tumors are diagnosed by endoscopic biopsy of the ampulla of Vater. We encountered a rare case of acute pancreatitis following endoscopic biopsy of the ampulla. A 53-year-old man referred to our hospital for detailed examination of a suspected tumor of the ampulla of Vater. We conducted endoscopic biopsy from the ampulla. He developed severe abdominal pain four hours after the procedure. The serum amylase and serum lipase were elevated and abdominal computed tomography (CT) revealed pancreatic enlargement and diffuse stranding of the peri-pancreatic fat, compatible with the findings of acute pancreatitis. We diagnosed the patient as having acute pancreatitis caused by endoscopic biopsy of the ampulla of Vater. Conservative therapy improved his condition, however, a large pancreatic walled-off necrosis (WON) developed. Therefore, we performed endoscopic ultrasonography (EUS)-guided cyst drainage on the 74th day after admission. The WON diminished gradually in size and the symptoms disappeared, and the patient was discharged in good physical condition on the 137th day after admission. In this case, the ampullary biopsy may have caused mucosal edema or intraductal hematoma, resulting in pancreatic duct obstruction. It is important for endoscopists both to be aware of this potential complication following endoscopic biopsy of the ampulla and to inform the patients about possible complications of this procedure. PMID:24464133

Ishida, Yusuke; Okabe, Yoshinobu; Tokuyasu, Hidenori; Kaji, Ryohei; Sugiyama, Gen; Ushijima, Tomoyuki; Sasaki, Yu; Yasumoto, Makiko; Kuraoka, Kei; Tsuruta, Osamu; Sata, Michio

2013-01-01

232

Duodenal juice total protein and pancreatic enzyme synthesis, turnover, and secretion in patients after acute pancreatitis.  

PubMed Central

It is controversial whether acute pancreatitis has longterm effects on pancreatic function. Pancreatic enzyme synthesis, turnover, and secretion were measured in 10 patients in clinical remission who had had one or more (one to six) attacks of acute alcoholic pancreatitis. The studies were done between two and 29 months after the most recent attack. A control group included five patients with no evidence of pancreatic disease. A four hour primed/continuous intravenous infusion of [14C]L-leucine tracer was given with secretin (2 U/kg/h) and cholecystokinin (0.5 U/kg/h) and secreted duodenal juice aspirated. Amylase and trypsin were extracted from duodenal juice by affinity chromatography, permitting measurement of the rate of isotope incorporation into total protein, amylase, and trypsin. The results showed non-parallel changes in enzyme synthesis and turnover with decreases in total enzyme protein and amylase synthesis and turnover but preservation of trypsin synthesis and turnover. The low turnover rates may be ascribed to continuing pancreatic cell malfunction after recovery from acute alcoholic pancreatitis and suggest that the decreased amylase secretion rates are partly a consequence of impaired amylase synthesis and not simply because of loss of pancreatic tissue.

Ogden, J M; O'Keefe, S J; Louw, J A; Adams, G; Marks, I N

1993-01-01

233

[Acute pancreatitis and red cell distribution width (RDW)I at early phase of disease].  

PubMed

During last decade, many new biomarkers have been proposed for early diagnosis of acute pancreatitis and prognosis of its severity. However clinical availability of many markers are limited due to costly and time. consuming laboratory methods used, for their assessment, including ELISA technique. Recent studies revealed the usefulness of red cell distribution width (RDW), as a predictor of unfa vorable prognosis in many disease states. RDW is an easily available index generated automatically as a part of standard complete blood count In our group of 40 acute pancreatitis patients, RDW values assessed du ring first 5 days of disease, correlated positively with the duration of hospital stay and the severity of disease as well as with the concentration of selected inflammatory markers. Patients who died had significantly higher RDW comparing to survivors. Our results indicate that RDW may be helpful in early prediction of clinical course of acute pancreatitis. PMID:24697029

Kolber, Witold; Sporek, Mateusz; Dumnicka, Paulina; Ku?nierz-Cabala, Beata; Kuzniewski, Marek; Gurda-Duda, Anna; Solnica, Bogdan; Kulig, Jan

2013-01-01

234

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

PubMed

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

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

2007-10-01

235

Trypsinogen activation peptides (TAP) concentrations in the peritoneal fluid of patients with acute pancreatitis and their relation to the presence of histologically confirmed pancreatic necrosis.  

PubMed Central

This study measured the volume and colour, as well as concentrations of trypsinogen activation peptides (TAP) in the peritoneal fluid of 22 patients with acute pancreatitis and related these findings to the presence of pancreatic necrosis. Nine patients had a severe attack with histologically confirmed pancreatic necrosis, seven a severe attack without confirmed necrosis, and six a mild attack, also without confirmed necrosis. A free fluid volume > 20 ml or free fluid colour > grade 5 on the Leeds chart, or both detected histologically confirmed pancreatic necrosis with a sensitivity of 100% and specificity of 31%. A total peritoneal fluid TAP concentration of > or = nmol detected histologically confirmed pancreatic necrosis with a sensitivity of 89% and specificity of 85%, figures comparable with contrast enhanced computed tomography. These findings suggest that the measurement of peritoneal fluid TAP concentrations can detect effectively histologically confirmed pancreatic necrosis and that such measurements may prove useful in the selection of patients for surgery.

Heath, D I; Wilson, C; Gudgeon, A M; Jehanli, A; Shenkin, A; Imrie, C W

1994-01-01

236

Relapse of acute myeloid leukemia mimicking autoimmune pancreatitis after bone marrow transplantation.  

PubMed

We herein present the case of a 30-year-old man who developed recurrent pancreatitis and chronic graft-versus-host disease following unrelated bone marrow transplantation for acute myeloid leukemia (AML) with t(16;21)(p11;q22). Autoimmune pancreatitis was initially suspected due to the radiological findings and lack of response to gabexate mesilate and antibiotics. An examination of specimens successfully obtained via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) demonstrated invasion of AML cells in the pancreatic tissue. EUS-FNA is a less invasive method and a particularly useful diagnostic tool in severely ill patients. PMID:24492695

Ozeki, Kazutaka; Morishita, Yoshihisa; Sakai, Daisuke; Nakamura, Yosuke; Fukuyama, Ryuichi; Umemura, Koji; Yamaguchi, Yohei; Tatekawa, Shotaro; Watamoto, Koichi; Ozeki, Keiji; Kohno, Akio

2014-01-01

237

Controversial role of toll-like receptors in acute pancreatitis  

PubMed Central

Acute pancreatitis (AP) is a common clinical condition with an incidence of about 300 or more patients per million annually. About 10%-15% of patients will develop severe acute pancreatitis (SAP) and of those, 10%-30% may die due to SAP-associated complications. Despite the improvements done in the diagnosis and management of AP, the mortality rate has not significantly declined during the last decades. Toll-like receptors (TLRs) are pattern-recognition receptors that seem to play a major role in the development of numerous diseases, which make these molecules attractive as potential therapeutic targets. TLRs are involved in the development of the systemic inflammatory response syndrome, a potentially lethal complication in SAP. In the present review, we explore the current knowledge about the role of different TLRs that have been described associated with AP. The main candidate for targeting seems to be TLR4, which recognizes numerous damage-associated molecular patterns related to AP. TLR2 has also been linked with AP, but there are only limited studies that exclusively studied its role in AP. There is also data suggesting that TLR9 may play a role in AP.

Vaz, Juan; Akbarshahi, Hamid; Andersson, Roland

2013-01-01

238

Acute pancreatitis during all-trans-retinoic acid treatment for acute promyelocytic leukemia in a patient without overt hypertriglyceridemia.  

PubMed

All-trans-retinoic acid (ATRA) has been successfully used in the treatment of acute promyelocytic leukemia (APL). One of its adverse effects is acute pancreatitis. In the literature, a proposed cause of acute pancreatitis is hypertriglyceridemia. Here, we present the case of a 45-year-old male with APL, treated with ATRA combined with induction chemotherapy (cytarabine and idarubicin), who developed acute pancreatitis without overt hypertriglyceridemia. This finding suggests that hypertriglyceridemia might not be the sole contributing factor in the pathogenesis of ATRA-induced acute pancreatitis and that attention should be paid to the possibility that ATRA treatment causes acute pancreatitis in the absence of overt hypertriglyceridemia. PMID:15709095

Teng, Hao-Wei; Bai, Li-Yuan; Chao, Ta-Chung; Wang, Wei-Shu; Chen, Po-Min

2005-02-01

239

The amylase creatinine clearance ratio in acute pancreatitis.  

PubMed

One hundred and twenty-two patients have been studied in order to evaluate the usefulness of the amylase creatinine clearance ratio (ACCR) as a simple diagnostic test for acute pancreatitis. Sixteen out of 17 patients with acute pancreatitis had significant elevations in ACCR; in only 10 of these 17 cases was the serum amylase greater than 1200iu/l. The mean ACCR was within the normal range in control patients, in patients with chronic gastro-intestinal disease and in patients with acute abdominal conditions excluding pancreatitis; however, the mean serum amylase was significantly greater in patients with acute abdominal conditions than in the control group (P less than 0-05). The ACCR remained significantly elevated in patients with acute pancreatitis for longer than either serum or urine amylase values. The findings of the study suggest that the amylase creatinine clearance ratio is a simple yet reliable diagnostic test which could be used when screening patients suspected of having acute pancreatitis. PMID:890263

Murray, W R; Mackay, C

1977-03-01

240

Bacteremia in the Patients With Acute Pancreatitis as Revealed by 16S Ribosomal RNA Gene-Based Techniques.  

PubMed

OBJECTIVES:: To define the characteristic of bacteremia in the patients with acute pancreatitis and determine its possible association with the disease severity. DESIGN:: A prospective controlled study. SETTING:: ICU of Jinling Hospital, China. PATIENTS:: A total of 48 patients with mild or severe acute pancreatitis were enrolled in this study. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Samples of peripheral blood were collected from the patients at 4 or 5 and 9 or 10 days after acute pancreatitis was definitely diagnosed. Resulting DNA from the blood was analyzed using denaturing gradient gel electrophoresis, and separated fragments were sequenced for identification of bacterial species. Bacterial DNA was detected in peripheral blood from 68.8% of patients with acute pancreatitis, and more than half (60.4%) of the patients encountered polymicrobial flora. Translocated bacteria in patients with acute pancreatitis were primarily constituted of opportunistic pathogens derived from the gut, including Escherichia coli, Shigella flexneri, Enterobacteriaceae bacterium, Acinetobacter lwoffii, Bacillus coagulans, and Enterococcus faecium. And the species of circulating bacteria shifted remarkably among the patients with different severity. The presence of the bacteremia correlated positively with the Acute Physiology and Chronic Health Evaluation-II scores of patients with acute pancreatitis (r = 0.7918, p < 0.0001). CONCLUSIONS:: This study provides a detailed description on the prevalence of bacteremia and characteristic of bacterial species in patients with acute pancreatitis. We demonstrate an association between the bacteremia and the disease severity, which enables us to better understand a potential role of bacterial translocation in the pathogenesis of septic complication in acute pancreatitis. PMID:23764972

Li, Qiurong; Wang, Chenyang; Tang, Chun; He, Qin; Li, Ning; Li, Jieshou

2013-06-12

241

Selected biochemical parameters and ultrastructural picture of pancreas due to Ulinastatin treatment of experimental acute pancreatitis.  

PubMed

Urinary trypsin inhibitor (UTI, Ulinastatin) is a protease inhibitor that has not been yet used in Europe in any experimental trial of severe acute pancreatitis. We have combined the experimental model of severe, hemorrhagic form of acute pancreatitis, and pharmacological treatment with a protease inhibitor. Male Wistar rats were divided into four experimental groups: healthy controls, operated, operated with experimentally induced acute pancreatitis, and animals with acute pancreatitis--treated with UTI preparations. Subjects in the last group were administered UTI intraperitoneally 1 h after pancreatitis induction in an average standard dose of 3000 units/animal. Additionally, four subgroups were created in this treated group, based on the UTI administration time--number of standard doses received: 2 h - 1 standard dose, 6 h - 5 standard doses, 12 h - 11 doses, 24 and 48 h - 15 doses. Statistically significant differences in the serum amylase and lipase activity between the UTI-treated and non-treated subjects were found. In the group of non-treated animals, there a profound destruction of cellular organelles was observed with a total degradation of nuceli, endoplasmatic reticulum and zymogen granules. However, in the UTI-treated subjects, pathological processes proceeded with the significantly slower pace and in much smaller quantities. PMID:15816359

Maciejewski, R; Burdan, F; Burski, K; Madej, B; Ziemiakowicz, R; Dabrowski, A; Wallner, G

2005-03-01

242

Use of pre-, pro- and synbiotics in patients with acute pancreatitis: A meta-analysis  

PubMed Central

AIM: To assess the clinical outcomes of pre-, pro- and synbiotics therapy in patients with acute pancreatitis. METHODS: The databases including Medline, Embase, the Cochrane Library, Web of Science and Chinese Biomedicine Database were searched for all relevant randomized controlled trials that studied the effects of pre-, pro- or synbiotics in patients with acute pancreatitis. Main outcome measures were postoperative infections, pancreatic infections, multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS), length of hospital stay, antibiotic therapy and mortality. RESULTS: Seven randomized studies with 559 acute pancreatic patients were included. Pre-, pro- or synbiotics treatment showed no influence on the incidence of postoperative infections [odds ratios (OR) 0.30, 95% confidence interval (CI): 0.09-1.02, P = 0.05], pancreatic infection (OR 0.50, 95% CI: 0.12-2.17, P = 0.36), MOF (OR 0.88, 95% CI: 0.35-2.21, P = 0.79) and SIRS (OR 0.78, 95% CI: 0.20-2.98, P = 0.71). There were also no significant differences in the length of antibiotic therapy (OR 0.75, 95% CI: 0.50-1.14, P = 0.18) and the mortality (OR 0.75, 95% CI: 0.25-2.24, P = 0.61). However, Pre-, pro- or synbiotics treatment was associated with a reduced length of hospital stay (OR -3.87, 95% CI: -6.20 to -1.54, P = 0.001). When stratifying for the severity of acute pancreatitis, the main results were similar. CONCLUSION: Pre-, pro- or synbiotics treatment shows no significant influence on patients with acute pancreatitis. There is a lack of evidence to support the use of probiotics/synbiotics in this area.

Zhang, Ming-Ming; Cheng, Jing-Qiu; Lu, Yan-Rong; Yi, Zhi-Hui; Yang, Ping; Wu, Xiao-Ting

2010-01-01

243

The Importance of Interleukin 18, Glutathione Peroxidase, and Selenium Concentration Changes in Acute Pancreatitis  

Microsoft Academic Search

Cytokinemia and oxidative stress are important factors responsible for an inadequate immune response in the early course of acute pancreatitis (AP). The aim of the study was to evaluate the profiles of interleukin 18 (IL-18), glutathione peroxidase (GPx), and selenium concentrations in serum with respect to AP severity and to study the relationships between these parameters and recognized prognostic indicators

Urszula Wereszczynska-Siemiatkowska; Barbara Mroczko; Andrzej Siemiatkowski; Maciej Szmitkowski; Maria Borawska; Juliusz Kosel

2004-01-01

244

Variations in implementation of current national guidelines for the treatment of acute pancreatitis: implications for acute surgical service provision.  

PubMed Central

OBJECTIVES: The aim of this study was to explore the implementation of the current national guidelines for the treatment of acute pancreatitis. By taking pooled data from all available individual and regional audits, the study aimed to identify areas of consistent variance from the 'best practice' stipulated in the guidelines. METHODS: All published audits of the management of acute pancreatitis where treatment was compared to the current British Society of Gastroenterology guidelines for the treatment of acute pancreatitis were identified from a search of MEDLINE and the published abstracts of relevant specialty meetings. RESULTS: Five audits providing pooled data on 545 patients were identified. Overall mortality from severe disease was 8% (range, 4-17%). Definitive treatment of gallstone disease within 4 weeks of index attack was performed in 49% (range, 16-65%). High dependency or intensive care facilities for severe disease were available in 52% (range, 20-100%). CONCLUSION: This study demonstrates the presence of striking variations in the implementation of the current national guidelines for the treatment of acute pancreatitis.

Barnard, J.; Siriwardena, A. K.

2002-01-01

245

Giant cell arteritis complicated by acute pancreatitis: a case report  

PubMed Central

Introduction We describe a case of giant cell arteritis in a woman who was treated with high-dose systemic corticosteroids and subsequently developed acute pancreatitis. Case presentation A 78-year-old Caucasian woman presented with four weeks of progressive headache and scalp tenderness. One day before ophthalmology assessment, she had experienced visual obscurations in both eyes. Her visual acuity was 6/9 in both eyes, with a right afferent pupillary defect and right swollen optic nerve. She was diagnosed as having temporal arteritis and was urgently treated with high-dose pulsed intravenous and oral corticosteroids. Her previous diet-controlled diabetes needed insulin and oral hyperglycaemic therapy to control erratic blood sugars. On day 8 of treatment with steroids, she became unwell with epigastric pain and vomiting. She was diagnosed with acute pancreatitis and was treated conservatively. Conclusion Acute pancreatitis, a potentially life-threatening condition, is a rare but important side effect of systemic corticosteroids.

Seneviratne, Deepthi Renuka; Mollan, Susan P; Elsherbiny, Samer; Worstmann, Theresa

2008-01-01

246

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

PubMed Central

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.

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

2014-01-01

247

Diabetic ketoacidosis associated with acute pancreatitis in a heart transplant recipient treated with tacrolimus.  

PubMed

New-onset diabetes mellitus after transplant is a well-recognized complication of tacrolimus immunosuppression and commonly occurs as a form of type 2 diabetes mellitus. However, tacrolimus-associated acute pancreatitis causing diabetic ketoacidosis has not been reported in heart transplant patients. We report a 22-year-old women hospitalized owing to diabetic ketoacidosis associated with acute pancreatitis 7 months after a heart transplant. Her immunosuppression included tacrolimus. She was admitted with complaints of polydipsia, anorexia, and abdominal pain of 3 days' duration. Her initial laboratory test revealed a toxic level of tacrolimus (> 30 ng/mL), severe hyperglycemia (39 mmol/L), severe metabolic acidosis (pH 6.9), and ketonuria, although diabetes mellitus had never been diagnosed. Serum amylase and lipase levels and abdominal computed tomography suggested the presence of acute pancreatitis. After correcting the diabetic ketoacidosis and getting the tacrolimus level to the normal range, she was discharged home. Three months later, insulin was replaced with oral hypoglycemic agents. Pancreatitis can present with diabetic ketoacidosis in the recipient of a heart transplant treated with tacrolimus. Clinicians should pay more attention to tacrolimus levels and the risk of pancreatitis. PMID:23075084

Im, Moon-Sun; Ahn, Hyo-Suk; Cho, Hyun-Jai; Kim, Ki-Bong; Lee, Hae-Young

2013-02-01

248

Severe acute malnutrition in Asia.  

PubMed

Severe acute malnutrition (SAM) is a common condition that kills children and intellectually maims those who survive. Close to 20 million children under the age of 5 years suffer from SAM globally, and about 1 million of them die each year. Much of this burden takes place in Asia. Six countries in Asia together have more than 12 million children suffering from SAM: 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen. This article is based on a review of SAM burden and intervention programs in Asian countries where, despite the huge numbers of children suffering from the condition, the coverage of interventions is either absent on a national scale or poor. Countries in Asia have to recognize SAM as a major problem and mobilize internal resources for its management. Screening of children in the community for SAM and appropriate referral and back referral require good health systems. Improving grassroots services will not only contribute to improving management of SAM, it will also improve infant and young child feeding and nutrition in general. Ready-to-use therapeutic food (RUTF), the key to home management of SAM without complications, is still not endorsed by many countries because of its unavailability in the countries and its cost. It should preferably be produced locally from locally available food ingredients. Countries in Asia that do not have the capacity to produce RUTF from locally available food ingredients can benefit from other countries in the region that can produce it. Health facilities in all high-burden countries should be staffed and equipped to treat children with SAM. A continuous cascade of training of health staff on management of SAM can offset the damage that results from staff attrition or transfers. The basic nutrition interventions, which include breastfeeding, appropriate complementary feeding, micronutrient supplementation, and management of acute malnutrition, should be scaled up in Asian countries that are plagued with the burden of malnutrition. PMID:25069289

Ahmed, Tahmeed; Hossain, Muttaquina; Mahfuz, Mustafa; Choudhury, Nuzhat; Hossain, Mir Mobarak; Bhandari, Nita; Lin, Maung Maung; Joshi, Prakash Chandra; Angdembe, Mirak Raj; Wickramasinghe, V Pujitha; Hossain, S M Moazzem; Shahjahan, Mohammad; Irianto, Sugeng Eko; Soofi, Sajid; Bhutta, Zulfiqar

2014-06-01

249

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

Microsoft Academic Search

Background: Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are complex syndromes associated with numerous etiologies, clinical variables and complications. We developed the North American Pancreatitis Study 2 (NAPS2) to be sufficiently powered to understand the complex environmental, metabolic and genetic mechanisms underlying RAP and CP. Methods: Between August 2000 and September 2006, a consortium of 20 expert academic and

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

2008-01-01

250

Retrospective analysis of clinical problems concerning acute pancreatitis in one treatment center  

PubMed Central

Introduction Severe acute pancreatitis is still a difficult clinical problem, it is a challenge for medical teams, which should include the strategy of personalized medicine. In clinical observations, among patients with the fulminating course of acute pancreatitis developed during the first hours leading to irreversible multiorgan failure and death. Aim To evaluate the frequency of occurrence and analyze the progression and treatment of severe acute pancreatitis (AP) in patients hospitalized during the years 2004–2010 at the Clinical Surgery Ward. Material and methods One thousand and fifty patients treated for AP were included in the study; 97 patients with severe AP were subjected to a detailed clinical analysis. Results The average age of the patients was 52.8 years. Relapses occurred in 14.9% of patients. The severe form of acute pancreatitis was diagnosed in 97 patients, which accounts for 9.2% of all the illnesses, and occurred significantly more often in male patients (p < 0.01). The most frequent etiological factors were cholelithiasis (46.4%), and idiopathic pancreatitis (27.8%); alcohol consumption was responsible for 22.7% of the cases; the occurrence of both a bile-derivative and alcoholic factor was found in 3.1% of the cases. A worsening clinical state resulted in laparotomy in 26 patients (26.8%), and re-laparotomy in 5 patients. Necrosectomy was performed on 15 patients, of whom 33.3% died due to complications. The total mortality in severe AP was 38.1%. The average age of the deceased was 66.5. Early deaths within 14 days were noted in 78.4% of patients (n = 29) who died due to severe AP. Conclusions Severe AP in spite of implementing modern diagnosis and treatment methods is still associated with a high risk of death. Constant clinical observation and use of available prognostic scales are essential in improving AP prognoses.

Kozlowska, Monika; Deneka, Jan; Matykiewicz, Jaroslaw; Gluszek, Stanislaw

2013-01-01

251

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

PubMed

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

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

2013-11-27

252

Acute pancreatitis with saw palmetto use: a case report  

PubMed Central

Introduction Saw palmetto is a phytotherapeutic agent commercially marketed for the treatment of benign prostatic hyperplasia. Evidence suggests that saw palmetto is a safe product, and mild gastrointestinal adverse effects have been reported with its use. We report a case of acute pancreatitis, possibly secondary to the use of saw palmetto. Case presentation A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. He denied drinking alcohol prior to the development of his symptoms. His home medications included saw palmetto, lansoprazole and multivitamins. Laboratory results revealed elevated lipase and amylase levels. An abdominal ultrasound demonstrated a nondilated common bile duct, without choledocholithiasis. Computed tomography of his abdomen showed the pancreatic tail with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient's condition improved with intravenous fluids and pain management. On the fourth day of hospitalization his pancreatic enzymes were within normal limits: he was discharged home and advised to avoid taking saw palmetto. Conclusion It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions.

2011-01-01

253

A case of acute pancreatitis associated with risperidone treatment.  

PubMed

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

Kawabe, Kentaro; Ueno, Shu-Ichi

2014-04-01

254

Case of acute pancreatitis associated with Campylobacter enteritis  

PubMed Central

A 25-year-old man was admitted with the chief complaints of right flank pain, watery diarrhea, and fever. Blood tests revealed high levels of inflammatory markers, and infectious enteritis was diagnosed. A stool culture obtained on admission revealed no growth of any significant pathogens. Conservative therapy was undertaken with fasting and fluid replacement. On day 2 of admission, the fever resolved, the frequency of defecation reduced, the right flank pain began to subside, and the white blood cell count started to decrease. On hospital day 4, the frequency of diarrhea decreased to approximately 5 times per day, and the right flank pain resolved. However, the patient developed epigastric pain and increased blood levels of the pancreatic enzymes. Abdominal computed tomography revealed mild pancreatic enlargement. Acute pancreatitis was diagnosed, and conservative therapy with fasting and fluid replacement was continued. A day later, the blood levels of the pancreatic enzymes peaked out. On hospital day 7, the patient passed stools with fresh blood, and Campylobacter jejuni/coli was detected by culture. Lower gastrointestinal endoscopy performed on hospital day 8 revealed diffuse aphthae extending from the terminal ileum to the entire colon. Based on the findings, pancreatitis associated with Campylobacter enteritis was diagnosed. In the present case, a possible mechanism of onset of pancreatitis was invasion of the pancreatic duct by Campylobacter and the host immune responses to Campylobacter.

Kobayashi, Rumiko; Matsumoto, Satohiro; Yoshida, Yukio

2014-01-01

255

Case of acute pancreatitis associated with Campylobacter enteritis.  

PubMed

A 25-year-old man was admitted with the chief complaints of right flank pain, watery diarrhea, and fever. Blood tests revealed high levels of inflammatory markers, and infectious enteritis was diagnosed. A stool culture obtained on admission revealed no growth of any significant pathogens. Conservative therapy was undertaken with fasting and fluid replacement. On day 2 of admission, the fever resolved, the frequency of defecation reduced, the right flank pain began to subside, and the white blood cell count started to decrease. On hospital day 4, the frequency of diarrhea decreased to approximately 5 times per day, and the right flank pain resolved. However, the patient developed epigastric pain and increased blood levels of the pancreatic enzymes. Abdominal computed tomography revealed mild pancreatic enlargement. Acute pancreatitis was diagnosed, and conservative therapy with fasting and fluid replacement was continued. A day later, the blood levels of the pancreatic enzymes peaked out. On hospital day 7, the patient passed stools with fresh blood, and Campylobacter jejuni/coli was detected by culture. Lower gastrointestinal endoscopy performed on hospital day 8 revealed diffuse aphthae extending from the terminal ileum to the entire colon. Based on the findings, pancreatitis associated with Campylobacter enteritis was diagnosed. In the present case, a possible mechanism of onset of pancreatitis was invasion of the pancreatic duct by Campylobacter and the host immune responses to Campylobacter. PMID:24966623

Kobayashi, Rumiko; Matsumoto, Satohiro; Yoshida, Yukio

2014-06-21

256

Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema  

PubMed Central

Serial serum amylase and blood glucose levels were measured in 68 hypothermic (rectal temperature 35°C or less) patients, including 15 who had hypothermic myxoedema (serum protein bound iodine 3·5 ?g/100 ml or less). Raised amylase levels were found in 34 patients and probably reflected a mild acute pancreatitis. The high amylase levels correlated with low arterial PO2 levels and significantly with high arterial PCO2 levels and the base deficit but not with the severity or duration of the hypothermia. The acute pancreatitis does not explain why hypothermic patients with myxoedema have a poorer prognosis than those who are euthyroid. The pancreatitis occasionally contributed to the development, sometimes delayed, of diabetic ketoacidosis, blood glucose levels of over 120 mg/100 ml being found in 20 patients. There was a significant correlation between the raised serum amylase levels and the hyperglycaemia. Hypoglycaemia, sometimes profound, was found in 12 patients.

Maclean, D.; Murison, J.; Griffiths, P. D.

1973-01-01

257

Pancreatic secretory trypsin inhibitor I reduces the severity of chronic pancreatitis in mice overexpressing interleukin-1? in the pancreas  

PubMed Central

IL-1? is believed to play a pathogenic role in the development of pancreatitis. Expression of human IL-1? in pancreatic acinar cells produces chronic pancreatitis, characterized by extensive intrapancreatic inflammation, atrophy, and fibrosis. To determine if activation of trypsinogen is important in the pathogenesis of chronic pancreatitis in this model, we crossed IL-1? transgenic [Tg(IL1?)] mice with mice expressing a trypsin inhibitor that is normally produced in rat pancreatic acinar cells [pancreatic secretory trypsin inhibitor (PTSI) I]. We previously demonstrated that transgenic expression of PSTI-I [Tg(Psti1)] increased pancreatic trypsin inhibitor activity by 190%. Tg(IL1?) mice were found to have marked pancreatic inflammation, characterized by histological changes, including acinar cell loss, inflammatory cell infiltration, and fibrosis, as well as elevated myeloperoxidase activity and elevated pancreatic trypsin activity, as early as 6 wk of age. In contrast to Tg(IL1?) mice, pancreatitis was significantly less severe in dual-transgenic [Tg(IL1?)-Tg(Psti1)] mice expressing IL-1? and PSTI-I in pancreatic acinar cells. These findings indicate that overexpression of PSTI-I reduces the severity of pancreatitis and that pancreatic trypsin activity contributes to the pathogenesis of an inflammatory model of chronic pancreatitis.

Romac, Joelle M.-J.; Shahid, Rafiq A.; Choi, Steve S.; Karaca, Gamze F.; Westphalen, Christoph B.; Wang, Timothy C.

2012-01-01

258

Antibiotic treatment improves survival in experimental acute necrotizing pancreatitis  

Microsoft Academic Search

BACKGROUND & AIMS: It is still unproven whether prophylactic antibiotics can reduce mortality from acute necrotizing pancreatitis (ANP). The aim of this study was to investigate whether antibiotic therapy can influence long-term outcome in ANP and how appropriate this therapy is. METHODS: ANP was induced in rats by standardized intraductal bile acid infusion and cerulein hyperstimulation. Serum trypsinogen activation peptide

K Mithofer; C Fernandez-del Castillo; MJ Ferraro; K Lewandrowski; DW Rattner; AL Warshaw

1996-01-01

259

Abdominal compartment syndrome in acute pancreatitis: a systematic review.  

PubMed

Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were number of patients with ACS, radiologic and surgical interventions, morbidity, mortality, and methodological quality.After screening 169 articles, 7 studies were included. Three studies were prospective and 4 studies were retrospective. The overall methodological quality of the studies was moderate to low. The pooled data consisted of 271 patients, of whom 103 (38%) developed ACS. Percutaneous drainage of intraabdominal fluid was reported as first intervention in 11 (11%) patients. Additional decompressive laparotomy was performed in 8 patients. Decompressive laparotomy was performed in a total of 76 (74%) patients. The median decrease in intraabdominal pressure was 15 mm Hg (range, 33-18 mm Hg). Mortality in acute pancreatitis patients with ACS was 49% versus 11% without ACS. Morbidity ranged from 17% to 90%.Abdominal compartment syndrome during acute pancreatitis is associated with high mortality and morbidity. Studies are relatively small and have methodological shortcomings. The optimal timing and method of invasive interventions, as well as their effect on clinical outcomes, should be further evaluated. PMID:24921201

van Brunschot, Sandra; Schut, Anne Julia; Bouwense, Stefan A; Besselink, Marc G; Bakker, Olaf J; van Goor, Harry; Hofker, Sijbrand; Gooszen, Hein G; Boermeester, Marja A; van Santvoort, Hjalmar C

2014-07-01

260

Chlorpromazine Treatment of Experimental Acute Fulminant Pancreatitis in Pigs  

Microsoft Academic Search

Acute pancreatitis was induced in 20 piglets. In the controls (10 piglets) no specific treatment was given, while in the experimental group the animals were treated with chlorpromazine, a potent phospholipase A2 inhibitor in vitro. Blood samples were taken from all animals for the assay of amylase, lipase, phospholipase A2, calcium, blood glucose and arterial blood gases both before the

T. Schröder; M. Lempinen; S. Nordling; P. K. J. Kinnunen

1981-01-01

261

Acute necrotising pancreatitis—a role for enterokinase  

Microsoft Academic Search

The pathogenesis of acute necrotising pancreatitis has remained controversial primarily because the multiplicity of aetiological factors reported to be associated with the disease have apparently precluded a common sequence of events to explain the inappropriate activation of the proenzymes within the acinii and secretory ducts. There are two stages in the detonation of the stored proenzymes, one being the destabilisation

David Grant

1986-01-01

262

Minimally invasive retroperitoneal necrosectomy in management of acute necrotizing pancreatitis  

PubMed Central

Introduction One of the most important requirements in treatment of acute necrotizing pancreatitis is minimized invasion. Aim We are presenting experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, comparing our results to other studies, evaluating feasibility and safety, discussing advantages and disadvantages of this method. Material and methods We performed a retrospective analysis of 13 patients who had acute necrotizing pancreatitis with large fluid collections in retroperitoneal space and underwent retroperitoneal necrosectomy. Results There were eight males and three females aged between 24 and 60 years, average age was 42.8 ±9.2 years. The most common cause of pancreatitis was alcohol, 10 patients (76.9%). Average time between diagnosis and performance of operation was 25.7 ±11.3 days. One patient underwent eight repeated interventions: two retroperitoneal necrosectomies; five laparotomies; ultrasound-guided drainage. One patient underwent four reinterventions: lumbotomy; revision; two lavages. Three patients had two reinterventions: one had laparotomy and tamponation; one had two repeated retroperitoneal necrosectomies; third had one repeated retroperitoneal necrosectomy and one had ultrasound-guided drainage. Three patients needed one additional retroperitoneal necrosectomy. Five patients did not required additional interventions. 61.5% of our patients did not require more than one reintervention. Postoperative stay varied from 9 to 94 days, average 50.8 ±32.6 days. Conclusions Minimally invasive techniques should be considered as first-choice surgical option in treating patients with acute necrotizing pancreatitis. Pancreatic necrosis occupying less than 30% and with massive fluid collections in the left retroperitoneal space can be safely managed by minimally invasive retroperitoneal necrosectomy.

Beisa, Virgilijus; Beisa, Augustas; Samuilis, Arturas; Serpytis, Mindaugas; Strupas, Kestutis

2012-01-01

263

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?  

Microsoft Academic Search

Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded

Paul Georg Lankisch; Markus M. Lerch

2006-01-01

264

Role of interleukin 18 in nitric oxide production and pancreatic damage during acute pancreatitis.  

PubMed

The release of the immunomodulator, interleukin 18 (IL-18) into sera early in acute pancreatitis (AP) corresponds to disease severity. IL-18 induces nitric oxide (NO), which is involved in the pathophysiology of pancreatitis. The objective of this study was to clarify the role of IL-18 in pathogenesis and NO production during early AP using recombinant mouse (rm) IL-18 protein and IL-18 gene knockout (KO) mice. After pretreatment with phosphate-buffered saline or rmIL-18, wild-type (WT) or KO mice were injected intraperitoneally with phosphate-buffered saline (sham) or cerulein (AP) hourly for 3 h. Blood, pancreas, spleen, and liver were collected until 24 h after the first dose. Main outcome measures were serum IL-18, amylase and lipase levels, histological evaluation of the pancreas with parenchyma vacuolization of acinar cells, mRNA expression of inducible NO synthase (iNOS) in the pancreas, and spleen, liver, and plasma NO metabolite level. Serum IL-18 was significantly increased immediately after induction of AP in WT mice. Serum amylase, lipase, and the numbers of acinar cells with parenchyma vacuolization were significantly higher in the group AP/KO than in the group AP/WT, but these parameters were improved by dose-dependent pretreatment with rmIL-18 administration in both groups. Pancreatic iNOS gene expression and plasma NO metabolites were significantly increased by 6 h after the initiation of AP, but were significantly lower in the group AP/KO than in the AP/WT mice. Pretreatment with rmIL-18 also significantly increased these levels in both groups. Splenic and hepatic iNOS expression was not changed after the initiation of AP in WT mice, whereas pretreatment with rmIL-18 also increased these levels. Administration of aminoguanidine, a selective iNOS inhibitor, before AP induction abolished the protective effect of pretreatment with rmIL-18 on pancreatic injury. IL-18 appears to protect the pancreas during early induced-induced AP in mice, probably through induction of NO release from an iNOS source. IL-18 may be a target for new AP therapeutics. PMID:16317388

Ueno, Naoko; Kashiwamura, Shin-Ichiro; Ueda, Haruyasu; Okamura, Haruki; Tsuji, Noriko M; Hosohara, Katsushi; Kotani, Joji; Marukawa, Seishiro

2005-12-01

265

The effects of gingko biloba extract (EGb 761) on experimental acute pancreatitis  

Microsoft Academic Search

Background and objectiveAcute pancreatitis is an important and fatal disease with high mortality and morbidity. Although the pathogenesis of acute pancreatitis is poorly understood, there are many studies that suggest the role for oxygen free radicals (OFRs) in the development of pancreatitis and its complications and show beneficial effects of scavenger treatment. In the present study, we aimed to investigate

Nazif Zeybek; Semih Gorgulu; Gokhan Yagci; Muhittin Serdar; Abdurrahman Simsek; Nihat Kaymakcioglu; Salih Deveci; Hakan Ozcelik; Turgut Tufan

2003-01-01

266

Necrotizing acute pancreatitis induced by salmonella infection  

Microsoft Academic Search

Summary  A case of salmonellosis complicated by hemorrhagic pancreatitis is presented. It is emphasized that removal of the gallbladder\\u000a when stones are present is mandatory in sepsis induced by salmonellosis in the bilepancreatic region, in spite of modem antibiotic\\u000a treatment.

Ake Andrén-Sandberg; Henning Höjer

1994-01-01

267

Age-Dependent Effects of UCP2 Deficiency on Experimental Acute Pancreatitis in Mice  

PubMed Central

Reactive oxygen species (ROS) have been implicated in the pathogenesis of acute pancreatitis (AP) for many years but experimental evidence is still limited. Uncoupling protein 2 (UCP2)-deficient mice are an accepted model of age-related oxidative stress. Here, we have analysed how UCP2 deficiency affects the severity of experimental AP in young and older mice (3 and 12 months old, respectively) triggered by up to 7 injections of the secretagogue cerulein (50 ?g/kg body weight) at hourly intervals. Disease severity was assessed at time points from 3 hours to 7 days based on pancreatic histopathology, serum levels of alpha-amylase, intrapancreatic trypsin activation and levels of myeloperoxidase (MPO) in lung and pancreatic tissue. Furthermore, in vitro studies with pancreatic acini were performed. At an age of 3 months, UCP2-/- mice and wild-type (WT) C57BL/6 mice were virtually indistinguishable with respect to disease severity. In contrast, 12 months old UCP2-/- mice developed a more severe pancreatic damage than WT mice at late time points after the induction of AP (24 h and 7 days, respectively), suggesting retarded regeneration. Furthermore, a higher peak level of alpha-amylase activity and gradually increased MPO levels in pancreatic and lung tissue were observed in UCP2-/- mice. Interestingly, intrapancreatic trypsin activities (in vivo studies) and intraacinar trypsin and elastase activation in response to cerulein treatment (in vitro studies) were not enhanced but even diminished in the knockout strain. Finally, UCP2-/- mice displayed a diminished ratio of reduced and oxidized glutathione in serum but no increased ROS levels in pancreatic acini. Together, our data indicate an aggravating effect of UCP2 deficiency on the severity of experimental AP in older but not in young mice. We suggest that increased severity of AP in 12 months old UCP2-/- is caused by an imbalanced inflammatory response but is unrelated to acinar cell functions.

Kruger, Burkhard; Fitzner, Brit; Lange, Falko; Bock, Cristin N.; Nizze, Horst; Ibrahim, Saleh M.; Fuellen, Georg; Wolkenhauer, Olaf; Jaster, Robert

2014-01-01

268

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

PubMed Central

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.

Quintanilla-Flores, Dania Lizet; Flores-Caballero, Miguel Angel; Rodriguez-Gutierrez, Rene; Tamez-Perez, Hector Eloy; Gonzalez-Gonzalez, Jose Gerardo

2014-01-01

269

Sesamol attenuates oxidative stress-mediated experimental acute pancreatitis in rats.  

PubMed

Acute pancreatitis is a potentially fatal disease with no known cure. The initial events in acute pancreatitis may occur within the acinar cells. We examined the effect of sesamol on (i) a cerulein-induced pancreatic acinar cancer cell line, AR42J, and (ii) cerulein-induced experimental acute pancreatitis in rats. Sesamol inhibited amylase activity and increased cell survival. It also inhibited medium lipid peroxidation and 8-hydroxydeoxyguanosine in AR42J cells compared with the cerulein-alone groups. In addition, in cerulein-treated rats, sesamol inhibited serum amylase and lipase levels, pancreatic edema, and lipid peroxidation, but it increased pancreatic glutathione and nitric oxide levels. Thus, we hypothesize that sesamol attenuates cerulein-induced experimental acute pancreatitis by inhibiting the pancreatic acinar cell death associated with oxidative stress in rats. PMID:22076497

Chu, P-Y; Srinivasan, P; Deng, J-F; Liu, M-Y

2012-04-01

270

Marked elevation of transaminases and pancreatic enzymes in severe malnourished male with eating disorder.  

PubMed

We report a case of a 45 year old Caucasian malnourished male with an history of eating disorder who developed severe liver and pancreatic damage and multiorgan disfunction. At admission to our department, his body mass index (BMI) was 11.1. Biochemical evaluation showed elevated serum levels of transaminases (AST= 2291 U/L, ALT= 1792 U/L), amylase (3620 U/L), lipase (4102 U/L), CPK= 1370 U/L, LDH= 2082 U/L. No other cause of acute liver and pancreatic damage was evidenced. Haematological disorders (anemia, thrombocytopenia, leukopenia) found on admission seem related to bone marrow hypoplasia and to gelatinous marrow transformation described in severe state of malnutrition. Although a moderate increase in liver and pancreatic enzymes are a common finding in malnourished patients, only a small number of reports describes severe liver injury and multiorgan dysfunction. After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. The association of chronic malnutrition and a decrease in systemic perfusion may be responsible for multiorgan dysfunction. In our patient the high levels of transaminases and pancreatic enzymes were the most important biochemical abnormalities normalized after refeeding. PMID:24217841

Urso, C; Brucculeri, S; Caimi, G

2013-01-01

271

Cannabinoid HU210 Protects Isolated Rat Stomach against Impairment Caused by Serum of Rats with Experimental Acute Pancreatitis  

PubMed Central

Acute pancreatitis (AP), especially severe acute pancreatitis often causes extra-pancreatic complications, such as acute gastrointestinal mucosal lesion (AGML) which is accompanied by a considerably high mortality, yet the pathogenesis of AP-induced AGML is still not fully understood. In this report, we investigated the alterations of serum components and gastric endocrine and exocrine functions in rats with experimental acute pancreatitis, and studied the possible contributions of these alterations in the pathogenesis of AGML. In addition, we explored the intervention effects of cannabinoid receptor agonist HU210 and antagonist AM251 on isolated and serum-perfused rat stomach. Our results showed that the AGML occurred after 5 h of AP replication, and the body homeostasis was disturbed in AP rat, with increased levels of pancreatic enzymes, lipopolysaccharide (LPS), proinflammtory cytokines and chemokines in the blood, and an imbalance of the gastric secretion function. Perfusing the isolated rat stomach with the AP rat serum caused morphological changes in the stomach, accompanied with a significant increment of pepsin and [H+] release, and increased gastrin and decreased somatostatin secretion. HU210 reversed the AP-serum-induced rat pathological alterations, including the reversal of transformation of the gastric morphology to certain degree. The results from this study prove that the inflammatory responses and the imbalance of the gastric secretion during the development of AP are responsible for the pathogenesis of AGML, and suggest the therapeutic potential of HU210 for AGML associated with acute pancreatitis.

Cao, Ming-hua; Li, Yong-yu; Xu, Jing; Feng, Ya-jing; Lin, Xu-hong; Li, Kun; Han, Tong; Chen, Chang-Jie

2012-01-01

272

[Epidural blockade for analgesia and treatment of acute pancreatitis].  

PubMed

The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.8%, and necrosis of the pancreas in 34.6%. RESULTS. On average, 3.4 (1-6) injections with single doses of 6-20 ml 0.25% bupivacaine were injected per day. In four patients, morphine (up to 4 mg per 24 h) was added to the local anesthetic. The duration of treatment was between 1 and 15 days. After 10.5% of the injections, the systolic pressure decreased by more than 20%, and after 12.8% of the injections the blood pressure decreased by more than 30%. Hypotension of more than 30% was treated with 0.3 to 0.5 ml theodrenaline (Akrinor) and/or 0.1 to 0.2 mg dihydro-ergotamine (Dihydergot). General analgesics had to be administered in addition on 21.8% of the treatment days and intensive care treatment (artificial ventilation) on 32% of the treatment days. The duration of epidural analgesia varied between 1 and 15 days depending on the intensity of symptoms (pain, ileus). Within 4 days, the enzyme activity of the lipase fell from 8120 to 427 IU, and that of alpha amylase fell from 1401 to 143 IU. In 3 patients laparotomy (for drainage) was performed. An ERCP was carried out in 16 patients. Cardiopulmonary failure necessitated artificial ventilation over a period of 1-15 days in 6 patients; the epidural blockade was continued during the artificial ventilation. Cholecystectomy was carried out as an interval operation in 6 patients. No neurological complications were observed. All patients survived and were discharged from hospital. PMID:1780489

Niesel, H C; Klimpel, L; Kaiser, H; Bernhardt, A; al-Rafai, S; Lang, U

1991-12-01

273

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

PubMed

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

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

2014-06-01

274

Spontaneous resolution of pancreatic masses (pseudocysts?)--Development and disappearance after acute alcoholic pancreatitis.  

PubMed

To determine the incidence and the natural history of retroperitoneal masses complicating acute pancreatitis, 104 cases of acute alcoholic pancreatitis were evaluated prospectively for mass formation. Abdominal masses detected by physical examination and serial x-ray films of the upper portion of the gastrointestinal tract were localized to the retroperitoneum by additional contrast studies, including abdominal angiography. Nonoperative management was urged only for patients with an asymptomatic mass. An abdominal mass developed in 19 patients (18%). In eight of these, it disappeared rapidly, but in 11 (11%), it persisted, and was considered to be a pancreatic pseudocyst. Eight of the 11 patients were treated nonoperatively, and the mass resolved without complication three weeks to three months after diagnosis. In three patients, a pseudocyst was confirmed at laparotomy. Exploration was justified by an unstable clinical course in only one instance. A routine surgical approach to an asymptomatic retroperitoneal mass developing after acute alcoholic pancreatitis may not be necessaary in patients who are improving clinically because the mass may resolve without complication. PMID:1138670

Czaja, A J; Fisher, M; Marin, G A

1975-04-01

275

Acute pancreatitis - from cellular signalling to complicated clinical course  

PubMed Central

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

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

2007-01-01

276

Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases.  

PubMed Central

Of 279 patients admitted to a specialist unit with acute pancreatitis, 210 were admitted directly and 69 were transferred for treatment of local or systemic complications. Outcome was assessed in terms of mortality and morbidity and in relation to aetiology, predicted severity of disease (modified Glasgow score), organ failure (modified Goris multiple organ failure score), and need for surgical intervention. The death rate was 1.9% in patients admitted directly but was 18.8% in those transferred from other units. Mortality in gall stone related pancreatitis was 3% compared with 15% (p = 0.03) in pancreatitis of unknown aetiology and 27% (p = 0.01) in post-endoscopic retrograde cholangiopancreatography pancreatitis. Mortality was related to age (mortality > 55 years old 11% v 2%; p = 0.003) and Goris score (score 0, mortality 0% v score 5-9, mortality 67%; p = 0.001). In patients transferred from other units, mortality was 11% in those transferred within a week of diagnosis and 35% when transfer was delayed (p = 0.04). Thirty six patients had pancreatic necrosis on dynamic computed tomography of whom 29 underwent pancreatic necrosectomy with a 34% mortality. Mortality was related to the modified Goris score (median score 2 in survivors v 6 in non-survivors; p = 0.005) and was higher when necrosectomy was performed within the first two weeks of admission (100% vs 21%; p = 0.004). In conclusion, mortality in acute pancreatitis is influenced by age, aetiology of the disease, and presence of organ failure. Patients transferred for specialist care have a 10-fold greater mortality than those admitted directly and mortality is greatest when transfer is delayed. Early necrosectomy carries a prohibitively high mortality.

de Beaux, A C; Palmer, K R; Carter, D C

1995-01-01

277

The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis  

Microsoft Academic Search

Background—Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis.Aims—To

B Rau; G Steinbach; F Gansauge; J M Mayer; A Grünert; H G Beger

1997-01-01

278

Effects of clotrimazol on the acute necrotizing pancreatitis in rats.  

PubMed

This study aims to investigate the influence of clotrimazol (CLTZ) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. Rats were divided into five groups as sham + saline, sham + CLTZ, sham + polyethylene glycol, ANP + saline, and ANP + CLTZ. ANP in rats was induced by glycodeoxycholic acid. The extent of acinar cell injury, mortality, systemic cardiorespiratory variables, functional capillary density (FCD), renal/hepatic functions, and changes in some enzyme markers for pancreatic and lung tissue were investigated during ANP in rats. The use of CLTZ after the induction of ANP resulted in a significant decrease in the mortality rate, pancreatic necrosis, and serum activity of amylase, alanine aminotransferase, interleukin-6, lactate dehydrogenase in bronchoalveolar lavage fluid, serum concentration of urea, and tissue activity of myeloperoxidase, and malondialdehyde in the pancreas and lung and a significant increase in concentrations of calcium, blood pressure, urine output, pO2, and FCD. This study showed that CLTZ demonstrated beneficial effect on the course of ANP in rats. Therefore, it may be used in the treatment of acute pancreatitis. PMID:23892997

Cekic, Arif Burak; Alhan, Etem; Usta, Arif; Türky?lmaz, Serdar; Kural, Birgül Vanizor; Erçin, Cengiz

2013-12-01

279

Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case  

PubMed Central

We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic.

Kim, Mi-Young; Chung, Cho-Yun; Kim, Jong-Sun; Myung, Dae-Seong; Cho, Sung-Bum; Park, Chang-Hwan; Kim, Young

2013-01-01

280

Parathyroid cyst presenting as acute pancreatitis: report of a case.  

PubMed

We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic. PMID:24400215

Kim, Mi-Young; Chung, Cho-Yun; Kim, Jong-Sun; Myung, Dae-Seong; Cho, Sung-Bum; Park, Chang-Hwan; Kim, Young; Joo, Young-Eun

2013-12-01

281

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

PubMed Central

The role of pancreatic acinar cells in initiating necro-inflammatory responses during the early onset of alcoholic acute pancreatitis (AP) has not been fully evaluated. We investigated the ability of acinar cells to generate pro- and anti-inflammatory mediators, including inflammasome-associated IL-18/caspase-1, and evaluated acinar cell necrosis in an animal model of AP and human samples. Rats were fed either an ethanol-containing or control diet for 14 weeks and killed 3 or 24?h after a single lipopolysaccharide (LPS) injection. Inflammasome components and necro-inflammation were evaluated in acinar cells by immunofluorescence (IF), histology, and biochemical approaches. Alcohol exposure enhanced acinar cell-specific production of TNF?, IL-6, MCP-1 and IL-10, as early as 3?h after LPS, whereas IL-18 and caspase-1 were evident 24?h later. Alcohol enhanced LPS-induced TNF? expression, whereas blockade of LPS signaling diminished TNF? production in vitro, indicating that the response of pancreatic acinar cells to LPS is similar to that of immune cells. Similar results were observed from acinar cells in samples from patients with acute/recurrent pancreatitis. Although morphologic examination of sub-clinical AP showed no visible signs of necrosis, early loss of pancreatic HMGB1 and increased systemic levels of HMGB1 and LDH were observed, indicating that this strong systemic inflammatory response is associated with little pancreatic necrosis. These results suggest that TLR-4-positive acinar cells respond to LPS by activating the inflammasome and producing pro- and anti-inflammatory mediators during the development of mild, sub-clinical AP, and that these effects are exacerbated by alcohol injury.

Gu, H; Werner, J; Bergmann, F; Whitcomb, D C; Buchler, M W; Fortunato, F

2013-01-01

282

Acute ethanol administration induces oxidative changes in rat pancreatic tissue  

Microsoft Academic Search

BACKGROUND--There is mounting clinical evidence that ethanol toxicity to the pancreas is linked with glutathione depletion from oxidative stress but there is not experimental proof that this occurs. AIMS AND METHODS--The effect of acute ethanol ingestion (4 g\\/kg) on the pancreatic content of reduced (GSH) and oxidised (GSSG) glutathione, malondialdehyde (MDA), and carbonyl proteins were therefore studied in the rat.

E Altomare; I Grattagliano; G Vendemiale; V Palmieri; G Palasciano

1996-01-01

283

Spontaneous rupture of spleen masquerading as acute pancreatitis.  

PubMed

Splenic rupture most commonly follows blunt abdominal trauma. Nontraumatic rupture of the spleen is rare. Nontraumatic rupture of the spleen has been described in a variety of pathologic conditions, which include neoplastic, infectious, and hematologic diseases affecting the spleen. Spontaneous rupture of nondiseased spleen is extremely rare. We report a case of spontaneous rupture of spleen in a chronic alcoholic clinically simulating acute pancreatitis. PMID:24268850

Debnath, Jyotindu; Sonkar, Samrat; Sharma, Vivek; Chatterjee, Samar; Srivastava, Vikash; Khanna, Shiv Pankaj

2014-04-01

284

Giant cell arteritis complicated by acute pancreatitis: a case report  

Microsoft Academic Search

INTRODUCTION: We describe a case of giant cell arteritis in a woman who was treated with high-dose systemic corticosteroids and subsequently developed acute pancreatitis. CASE PRESENTATION: A 78-year-old Caucasian woman presented with four weeks of progressive headache and scalp tenderness. One day before ophthalmology assessment, she had experienced visual obscurations in both eyes. Her visual acuity was 6\\/9 in both

Deepthi Renuka Seneviratne; Susan P Mollan; Samer Elsherbiny; Theresa Worstmann

2008-01-01

285

Role of antibiotics in acute pancreatitis: A meta-analysis  

Microsoft Academic Search

In an attempt to decrease the infectious complications of acute pancreatitis and its high mortality, many investigators have\\u000a conducted randomized prospective trials on the efficacy of prophylactic antibiotics. The results of these studies are conflicting,\\u000a and many have called for a large multicenter study. Because multicenter trials are costly and difficult to organize, we believe\\u000a that meta-analysis is a reasonable

Robert Golub; Faizi Siddiqi; Dieter Pohl

1998-01-01

286

The role of oxygen free radicals in experimental acute pancreatitis in the rat  

Microsoft Academic Search

Summary  In order to elucidate the role of oxygen-derived free radicals in acute pancreatitis, scavengers and an inhibitor of production\\u000a of these free radicals were administered to rats with experimentally-induced acute pancreatitis. Acute reflux pancreatitis\\u000a was produced by the occlusion of the common bile duct (OCD). Catalase and superoxide dismutase (SOD) were used as scavengers,\\u000a and allopurinol was used as an

Toshihiko Koiwai; Hisao Oguchi; Shigeyuki Kawa; Yasutoshi Yanagisawa; Takeshi Kobayashi; Tatsuji Homma

1989-01-01

287

Concentration of tissue angiotensin II increases with severity of experimental pancreatitis.  

PubMed

Necrotizing pancreatitis is a serious condition that is associated with high morbidity and mortality. Although vasospasm is reportedly involved in necrotizing pancreatitis, the underlying mechanism is not completely clear. In addition, the local renin?angiotensin system has been hypothesized to be involved in the progression of pancreatitis and trypsin has been shown to generate angiotensin II under weakly acidic conditions. However, to the best of our knowledge, no studies have reported elevated angiotensin II levels in tissue with pancreatitis. In the present study, the concentration of pancreatic angiotensin II in rats with experimentally induced acute pancreatitis was measured. Acute pancreatitis was induced by retrograde injection of 6% sodium taurocholate into the biliopancreatic duct. Control rats were sacrificed without injection into the biliopancreatic duct. The concentration of tissue angiotensin II was measured using the florisil method. Angiotensin II concentration in tissues with acute pancreatitis measured at 3, 6, 12 and 24 h following taurocholate injection were significantly higher than that of normal pancreatic tissue. In addition, the concentration of angiotensin II increased in a time?dependent manner. The results demonstrated that the angiotensin II generating system is involved in the transition from edematous to necrotizing pancreatitis in experimental animals. We hypothesize that locally formed angiotensin II affects the microenvironment in pancreatitis. PMID:23754456

Furukawa, Hiroyuki; Shinmura, Atsushi; Tajima, Hidehiro; Tsukada, Tomoya; Nakanuma, Shin-Ichi; Okamoto, Koichi; Sakai, Seisho; Makino, Isamu; Nakamura, Keishi; Hayashi, Hironori; Oyama, Katsunobu; Inokuchi, Masafumi; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Fujita, Hideto; Takamura, Hiroyuki; Ninomiya, Itasu; Kitagawa, Hirohisa; Fushida, Sachio; Fujimura, Takashi; Ohta, Tetsuo; Wakayama, Tomohiko; Iseki, Shoichi

2013-08-01

288

Pancreatic T cell protein-tyrosine phosphatase deficiency ameliorates cerulein-induced acute pancreatitis  

PubMed Central

Background Acute pancreatitis (AP) is a common clinical problem whose incidence has been progressively increasing in recent years. Onset of the disease is trigged by intra-acinar cell activation of digestive enzyme zymogens that induce autodigestion, release of pro-inflammatory cytokines and acinar cell injury. T-cell protein tyrosine phosphatase (TCPTP) is implicated in inflammatory signaling but its significance in AP remains unclear. Results In this study we assessed the role of pancreatic TCPTP in cerulein-induced AP. TCPTP expression was increased at the protein and messenger RNA levels in the early phase of AP in mice and rats. To directly determine whether TCPTP may have a causal role in AP we generated mice with pancreatic TCPTP deletion (panc-TCPTP KO) by crossing TCPTP floxed mice with Pdx1-Cre transgenic mice. Amylase and lipase levels were lower in cerulein-treated panc-TCPTP KO mice compared with controls. In addition, pancreatic mRNA and serum concentrations of the inflammatory cytokines TNF? and IL-6 were lower in panc-TCPTP KO mice. At the molecular level, panc-TCPTP KO mice exhibited enhanced cerulein-induced STAT3 Tyr705 phosphorylation accompanied by a decreased cerulein-induced NF-?B inflammatory response, and decreased ER stress and cell death. Conclusion These findings revealed a novel role for pancreatic TCPTP in the progression of cerulein-induced AP.

2014-01-01

289

Pharmacological inhibition of PAR2 with the pepducin P2pal-18S protects mice against acute experimental biliary pancreatitis  

PubMed Central

Pancreatic acinar cells express proteinase-activated receptor-2 (PAR2) that is activated by trypsin-like serine proteases and has been shown to exert model-specific effects on the severity of experimental pancreatitis, i.e., PAR2?/? mice are protected from experimental acute biliary pancreatitis but develop more severe secretagogue-induced pancreatitis. P2pal-18S is a novel pepducin lipopeptide that targets and inhibits PAR2. In studies monitoring PAR2-stimulated intracellular Ca2+ concentration changes, we show that P2pal-18S is a full PAR2 inhibitor in acinar cells. Our in vivo studies show that P2pal-18S significantly reduces the severity of experimental biliary pancreatitis induced by retrograde intraductal bile acid infusion, which mimics injury induced by endoscopic retrograde cholangiopancreatography (ERCP). This reduction in pancreatitis severity is observed when the pepducin is given before or 2 h after bile acid infusion but not when it is given 5 h after bile acid infusion. Conversely, P2pal-18S increases the severity of secretagogue-induced pancreatitis. In vitro studies indicate that P2pal-18S protects acinar cells against bile acid-induced injury/death, but it does not alter bile acid-induced intracellular zymogen activation. These studies are the first to report the effects of an effective PAR2 pharmacological inhibitor on pancreatic acinar cells and on the severity of experimental pancreatitis. They raise the possibility that a pepducin such as P2pal-18S might prove useful in the clinical management of patients at risk for developing severe biliary pancreatitis such as occurs following ERCP.

Michael, E. S.; Kuliopulos, A.; Covic, L.; Steer, M. L.

2013-01-01

290

Pharmacological inhibition of PAR2 with the pepducin P2pal-18S protects mice against acute experimental biliary pancreatitis.  

PubMed

Pancreatic acinar cells express proteinase-activated receptor-2 (PAR2) that is activated by trypsin-like serine proteases and has been shown to exert model-specific effects on the severity of experimental pancreatitis, i.e., PAR2(-/-) mice are protected from experimental acute biliary pancreatitis but develop more severe secretagogue-induced pancreatitis. P2pal-18S is a novel pepducin lipopeptide that targets and inhibits PAR2. In studies monitoring PAR2-stimulated intracellular Ca(2+) concentration changes, we show that P2pal-18S is a full PAR2 inhibitor in acinar cells. Our in vivo studies show that P2pal-18S significantly reduces the severity of experimental biliary pancreatitis induced by retrograde intraductal bile acid infusion, which mimics injury induced by endoscopic retrograde cholangiopancreatography (ERCP). This reduction in pancreatitis severity is observed when the pepducin is given before or 2 h after bile acid infusion but not when it is given 5 h after bile acid infusion. Conversely, P2pal-18S increases the severity of secretagogue-induced pancreatitis. In vitro studies indicate that P2pal-18S protects acinar cells against bile acid-induced injury/death, but it does not alter bile acid-induced intracellular zymogen activation. These studies are the first to report the effects of an effective PAR2 pharmacological inhibitor on pancreatic acinar cells and on the severity of experimental pancreatitis. They raise the possibility that a pepducin such as P2pal-18S might prove useful in the clinical management of patients at risk for developing severe biliary pancreatitis such as occurs following ERCP. PMID:23275617

Michael, E S; Kuliopulos, A; Covic, L; Steer, M L; Perides, G

2013-03-01

291

Acute necrotizing pancreatitis: laboratory, clinical, and imaging findings as predictors of patient outcome.  

PubMed

OBJECTIVE. In patients with acute necrotizing pancreatitis, we analyzed whether laboratory and clinical findings determined in the early phase of disease and morphologic features on contrast-enhanced CT (CECT) at the beginning of the late phase of disease are helpful in predicting patient outcome and whether CECT findings provide additional information in establishing prognosis compared with the laboratory and clinical findings. MATERIALS AND METHODS. A retrospective analysis of 99 patients with acute necrotizing pancreatitis was performed. Four laboratory variables (albumin, calcium, C-reactive protein, WBC count) and three clinical variables (Acute Physiology, Age, Chronic Health Evaluation [APACHE] II score; Simplified Acute Physiology Score [SAPS] II; persistent organ failure) were assessed. Five morphologic features on CECT including Balthazar grade and CT severity index were reviewed. The endpoints of patient outcome were peripancreatic or pancreatic infection, need for intervention, duration of organ failure, ICU and hospital stays, and death. Based on receiver operating characteristic curve analysis for infection, high-and low-risk groups for each prognostic variable were calculated and univariable and multivariable Cox regression analyses were carried out. RESULTS. In our study population of 99 patients (63 men, 36 women; median age, 52 years; age range, 18-84 years), 25 patients (25%) developed infection, 42 patients (42%) experienced organ failure, and 12 patients (12%) died. Regarding the laboratory and clinical variables, albumin level, APACHE II score, and particularly persistent organ failure were the strongest independent predictors of patient outcome. Regarding the imaging variables, Balthazar grade and a morphologic feature that takes the distribution of intrapancreatic necrosis into account were the strongest independent predictors. In the multivariable analysis of all studied variables, imaging variables were independent and strong predictors of patient outcome and provided additional information in establishing prognosis compared with clinical and laboratory findings. CONCLUSION. In patients with suspected or proven acute necrotizing pancreatitis, performing CECT at the beginning of the late phase of disease is recommended to identify patients at increased risk for adverse outcomes. PMID:24848818

Brand, Michael; Götz, Andrea; Zeman, Florian; Behrens, Gundula; Leitzmann, Michael; Brünnler, Tanja; Hamer, Okka W; Stroszczynski, Christian; Heiss, Peter

2014-06-01

292

Pancreatitis after sphincter of Oddi manometry  

Microsoft Academic Search

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

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

1990-01-01

293

Severe acute hypertriglyceridemia during acute lymphoblastic leukemia induction successfully treated with plasmapheresis.  

PubMed

Children suffering from Acute Lymphoblastic Leukaemia (ALL) treated with asparaginase and corticosteroids are at risk of developing severe lipid abnormalities. The authors report the case of a 10-year-old male with extremely high plasma triglyceride concentrations (4,000 mg/dl) during the induction phase of ALL associated with mild pancreatitis. Hypertriglyceridemia was successfully managed with plasmapheresis with a decrease in triglyceride levels to 590 mg/dl. Apheresis appears to be safe and effective in reducing hypertriglyceridemia and preventing related complications. PMID:16883590

Ridola, Vita; Buonuomo, Paola Sabrina; Maurizi, Palma; Putzulu, Rossana; Annunziata, Maria Laura; Pietrini, Domenico; Riccardi, Riccardo

2008-02-01

294

Effects of Octreotide on Lipid Peroxidation in Pancreas and Plasma in Acute Hemorrhagic Necrotizing Pancreatitis in Rats  

Microsoft Academic Search

Background: The therapeutic effects of octreotide in acute hemorrhagic necrotizing pancreatitis (ANP) have always been considered to be due to the inhibition of the exocrine pancreatic secretion in order to reduce pancreatic autodigestion. In this experimental study we analyzed whether octreotide has also antioxidative effects on acute pancreatitis. Methods: 40 male Wistar rats were randomized into four groups (n =

Frank Axel Wenger; Maik Kilian; Christoph Andreas Jacobi; Jan Ilja Gregor; Hans Guski; Ingolf Schimke; Joachim Michael Müller

2002-01-01

295

Gene Polymorphisms of the Macrophage Migration Inhibitory Factor and Acute Pancreatitis  

Microsoft Academic Search

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

Rohit Makhija; Andrew Kingsnorth; Andrew Demaine

296

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

PubMed Central

Neural cross talk between visceral organs may play a role in mediating inflammation and pain remote from the site of the insult. We hypothesized such a cross talk exists between the duodenum and pancreas, and further it induces pancreatitis in response to intraduodenal toxins. A dichotomous spinal innervation serving both the duodenum and pancreas was examined, and splanchnic nerve responses to mechanical stimulation of these organs were detected. This pathway was then excited on the duodenal side by exposure to ethanol followed by luminal mustard oil to activate transient receptor potential subfamily A, member 1 (TRPA1). Ninety minutes later, pancreatic inflammation was examined. Ablation of duodenal afferents by resiniferatoxin (RTX) or blocking TRPA1 by Chembridge (CHEM)-5861528 was used to further investigate the duodeno-pancreatic neural reflex via TRPA1. ?40% of dorsal root ganglia (DRG) from the spinal cord originated from both duodenum and pancreas via dichotomous peripheral branches; ?50% splanchnic nerve single units responded to mechanical stimulation of both organs. Ethanol sensitized TRPA1 currents in cultured DRG neurons. Pancreatic edema and myeloperoxidase activity significantly increased after intraduodenal ethanol followed by mustard oil (but not capsaicin) but significantly decreased after ablation of duodenal afferents by using RTX or blocking TRPA1 by CHEM-5861528. We found the existence of a neural cross talk between the duodenum and pancreas that can promote acute pancreatitis in response to intraduodenal chemicals. It also proves a previously unexamined mechanism by which alcohol can induce pancreatitis, which is novel both in terms of the site (duodenum), process (neurogenic), and receptor (TRPA1).

Li, Cuiping; Zhu, Yaohui; Shenoy, Mohan; Pai, Reetesh; Liu, Liansheng

2013-01-01

297

Postburn pancreatitis.  

PubMed Central

OBJECTIVE: The authors examined the prevalence and complications of pancreatitis in severely burned patients. Factors predictive for the development of pancreatitis after burns are considered. SUMMARY BACKGROUND DATA: Pancreatitis has been documented at necropsy after burns; however, it is not clinically recognized as a common complication of burn injury. Recent improvements in survival rates could yield previously unrecognized complications, such as pancreatitis, particularly in those patients who previously would have not survived. The hypothesis is that pancreatitis is a frequent complication after major burn injury and causes significant morbidity for patients with large burns. METHODS: This retrospective review of adult patients with large burns examines postburn pancreatitis using stepwise logistic regression analysis. RESULTS: Forty-nine of 121 (40%) patients developed hyperamylasemia or hyperlipasemia well after the admission period (23 +/- 3 days), and all enzyme abnormalities were temporally associated with emerging infections. Most of these patients (40/49, 82%) had symptoms of pancreatitis. Three patients (6%) had pancreatic pseudocysts or abscesses. Inhalation injury (p = 0.0001), associated trauma (p = 0.0311), and escharotomy (p = 0.0415) were risk factors for pancreatitis. Using Fischer's exact test, patients with pancreatitis had increased mortality and length of stay. Patients with high enzyme elevations and > or = 50% body surface area burned were at severe risk of pancreatic pseudocyst or abscess development (43%; 90% confidence interval of 23-77%). CONCLUSIONS: Pancreatitis is a frequent complication after large burn injuries. Patients at high risk for pancreatitis complications should receive surveillance examinations during their acute hospitalization.

Ryan, C M; Sheridan, R L; Schoenfeld, D A; Warshaw, A L; Tompkins, R G

1995-01-01

298

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research.  

PubMed

Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30-50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca(2+) overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP. PMID:22221567

Wan, Mei H; Huang, Wei; Latawiec, Diane; Jiang, Kun; Booth, David M; Elliott, Victoria; Mukherjee, Rajarshi; Xia, Qing

2012-02-01

299

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research  

PubMed Central

Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30–50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca2+ overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP.

Wan, Mei H; Huang, Wei; Latawiec, Diane; Jiang, Kun; Booth, David M; Elliott, Victoria; Mukherjee, Rajarshi; Xia, Qing

2012-01-01

300

Acute Cholecystitis Accompanied by Acute Pancreatitis Potentially Caused by Dolosigranulum pigrum  

PubMed Central

We report a case of acute cholecystitis accompanied by acute pancreatitis and caused by Dolosigranulum pigrum in a 76-year-old male with gallstones. D. pigrum was isolated from a blood culture and confirmed by biochemistry tests and 16S rRNA sequencing. The isolate was susceptible to the ?-lactams ampicillin, penicillin, cephalothin, ceftriaxone, ceftazidime, chloramphenicol, and vancomycin but was intermediate to erythromycin and clindamycin. The patient recovered without sequelae after treatment with appropriate antibiotics for two weeks.

Lin, Jung-Chung; Hou, Shu-Jin; Huang, Li-Ung; Sun, Jun-Ren; Chang, Wei-Kuo; Lu, Jang-Jih

2006-01-01

301

Acute pancreatitis with diabetic ketoacidosis associated with hypermyoglobinemia, acute renal failure, and DIC  

Microsoft Academic Search

We report a case of acute pancreatitis with diabetic ketoacidosis associated with increased serum myoglobin concentration,\\u000a acute renal failure, and disseminated intravascular coagulation. A 49-year-old man suffering from diarrhea, vomiting, and\\u000a somnolence was admitted to the hospital. He had had flu-like symptoms for 4 days prior to the onset of these symptoms. He\\u000a was a habitual drinker and had been

Shigekazu Nakano; Masatoshi Mugikura; Masaaki Endoh; Yoshimitsu Ogami; Makoto Otsuki

1996-01-01

302

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

PubMed Central

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

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

2013-01-01

303

Acute pancreatitis possibly caused by allergy to bananas.  

PubMed

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

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

2005-01-01

304

Ligustrazine alleviates acute renal injury in a rat model of acute necrotizing pancreatitis  

Microsoft Academic Search

AIM: To evaluate the effect of ligustrazine, a traditional Chinese medicine, on renal injury in a rat model of acute necrotizing pancreatitis (ANP). METHODS: A total of 192 rats were randomly divided into three groups: control (C group), ANP without treatment (P group), and ANP treated with ligustrazine (T group). Each group was further divided into 0.5, 2, 6, 12

Jian-Xin Zhang; Sheng-Chun Dang; Jian-Guo Qu; Xue-Qing Wang

305

Posterior reversible encephalopathy syndrome following acute pancreatitis during chemotherapy for acute monocytic leukemia.  

PubMed

We describe an 18-year-old man with acute leukemia who presented with posterior reversible encephalopathy syndrome (PRES) shortly after developing acute pancreatitis. On day 15 after the third consolidation course with high-dose cytarabine, treatment with broad-spectrum antibiotics was initiated for febrile neutropenia. On day 16, he developed septic shock, and subsequently, acute respiratory distress syndrome (ARDS). After adding vancomycin, micafungin and high-dose methylprednisolone (mPSL) to his treatment regimen, these manifestations subsided. On day 22, he received hemodialysis for drug-induced acute renal failure. On day 24, he developed acute pancreatitis possibly due to mPSL; the following day he had generalized seizures, and was intubated. Cerebrospinal fluid findings were normal. Brain MRI revealed hyperintense signals on FLAIR images and increased apparent diffusion coefficient values in the sub-cortical and deep white matter areas of the bilateral temporal and occipital lobes, indicative of vasogenic edema. Thus, we diagnosed PRES. Blood pressure, seizures and volume status were controlled, with MRI findings showing improvement by day 42. He was extubated on day 32 and discharged on day 49 without complications. Although little is known about PRES following acute pancreatitis, clinicians should be aware that this condition may develop. PMID:24881921

Nishimoto, Mitsutaka; Koh, Hideo; Bingo, Masato; Yoshida, Masahiro; Nanno, Satoru; Hayashi, Yoshiki; Nakane, Takahiko; Nakamae, Hirohisa; Shimono, Taro; Hino, Masayuki

2014-05-01

306

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

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.

2014-01-01

307

[Fulminant acute pancreatitis. Are there objective criteria of the disease?].  

PubMed

A retrospective analysis has been made of the results of the diagnosis and treatment of 71 patients having severe pancreatitis. As a result, factors were revealed which restrict the possibilities of conservative treatment associated with pessimistic prognosis of the disease. Among them there are pancretitis-specific organic abnormalities (pulmonary, cardio-vascular, renal dysfunctions), diffused pancreonecrosis and infection of destructive zones. All the parameters in question are included in the proposed model of prognosis of the fulminant course of pancreatitis having high diagnostic accuracy up to 88.3%. PMID:23038910

Topuzov, E G; Galeev, Sh I; Rubtsov, M A; Abdullaev, Ia P; Kolosovski?, Ia V; Kniazeva, Iu V

2012-01-01

308

Acute pancreatitis as the initial manifestation of an adenocarcinoma of the major duodenal papilla in a patient with familial adenomatous polyposis syndrome: a case report and literature review.  

PubMed

We report a case of an ampullary carcinoma presenting as acute pancreatitis in a patient with familial adenomatous polyposis (FAP) syndrome and severe duodenal adenomatosis. A 48-year-old woman was hospitalised because of an episode of acute pancreatitis. She had a history of prophylactic total colectomy for FAP 2 years earlier. On admission, abdominal ultrasonography and computed tomography revealed dilatation of the main pancreatic and common bile duct. Spigelman's stage IV duodenal adenomatosis involving the major duodenal papilla was diagnosed on endoscopy and a classical Whipple procedure was proposed. Pathologic examination of the duodenopancreatectomy specimen revealed a tubular adenocarcinoma of the papilla that occluded the major pancreatic ducts. The patient had no evidence of disease and experienced no recurrent attacks of acute pancreatitis during a 36-month period of follow-up. PMID:24494478

Vasiliadisl, K; Papavasiliou, C; Pervana, S; Nikopoulos, K; Makridis, C

2013-01-01

309

TLR9 and the NLRP3 Inflammasome Link Acinar Cell Death With Inflammation in Acute Pancreatitis  

PubMed Central

BACKGROUND & AIMS Acute pancreatitis is characterized by early activation of intracellular proteases followed by acinar cell death and inflammation. Activation of damage-associated molecular pattern (DAMP) receptors and a cytosolic complex termed the inflammasome initiates forms of inflammation. In this study, we examined whether DAMP-receptors and the inflammasome provide the link between cell death and the initiation of inflammation in pancreatitis. METHODS Acute pancreatitis was induced by caerulein stimulation in wild-type mice and mice deficient in components of the inflammasome (ASC, NLRP3, caspase-1), Toll-like receptor 9 (TLR9), or the purinergic receptor P2X7. Resident and infiltrating immune cell populations and pro-IL-1? expression were characterized in control and caerulein-treated adult murine pancreas. TLR9 expression was quantified in pancreatic cell populations. Additionally, wild-type mice were pretreated with a TLR9 antagonist prior to induction of acute pancreatitis by caerulein or retrograde bile duct infusion of taurolithocholic acid 3-sulfate (TLCS). RESULTS Caspase-1, ASC, and NLPR3 were required for inflammation in acute pancreatitis. Genetic deletion of Tlr9 reduced pancreatic edema, inflammation, and pro-IL-1? expression in pancreatitis. TLR9 was expressed in resident immune cells of the pancreas, which are predominantly macrophages. Pretreatment with the TLR9 antagonist IRS954 reduced pancreatic edema, inflammatory infiltrate, and apoptosis. Pretreatment with IRS954 reduced pancreatic necrosis and lung inflammation in TLCS-induced acute pancreatitis. CONCLUSIONS Components of the inflammasome, specifically ASC, caspase-1, and NLRP3, are required for the development of inflammation in acute pancreatitis. TLR9 and P2X7 are important DAMP receptors upstream of inflammasome activation, and their antagonism could provide a new therapeutic strategy for treating acute pancreatitis.

Hoque, Rafaz; Sohail, Muhammad; Malik, Ahsan; Sarwar, Sherhayar; Luo, Yuhuan; Shah, Ahsan; Barrat, Franck; Flavell, Richard; Gorelick, Fred; Husain, Sohail; Mehal, Wajahat

2011-01-01

310

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

PubMed

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

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

2014-08-15

311

Severe permanent encephalopathy in acute lymphoblastic leukemia.  

PubMed

As survival rates for childhood acute lymphoblastic leukemia have increased, concerns over improved quality-of-life have also increased. Although 3-10% of children may experience acute transient neurotoxicity during induction chemotherapy, they are felt to be at low risk for late sequelae. We report three previously healthy boys with newly-diagnosed acute lymphoblastic leukemia who presented with obtundation and severe seizures during late induction with a standard four drug chemotherapy regimen. While all three are disease-free survivors, they unexpectedly have persistent and medically intractable partial complex seizures, broad-based neuropsychological impairment and striking neuroimaging abnormalities. These findings suggest that children with leukemia who develop an acute encephalopathy during induction chemotherapy are at risk for long-term neurological and neuropsychological sequelae, despite the cessation of further potentially neurotoxic therapy. PMID:8221383

Maria, B L; Dennis, M; Obonsawin, M

1993-08-01

312

No Debridement Is Necessary for Symptomatic or Infected Acute Necrotizing Pancreatitis: Delayed, Mini-Retroperitoneal Drainage for Acute Necrotizing Pancreatitis Without Debridement and Irrigation  

Microsoft Academic Search

We sought to determine if necrosectomy can be omitted for complicated acute necrotizing pancreatitis (ANP). Since 1996, we prospectively performed retroperitoneal drainage by introducing a sump drain to the pancreatic head area via a small left flank incision without debridement and irrigation on 19 consecutive complicated ANP patients. We purposely delayed surgery until liquefaction of retroperitoneal tissue reached the left

Yu-Chung Chang; Hong-Min Tsai; Xi-Zhang Lin; Chia-Hao Chang; Jen Pin Chuang

2006-01-01

313

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

PubMed Central

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

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

2013-01-01

314

Acute Pancreatitis in Type 2 Diabetes Treated With Exenatide or Sitagliptin  

PubMed Central

OBJECTIVE Cases of acute pancreatitis have been reported in association with exenatide, sitagliptin, and type 2 diabetes without use of these medications. It remains unknown whether exenatide or sitagliptin increase the risk of acute pancreatitis. RESEARCH DESIGN AND METHODS A retrospective cohort study of a large medical and pharmacy claims database was performed. Data for 786,656 patients were analyzed. Cox proportional hazard models were built to compare the risk of acute pancreatitis between diabetic and nondiabetic subjects and between exenatide, sitagliptin, and control diabetes medication use. RESULTS Incidence of acute pancreatitis in the nondiabetic control group, diabetic control group, exenatide group, and sitagliptin group was 1.9, 5.6, 5.7, and 5.6 cases per 1,000 patient years, respectively. The risk of acute pancreatitis was significantly higher in the combined diabetic groups than in the nondiabetic control group (adjusted hazard ratio 2.1 [95% CI 1.7–2.5]). Risk of acute pancreatitis was similar in the exenatide versus diabetic control group (0.9 [0.6–1.5]) and sitagliptin versus diabetic control group (1.0 [0.7–1.3]). CONCLUSIONS Our study demonstrated increased incidence of acute pancreatitis in diabetic versus nondiabetic patients but did not find an association between the use of exenatide or sitagliptin and acute pancreatitis. The limitations of this observational claims-based analysis cannot exclude the possibility of an increased risk.

Garg, Rajesh; Chen, William; Pendergrass, Merri

2010-01-01

315

Hyperbaric Oxygen Reduces Inflammatory Response in Acute Pancreatitis by Inhibiting NF-?B Activation  

Microsoft Academic Search

Aim: The mechanism of hyperbaric oxygen (HBO) therapy for acute pancreatitis has not been fully clarified yet. The main purpose of this study was to investigate the effect of HBO on nuclear factor ?B (NF-?B) activation and the inflammatory response in rats with acute necrotizing pancreatitis (ANP). Methods: A total of 120 male Sprague-Dawley rats were randomly divided into 3

X. Yu; Y. G. Li; X. W. He; X. R. Li; B. N. Din; Y. Gan; M. Xu

2009-01-01

316

Effect of octreotide on sphincter of oddi motility in patients with acute recurrent pancreatitis  

Microsoft Academic Search

Sphincter of Oddi dysfunction has been reported as a cause of acute idiopathic recurrent pancreatitis (IRP). Octreotide, a long-acting somatostatin analogue, is an antisecretory drug used in the treatment and prevention of acute pancreatitis. Its action on sphincter of Oddi motility is controversial and no data are available for IRP patients. The aim of this study was to assess sphincter

Vincenzo Di Francesco; Giampaolo Angelini; Paolo Bovo; Maria Beatrice Casarini; Marco Filippini; Bruna Vaona; Luca Frulloni; Laura Rigo; Maria Paola Brunori; Giorgio Cavallini

1996-01-01

317

Effect of pentoxifylline and\\/or alpha lipoic acid on experimentally induced acute pancreatitis  

Microsoft Academic Search

Acute pancreatitis is a sudden inflammation of the pancreas that may be life threatening disease with high mortality rates; particularly in presence of systemic inflammatory response and multiple organ failure despite of the conventional antibiotic and symptomatic treatment. Oxidative stress has been shown to be involved in the pathophysiology of acute pancreatitis. This study was designed to investigate the possible

Amany A. Abdin; Mohammed A. Abd El-Hamid; Samia H. Abou El-Seoud; Mohammed F. H. Balaha

2010-01-01

318

Nifuroxazide-induced acute pancreatitis: a new side-effect for an old drug?  

PubMed

We report the case of a middle-aged woman who developed a typical picture of acute pancreatitis together with systemic features of immunoallergy after the intake of two capsules (200 mg) of nifuroxazide. Even if acute pancreatitis is a rare adverse event of nitrofuran derivative therapy, nifuroxazide-induced pancreatitis as not been previously described. As suggested by associated systemic features, the disease is likely of immunoallergic origin. PMID:17619536

Shindano, Akilimali; Marot, Liliane; Geubel, André P

2007-01-01

319

A novel lipoprotein lipase gene missense mutation in Chinese patients with severe hypertriglyceridemia and pancreatitis  

PubMed Central

Background Alterations or mutations in the lipoprotein lipase (LPL) gene contribute to severe hypertriglyceridemia (HTG). This study reported on two patients in a Chinese family with LPL gene mutations and severe HTG and acute pancreatitis. Methods Two patients with other five family members were included in this study for DNA-sequences of hyperlipidemia-related genes (such as LPL, APOC2, APOA5, LMF1, and GPIHBP1) and 43 healthy individuals and 70 HTG subjects were included for the screening of LPL gene mutations. Results Both patients were found to have a compound heterozygote for a novel LPL gene mutation (L279V) and a known mutation (A98T). Furthermore, one HTG subject out of 70 was found to carry this novel LPL L279V mutation. Conclusions The data from this study showed that compound heterozygote mutations of A98T and L279V inactivate lipoprotein lipase enzymatic activity and contribute to severe HTG and acute pancreatitis in two Chinese patients. Further study will investigate how these LPL gene mutations genetically inactivate the LPL enzyme.

2014-01-01

320

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

PubMed Central

Background Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages. Methods and Findings We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference ?2.18; 95%CI ?3.48?(?0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05). Conclusion Enteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.

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

2013-01-01

321

Recurrent acute pancreatitis: an approach to diagnosis and management.  

PubMed

Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%-25% of cases of AP. The causes of idiopathic RAP (IRAP) can be mechanical, toxic-metabolic, anatomical, or miscellaneous. Microlithiasis commonly reported from the West is not a common cause of IRAP among Indian patients. Pancreas divisum (PD) is now believed as a cofactor, the main factor being associated genetic mutations. The role of Sphincter of Oddi dysfunction (SOD) as a cause of IRAP remains controversial. Malignancy should be ruled out in any patient with IRAP > 50 years of age. Early CP can present initially as RAP. The work-up of patients with IRAP includes a detailed history and investigations. Primary investigations include liver function tests (LFT), serum calcium and triglyceride, abdominal ultrasonography (USG) and contrast-ehhanced computed tomography (CECT) abdomen. Endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and possibly endoscopic retrograde cholangiopancreatography (ERCP) are indicated in the secondary phase if the work-up is negative after the primary investigations. EUS is advised usually 6-8 weeks after an acute episode. Treatment of patients with IRAP is aimed at the specific aetiology. In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course. PMID:24851521

Kedia, Saurabh; Dhingra, Rajan; Garg, Pramod Kumar

2013-01-01

322

Induction of Lithostathine\\/ regmRNA Expression by Serum from Rats with Acute Pancreatitis and Cytokines in Pancreatic Acinar AR42J Cells  

Microsoft Academic Search

During the acute phase of pancreatitis, expression of most pancreatic enzymes decreases, whereas mRNAs of pancreatitis associated protein and lithostathine\\/regincrease dramatically. In the present study we have investigated the effect of serum from rats with acute pancreatitis (SAP) and cytokines on the lithostathine\\/regmRNA expression in AR-42J cells. Lithostathine\\/regmRNA was strongly induced by SAP in a dose-dependent manner. Induction was abolished

Nelson J. Dusetti; Gustavo V. Mallo; Emilia M. Ortiz; Volker Keim; Jean-Charles Dagorn; Juan L. Iovanna

1996-01-01

323

AGE-DEPENDENT VULNERABILITY TO EXPERIMENTAL ACUTE PANCREATITIS IS ASSOCIATED WITH INCREASED SYSTEMIC INFLAMMATION AND THROMBOSIS  

PubMed Central

SUMMARY The severity and mortality rates of acute pancreatitis (AP) are significantly elevated in the elderly population. However, due to a lack of appropriate animal models, the underlying mechanisms for this age-dependent vulnerability remain largely unknown. The purpose of this study was to characterize a murine model of AP, which displays age-associated severity, and to use this model to identify pathophysiologies that are distinctive of the aged with AP. AP was induced in young (4–5 months), middle-aged (12–13 months), and aged (23–25 months) C57BL/6 mice by repeated injection of caerulein, a homologue of the gastrointestinal hormone cholecystokinin. Approximately 10% of aged mice died during AP while young and middle-aged mice showed no mortality. Although both young and aged mice exhibited early signs of edema and inflammation in the pancreas, kidney, and lung, young mice showed signs of recovery within 24 h while aged mice exhibited increasingly severe tissue damage and cell death. There was a significant age-dependent increase in pancreatic neutrophil activation and systemic inflammation as assessed by pancreatic myeloperoxidase (MPO) and plasma interleukin-6 (IL-6) concentration, respectively. Importantly, aged but not young mice with AP showed significantly elevated thrombosis in the lung and kidney as well as a marked increase in plasma concentration of plasminogen activator inhibitor-1 (PAI-1), a primary inhibitor of the fibrinolytic system. These results demonstrate that aging is associated with increased severity of AP characterized by augmented and prolonged pancreatic inflammation and the presence of multiple extra-pancreatic sequelae including thrombosis.

Okamura, Daiki; Starr, Marlene E.; Lee, Eun Y.; Stromberg, Arnold; Evers, B. Mark; Saito, Hiroshi

2013-01-01

324

A nonpancreatic source of the proteolytic-enzyme amidase and bacteriology in experimental acute pancreatitis.  

PubMed

In previous studies of human and experimental acute pancreatitis, three main assumptions have been made. First, that the disease is due to activation of pancreatic proteolytic enzymes in the pancreas with resulting "autodigestion" of the gland. Second, that interstitial pancreatitis is a mild form of hemorrhagic pancreatitis into which it may progress, and third, that bacteria play little part, if any, in the initiation of the disease. These assumptions are now questioned. In the present study in dogs, levels of proteolytic enzymes in blood, thoracicduct lymph and peritoneal fluid were measured using benzoylarginine amide. Raised levels of amidase were found in hemorrhagic, but not with interstitial, pancreatitis, and biochemical examination of amidase suggested it was not a pancreatic protease, but with its broad specificity and stability derived from bacteria. Addition of antibiotic to the blind duodenal loop in hemorrhagic pancreatitis reduced the level of blood amidase, but Trasylol given intravenously did not, nor did it inhibit amidase in vitro. In all animals, histological examination was made of the pancreas at time of death. On bacteriology, it is concluded that experimental interstitial pancreatitis results from damage to the pancreatic duct system without infection, and haemorrhagic pancreatitis mainly from reflux of bacteria into the pancreatic ducts from the duodenum. Only bacteria such as Escherichia coli and Clostridium welchii that produce proteolytic enzymes and cytotoxins appear to be able to cause haemorrhagic pancreatitis, and these bacteria may explain the release of vasoactive polypeptides and the vascular effects. In hemorrhagic pancreatitis such bacteria were found in the pancreas, but none in interstitial pancreatitis. Evidence is given to suggest that pancreatic proteolytic enzymes are unlikely to cause the cell necrosis which is a pathological feature of hemorrhagic pancreatitis, and that "autodigestion" is likewise unlikely to be a cause of this condition. An extrapancreatic source of proteolytic enzymes from bacteria is now suggested in haemorrhagic pancreatitis, and more attention to bacteriology in human acute pancreatitis is urgently needed. Amidase levels were highest in peritoneal fluid, suggesting a rationale for peritoneal lavage in the treatment of acute pancreatitis, and it is unlikely that Trasylol can give any benefit. The assessment of treatment of acute pancreatitis will be unsatisfactory as long as the proportion of haemorrhagic to interstitial pancreatitis in any series is not known accurately. PMID:6987958

Keynes, W M

1980-02-01

325

Melatonin attenuates acute pancreatitis-associated lung injury in rats by modulating interleukin 22  

PubMed Central

AIM: To investigate whether therapeutic treatment with melatonin could protect rats against acute pancreatitis and its associated lung injury. METHODS: Seventy-two male Sprague-Dawley rats were randomly divided into three groups: the sham operation (SO), severe acute pancreatitis (SAP), and melatonin treatment (MT) groups. Acute pancreatitis was induced by infusion of 1 mL/kg of sodium taurocholate (4% solution) into the biliopancreatic duct. Melatonin (50 mg/kg) was administered 30 min before pancreatitis was induced, and the severity of pancreatic and pulmonary injuries was evaluated 1, 4 and 8 h after induction. Serum samples were collected to measure amylase activities, and lung tissues were removed to measure levels of mRNAs encoding interleukin 22 (IL-22) and T helper cell 22 (Th22), as well as levels of IL-22. RESULTS: At each time point, levels of mRNAs encoding IL-22 and Th22 were significantly higher (P < 0.001) in the MT group than in the SAP group (0.526 ± 0.143 vs 0.156 ± 0.027, respectively, here and throughout, after 1 h; 0.489 ± 0.150 vs 0.113 ± 0.014 after 4 h; 0.524 ± 0.168 vs 0.069 ± 0.013 after 8 h, 0.378 ± 0.134 vs 0.122 ± 0.015 after 1 h; 0.205 ± 0.041 vs 0.076 ± 0.019 after 4 h; 0.302 ± 0.108 vs 0.045 ± 0.013 after 8 h, respectively) and significantly lower (P < 0.001) in the SAP group than in the SO group (0.156 ± 0.027 vs 1.000 ± 0.010 after 1 h; 0.113 ± 0.014 vs 1.041 ± 0.235 after 4 h; 0.069 ± 0.013 vs 1.110 ± 0.213 after 8 h, 0.122 ± 0.015 vs 1.000 ± 0.188 after 1 h; 0.076 ± 0.019 vs 0.899 ± 0.125 after 4 h; 0.045 ± 0.013 vs 0.991 ± 0.222 after 8 h, respectively). The mean pathological scores for pancreatic tissues in the MT group were significantly higher (P < 0.01) than those for samples in the SO group (1.088 ± 0.187 vs 0.488 ± 0.183 after 1 h; 2.450 ± 0.212 vs 0.469 ± 0.242 after 4 h; 4.994 ± 0.184 vs 0.513 ± 0.210 after 8 h), but were significantly lower (P < 0.01) than those for samples in the SAP group at each time point (1.088 ± 0.187 vs 1.969 ± 0.290 after 1 h; 2.450 ± 0.212 vs 3.344 ± 0.386 after 4 h; 4.994 ± 0.184 vs 6.981 ± 0.301 after 8 h). The severity of SAP increased significantly (P < 0.01) over time in the SAP group (1.088 ± 0.187 vs 2.450 ± 0.212 between 1 h and 4 h after inducing pancreatitis; and 2.450 ± 0.212 vs 4.994 ± 0.184 between 4 and 8 h after inducing pancreatitis). CONCLUSION: Melatonin protects rats against acute pancreatitis-associated lung injury, probably through the upregulation of IL-22 and Th22, which increases the innate immunity of tissue cells and enhances their regeneration.

Huai, Jia-Ping; Sun, Xue-Cheng; Chen, Meng-Jun; Jin, Yin; Ye, Xiao-Hua; Wu, Jian-Sheng; Huang, Zhi-Ming

2012-01-01

326

Hypertriglyceridemia-induced recurrent acute pancreatitis: A case-based review  

PubMed Central

Hypertriglyceridemia is a rare, but well-known cause of acute pancreatitis. A serum triglyceride level of more than 1000 to 2000 mg / dl is the identifiable risk factor. It typically presents as an episode of acute pancreatitis or recurrent acute pancreatitis. The clinical course and routine management of Hypertriglyceridemia-induced pancreatitis is similar to other causes. A thorough family history is important, as is the identification of secondary causes of hypertriglyceridemia. The mainstay of therapy includes dietary restriction of fatty meal and fibric acid derivatives. We hereby report the case of a 37-year-old lady with a family history of dyslipidemia presenting with recurrent episodes of acute pancreatitis. We also review the literature for pathogenesis and management of hyperlipidemia.

Kota, Sunil K.; Kota, Siva K.; Jammula, Sruti; Krishna, S. V. S.; Modi, Kirtikumar D.

2012-01-01

327

Acute pancreatitis occurring in gastric aberrant pancreas treated with surgery and proved by histological examination.  

PubMed

We describe a case of gastric aberrant pancreas with acute pancreatitis. Barium meal examination, endoscopic examination and computed tomography of a 32-year-old man with abdominal pain revealed a submucosal tumor, about 3.5 cm in diameter, at the angulus of his stomach. Endoscopic ultrasonography revealed a hypoechoic mass with anechoic capillary areas. His serum amylase level was high at 262 IU/l. Laparoscopy-assisted local resection was carried out. The resected tumor revealed pancreatic tissue with extensive neutrophil infiltration in the gastric wall and fat necrosis in the subserosa. There are few cases of histologically proven acute pancreatitis in gastric aberrant pancreatic tissue. PMID:16357455

Hirasaki, Shoji; Tanimizu, Masahito; Moriwaki, Toshikazu; Nasu, Junichirou

2005-11-01

328

C/EBP homologous protein deficiency aggravates acute pancreatitis and associated lung injury  

PubMed Central

AIM: To investigate the pathophysiological role of C/EBP homologous protein (CHOP) in severe acute pancreatitis and associated lung injury. METHODS: A severe acute pancreatitis model was induced with 6 injections of cerulein (Cn, 50 ?g/kg) at 1-h intervals, then intraperitoneal injection of lipopolysaccharide (LPS, 7.5 mg/kg) in CHOP-deficient (Chop-/-) mice and wild-type (WT) mice. Animals were sacrificed under anesthesia, 3 h or 18 h after LPS injection. Serum amylase, lipase, and cytokines [interleukin (IL)-6 and tumor necrosis factor (TNF)-?], pathological changes, acute lung injury, and apoptosis in the pancreas were evaluated. Serum amylase and lipase activities were detected using a medical automatic chemical analyzer. Enzyme-linked immunosorbent assay kits were used to evaluate TNF-? and IL-6 levels in mouse serum and lung tissue homogenates. Apoptotic cells in sections of pancreatic tissues were determined by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) analysis. The mouse carotid arteries were cannulated and arterial blood samples were collected for PaO2 analysis. The oxygenation index was expressed as PaO2/FiO2. RESULTS: Administration of Cn and LPS for 9 and 24 h induced severe acute pancreatitis in Chop-/- and WT mice. When comparing Chop-/- mice and WT mice, we observed that CHOP-deficient mice had greater increases in serum TNF-? (214.40 ± 19.52 pg/mL vs 150.40 ± 16.70 pg/mL; P = 0.037), amylase (4236.40 ± 646.32 U/L vs 2535.30 ± 81.83 U/L; P = 0.041), lipase (1678.20 ± 170.57 U/L vs 1046.21 ± 35.37 U/L; P = 0.008), and IL-6 (2054.44 ± 293.81 pg/mL vs 1316.10 ± 108.74 pg/mL; P = 0.046) than WT mice. The histopathological changes in the pancreases and lungs, decreased PaO2/FiO2 ratio, and increased TNF-? and IL-6 levels in the lungs were greater in Chop-/- mice than in WT mice (pancreas: Chop-/- vs WT mice, hemorrhage, P = 0.005; edema, P = 0.005; inflammatory cells infiltration, P = 0.005; total scores, P = 0.006; lung: hemorrhage, P = 0.017; edema, P = 0.017; congestion, P = 0.017; neutrophil infiltration, P = 0.005, total scores, P = 0.001; PaO2/FiO2 ratio: 393 ± 17.65 vs 453.8, P = 0.041; TNF-?: P = 0.043; IL-6, P = 0.040). Results from TUNEL analysis indicated increased acinar cell apoptosis in mice following the induction of acute pancreatitis. However, Chop-/- mice displayed significantly reduced pancreatic apoptosis compared with the WT mice (201.50 ± 31.43 vs 367.00 ± 47.88, P = 0.016). CONCLUSION: These results suggest that CHOP can exert protective effects against acute pancreatitis and limit the spread of inflammatory damage to the lungs.

Weng, Te-I; Wu, Hsiao-Yi; Chen, Bo-Lin; Jhuang, Jie-Yang; Huang, Kuo-How; Chiang, Chih-Kang; Liu, Shing-Hwa

2013-01-01

329

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

PubMed Central

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

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

2014-01-01

330

Knockdown of GRP78 promotes apoptosis in pancreatic acinar cells and attenuates the severity of cerulein and LPS induced pancreatic inflammation.  

PubMed

Acute pancreatitis (AP) is a potentially lethal disease characterized by inflammation and parenchymal cell death; also, the severity of AP correlates directly with necrosis and inversely with apoptosis. However, mechanisms of regulating cell death in AP remain unclear. The endoplasmic reticulum (ER) chaperone protein GRP78 has anti-apoptotic properties, in addition to modulating ER stress responses. This study used RNA interference (RNAi) approach to investigate the potential role of GRP78 in regulating apoptosis during AP. In vitro models of AP were successfully developed by treating AR42J cells with cerulein or cerulein plus lipoplysaccharide (LPS). There was more pancreatic inflammation and less apoptosis with the cerulein plus LPS treatment. Furthermore, knockdown of GRP78 expression markedly promoted apoptosis and reduced necrosis in pancreatic acinar cells. This was accomplished by enhancing the activation of caspases and inhibiting the activity of X-linked inhibitor of apoptosis protein (XIAP), as well as a receptor interacting protein kinase-1(RIPK1), which is a key mediator of necrosis. This attenuated the severity of pancreatic inflammation, especially after cerulein plus LPS treatment. In conclusion, these findings indicate that GRP78 plays an anti-apoptotic role in regulating the cell death response during AP. Therefore, GRP78 is a potential therapeutic target for AP. PMID:24643222

Liu, Yong; Yang, Lie; Chen, Ke-Ling; Zhou, Bin; Yan, Hui; Zhou, Zong-Guang; Li, Yuan

2014-01-01

331

Treatment of severe acute respiratory syndrome  

Microsoft Academic Search

The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were\\u000a used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective\\u000a in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication.\\u000a The effectiveness of corticosteroids has only

S. T. Lai

2005-01-01

332

Acute Pancreatitis Secondary to Ciprofloxacin Therapy in Patients with Infectious Colitis  

PubMed Central

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

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

2014-01-01

333

A Ten-Year Analysis of the Incidence and Risk Factors for Acute Pancreatitis Requiring Hospitalization in an Urban HIV Clinical Cohort  

PubMed Central

To assess the incidence of and risk factors for acute pancreatitis in HIV-infected patients in the contemporary highly active antiretroviral therapy (HAART) era, we evaluated all cases of acute pancreatitis requiring hospitalization between 1996 and 2006 in patients followed at Johns Hopkins Hospital’s HIV clinic. A nested, case-control analysis was employed for initial episodes of acute pancreatitis, and conditional logistic regression was used to assess risk factors. Of 5970 patients followed for 23,460 person–years (PYs), there were 85 episodes of acute pancreatitis (incidence: 3.6 events/1000 PYs). The incidence of pancreatitis from 1996 to 2000 was 2.6 events/1000 PYs; the incidence from 2001 to 2006 was 5.1 events/1000 PYs (p = 0.0014, comparing rates in two time periods). In multivariate regression, factors associated with pancreatitis included female gender (adjusted odds ratio [AOR] 2.96 [1.69, 5.19]; p = 0.001); stavudine use (AOR 2.19 [1.16, 4.15]; p = 0.016); aerosolized pentamidine use (OR 6.27; [1.42, 27.63]; p = 0.015); and CD4 count less than 50 cells/mm3 (AOR 10.47 [3.33, 32.90]; p = 0.001). Race/ethnicity, HIV risk factor, HIV-1 RNA, and newer non-nucleoside reverse transcriptase inhibitors (NNRTI)- and protease inhibitor (PI)-based HAART regimens were not associated with an increased risk of pancreatitis after adjustment for the above factors. Pancreatitis remains a significant cause of morbidity in the HIV population in the HAART era. Acute pancreatitis is associated with female gender, severe immunosuppression, and stavudine and aerosolized pentamidine usage. Of note, newer antiretrovirals, particularly atazanavir, lopinivir/ritonavir, tenofovir, abacavir, and efavirenz, were not associated with an increased risk of pancreatitis.

RIEDEL, DAVID J.; GEBO, KELLY A.; MOORE, RICHARD D.; LUCAS, GREGORY M.

2008-01-01

334

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

PubMed Central

OBJECTIVE: We developed a new method to quantitate leukocyte accumulation in tissues and used it to examine the time course and severity of acute experimental pancreatitis. BACKGROUND: Leukocyte activation and infiltration are believed to be critical steps in the progression from mild to severe pancreatitis and responsible for many of its systemic complications. METHODS: Pancreatitis of graded severity was induced in Sprague-Dawley rats with a combination of caerulein and controlled intraductal infusion. Technetium-99m (99mTc)-labeled leukocytes were quantified in pancreas, lung, liver, spleen, and kidney and compared with myeloperoxidase activity. The severity of pancreatitis was ascertained by wet/dry weight ratio, plasma amylase, and trypsinogen activation peptide in the pancreas. The time course of leukocyte accumulation was determined over 24 hours. RESULTS: Pancreatic leukocyte infiltration correlated well with tissue myeloperoxidase concentrations. In mild pancreatitis, leukocytes accumulated only in the pancreas. Moderate and severe pancreatitis were characterized by much greater leukocyte infiltration in the pancreas than in mild disease (p < 0.01), and increased 99mTc radioactivity was detectable in the lung as early as 3 hours. 99mTc radioactivity correlated directly with the three levels of pancreatitis. CONCLUSIONS: Mild pancreatitis is characterized by low-level leukocyte activation and accumulation in the pancreas without recruitment of other organs; marked leukocyte accumulation was found in the pancreas and in the lung in more severe grades of pancreatitis. These findings provide a basis for the pathophysiologic production of cytokines and oxygen free radicals, which potentiate organ injury in severe pancreatitis. This study validates a new tool to study local and systemic effects of leukocytes in pancreatitis as well as new therapeutic hypotheses.

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

1998-01-01

335

[Potentialities of non-invasive hemodynamic monitoring in patients with acute destructive pancreatitis].  

PubMed

The potentialities of non-invasive hemodynamic monitoring were estimated in 49 patients with acute destructive pancreatitis in the postoperative period. Cardiac performance monitoring according to the results of which the patients were divided into 2 groups was analyzed. The low cardiac output values persisting within 10-12 days following the first operation were indicative of the severity of destruction processes and the high risk of complications. The simplicity, comparative low prices, initial computerization and non-invasive pattern make remonitoring an optimal source of information on hemodynamics in this cohort of patients. PMID:19514435

Bulatov, R D; Galeev, F S

2009-01-01

336

Transient reduction of spleen density in acute pancreatitis: case reports and literature review.  

PubMed

A healthy spleen has density stable on computed tomographic (CT) scan; in some patients, spleen infarction can be associated with acute pancreatitis. Here, we report 2 patients with acute pancreatitis associated with transient reduction of spleen density that were confirmed in our hospital. The clinical data of the 2 patients were retrospectively analyzed, and the relevant literature was reviewed. Acute pancreatitis with transient reduction of splenic density has certain characteristics in clinical and radiological aspects. After clinical treatment, the spleen density can be restored. Its mechanism may be related to glucose and lipid metabolism, transient thrombosis formation in splenic vessels, and so on. PMID:24651738

Jiang, Xing Yue; Bian, Jia; Zhang, Cheng Zhou; Wang, Shan Shan; Nie, Tai Ming; Zhang, Lin

2014-01-01

337

Acute pancreatitis as rare complication of the right radical transperitoneal open nephrectomy  

PubMed Central

Radical open nephrectomy is considered the standard treatment for kidney tumors or masses greater than 10 cm. We present a rare case of acute pancreatitis that occurred after right radical transperitoneal nephrectomy, which was treated by nonsurgical conservative interventions. The incidence of acute pancreatitis after renal surgery is not known in the literature. A 56-year-old man developed acute pancreatitis postoperatively after radical transperitoneal nephrectomy. An initial CT scan showed an enlarged pancreas with hypodense, heterogeneous consistency and with peripancreatic, perihepatic, mesenteric, and pelvic fluid collections. This complication was managed conservatively.

Thimary, Felix; Pummer, Karl

2012-01-01

338

Acute pancreatitis as rare complication of the right radical transperitoneal open nephrectomy.  

PubMed

Radical open nephrectomy is considered the standard treatment for kidney tumors or masses greater than 10 cm. We present a rare case of acute pancreatitis that occurred after right radical transperitoneal nephrectomy, which was treated by nonsurgical conservative interventions. The incidence of acute pancreatitis after renal surgery is not known in the literature. A 56-year-old man developed acute pancreatitis postoperatively after radical transperitoneal nephrectomy. An initial CT scan showed an enlarged pancreas with hypodense, heterogeneous consistency and with peripancreatic, perihepatic, mesenteric, and pelvic fluid collections. This complication was managed conservatively. PMID:24578966

Al-Ali, Badereddin Mohamad; Thimary, Felix; Pummer, Karl

2012-01-01

339

Functional Effect of Polymorphisms in the Promoter of TNFAIP3 (A20) in Acute Pancreatitis in the Han Chinese Population  

PubMed Central

Background The zinc finger protein A20 is an important negative regulator of inflammation; polymorphisms in the corresponding gene, TNFAIP3, have been reported to be associated with several inflammation diseases. However, only a few studies have focused on the relationship between TNFAIP3 polymorphisms and acute pancreatitis (AP). Methods We enrolled 201 healthy controls and 190 acute pancreatitis patients (including 47 systemic inflammatory response syndrome patients) for this study and used DNA sequencing to investigate polymorphisms in the TNFAIP3 promoter. The functional effects of these variants on transcriptional activity, A20 expression, NF-?B activity, and TNF-? and IL-1? levels, after in vitro lipopolysaccharide stimulation, were assessed. Results Two SNPs (rs59693083 and rs5029924) in the TNFAIP3 promoter were selected based on bioinformatic analysis. Neither of these SNPs was associated with susceptibility to AP; however, acute pancreatitis patients who possessed the T allele of rs5029924 were more likely to experience systemic inflammatory response syndrome. Moreover, rs5029924 was found to affect TNFAIP3 promoter activity. After lipopolysaccharide stimulation, the expression of A20 protein significantly decreased, while the activity of NF-?B and the production of TNF-? and IL-1? significantly increased in whole blood leukocytes from subjects with the T allele. Conclusion The rs5029924 polymorphism in the TNFAIP3 promoter may alter the risk of systemic inflammatory response syndrome in acute pancreatitis patients by influencing the expression of A20 protein.

Wu, Lijuan; Chen, Guangyu; Wu, Ailin; Zeng, Ping; Xu, Wanqing

2014-01-01

340

Differential effects of saralasin and ramiprilat, the inhibitors of renin–angiotensin system, on cerulein-induced acute pancreatitis  

Microsoft Academic Search

Acute pancreatitis is an inflammatory disease characterized by pancreatic tissue edema, acinar cell necrosis, hemorrhage and inflammation of the damaged gland. It is believed that acinar cell injury is initiated by the activation of digestive zymogens inside the acinar cells, leading finally to the autodigestion of the pancreas. Previous study in our laboratory demonstrated that cerulein-induced acute pancreatitis was associated

Siu Wai Tsang; Siu Po Ip; Tung Po Wong; Chun Tao Che; Po Sing Leung

2003-01-01

341

Treatment of acute pancreatitis with protease inhibitors administered through intravenous infusion: an updated systematic review and meta-analysis  

PubMed Central

Background The intravenous use of protease inhibitors in patients with acute pancreatitis is still controversial. The purpose of this study was to evaluate the effectiveness of protease inhibitors intravenously administered to prevent pancreatitis-associated complications. Methods We updated our previous meta-analysis with articles of randomized controlled trials published from January 1965 to March 2013 on the effectiveness of protease inhibitors for acute pancreatitis. A systematic search of PubMed, EMBASE, the Cochrane Library, and Japana Centra Revuo Medicina was conducted. In addition, Internet-based registries (ClinicalTrials.gov, controlled-trials.com, UMIN, JMACCT, and JAPIC) were used to search for on-going clinical trials. Furthermore, references of review articles and previously published meta-analyses were handsearched. The main outcome of interest was the overall mortality rate from acute pancreatitis. Results Seventeen trials were selected for analysis. Overall, protease inhibitors did not achieve a significant risk reduction in mortality (pooled risk difference [RD], -0.02; 95% Confidence Interval [CI], -0.05 to 0.01; number needed to treat [NNT], 74.8) with low heterogeneity. A subgroup analysis in moderate to severe pancreatitis (defined by control mortality rate [CMR] >0.10) did not show a significant effect of protease inhibitors to prevent death (pooled RD, -0.03; 95% CI, -0.07 to 0.01; NNT, 1603.9) with low heterogeneity. An additional subgroup analysis of two trials with CMR >0.20 (i.e., low quality) revealed a significant risk reduction. Conclusion The present meta-analysis re-confirmed that there is no solid evidence that supports the intravenous use of protease inhibitors to prevent death due to acute pancreatitis.

2014-01-01

342

Association of CTRC and SPINK1 gene variants with recurrent hospitalizations for pancreatitis or acute abdominal pain in lipoprotein lipase deficiency  

PubMed Central

Background: There are important inter-individual variations in the incidence and severity of acute pancreatitis in patients with severe hypertriglyceridemia. Several genes involved in triglyceride-rich lipoprotein metabolism or serine proteases pathways are known to influence the risk of pancreatitis. Aim: To evaluate the association between genes regulating serine proteases, chymotrypsin C (CTRC) and serine peptidase inhibitor kazal type1 (SPINK1), and recurrence of hospitalizations for acute pancreatitis or severe abdominal pain in patients with Lipoprotein Lipase Deficiency (LPLD), a rare and extreme monogenic model of severe hypertriglyceridemia and pancreatitis. Method: The CTRC and SPINK1 genes promoter and coding regions sequencing has been performed in a sample of 38 LPLD adults (22 men and 16 women) and 100 controls (53 men and 47 women). Estimation of the association of CTRC and SPINK1 gene variants or combinations of variants with history of hospitalizations for pancreatitis or acute abdominal pain in LPLD was investigated using non-parametric analyses with correction for multiple testing and logistic regression models controlling for age, gender, family history, and life habits. Results: Gene sequencing followed by genotype-stratified analyses of the CTRC and SPINK1 genes in LPLD and controls revealed a positive association between recurrence of hospitalizations and the rs545634 (CTRC)—rs11319 (SPINK1) combination [OR = 41.4 (CI: 2.0–848.0); p = 0.016]. In all models, a positive family history of pancreatitis was a significant predictor of recurrent hospitalizations independently of the contribution of SPINK1 or CTRC (p < 0.001). Conclusion: These results suggest that a positive family history of pancreatitis and genetic markers in the serine protease pathways could be associated with a risk of recurrent hospitalization for acute pancreatitis in severe hypertriglyceridemia due to LPLD.

Tremblay, Karine; Dubois-Bouchard, Camelia; Brisson, Diane; Gaudet, Daniel

2014-01-01

343

Thirty-eight cases of acute pancreatitis in pregnancy: a 6-year single center retrospective analysis.  

PubMed

Thirty-eight pregnant inpatients with acute pancreatitis (AP) were retrospectively reviewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27‰. Most (78.95%) of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% (12 cases). Primary diseases were absent in most cases (57.89%). The most common clinical presentations were abdominal pain (89.47%) and vomiting (68.42%). Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required intensive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imaging examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up. PMID:23771661

Zhang, Dong-lin; Huang, Yi; Yan, Li; Phu, Amy; Ran, Xiao; Li, Shu-sheng

2013-06-01

344

To Study the Clinical, Biochemical and Radiological Features of Acute Pancreatitis in HIV and AIDS  

PubMed Central

Background Pancreatitis complicating HIV infection, even in the Highly Active Antiretroviral Therapy (HAART) era, remains a management challenge. We felt there is a need to discern patterns in the biochemical markers, radiological studies, co-infections, length of stay (LOS) in patients with HIV or AIDS AND pancreatitis. Methods This is a retrospective study conducted from June, 2008 to August, 2010 on patients admitted with acute pancreatitis to our hospital. We extracted and compared the following parameters: biochemical markers, HBV markers (surface antigen, core antibody and surface antibody), HCV antibody, radiological studies, and length of stay (LOS). The Balthazar Grade score was used to assess radiological severity of disease. We stratified the cohort into comparison subsets according to CD4 count. Results Ninety-four admissions met the criteria for HIV or AIDS AND pancreatitis; 67 unique patients comprised the cohort. Median age was 48 years (range, 23 to 60 years). Thirty seven (55%) were male, 30 (45%), female. Two third (n = 51) (76%) were African American. Known risk factors included a history of pancreatitis, 17 (25%); cholecystitis, 13 (19%); alcohol abuse, 25 (37%); Intravenous drug abuse, 18 (27%). Only 36 (38%) admissions were on HAART regimen. Biochemical features on admission were: WBC, 6,100/mm3 (900 - 25,700); amylase, 152 U/L (30 - 1,344); lipase, 702.5 U/L (30 - 5,766), triglyceride, 65 mg/dL (57 - 400); glucose, 94 mg/dL (60 - 1,670); lactate, 2.3 mmol/L (1.09 - 5.49); AST, 61.5 U/L (9 - 1,950); LDH, 762 U/L (394 - 5,500); bicarbonate 19.5 mEq/L (3.3 - 82.7). Interestingly, 62% patients had normal pancreas on CT scan on admission. Of 67 individuals, hepatitis profile was available in 43, 21 (49%) were positive for HCV, 11 (26%) had markers for HBV. Four of 11 patients (36) with CD4 < 50 had evidence of persistent HBV (+core, -surface ab). Patients with CD4 < 200 have a median time for hospital course of 8 days (range 4 - 61 days) compare to 3 days in patients with CD4 > 200. P = 0.03 via t-test comparison. One patient with CD4 < 50 died due to acute pancreatitis. Conclusion Pancreatitis remains a major cause of morbidity in HIV-infected individuals. This study has provided detailed features in the HAART therapy era about the clinical, biochemical and radiological features of pancreatitis. Half of our patients were positive for HCV; additionally, 36% with CD4 < 50 had persistent HBV. As opposed to earlier studies, we did not find a female predominance. Patients with CD4 < 200 had a 2.67-fold increase length of stay. Future studies are needed for a closer look on viral cofactors which might precipitate episodes of acute pancreatitis.

Raza, Shahzad; Chaudhry, Naueen A.; Brown, Jordan D.; Aghaie, Sina; Rezai, Damoun; Khan, Areej; Tan, Paul De Leon; Berger, Barbara J.

2013-01-01

345

Effects of N-Acetylcysteine on Acute Necrotizing Pancreatitis in Rats  

Microsoft Academic Search

The aim of this study was to investigate the influence of N-acetylcysteine (NAC) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in significant increase in mortality rate, pancreatic necrosis and serum activity of amylase, alanine aspartate transferase (ALT), interleukin-6 (IL-6), lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, serum concentration of urea,

S. Mumcu; E. Alhan; B. V. Kural; C. Erçin; N. I. Kalyoncu

2005-01-01

346

Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA  

Microsoft Academic Search

OBJECTIVE:The aim of this study was to evaluate the incidence, pathogenesis, and prognosis of acute pancreatitis (AP) in diabetic ketoacidosis (DKA). DKA is associated with nonspecific increase in serum amylase levels. Autopsy studies, on the other hand, had previously raised the issue of pancreatic necrosis in patients with DKA. However, the incidence, pathogenesis and prognosis of AP in the setting

Satheesh Nair; Dhiraj Yadav; C. S. Pitchumoni

2000-01-01

347

Influence of acute pancreatitis on the in vitro responsiveness of rat mesenteric and pulmonary arteries  

Microsoft Academic Search

BACKGROUND: Acute pancreatitis is an inflammatory disease characterized by local tissue injury and systemic inflammatory response leading to massive nitric oxide (NO) production and haemodynamic disturbances. Therefore, the aim of this work was to evaluate the vascular reactivity of pulmonary and mesenteric artery rings from rats submitted to experimental pancreatitis. Male Wistar rats were divided into three groups: saline (SAL);

Enilton A Camargo; Maria Andréia Delbin; Tatiane Ferreira; Edson Antunes; Angelina Zanesco

2008-01-01

348

Effects of trimetazidine in acute pancreatitis induced by L-arginine  

PubMed Central

Background In acute pancreatitis, oxygen free radicals (OFRs) and cytokines have been shown to play a role in the failure of pancreatic microcirculation and the development of local tissue damage. We studied the effects of trimetazidine (TMZ), a potent antioxidant and anti-ischemic agent, on acute pancreatitis. Methods Rats were randomized into 3 groups: a control group (n = 15), a study group (n = 15) in which acute pancreatitis was induced with with L-arginine, and a treatment group (n = 15) in which pancreatitis was induced and treated with TMZ intraperitoneally. The rats were followed for 24 hours. At the 24th hour we determined serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lactate dehydrogenase (LDH), interleukin 1-? (IL-1?), interleukin 6 (IL-6) and tumour necrosis factor-? (TNF-?), and the pancreatic tissues were analyzed histopathologically. Results The AST (p < 0.001), ALT (p < 0.01), amylase (p < 0.001), LDH (p < 0.01), TNF-? (p < 0.01), IL-1? (p < 0.001) and IL-6 (p < 0.001) levels, and pancreatic tissue edema (p < 0.01), hemorrhage (p < 0.05), acinar cell necrosis (p < 0.001) and level of perivascular inflammation (p < 0.01), were significantly lower in the treatment group than the study group. Conclusion Trimetazidine markedly decreases biochemical and histopathologic changes during the early stages of acute pancreatitis, thus preserving the pancreas histologically.

Yenicerioglu, Akan; Cetinkaya, Ziya; Girgin, Mustafa; Ustundag, Bilal; Ozercan, Ibrahim Hanefi; Ayten, Refik; Kanat, Burhan Hakan

2013-01-01

349

Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography  

Microsoft Academic Search

Background & Aims:Acute pancreatitis following endoscopic retrograde cholangiopancreatography presents a unique opportunity for prophylaxis and early modification of the disease process because the initial triggering event is temporally well defined and takes place in the hospital. We report a prospective, single-center, randomized, double-blind controlled trial to determine if rectal diclofenac reduces the incidence of pancreatitis following cholangiopancreatography.

Bill Murray; Ross Carter; Clem Imrie; Susan Evans; Criostoir O’suilleabhain

2003-01-01

350

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

PubMed

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

Arcana, Ronald; Frisancho, Oscar

2011-01-01

351

Membrane Proteome Analysis of Cerulein-Stimulated Pancreatic Acinar Cells: Implication for Early Event of Acute Pancreatitis  

PubMed Central

Background/Aims Cerulein pancreatitis is similar to human edematous pancreatitis with dysregulation of the production and secretion of digestive enzymes, edema formation, cytoplasmic vacuolization and the death of acinar cells. We hypothesized that membrane proteins may be altered as the early event during the induction of acute pancreatitis. Present study aims to determine the differentially expressed proteins in the membranes of cerulein-treated pancreatic acinar cells. Methods Pancreatic acinar AR42J cells were treated with 10-8 M cerulein for 1 hour. Membrane proteins were isolated from the cells and separated by two-dimensional electrophoresis using pH gradients of 5-8. Membrane proteins were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis of the peptide digests. The differentially expressed proteins, whose expression levels were more or less than three-fold in cerulein-treated cells, were analyzed. Results Two differentially expressed proteins (mannan-binding lectin-associated serine protease-2, heat shock protein 60) were up-regulated while four proteins (protein disulfide isomerase, ?-actin, isocitrate dehydrogenase 3, seven in absentia homolog 1A) were down-regulated by cerulein treatment in pancreatic acinar cells. These proteins are related to cell signaling, oxidative stress, and cytoskeleton arrangement. Conclusions Oxidative stress may induce cerulein-induced cell injury and disturbances in defense mechanism in pancreatic acinar cells.

Lee, Jangwon; Seo, Ji Hye; Lim, Joo Weon

2010-01-01

352

Effects of Taurine on Cerulein-Induced Acute Pancreatitis in the Rat  

Microsoft Academic Search

Taurine, or 2-aminoethane sulfonic acid, is an intracellular amino acid and has been suggested to have a function in protecting biological systems from oxidative tissue damage. The aim of this study was to determine the effect of taurine against cerulein-induced acute pancreatitis in rats. Acute pancreatitis was induced by administering three subcutaneous injections of cerulein (40 ?g\\/kg body weight) at

Byung Ok Ahn; Kwang Hee Kim; Goo Lee; Hong Sik Lee; Chang Duck Kim; Young Sik Kim; Mi Won Son; Won Bae Kim; Tae Young Oh; Jin Hai Hyun

2001-01-01

353

Occult gallbladder microlithiasis causing acute recurrent pancreatitis. A report of three cases.  

PubMed

Gallbladder microlithiasis may be a cause of acute recurrent pancreatitis. When this process cannot be detected with routine investigative procedures, a precise etiologic diagnosis cannot be formulated. In such circumstances, endoscopic collection of bile followed by microscopic examination for presence of cholesterol crystals constitutes a valid diagnostic tool. Three cases of acute recurrent pancreatitis are presented in which cholesterol crystals were found in the bile. The technique and advantages of the method are described and a useful diagnostic approach is proposed. PMID:6495984

Negro, P; Flati, G; Flati, D; Porowska, B; Tuscano, D; Carboni, M

1984-01-01

354

Ordered transcriptional factor recruitment and epigenetic regulation of tnf-alpha in necrotizing acute pancreatitis  

Microsoft Academic Search

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

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

2010-01-01

355

Bile-pancreatic juice (BPJ) exclusion exacerbates Akt\\/NF-kB pathway activation and increases chemokine production in ligation-induced acute pancreatitis  

Microsoft Academic Search

Introduction: Using a unique surgical model (The Donor Rat Model) we showed that duodenal replacement of BPJ, obtained fresh from a Donor Rat, ameliorates pancreatic morphologic changes, hyperamylasemia and hypercholecystokininemia in ligation-induced acute pancreatitis. We hypothesize that BPJ exclusion from gut exacerbates Akt\\/NF-kB pathway activation and induces proinflammatory chemokine production in ligation-induced acute pancreatitis. The cytosolic IkB\\/NF-kB complex dissociates when

Isaac Samuel; Smita Zaheer; Mark Yorek; Asgar Zaheer

2004-01-01

356

Severe necrotic and septic pancreatitis. Indications to endoscopic, surgical, and nutritional therapy  

PubMed Central

Summary Severe acute pancreatitis (SAP) management has changed over the last fifteen years, and from too aggressive behaviour, we moved to a cautious one. In every case, we can appreciate defect of extremist conceptual position. We reviewed our strategy on disease treatment, and we analyzed treatment of single cases. We collected 4 SAP cases from January 2009 to January 2010. All patients were septic, and we adopted the same approach for all of them, avoiding surgery without peritoneal infection. In all patients we placed jejumostomy and, after cleaning of septic site, we started immediate enteral nutrition (EN). Antibiotic therapy against Gram+, Gram? and antifugal drug had been started. No one died and all patients were back to an active life even if social costs are considerably high especially due to very long hospital stay.

MANGIANTE, G.; RODELLA, L.; CEROFOLINI, A.; GIACOPUZZI, S.; PASSERI, V.; STERZI, E.; CATALANO, F.; SCHENAL, G.; de MANZONI, G.

2013-01-01

357

Impact of hyperglycemia and acute pancreatitis on the receptor for advanced glycation endproducts.  

PubMed

Since hyperglycemia aggravates acute pancreatitis and also activates the receptor for advanced glycation endproducts (RAGE) in other organs, we explored if RAGE is expressed in the pancreas and if its expression is regulated during acute pancreatitis and hyperglycemia. Acute pancreatitis was induced by cerulein in untreated and streptozotocin treated diabetic mice. Expression of RAGE was analyzed by Western blot and immunohistochemistry. To evaluate signal transduction the phosphorylation of ERK1/ERK2 was assessed by Western blot and the progression of acute pancreatitis was monitored by evaluation of lipase activity and the pancreas wet to dry weight ratio. RAGE is mainly expressed by acinar as well as interstitial cells in the pancreas. During acute pancreatitis infiltrating inflammatory cells also express RAGE. Using two distinct anti-RAGE antibodies six RAGE proteins with diverse molecular weight are detected in the pancreas, whereas just three distinct RAGE proteins are detected in the lung. Hyperglycemia, which aggravates acute pancreatitis, significantly reduces the production of two RAGE proteins in the inflamed pancreas. PMID:24133579

Zechner, Dietmar; Sempert, Kai; Genz, Berit; Timm, Franziska; Bürtin, Florian; Kroemer, Tim; Butschkau, Antje; Kuhla, Angela; Vollmar, Brigitte

2013-01-01

358

Impact of hyperglycemia and acute pancreatitis on the receptor for advanced glycation endproducts  

PubMed Central

Since hyperglycemia aggravates acute pancreatitis and also activates the receptor for advanced glycation endproducts (RAGE) in other organs, we explored if RAGE is expressed in the pancreas and if its expression is regulated during acute pancreatitis and hyperglycemia. Acute pancreatitis was induced by cerulein in untreated and streptozotocin treated diabetic mice. Expression of RAGE was analyzed by Western blot and immunohistochemistry. To evaluate signal transduction the phosphorylation of ERK1/ERK2 was assessed by Western blot and the progression of acute pancreatitis was monitored by evaluation of lipase activity and the pancreas wet to dry weight ratio. RAGE is mainly expressed by acinar as well as interstitial cells in the pancreas. During acute pancreatitis infiltrating inflammatory cells also express RAGE. Using two distinct anti-RAGE antibodies six RAGE proteins with diverse molecular weight are detected in the pancreas, whereas just three distinct RAGE proteins are detected in the lung. Hyperglycemia, which aggravates acute pancreatitis, significantly reduces the production of two RAGE proteins in the inflamed pancreas.

Zechner, Dietmar; Sempert, Kai; Genz, Berit; Timm, Franziska; Burtin, Florian; Kroemer, Tim; Butschkau, Antje; Kuhla, Angela; Vollmar, Brigitte

2013-01-01

359

Experimental Models of Pancreatitis  

PubMed Central

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.

Hyun, Jong Jin

2014-01-01

360

Experimental models of pancreatitis.  

PubMed

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

Hyun, Jong Jin; Lee, Hong Sik

2014-05-01

361

Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease.  

PubMed

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

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

2013-02-01

362

Acute non-traumatic pancreatitis in a patient with pancreas divisum: a case report  

PubMed Central

Pancreas divisum is a frequent congenital anatomical anomaly characterized by the failure of fusion of the ducts of Santorini and Wirsung during fetal development. Although the condition usually remains asymptomatic, it has been reported to be a predisposing factor of chronic and recurrent idiopathic pancreatitis. We report a case of acute non-traumatic pancreatitis in a 54-year-old Caucasian male with pancreas divisum. Diagnosis was established based on the findings from magnetic resonance imaging and magnetic resonance cholangiopancreatography. The patient was managed conservatively and was discharged home having an uneventful clinical course after five days of hospitalization. Although the role of the pancreas in the induction of acute pancreatitis is still a matter of debate, physicians have to be aware about this prevalent pancreatic anatomic abnormality. Timely detection may help in the prevention of potential recurrent pancreatic reaction.

Anyfantakis, D; Partalis, N; Polimili, G; Kastanakis, S

2013-01-01

363

Enrichment of Murine CD68+CCR2+ and CD68+CD206+ Lung Macrophages in Acute Pancreatitis-Associated Acute Lung Injury  

PubMed Central

Acute lung injury (ALI) is an important cause of mortality in critically ill patients. Acute pancreatitis (AP) is one of the risk factors for developing this syndrome. Among the inflammatory cells, macrophages have a key role in determining the severity of the acute lung injury. In the lungs, macrophages constitute a heterogeneous cell population distributed in different compartments. Changes in not only the macrophage count, but also in their phenotype have been seen during the course of lung injury. A murine ductal ligation model of acute pancreatitis showed substantial morphological changes in the pancreas and lungs. Immunohistochemistry showed neutrophil recruitment into both organs after 9 hours and later on. F4/80+ cells in the pancreas increased in the ligated animals, though there was not a significant difference in their number in the lungs as compared to sham operated animals. Flow cytometry analysis of lung macrophages demonstrated an enrichment of F4/80? CD68+CCR2+ and F4/80? CD68+CD206+ lung macrophages in ligated animals (AP) as compared to the sham operated group. The level of interleukin-6 in plasma increased 3 hours after ligation compared to the sham operated group, as a first indicator of a systemic inflammatory response. This study suggests a role for F4/80? CD68+ macrophages in the pathogenesis of acute lung injury in acute pancreatitis. Studying lung macrophages for different phenotypic markers, their polarization, activation and recruitment, in the context of acute lung injury, is a novel area to potentially identify interventions which may improve the outcome of acute lung injury.

Akbarshahi, Hamid; Menzel, Mandy; Posaric Bauden, Monika; Rosendahl, Ann; Andersson, Roland

2012-01-01

364

Severe Leukoencephalopathy Following Acute Oxycodone Intoxication  

Microsoft Academic Search

Background  Post-opioid toxic encephalopathy is described associated with the synthetic opioid, methadone, and after heroin intoxication,\\u000a (inhaled, injected or ingested).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We describe the clinical and radiologic findings of a 46-year-old man with oxycodone and oxycontin overdose who developed\\u000a multifocal encephalopathy and severe cerebellitis causing acute obstructive hydrocephalus, and discuss the possible mechanisms\\u000a involved.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Brain MRI showed a non-vascular distribution of diffusion

Yazmin Morales Odia; Madhavi Jinka; Wendy C. Ziai

2010-01-01

365

The Normal Transverse Mesocolon and Involvement of the Mesocolon in Acute Pancreatitis: An MRI Study  

PubMed Central

Objective To study the MRI findings of the normal transverse mesocolon and the involvement of the mesocolon in acute pancreatitis (AP) as well as the relationship between the involvement of the mesocolon and the severity of AP. Materials and Methods Forty patients without pancreatic disorders were retrospectively analyzed to observe the normal transverse mesocolon using MRI; 210 patients with AP confirmed by clinical and laboratory tests were retrospectively analyzed using MRI to observe transverse-mesocolon involvement (TMI). The severity of TMI was recorded as zero points (no abnormalities and transverse-mesocolon vessel involvement), one point (linear and patchy signal in the transverse mesocolon) or two points (transverse-mesocolon effusion). The AP severity was graded by the MRI severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) scoring system. The correlations of TMI with MRSI and APACHE-II were analyzed. Results In a normal transverse mesocolon, the display rates of the middle colic artery, the middle colic vein and the gastrocolic trunk on MRI were 95.0%, 82.5% and 100.0%, respectively. Of the 210 patients with AP, 130 patients (61.9%) had TMI. According to the TMI grading, 40%, 39% and 20% of the patients were graded at zero, one and two points, respectively. TMI was strongly correlated with the MRSI score (r?=?0.759, P?=?0.000) and the APACHE-II score (r?=?0.384, P?=?0.000). Conclusion MRI could be used to visualize transverse-mesocolon involvement. The severity of TMI could reflect that of AP in the clinical setting and imaging. TMI might be a supplementary indicator of the severity of AP.

Zhang, Xiao Ming; Huang, Xiao Hua; Yang, Lin; Tang, Wei; Xiao, Bo

2014-01-01

366

[Variability of measured energy expenditure in patients with acute pancreatitis: is it possible to obtain a reliable pathology factor for these cases?].  

PubMed

Energy expenditure was measured in 55 patients with acute pancreatitis, during variable periods ranging from 1 to 5 weeks and it was compared with estimated energy expenditure according to Harris Benedict equations. Patients with severe pancreatitis had similar measured and measured/estimated energy expenditure rations, compared to those with mild pancreatitis (1678 +/- 349.6 kcal/day and 1.1 +/- 0.19 vs 1632 +/- 383 kcal/day and 1.06 +/- 0.19). There was a high dispersion of measured/estimated rations (0.67 - 1.7) that precluded the calculation of a reliable energy expenditure correction factor for this disease. It is concluded that energy expenditure must be measured and not estimated, when planning an adequate nutritional support in patients with acute pancreatitis. PMID:8066343

Velasco, N; Papapietro, K; Rapaport, J; Klaassen, J; Guzmán, S; Maiz, A; Acosta, A M; Escalona, M; Campano, M; Valenzuela, A

1994-01-01

367

Glucagon therapy in acute pancreatitis. Report of a double-blind trial.  

PubMed Central

The results of a double-blind trial of glucagon in 69 patients with acute pancreatitis are reported. In a subgroup of 59 patients statistical analysis showed no significant differences between the glucagon-treated (n = 29; 2 X 5 mg protamine-zinc glucagon intramuscularly per day) and the placebo-treated (n = 30) subjects for the following data: duration of pain left spontaneously and induced by palpation, amounts of analgesics and antispasmodics required by the patients, duration of hospital stay, amylase activities in serum and 24 hour urine collections. Mortality rates did not differ significantly between the glucagon-treated and the placebo-treated subjects in the total group of 69 patients and in the two subgroups of patients who were treated conservatively (n = 59) and those who underwent laparotomy because of severe peritonitis (n = 10). From the results of this study it is concluded that favourable effects of glucagon upon the course of acute pancreatitis--if they do exist--are not significant.

Durr, H K; Maroske, D; Zelder, O; Bode, J C

1978-01-01

368

Differential effects of saralasin and ramiprilat, the inhibitors of renin-angiotensin system, on cerulein-induced acute pancreatitis.  

PubMed

Acute pancreatitis is an inflammatory disease characterized by pancreatic tissue edema, acinar cell necrosis, hemorrhage and inflammation of the damaged gland. It is believed that acinar cell injury is initiated by the activation of digestive zymogens inside the acinar cells, leading finally to the autodigestion of the pancreas. Previous study in our laboratory demonstrated that cerulein-induced acute pancreatitis was associated with an up-regulation of local renin-angiotensin system (RAS) in rat pancreas. Therefore, the utilization of RAS inhibitors may provide a novel and alternative treatment for acute pancreatitis. By means of a rat model of cerulein-induced acute pancreatitis, results from the present study showed that an intravenous injection of saralasin, an antagonist for angiotensin II receptors, at a dose of 40 microg/kg 30 min before the induction of acute pancreatitis significantly attenuated pancreatic edema. Results from the biochemical measurements showed that pretreatment with saralasin at a dose of 20 microg/kg markedly reduced pancreatic injury, as evidenced by the decreased activities of alpha-amylase and lipase in plasma. However, the same recipe of ramiprilat, a specific inhibitor for angiotensin-converting enzyme, at a dose of 20 microg/kg did not provide any protective effect against acute pancreatitis. On the contrary, pretreatment with ramiprilat at a dose 40 microg/kg enhanced cerulein-induced pancreatic injury. Results from histopathological analysis of these RAS inhibitors further confirmed with those results as obtained from biochemical analysis. These data indicate that administration of saralasin but not ramiprilat could be protective against acute pancreatitis and that activation of pancreatic RAS in acute pancreatitis may play a role in pancreatic tissue injury. PMID:12609748

Tsang, Siu Wai; Ip, Siu Po; Wong, Tung Po; Che, Chun Tao; Leung, Po Sing

2003-03-28

369

Acute Pancreatitis Associated with Interferon and Ribavirin Therapy in Patients with Chronic Hepatitis C  

Microsoft Academic Search

Acute pancreatitis is a rare complication of interferon (IFN) and ribavirin (RBV) therapy. The aimof this study was to determine the incidence, clinical presentation, and outcome of acute pancreatitisin patients with chronic hepatitis C virus (HCV) infection treated with IFN and RBV combinationtherapy. We conducted a retrospective review of 1706 HCV-infected patients treated with IFN a-2band RBV. The diagnosis of

Swati Chaudhari; James Park; Bhupinderjit S. Anand; Neville R. Pimstone; Douglas T. Dieterich; Steven Batash; Edmund J. Bini

2004-01-01

370

Acute Pancreatitis Associated with Elevated Troponin Levels: Whether to Thrombolyse or Not?  

PubMed Central

The presentation of retrosternal chest pain with normal electrocardiogram (ECG) during chest pain followed by initial presentation of acute pancreatitis can lead to a dilemma in managing such a patient, and whether to thrombolyse such a patient is a real controversy. We hereby present a similar case who was diagnosed to be having acute pancreatitis on admission, on clinical grounds, confirmed by laboratory investigations and ultrasonography, who subsequently developed retrosternal chest pain with normal ECG during the chest pain. All further serial ECGs after the onset of chest pain were within normal limits. The troponin-I level of this patient was positive twice (done 16 h apart). The patient was treated as acute coronary syndrome along with the standard management protocol of acute pancreatitis.

Aundhakar, SC; Mahajan, SK; Agarwal, AO; Mhaskar, DM

2013-01-01

371

Experimental and clinical evidence of antioxidant therapy in acute pancreatitis  

PubMed Central

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

Esrefoglu, Mukaddes

2012-01-01

372

Oxidative and nitrosative stress in acute pancreatitis. Modulation by pentoxifylline and oxypurinol.  

PubMed

Reactive oxygen species are considered mediators of the inflammatory response and tissue damage in acute pancreatitis. We previously found that the combined treatment with oxypurinol - as inhibitor of xanthine oxidase- and pentoxifylline - as inhibitor of TNF-? production-restrained local and systemic inflammatory response and decreased mortality in experimental acute pancreatitis. Our aims were (1) to determine the time-course of glutathione depletion and oxidation in necrotizing pancreatitis in rats and its modulation by oxypurinol and pentoxifylline; (2) to determine whether TNF-? is responsible for glutathione depletion in acute pancreatitis; and (3) to elucidate the role of oxidative stress in the inflammatory cascade in pancreatic AR42J acinar cells. We report here that oxidative stress and nitrosative stress occur in pancreas and lung in acute pancreatitis and the co-treatment with oxypurinol and pentoxifylline prevents oxidative stress in both tissues. Oxypurinol was effective in preventing glutathione oxidation, whereas pentoxifylline abrogated glutathione depletion. This latter effect was independent of TNF-? since glutathione depletion occurred in mice deficient in TNF-? or its receptors after induction of pancreatitis. The beneficial effects of oxypurinol in the inflammatory response may also be ascribed to a partial inhibition of MEK1/2 activity. Pentoxifylline markedly reduced the expression of Icam1 and iNos induced by TNF-? in vitro in AR42J cells. Oxidative stress significantly contributes to the TNF-?-induced up-regulation of Icam and iNos in AR42J cells. These results provide new insights into the mechanism of action of oxypurinol and pentoxifylline as anti-inflammatory agents in acute pancreatitis. PMID:22000995

Escobar, Javier; Pereda, Javier; Arduini, Alessandro; Sandoval, Juan; Moreno, Mari Luz; Pérez, Salvador; Sabater, Luis; Aparisi, Luis; Cassinello, Norberto; Hidalgo, Juan; Joosten, Leo A B; Vento, Máximo; López-Rodas, Gerardo; Sastre, Juan

2012-01-01

373

Hereditary Pancreatitis  

MedlinePLUS

... Information Animated Pancreas Patient About the Pancreas Pancreatic Cancer Chronic Pancreatitis Acute Pancreatitis Children/Pediatric Other Pancreas Ailments Patient/Family Information Clinical Trials Financial Assistance Research Research ...

374

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

PubMed Central

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

2014-01-01

375

[Mesenchymal stromal cells transplantation in acute and chronic pancreatitis in rats].  

PubMed

Before using MSC transplantation in the clinic to conduct preclinical studies MSCs to animals with acute and chronic pancreatitis. Work out the timing and dose of MSCs. The rationale of MSCs transplantation for the regeneration of damaged pancreatic tissue. The essence of the experiments is to establish the existence of common pathogenetic mechanisms for the development of pathological processes and sanogenesis toxic damage of pancreatic tissue. The study was work out in the rat model of acute and chronic pancreatitis, to explore beneficial and adverse effects of allogeneic stem cells for regenerative-reduction processes. For cell transplantation using allogenic stromal cell fraction of bone marrow, the cell suspension was injected at a dose of 2 x 10(6) and 5 x 10(6) cells. PMID:22363996

Lazebnik, L B; Trubitsyna, I E; Agafonov, M A; Kniazev, O V; Liundup, A V

2011-01-01

376

[Protective effect of ranitidine in acute experimental pancreatitis in the rat].  

PubMed

Acute experimental pancreatitis was induced in rats, with a polyethylene splint placed into the duodenum, by the closed duodenal loop technique. Ranitidine (20 mg . kg-1) or saline were administered intraperitoneally every 8 hrs, beginning 15 min prior to surgery. The degree of pancreatitis and the amylase to creatinine clearance ratio (ACCR) were evaluated in all the animals after sacrifice. Ranitidine-treated animals showed significant by reduced pancreatic damage and ACCR values in comparison with non-treated rats. These data confirm the efficacy of ranitidine as a preventive agent in the development of acute pancreatitis and suggest that controlled trials should be performed with this H2-antagonist in the human subyects with this disease. PMID:6188631

Scarpignato, C; Bertaccini, G; Sarli, L; Lupi, M; Gafŕ, M

1983-02-01

377

Treatment of severe hypertriglyceridemia associated with accidental pegylated asparaginase push in a child with relapsed acute lymphoblastic leukemia.  

PubMed

Asparaginase treatment is associated with several adverse effects, including allergy, thromboembolic events, acute pancreatitis, altered liver function, and hyperglycemia. In addition, asparaginase can cause abnormalities in lipid metabolism, predominantly hypercholesterolemia and -triglyceridemia. Herein, we report on the case of a 5-year-old male presenting with acute severe hypertriglyceridemia caused by accidental pegylated asparaginase push during treatment of relapsed acute lymphoblastic leukemia. Hypertriglyceridemia did not occur after appropriate administrations of pegylated asparaginase before and after accidental drug infusions, so we speculate that the rate of pegylated asparaginase administration may have an effect on the serum triglyceride level. PMID:22149271

Malbora, Baris; Avci, Zekai; Ozbek, Namik

2012-10-01

378

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

PubMed

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

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

2014-01-01

379

[The effect of 5-fluorouracil on lipid metabolism in patients with acute pancreatitis].  

PubMed

The state of lipid metabolism was investigated in 72 patients with acute pancreatitis using the method of thin-layer chromatography on "Silufol" plates. It was established that the level of general phospholipids underwent a reduction in destructive pancreatitis. The level of triglycerids reduced sharply after treatment with 5-fluoruracil. The revealed changes were the basis for instituting fatty emulsions and lipid mixtures in the treatment of these patients. PMID:2330712

Bondarenko, N M; Desiaterik, V I; Kryshen', V P

1990-01-01

380

Expression of stress proteins heme oxygenase-1 and -2 in acute pancreatitis and pancreatic islet ?TC3 and acinar AR42J cells  

Microsoft Academic Search

Oxygen-derived free radicals have been implicated in the pathogenesis of acute pancreatitis, yet adaptive responses in the pancreas in vivo to oxidative stress remain poorly defined. We have investigated expression of the stress protein heme oxygenase in the intact pancreas of rats with caerulein-induced pancreatitis and in cultured pancreatic acinar and islet cell lines. Expression of inducible heme oxygenase-1 (HO-1)

Hideyo Sato; Richard C. M. Siow; Simon Bartlett; Shigeru Taketani; Tetsuro Ishii; Shiro Bannai; Giovanni E. Mann

1997-01-01

381

The role of endoscopic retrograde cholangiopancreatography in acute and chronic pancreatitis.  

PubMed

Endoscopic retrograde cholangiopancreatography (ERCP) plays a pivotal role in the managemen