Acute Pancreatitis Research Papers - Academia.edu (original) (raw)

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 analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis. Patients and methods-Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III). After admission serum samples were drawn daily for two weeks. Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8).

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- Nonparametric Statistics, Adolescent, Prospective studies, Course Management Systems
- by Pablo Moreno
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- Risk, Colorectal cancer, Prospective studies, Acute Pancreatitis

Nous rapportons un cas d'hypertriglycéridémie à 140 fois la normale de découverte fortuite à 33 semaines d'aménorrhée (SA), au cours d'une deuxième grossesse. Le risque de pancréatite aiguë a fait réaliser trois séances de plasmaphérèses permettant une réduction de la triglycéridémie (6N) avec une bonne tolérance foetale. La réascension immédiate a conduit au déclenchement à 34 SA avec résolution spontanée en post-partum. Les explorations complémentaires ont retrouvé des activités lipasiques abaissées sans mutation de l'apolipoprotéine E, ni de la lipoprotéine lipase (LPL), ce qui pourrait être en faveur d'un inhibiteur de la dégradation des lipoprotéines présent uniquement lors de la grossesse.

- by B. Jacquetin
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- Acute Pancreatitis, Lipoprotein Lipase

A total of 434 patients (201 male and 233 female; mean age 63.9 yr, range 1896 yr) scheduled for ERCP were prospectively recruited in 25 Italian centers. Patients were randomized double-blind to two treatment groups. All subjects... more

- by Guido Costamagna
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- Treatment Outcome, Risk assessment, Pancreatitis, Adolescent

Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz. Methods: The results of our first 209 OAGB patients operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight 66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery (18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation had been performed previously. Results: 2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3 patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%), 1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only 2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80% at 2 years. Conclusion: OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric bypass, quicker return to normal activities, and better quality of life.

- by Obed Garcia
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- Quality of life, Adolescent, Weight Loss, Pulmonary Embolism

Background: Although several authors have documented the safety and efficacy of laparoscopic fundoplication, it is important to determine the rate of conversions and complications of this procedure.

- by Julio Coelho
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- Surgery, Treatment, Adolescent, Complication

The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present, most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

- by vita san
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- Stents, Acute Pancreatitis, Chronic Pancreatitis, Inflammatory disease

This is a new electrochemical method for determination of lipase activity in biological fluids, including serum, plasma, and duodenal juice. Advantages of turbidimetric methods--short reaction time, and small sample and reagent volumes--are combined with those of titrimetric methods: measurement of absolute activity (i.e., no standardization required), saturated substrate conditions, and direct measurement of reaction products. The proposed method is easy, inexpensive, and takes only 3 min. Precision is good: CV = 3.74% within day and 7.3% between days at the clinical-decision concentration, CV = 1.86% within day and 4.65% between days for above-normal lipase activities. The standard curve is linear up to 4500 U/L. Results (y) correlate well with those by turbidimetry (x): y = 0.9287x - 65.3 (r = 0.9719). Reference values are between 0 and 130 U/L.

- by Ferruccio Ceriotti
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- Kinetics, Olive Oil, Oils, Clinical Chemistry

References 1. Finlay JL, Zacharoulis S. The treatment of high grade gliomas and diffuse intrinsic pontine tumors of childhood and adolescence: a historical -and futuristic -perspective. J Neurooncol 2005; 75: 253-66.

- by Mauricio Horta
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- Pediatrics, Victimology, Pancreatitis, Child

BACKGROUND: The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has... more

Heparin and insulin stimulate lipoprotein lipase activity. Therefore, they reduce serum triglyceride levels. However, heparin and insulin's efficacy in treatment of hypertriglyceridemia-induced acute pancreatitis is not well established.... more

- by Tarkan Karakan
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- Pancreatitis, Heparin, Insulin, Digestive and Liver Diseases

Oxidative stress directly correlates to the development and clinical course of severe acute surgical pathology, increasing its mortality, particularly in acute diffuse peritonitis (ADP), acute intestinal obstruction (AIO) with acute pancreatitis (AP).
In the experimental study, in terms of ADP, AIO and AP marked a significant disorders in the LPO/AOP system ratio, which was reflected in the activation of lipid peroxidation and reduced antioxidant activity, and have been demonstrating the failure of endogenous metabolic and cellular defense mechanisms.

- by Marta Gerasymchuk
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- Oxidative Stress, Experimental Pathology, Acute Pancreatitis, Peritonitis

No procedure has yet been identified as the standard for the detection and management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy. A prospective study involved 1305 patients undergoing elective laparoscopic cholecystectomy. Intravenous cholangiography was performed on all patients except those with jaundice or cholangitis, acute pancreatitis, or allergy to contrast material. Patients underwent endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy when there was a strong suspicion of choledocholithiasis, positive or inconclusive findings on intravenous cholangiography or allergy to contrast material with signs of possible choledocholithiasis. Intraoperative cholangiography was performed when patients did not undergo ERC or intravenous cholangiography and whenever the surgeon was in doubt about biliary anatomy or biliary clearance. Two hundred thirty-one patients (17.7%) were referred for preoperative ERC; 14 of them were referred for open surgery because of failure of ERC or sphincterotomy. Only 54 patients underwent intraoperative cholangiography. Bile duct stones, detected in 186 cases (14.2%) (68 of which were asymptomatic), were removed before surgery in 162 cases (87.1%) and during surgery in 20 (10.7%). Self-limited pancreatitis occurred in 3.6% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.7% of the cases. The conversion rate was 8% if sphincterotomy had been performed previously, and 3% after standard laparoscopic cholecystectomy (p < 0.001). The morbidity rate was 5% and the mortality rate 0.08%. During the follow-up period 4 patients had retained stones that were treated endoscopically. Preoperative ERC followed by laparoscopy is the best approach to treatment of patients with cholecystolithiasis and suspected choledocholithiasis.

- by Renato Costi and +1
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- Algorithms, Treatment Outcome, Adolescent, Prospective studies

The parasitic pancreas is a many-faceted entity, the study of which leads to review many nosologic settings. Internal organ not involved in the cycles of parasitic replication as opposed to what one observes for the liver and the digestive tract, the pancreas can however be concerned by cosmopolitan or exotic various parasites. Parasites as usual hosts of the small intestine

- by Francis Klotz
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- International organizations, Acute Pancreatitis, Oscillations, Chronic Pancreatitis

An ideal laboratory test in the evaluation of a patient with acute pancreatitis (AP) should, in addition to accurately establishing the diagnosis of AP, provide early assessment of its severity and identify the etiology. None of the tests available today meet all these criteria, and presently there is no biochemical test that can be considered the "gold standard" for the diagnosis and assessment of severity of AP. In the diagnosis of AP, serum amylase and lipase remain important tests. Advantages of amylase estimation are its technical simplicity, easy availability, and high sensitivity. However, its greatest disadvantage is its low specificity. A normal amylase would usually exclude the diagnosis of AP, with the exception of AP secondary to hyperlipidemia, acute exacerbation of chronic pancreatitis, and when the estimation of amylase is delayed in the course of the disease. The major advantage of lipase is an increased sensitivity in acute alcoholic pancreatitis and in pa...

- by Dhiraj Yadav
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- Pancreatitis, Emergency Room, Acute Pancreatitis, Chronic Pancreatitis

The value of the Acute Physiology and Chronic Health Enquiry (APACHE-II) score, the Simplified Acute Physiology score, and the Medical Research Council (MRC) sepsis score were compared with clinical assessment and Ranson and Imrie scores in the evaluation and monitoring of acute pancreatitis in 290 attacks. Attacks were graded mild (231) if uncomplicated, or severe (59) when major organ failure or a pancreatic collection occurred. Only APACHE-II scores were available at the time of admission; they correctly predicted outcome in 77% of attacks and identified 63% of severe attacks, compared with 44% achieved by clinical assessment. After 48 h, APACHE-II was most accurate, and correctly predicted outcome in 88% of attacks, compared with 69% for Ranson and 84% for Imrie scores. APACHE-II predicted 73% of pancreatic collections at 48 h, compared with 65% for Ranson and 58% for Imrie scores. In acute pancreatitis, APACHE-II may facilitate rapid selection of patients for intensive therapy or clinical trials, improve comparison between groups of patients, and indicate that a pancreatic collection is probable.

- by David Leaper
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- Evaluation, Pancreatitis, Adolescent, Prospective studies
- by Jennifer Marti
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- Pancreatitis, Anorexia Nervosa, Bulimia Nervosa, Case Report
- by Alexandro Berrospi San Martín
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- Pancreatitis, Internal Medicine, Semiology, Acute Pancreatitis

The aim was to investigate alterations of intestinal motility in models of acute pancreatitis and to investigate the effects of the Chinese herbal preparation Qing Yi Tang (QYT) on these alterations. Upper gastrointestinal transit was evaluated in mice following induction of mild acute pancreatitis (MAP) using caerulein. Myoelectrical activity was recorded in rats after induction of severe acute pancreatitis (SAP) using sodium deoxycholate (SDOC). The contractility of jejunum segments was evaluated in the presence of SDOC, lipopolysaccharide (LPS) and trypsin.

- by Martin Storr
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- China, Pharmacognosy, Pancreatitis, Biological Sciences

Giriş ve amaç: Bu retrospektif çal›şmada, International Association of Pancreatology (IAP) k›lavuzu ›ş›ğ›nda, ard›ş›k 177 şiddetli ve ödematöz pankreatit olgusu incelenmiştir. Sonuçlar, IAP'nin önerileri ›ş›ğ›nda tar-t›ş›lm›ş ve elde olunan sonuçlar ile, tan› ve tedaviye yönelik bir algoritm geliştirmek hedeflenmiştir. Gereç ve yöntem: 1998 ile 2004 y›llar› ara-s›nda Ege Üniversitesi Akut Pankreatit veri taban›na kaydedilen 177 olgu çal›şmaya al›nd›. Bu veri taban›nda incelenen değişkenler; etyoloji, yaş, vücut kitle indeksi (VKİ), serum amilaz düzeyleri (IU/l), serum bilirubin düzeyleri(IU/l), lökosit say›s›(/mm 3 ), ateş (°C), serum kreatinin düzeyleri (mg/dl), serum C-reaktif protein düzeyleri(mg/dl), başvuru an›ndaki Ranson, Mannheim Peritonit İndeksi (MPI) ve APACHE II skorlar›d›r. Bunlar›n yan›s›ra, ERKP zamanlamas›, tan›da kullan›lan yöntemler ve antibiyotik tercihleri de kaydedilmiştir. Nekrozu olan şiddetli olgulara cerrahi veya laparoskopik / BT rehberliğinde drenaj sonra-s›nda periton lavaj› ve gereğinde (re-) laparatomi uygulanm›şt›r. Bulgular: Bu çal›şmada 151(%85.3) interstisiyel ödematöz ve 26 (%14.7) şiddetli (ŞP) olgusu incelenmiştir. Her iki grupta da en önde gelen etyolojik faktör safra taş›d›r (IOP n= 112, %74.6 ve SP n=22, %85). Serum amilaz düzeyleri bak›m›ndan iki grup aras›nda anlaml› bir fark saptanmam›şken (1640/1787), lökosit ve CRP düzeyleri şiddetli pankreatitte daha çok olacak şekilde farkl›d›r (s›ras›yla 11766 / 19595 ve 1,68 / 29,33). Interstisiyel ödematöz grubundaki 5 hasta, klinik izlem esnas›nda ŞP'e dönüşmüş (%3,8) ve bunlardan biri de çoğul organ yetmezliği nedeniyle kaybedilmiştir. Mortalite oranlar› ŞP grubunda 10 hasta ile %38.8 iken, interstisiyel ödematöz grubunda sadece bir hasta (%1'den az) ölmüştür. İÖP grubunda etyolojisinde safra taş› bulunan 112 olgudan 44'üne ayn› yat›şta kolesistektomi yap›lm›şt›r (39,2%). Nekrozektomi materyalinin mikrobiyolojik incelemesinde en s›k rastlanan etkenler S.aureus ve E.coli (n=24) olmuştur. Sonuç: Interstisiyel ödematöz grubundaki antibiyotik seçimleri hariç, sonuçlar›m›z ana hatlar›yla IAP k›lavuzundaki önerilerle uyumludur. Sonuçlar›m›za göre Ranson prognostik skorlar›n›n, şiddet belirlemede rolu yoktur. Şiddetli pankreatitin en yararl› biyokimyasal göstergesi CRP ve lökosit say›m›d›r. ERKP, özellikle intersitisyel ödematöz grubunda olmak üzere akut pankreatit olgu-lar›nda güvenle kullan›labilir. ŞP grubundaki son hastalarda BT rehberliğinde drenaj ve lavaj uygulamas›, aç›k nekrozektomi ve gereğinde relaparatomi ile periton lavaj›n›n yerini alm›şt›r.

- by AHMET ÇOKER
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- Acute Pancreatitis, C reactive protein, Body mass index (BMI), AKADEMIK

Piperine is a phenolic component of black pepper (Piper nigrum) and long pepper (Piper longum), fruits used in traditional Asian medicine. Our previous study showed that piperine inhibits lipopolysaccharide-induced inflammatory responses. In this study, we investigated whether piperine reduces the severity of cerulein-induced acute pancreatitis (AP). Administration of piperine reduced histologic damage and myeloperoxidase (MPO) activity in the pancreas and ameliorated many of the examined laboratory parameters, including the pancreatic weight (PW) to body weight (BW) ratio, as well as serum levels of amylase and lipase and trypsin activity. Furthermore, piperine pretreatment reduced the production of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, and IL-6 during cerulein-induced AP. In accordance with in vivo results, piperine reduced cell death, amylase and lipase activity, and cytokine production in isolated cerulein-treated pancreatic acinar cells. In addition, piperine inhibited the activation of mitogenactivated protein kinases (MAPKs). These findings suggest that the anti-inflammatory effect of piperine in cerulein-induced AP is mediated by inhibiting the activation of MAPKs. Thus, piperine may have a protective effect against AP. j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / y b b r c

- by Yong Chan Shin
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- Pepper, Pancreatitis, Apoptosis, Inflammatory Immune Response

and sharing with colleagues.

- by Stéphane M Schneider and +1
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- Drug Use, Inflammatory Immune Response, Chronic Disease, Acute Pancreatitis

Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. The incidence of acute abdomen during pregnancy is 1 in 500-635 pregnancies. Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is still inaccurate. Laboratory parameters are not specific and often altered as a physiologic consequence of pregnancy. Use of laparoscopic procedures as diagnostic tools makes diagnosis of such conditions earlier, more accurate, and safer. Appendicitis is the most common cause of the acute abdomen during pregnancy, occurring with a usual frequency of 1 in 500-2000 pregnancies, which amounts to 25% of operative indications for non-obstetric surgery during pregnancy. Surgical treatment is indicated in most cases, as in nonpregnant women. Laparoscopic procedures in the treatment of acute abdomen in pregnancy proved safe and accurate, and in selected groups of patients are becoming the procedures of choice with a perspective for the widening of such indications with more frequent use and subsequent optimal results. Despite these advances, laparotomy still remains the procedure of choice in complicated and uncertain cases. #

- by Goran Augustin
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- Physiology, Obstetrics, Surgery, Biology

BACKGROUND:
Acute pancreatitis is a catabolic illness and patients with the severe form have high metabolic and nutrient demands. Artificial nutritional support should therefore be a logical component of treatment. This review examines the evidence in favour of initiating nutritional support in these patients and the effects of such support on the course of the disease.
METHODS:
Medline and Science Citation Index searches were performed to locate English language publications on nutritional support in acute pancreatitis in the 25 years preceding December 1999. Manual cross-referencing was also carried out. Letters, editorials, older review articles and most case reports were excluded.
RESULTS AND CONCLUSION:
There is no evidence that nutritional support in acute pancreatitis affects the underlying disease process, but it may prevent the associated undernutrition and starvation, supporting the patient while the disease continues and until normal and sufficient eating can be resumed. The safety and feasibility of enteral nutrition in acute pancreatitis have been established; enteral nutrition may even be superior to parenteral nutrition. Some patients, however, cannot tolerate enteral feeding and this route may not be practical in others. Parenteral nutrition still has a role, either on its own or in combination with the oral and enteral routes, depending on the stage of the illness and the clinical situation.

- by Muhammed A Memon
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- Acute Pancreatitis
- by Suresh Verma
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- Ultrasound, Pancreatitis, Adolescent, Prospective studies

Clermont-Ferrand. BP 69, 63003 Clermont-Ferrand cedex 01. France c Service chirurgie digestive, Hôtel-Dieu. CHU de Clermont-Ferrand. BP 69, 63003 Clermont-Ferrand cedex 01. France Reçu le 12 juillet 2005 ; accepté le 10 octobre 2005 Disponible sur internet le 08 novembre 2005 Résumé Introduction. -L'atteinte pancréatique est une localisation exceptionnelle de la granulomatose de Wegener et mérite d'être signalée. Exégèse. -Nous décrivons une observation d'une forme pseudo-tumorale de granulomatose de Wegener localisée au pancréas. Nous discutons six autres observations d'atteinte pancréatique rapportées dans la littérature médicale (deux pseudo-tumeurs, trois pancréatites aiguës et une insuffisance pancréatique chronique). Conclusion. -C'est une localisation à ne pas méconnaître d'autant plus qu'un traitement rapidement instauré et associant corticoïdes et cyclophosphamide semble efficace. © 2005 Elsevier SAS. Tous droits réservés.

- by I. Marroun
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- Acute Pancreatitis

Infectious complications account for approximately 80% of deaths in severe acute necrotizing pancreatitis. The objective of our study was to determine the role of invasive procedures for the development of infected pancreas necrosis with bacteria resistant to firstline antibiotics. Patients and Methods: For the present investigation, a prospective, nonrandomized study design was used. The study population consisted of 47 consecutive

- by Zilvinas Dambrauskas and +2
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- Statistical Analysis, Ultrasound, Acute Pancreatitis, Risk factors

But : Les adénocarcinomes de la jonction anorectale, en particulier les lésions T3, sont habituellement traités par une amputation abdominopérinéale. Le but de cette étude était d'évaluer les résultats oncologiques et fonctionnels après traitement radiochirurgical conservateur de cancers de la jonction anorectale. Méthodes : De 1990 à 1999, parmi 395 patients opérés d'un cancer du rectum, 31 ont eu une chirurgie conservatrice pour une tumeur située entre 2 et 4,5 cm (moyenne : 3,6) de la marge anale. Il y avait 16 hommes et 15 femmes, d'âge moyen 62 ans (extrêmes : 30-86). Les lésions étaient réparties de la façon suivante : 5 T2, 23 T3 et 3 T4 ; 17 étaient N1 et 3 M1. Une radiothérapie préopératoire a été réalisée chez 26 patients (dose 46 Gy, extrêmes : 36-54), en association avec une chimiothérapie concomitante dans 14 cas. Six semaines plus tard, une résection rectale était réalisée, enlevant une partie ou la totalité du sphincter interne. Les anastomoses colo-anales étaient associées à un réservoir colique en J dans 22 cas et à une stomie de protection dans tous les cas. Résultats : Il n'y a pas eu de mortalité postopératoire. Sept complications sont survenues : trois fistules anastomotiques, trois hémorragies pelviennes, une pancréatite aiguë. Trois patients ont gardé une stomie définitive. Après radiothérapie, un down staging (pT0-2 N0) a été observé dans 46 % des cas (12/26). La marge de résection distale était de 2,2 cm (extrêmes : 1-3) microscopiquement saine dans tous les cas. La marge de résection latérale était non envahie (>1 mm) dans 97 % des cas. Avec un recul de 36 mois, aucune récidive locale n'a été suspectée. Vingt-six anastomose colo-anale / cancer du bas rectum / radiochimiothérapie préopératoire / résection intersphinctérienne ABSTRACT Conservative treatment of carcinomas of the anorectal junction by preoperative radiotherapy and intersphincteric resection. Aim: Adenocarcinomas of the anorectal junction, especially T3 lesions, are usually treated by abdominoperineal resection. The aim of this study was to evaluate oncologic and functional results following conservative radiosurgical treatment of cancers of the anorectal junction. Methods: From 1990 to 1999, among 395 patients with rectal carcinoma, 31 had sphincter-saving resection for a tumour located between 2 to 4.5 cm (mean 3.6) from the anal verge. There were 16 men and 15 women, mean age 62 years (range 30-86). There were 5 T2, 23 T3 and 3 T4 tumours; 17 were N1 and 3 were M1. Preoperative radiotherapy was performed in 26 patients (dose: 46 Gy, range:

- by Christophe Laurent
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- Acute Pancreatitis, Clinical Sciences, Rectal Cancer, Conservative treatment

To evaluate the role of tissue harmonic imaging (THI) in acute pancreatitis, and to compare its findings with conventional grey-scale sonography and contrast-enhanced computed tomography (CECT) scan, we evaluated 25 patients diagnosed with acute pancreatitis on clinical examination and laboratory findings. Conventional grey-scale ultrasound followed by tissue harmonic sonography was done on the same machine followed by a CECT within 12 h of the ultrasound examination. The present study showed that sonograms obtained with THI were of much better quality than those obtained conventionally, especially for the pancreatic tail. The benefits of harmonic imaging were more apparent in obese patients and in others whose body habitus was unfavourable for sonography. In the assessment of pancreatic image quality, grey-scale imaging had an accuracy of 60, 80 and 28% in relation to the head, body and tail, respectively. In comparison, THI had a far higher accuracy of 80, 92 and 60% in relation to the head, body and tail, respectively, with the superiority being most obvious in the pancreatic tail region. There were no cases in which tissue harmonic sonography provided less information than conventional sonography. However, CECT scan remained the best modality in all patients for the evaluation of acute pancreatitis. It showed superior demonstration of all the morphological changes, ranging from minimal pancreatic oedema to extensive fluid collections, necrosis and the haemorrhage that developed in fulminant severe pancreatitis. Our experience thus suggests that THI cannot replace CT scan as the gold standard in the assessment of acute pancreatitis, as it is poor in evaluating the pancreatic tail, cannot clearly distinguish phlegmon from necrosis, and is inferior to CT in the assessment of the complications of acute pancreatitis.

- by Anupam Lal
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- Pancreatitis, Prospective studies, Ultrasonography, Acute Pancreatitis
- by David Whitcomb
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- Gastroenterology, Pancreatitis, Hospitalization, Chronic Disease
- by Rakesh Kochhar
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- Treatment Outcome, Pancreatitis, Resuscitation, Acute Pancreatitis

Background: We sought to analyze the risk factors and natural history associated with post-cardiac surgery acute pancreatitis. Methods: Retrospective analysis of all patients having undergone cardiac surgery at our hospital between January 1, 1992, and October 1, 2001. Results: A total of 10,249 cardiac operations were performed. Thirty-nine (0.4%) patients developed postoperative pancreatitis. There was a higher incidence during the period spanning 1992 through 1996 than 1997 through 2001 (0.6% versus 0.2%, P Ͻ .05). Patients with pancreatitis had longer postoperative length of stay (51 Ϯ 5 days versus 10 Ϯ 1 days, P Ͻ .05) and a greater in-hospital mortality rate (28% versus 4%, P Ͻ .05) than patients who did not develop pancreatitis. A history of alcohol abuse, cardiac surgery performed during 1992 to 1996, increased cardiopulmonary bypass time, and increased cross-clamp time were independent risk factors for the development of pancreatitis. Multiple-organ failure was an independent predictor for death among patients with pancreatitis. Conclusions: Although the frequency of post-cardiac surgery pancreatitis is diminishing, it is still associated with significant mortality.

- by Saeid Farivar
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- Epidemiology, Natural History, Evolution, Pancreatitis

Objectives: The presentation of choledochal cysts (CDCs) is altered by complications such as acute severe cholangitis, hepatolithiasis, spontaneous perforation, portal hypertension, pancreatitis, malignancy of the biliary tract and... more

- by Richa Lal and +2
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- Liver diseases, Bladder Cancer, Child, Portal hypertension

In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced acute pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced acute pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced acute pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

- by Yasutoshi Kimura and +1
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- Treatment Outcome, Pancreatitis, Laparoscopic Cholecystectomy-Analgesia, Ultrasonography

The diagnosis of acute pancreatitis relies heavily on a raised amylase. Methods: In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls (n = 35), indeterminate as to pancreatitis (n = 189) or exclusions (non-pancreatitis diseases where amylase may be elevated; n = 53). Results: Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%. Day 1 serum lipase gave the greatest diagnostic accuracy (area under ROC curve = 0.128; P = 0.041 vs serum amylase). At the calculated diagnostic threshold of 208 U/L, lipase gave a sensitivity of 67% and a specificity of 97%. Other diagnostic thresholds (day 1) were: serum total amylase, 176 U/L (ROC 0.104, sensitivity 45%, specificity 97%), urinary total amylase, 550 U/L (ROC 0.108, sensitivity 62%, specificity 97%) and serum pancreatic isoamylase, 41 U/L (ROC 0.107, sensitivity 63%, specificity 85%). At delayed diagnosis (3 days) no enzyme was superior to lipase. The combination of lipase and amylase did not increase diagnostic accuracy. Conclusion: Serum lipase is recommended for diagnosis of AP, both early and late in the disease. Although highly specific when elevated, all pancreatic enzymes have low sensitivity for diagnosis.

- by Justin Bessell
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- Pancreatitis, Pancreas, Acute Pancreatitis, ROC Curve
- by Eugene Dimagno
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- Treatment Outcome, Pancreatitis, Endoscopy, Pancreas
- by Carlos Cafri
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- Cardiology, Pancreatitis, Electrocardiography, Differential Diagnosis

A female dog of the Shar Pei breed, aged 28 months, was euthanised due to familial shar pei fever with amyloidosis. Microscopic and ultrastructural analyses demonstrated the dog to be affected by acute pancreatitis as an outcome of renal amyloidosis and morphological lesions occurring in the liver. The presented case report depicts the microscopic and ultrastructural pattern of the dog

- by Józef Szarek
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- Case Report, Acute Pancreatitis
- by Apostolos Mamopoulos
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- Ultrasound, Pancreatitis, Laparoscopic Surgery, Pregnancy
- by Papavramidis Theodossis
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- Indian, Acute Pancreatitis, Enzyme, Spectrum

The two major forms of inflammatory pancreatic diseases, acute and chronic pancreatitis, require different approaches in nutritional management, which are presented in the present guideline. This clinical practice guideline gives evidence-based recommendations for the use of ONS and TF in these patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference.

- by R. Meier
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- Nutrition and Dietetics, Gastroenterology, Pancreatitis, Clinical Nutrition
- by Hassan Seddik
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- Acute Pancreatitis, Clinical Sciences, Pegylated Interferon, chronic hepatitis B

The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.

- by Nison Badalov
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- Pancreatitis, Ct, Tetracycline, Acute Pancreatitis