Concomitant Chronic Pancreatitis Research Articles

Assessment of the Quality of Life of Patients with Comorbidity of Hypothireosis and Chronic Pancreatitis

Today, comorbidity has been recognized as a global problem of modern medicine around the world. The combined pathology of the thyroid gland and pancreas requires constant search and improvement of an individual approach to the treatment of patients and can improve large-scale socio-economic consequences. The article presents the analysis of quality of life (QL) of patients with comorbidity of hypothyroidism and chronic pancreatit is (CP). Materials and methods. The study included 62 inpatient patients with hypothyroidism and concomitant CP, who were treated at the gastroenterology center of the Yuriy Semeniuk Rivne Regional Clinical Hospital. The comparison group involved 48 patients with isolated CP. GSRS (Gastrointestinal Symptom Rating Scale) was used to evaluate the severity of gastroenterological symptoms and QL. Results. Analyzing the data of the GSRS questionnaire, it was found that in patients with hypothyroidism with concomitant CP, reflux, pain and dyspeptic syndromes were the most common clinical manifestations (p>0.05). According the GSRS questionnaire results, the clinical course of patients with the hypothyroidism was complicated by the comorbidity of the CP, namely: on the scale of gastric reflux – by 48.57 %, on a scale of dyspepsia – by 35.84 %, diarrhea – by 26.94 %, constipation – by 19.93 %, abdominal pain – by 40.81 %. Conclusions. As a result of the study, the lower level QL in patients with hypothyroidism with concomitant chronic pancreatitis (CP) was established compared to the isolated course of CP. It was determined that the comorbidity of hypothyroidism and CP leads to a complication of the clinical condition of patients.

Ефективність корекції маси тіла як частини реабілітаційних заходів у хворих на цукровий діабет 2 типу, поєднаний з ожирінням та хронічним панкреатитом

The purpose of the study was to analyze the impact of a physical exercise program and therapeutic massage as a part of rehabilitation program in patients with type 2 diabetes mellitus combined with obesity and chronic pancreatitis on carbohydrate metabolism. Materials and methods. 579 patients with type 2 diabetes mellitus with overweight / obesity and concomitant chronic pancreatitis were included in the study. According to the analysis of the medical case histories, patients took metformin in the minimum dose that ensured the effectiveness and maximum tolerability of the drug, which was 1500-2000 mg/day. Combined therapy, which was taken by some patients, included: metformin and sulfonylurea derivatives in effective therapeutic doses. Against the background of the prescribed therapy, in the post-hospital period, rehabilitation programs were offered, which included a program of physical exercises and therapeutic massage, during 1 month. Results and discussion. It is likely that patients with type 2 diabetes mellitus, regardless of body mass index and the presence of chronic pancreatitis, received combined therapy. At the same time, the largest percentage of patients on combined therapy was recorded with type 2 diabetes mellitus and chronic pancreatitis. Both the use of metformin in the form of monotherapy and the use of combined therapy (metformin and gliclazide) in the condition of patients only with type 2 diabetes mellitus and with a comorbid type 2 diabetes mellitus with chronic pancreatitis and increased body weight / obesity do not allow reaching the target levels of glucose and HbA1c. It was established that the number of patients with type 2 diabetes mellitus without comorbidity who received mono- and combined therapy in combination with a complex of rehabilitation measures reached the target HbA1c indicators. It is also worth noting the increase in the number of insufficiency with type 2 diabetes mellitus combined with overweight / obesity and chronic pancreatitis, indicating the effectiveness of the proposed rehabilitation measures. Conclusion. The additional appointment in the post-hospital period of a complex of rehabilitation program, which includes physical exercises and therapeutic massage, contributed to the achievement of the target level of HbA1c in type 2 diabetes mellitus without comorbidity in 72.73% of patients with monotherapy and in 63.41% with combined therapy and with the associated course of diabetes mellitus, overweight / obesity and pancreatitis, respectively, in 37.62% and 38.28%

Vesicular-digestive fistulas in cholelithiasis with concomitant pancreatitis

Aim — evaluation of the incidence of pressure ulcers and vesicular-digestive fistulas in cholecystolithiasis, concomitant chronic pancreatitis, as well as the incidence and effectiveness of basic diagnostic studies of gallstone small bowel obstruction in these patients.
 Materials and methods. Over the past 10 years, we have analyzed 5055 cholecystectomies in the surgical department No 2 of the Kuzbass Clinical Emergency Hospital n. a. M. A. Podgorbunsky. In terms of anamnesis, 509 people in this group were treated for chronic pancreatitis, 116 had diabetes mellitus. We have analyzed the surgical treatment of 1086 patients with acute mechanical intestinal obstruction in the surgical department No 1 from 1997 to 2020, gallstone ileus was in 4 operated.
 Results. At 5055 cholecystectomies, 10 (0.19%) cases of biliodigestive fistulas were found, including 4 (0.08%) vesicular-duodenal and 6 (0.12%) vesicular-colonic fistulas. In 3 cases, patients underwent long-term treatment for chronic pancreatitis, one patient suffered from diabetes mellitus. Cholecystectomy was successfully combined with bowel suturing. Among 1086 patients, urgently operated on with mechanical intestinal obstruction, gallstone ileus was detected in 4 patients (0.37%). Convincing indications for surgical treatment were vomiting and paretic expansion of the initial sections of the small intestine with a delay in the advancement of barium suspension during its contrasting. Enterotomy and lithoextraction were performed in elderly patients.
 Conclusion. Vesicular-duodenal fistulas are formed in 0.08% of cases upon long-term cholecystolithiasis, surgeons detect vesicular-colonic fistulas in 0.12% during cholecystectomy. 30% of these patients received treatment for chronic pancreatitis. Cholelithiasis small bowel obstruction occurs in 0.37% of those operated on with mechanical intestinal obstruction. Diagnostic difficulties do not arise upon using radiation methods of examination.

S3216 Outcomes of Patients With Opioid Use Disorder and Concomitant Chronic Pancreatitis vs Chronic Pancreatitis: A Model to Predict Mortality and Hospital Length of Stay

S3216 Outcomes of Patients With Opioid Use Disorder and Concomitant Chronic Pancreatitis vs Chronic Pancreatitis: A Model to Predict Mortality and Hospital Length of Stay

S44 Analysis of Real World Patient Experience With Pancreatic Enzyme Replacement Therapy (PERT) in the Treatment of Exocrine Pancreatic Insufficiency (EPI)

Introduction: PERT is the standard of care treatment for EPI. Real-world data on patient experience with PERT is lacking. The aim of this patient survey was to assess patient understanding and their use of PERT. Methods: An IRB-approved survey of 75 members of Inspire’s Pancreatic Cancer and Pancreatitis Support communities (inspire.com) was conducted. Eligibility included having EPI secondary to chronic pancreatitis (CP), pancreatic cancer (PC), pancreatic surgery (PS), or acute pancreatitis (AP), and current or past PERT experience. 76% were male, 85% white, 56% age 50-69 yrs, 56% living in a large city/ suburb. 67% reported CP, 19% PC, 5% PS (non-CP/PC), 9% AP (no concomitant CP). PERT was prescribed by gastroenterologist/pancreatologist in 64%; oncologist 17%; surgeon 11%; others 8%. Results: 28% of respondents felt their physician did not provide detailed information about EPI and 31% did not get an explanation about how PERT works. 83% searched for EPI information mainly online. HCP counseling on need for chronic PERT use was reported in 67% of those on PERT (n=60) and 27% in those no longer on PERT (n=15). In the latter group, no patient took PERT for more than 5 years despite CP/PC history. 11% reported receiving no instructions on how and when to take PERT; 21% were instructed to take PERT with food or meals and no instructions for snacks, and 21% reported not taking PERT with any snacks. 59% were instructed to take PERT solely before or after eating and 56% were taking it as such. 36% reported PERT doses< 40,000 LU/meal. 10-15% did not understand how many capsules to take per meals or snacks. 24% decreased dosage mainly because they felt there will be no health consequences. 21% reported purposely skipping PERT mostly because they felt that PERT was not needed with every meal/snack. Patients stopped PERT mainly due to pill burden. 39% reported absence of follow-up by their physician on how they are doing since start of PERT. 84% of those with physician follow-up were asked about their EPI symptoms. Conclusion: Up to 1/3 of participants reported gaps in patient-physician dialogue regarding how to use PERT. More than half took PERT solely before or after eating. 36% of patients were underdosed (based on ACG Guidelines for CP). ∼ 1/4 skipped PERT or decreased the dose. Targeted education interventions are warranted to improve barriers to care and sequelae of untreated/undertreated EPI.

Role of dual-point 18F-FDG-PET/CT in the diagnosis of pancreatic adenocarcinoma, in patients with and without concomitant chronic pancreatitis: Comparison with CECT and EUS

PurposeThe aim of this study was to evaluate the diagnostic performance of dual-time-point-PET/CT, CECT and EUS + FNA in diagnosing pancreatic-ductal-adenocarcinomas (PDAC), in context of concomitant Chronic Pancreatitis (CP). Methods18F-FDG-PET/CTs were prospectively acquired in 22 confirmed CP and 23 confirmed PDAC patients (calculated for 90% power); and cut-offs of 2.2 for early-SUV(∼1hr), 2.4 for delayed-SUV(∼3hr) and 1.36 for Retention-index (RI), were derived. These cut-offs were validated in PET/CTs of 75 patients (51.9 ± 13.3years; 54 men) with pancreatic masses of unknown nature. Comparisons were made with triple-phase-CECT (73 patients) and EUS + FNA (54 patients). Histopathology was obtained in 68 patients (including all PDACs) and 7 were followed up for minimum of 2 years. ResultsIn patients without concomitant CP, sensitivity, specificity and accuracy for diagnosing malignancy in standard-acquisition-PET/CT, dual-time-point-PET/CT, CECT and EUS + FNA were 97.4%, 83.3%, 94.0%; 97.4%, 75.0%, 92%; 94.6%, 66.7%, 87.8% and 92.6%, 88.9%, 91.7% respectively. Corresponding values in patients with concomitant CP were 88.9%, 57.1%, 80.0%; 100%, 57.1%, 88%; 82.4%, 57.1%, 75% and 100%, 100%, 100% respectively. In lesions ≤2 cm (AJCC-T1), dual-time-point-PET/CT was the most sensitive (95.8%). ROC-analysis revealed significantly higher area-under-the-curve for RI over early-SUV (p = 0.002) in cases with concomitant CP only. In patients with confirmed liver-metastases, PET/CT and CECT identified 15/16 and 13/16 lesions. PET/CT identified additional lung-metastases in 3 and bone-metastasis in one patient. ConclusionIn patients without concomitant CP and with larger lesions, PET/CT and CECT are equivocal as screening modalities, with no benefit of dual-time-point-PET/CT acquisitions. However, in patients with concomitant CP and smaller lesions, dual-time-point PET/CT is better; with sensitivity comparable to EUS + FNA.

Possibilities of Complex Rehabilitation of Patients with Type 2 Diabetes and Concomitant Chronic Pancreatitis in Ambulatory Practice

Introduction: An important place in the formation of the rehabilitation program is occupied by non-drug methods, such as physiotherapy, reflexology, spa treatment, the use of which improves the effectiveness of correction of complications, reduces drug load, allows to achieve sustainable compensation for diabetes and chronic pancreatitis (CP), and also improves life quality suffering from such comorbidity. Aim: to investigate the effectiveness of the use of acupuncture in the complex rehabilitation of patients with type 2 diabetes in combination with chronic pancreatitis based on an assessment of the quality of life (QOL) and clinical parameters. Material and Methods: 60 patients with type 2 diabetes in combination with CP were examined and divided into 2 groups. The average age of the patients was (52.86±0.83) years. Control group – 15 healthy persons. To evaluate QOL, a questionnaire was interviewed using the SF-36 questionnaire in treatment dynamics. All patients with type 2 diabetes in combination with CP received adequate conventional therapy. In addition to the treatment, the patients of group II received the acupuncture course according to the methodology, which was formed on the basis of the experience of the Kyiv School of reflexology (EL Macheret et al.) and the Beijing School (Kong Lin). Results: Faecal α-elastase levels increased by 14.9% in group 1, by 25.6% in group 2, blood glucose decreased by 9.2% in group 1 and by 19.5% in group 2, HbA1c level – by 4.9% in Group 1 and by 12.2% in Group 2, changes in coprogram parameters in points – by 24.5% in Group 1 and by 55.2% in Group 2. According to the SF-36 scales, there was a positive dynamics of quality of life in patients of both groups. In group 2, there was a more significant positive trend in the total indicator of mental status (increased by 17.75% (p &lt;0.001) versus 8.71% (p &lt;0.005) in the group 1, respectively) and physical status (increased by 2.59% ( p &lt;0.05) versus 7.19% (p &lt;0.05)). Conclusions: Improved exocrine and endocrine functions of the pancreas, as well as improved quality of life in patients treated with a course of acupuncture increase the efficiency of complex rehabilitation of patients with type 2 diabetes in combination with CP was found.

Predictors, rates, and trends of opioid use disorder among patients hospitalized with chronic pancreatitis.

BackgroundPatients with chronic pancreatitis (CP) suffer from pain and receive increased opioid prescriptions with a high risk of opioid use disorder (OUD). We studied the predictors, trends and outcomes of OUD among patients hospitalized with CP.MethodsRecords with CP (with/without OUD) were extracted from the Nationwide Inpatient Sample (NIS) 2012-2014, and the association of OUD with the burden of CP was calculated. We then charted the trends of OUD and its interaction with concomitant CP from NIS 2007-2014 (SAS 9.4).ResultsIn the period 2012-2014, 4349 (4.99%) of the 87,068 CP patients had concomitant OUD, with higher risk among patients who were young, females, white vs. Hispanics, and individuals with chronic back pain, arthritis, non-opioid substance use, mental health disorders, and those hospitalized in urban centers. OUD was associated with a longer hospital stay (6.9 vs. 6.5 days, P=0.0015) but no significant difference in charges ($47,151 vs. $49,017, P=0.0598) or mortality (1.64% vs. 0.74%, P=0.0506). From 2007-2014, the average yearly rate of OUD was 174 cases per 10,000 hospitalizations (174/10,000), almost 3 times higher among CP vs. non-CP (479/10,000 vs. 173/10,000, P<0.001), and it increased from 2007 to 2014 (135/10,000 to 216/10,000, P<0.001). The yearly increase was 2.7 times higher among patients with CP vs. non-CP (29.9/10,000 vs. 11.3/10,000 hospitalizations/year, P<0.001).ConclusionsCP is associated with higher rates and trends of OUD. Patients with CP at high risk of OUD may benefit from alternate analgesic regimens or surveillance for OUD when they are prescribed opioids.

INVESTIGATION OF EXTERNAL RESPIRATORY FUNCTION AND HEMOSTASIS SYSTEM’S STATUS IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE WITH CONCOMITANT CHRONIC PANCREATITIS

INTRODUCTION: It can be assumed that the comorbidity course of сhronic obstructive pulmonary disease (COPD) and chronic pancreatitis (CP) can enhance the clinical symptoms of both diseases and lead to frequent relapses of the pathological process due to changes in the proteolysis intensity of high and low molecular weight plasma proteins and the state of the hemocoagulation.&#x0D; OBJECTIVE: To establish the features of hemocoagulation and proteolytic hemostasis at COPD with concomitant CP.&#x0D; METHODS: 120 patients with COPD and CP were examined. The function of external respiration, total coagulation potential of blood plasma, the state of enzymatic and non-enzymatic fibrinolysis, total fibrinolytic activity were investigated.&#x0D; RESULTS: CP contributes to the development of broncho-obstructive syndrome, and the maximum indicators of reduction of FEV1 relative to the proper values are observed in patients with a comorbid course of COPD and CP. Reducing the intensity of collagenolysis in patients of groups 1-2 contributed to the development of diffuse pulmonary fibrosis in response to chronic inflammation. The imbalanced increase in the intensity of proteolysis due to reduced expression of its inhibitors in COPD patients with CP led to progressive destruction of the cell membranes of alveolocytes, acinar epithelium of pancreas and epithelium of the bronchial mucosa, acceleration of their apoptosis and development of desquamation, atrophic changes, metaplasia, and the like. The above factors are active as inducers of inflammation, and the formation of pulmonary fibrosis and fibrosis of the pancreas.&#x0D; CONCLUSIONS: In COPD patients with accompanying CP are an increase in the lysis rate of low and high molecular weight proteins and a decrease in blood collagenolytic activity on the background of a significant imbalance in the activity of plasma proteinase inhibitors. Defined suppression of the activity of the anti-coagulation system factors and enzymatic, Hageman-factor-dependent fibrinolysis indicates the formation of hypercoagulation syndrome in these patients.

INDICES OF VASCULAR - ENDOTHELIAL AND GRANULOCYTIC COLONYSTIMULATING GROWTH FACTORS IN PATIENTS SUFFERING FROM CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CONCOMITANT CHRONIC PANCREATITIS IN THE DYNAMICS OF THERAPY

Purpose. Estimation of the level of the circulatory vascular-endothelial growth factor(VEGF) and granulocytic colony-stimulating growth factor (GCSF) in patients sufferingfrom chronic obstructive lung disease (COLD) with concomitant chronic pancreatitis(CP) in the dynamics of therapy.Material and methods. Investigation of 52 patients with COLD B-C groups, where theobstruction degree corresponded to COLD 1-2 with a low risk and more pronouncedsymptomatics (B), and also COLD 3 with a high risk but less pronounced symptomatics(C), - I group, 60 CP patients with corresponding characteristics of groups with concomitant COLD (II group) and 19 practically healthy persons as a referent group wascarried out. Patients of II group were divided into 3 subgroups according to theobtained treatment. Patients of IA subgroup (19 persons) received basic therapy according to the MPH order of Ukraine №555 dated from 27.06.2013. 23 patients, whoreceived "Essentsiale forte H" two capsules thrice a day during 1/12, except generallyaccepted treatment, constituted IB subgroup. In patients of IB subgroup (18 patients) thebasic treatment was combined with additional administration of kvertsetin in a dose of1.0 g thrice a day during 14 days.Results. Thus, in patients of II group VEGF level (median and 80% interprocentilerange) was 203 pg/ml [104,3 - 391, 68 pg/ml], that differed from healthy persons (p&lt;0,05).This index fluctuated from 104 to 195, 84 pg/ml, and median was equaled to 172, 92pg/ml in patients without concomitant pathology of the pancreas. In practically healthypersons it constituted 28, 7 [15, 07 - 44, 39] pg/ml accordingly. As to G-CSF its concentration was various in patients of both groups in comparison with the group ofpractically healthy persons. Differences between groups of patients were not revealed.Thus, this index fluctuated from 21 to 93, 3 pg/ml, median constituted 26, 2 pg/ml inpatients of II group, and in patients of III group it was 23-93, 3 pg/ml and median - 27, 9pg.ml.Conclusions. An increase of the circulating VEGF level at COLD exacerbation withconcomitant CP is probably associated with the systemic response syndrome to inflammatory process. CP presence deteriorates the indices of the endothelium functioning.

Analysis of lifestyle factors in patients with concomitant chronic pancreatitis and liver cirrhosis

Background & objectivesChronic pancreatitis (CP) and liver cirrhosis (LC) are common gastroenterological disorders but their co-incidence is considered to be rare. This study was designed to identify lifestyle factors that are associated with the development of concomitant LC in patients with CP. MethodsIn a retrospective case-control study between 2000 and 2005 122 patients with both CP and LC and 223 matched control patients with CP and no known liver disease were identified in 11 European university medical centers. Another 24 patients and 48 CP controls were identified in the period between 2006 and 2012. ResultsAlcoholism was most commonly regarded as aetiology for both CP (82.2%; 95% confidence interval (CI): 75.0–88.0%) and LC (79.5%; 95% CI: 72.0–85.7%) as compared to controls with CP only (68.6%; 95% CI: 62.7–74.1%). The preferred type of alcoholic beverage and pattern of alcohol intake were the only significant lifestyle factors in multivariate analysis. Frequency of alcohol intake (p = 0.105) and smoking status (p = 0.099) were not significant in bivariate analysis and dropped out of the multivariate model. Recurrent and chronic pancreatic pain was observed more often in patients with only CP, whereas gallstones were more common in individuals with both chronic disorders. ConclusionsThese findings indicate that certain lifestyle factors might be important for the development of concomitant CP and LC. More studies will be needed to identify additional genetic and environmental factors underlying this association.

HOMEOSTATIC DISORDERS IN PATIENTS WITH COMBINATION OF HYPERTONIC DISEASE AND CHRONIC PANCREATITIS

Введення. Практично немає жодного захворювання, у розвитку і перебігу якого вегетативна нервова система не відігравала б ролі Це визначає актуальність дослідницьких процесів підтримки гомеостазу при поєднанні різних захворювань.Мета. Метою даного дослідження було вивчити і порівняти характер порушень вегетативної, антиоксидантної, калікреїн-кінінової системи та параметрів ендогенної інтоксикації у хворих з поєднанням гіпертонічної хвороби (ГХ) і хронічного панкреатиту (ХП).Матеріали та методи. У дослідженні взяли участь 40 пацієнтів з ГХ і супутнім ХП в фазі нестійкої ремісії, 15 практично здорових осіб. Середній вік був (47,7 ± 1,2) років. Дослідження вегетативної регуляції проводилось за допомогою визначення стандартних статистичних і спектральних показників варіабельності серцевого ритму (ВСР). Було проведено лабораторне визначення стандартних параметрів антиоксидантної, калікреїн-кінінової системи і тяжкості ендогенної інтоксикації.Результати. Зниження загальної потужності спектра, збільшення частки гуморально-метаболічних впливів на частоту серцевих скорочень, схильність до асимптоматичної вегетативної реактивності, зниження рівня супероксиддисмутази, глутатіону, прекалікреїну, ALPHA 2-макроглобуліну, кінази II, більш високі рівні каталази, середньомолекулярних пептидів, загальної протеолітичної активності калікреїну плазми спостерігались у хворих з поєднанням гіпертонічної хвороби і хронічного панкреатитом.Висновки. У пацієнтів із гіпертонічною хворобою при приєднанні хронічного панкреатиту виявлено ознаки порушення компенсаторних механізмів і підвищення дисбалансу вегетативної системи зі зменшенням пластичності адаптаційних процесів. Поєднання патологій також супроводжувалось проявами ендогенної інтоксикації, порушеннями антиоксидантної, калікреїн-кінінової системи.

Urinary Peptide Analysis Differentiates Pancreatic Cancer From Chronic Pancreatitis.

Differentiation of pancreatic cancer (PCA) from chronic pancreatitis (CP) is challenging. We searched for peptide markers in urine to develop a diagnostic peptide marker model. Capillary electrophoresis-mass spectrometry was used to search for peptides in urine of patients with PCA (n = 39) or CP (n = 41). Statistical different peptides were included in a peptide multimarker model. Peptide markers were sequence identified and validated by immunoassay and immunohistochemistry (IHC). Applied to a validation cohort of 54 patients with PCA and 52 patients with CP, the peptide model correctly classified 47 patients with PCA and 44 patients with CP (area under the curve, 0.93; 87% sensitivity; 85% specificity). All 5 patients with PCA with concomitant CP were classified positive. Urine proteome analysis outperformed carbohydrate antigen 19-9 (area under the curve, 0.84) by a 15% increase in sensitivity at the same specificity. From 99 healthy subjects, only four were misclassified. Fetuin-A was the most prominent peptide marker source for PCA as verified by immunoassay and IHC. In silico protease mapping of the peptide markers' terminal sequences pointed to increased meprin-A activity in PCA, which in IHC was associated with neoangiogenesis. Urinary proteome analysis differentiates PCA from CP and may serve as PCA screening tool.

Impact mebicar inclusion in the treatment of hypertonic disease and concomitant chronic pancreatitis

The aim of the research: to study the clinical pattern of violations of the state, autonomic, antioxidant system and endogenous intoxica tion indicators in patients with essential hypertension (EH) and chronic pancreatitis (CP). To evaluate the effectiveness of the inclusion of the generally accepted complex treatment (ACT) psy chotropic drug mebicar, to be compared with exclusively medical treatment.The materials and methods. A study was conducted of patients with EH with concomitant chronic pancreatitis in the phase of unstable remission. In addition to clinical data in this group revealed patholog ical changes in autonomic regulation, antioxidant defense, and endoge nous intoxication signs.Results. On the obtained parameters before and after treatment of EH patients with concomitant chronic pancreatitis in the phase of unsta ble remission, it was found that the combination of ACT with veg etabilium drug mebicar more efficiently affects the heart rate variabil ity, clinical condition, severity of endogenous intoxication and indica tors of the antioxidant defense system.Conclusion. Included mebicar in the ACT resulted in a higher level of positive dynamics of the above indicators. It was conclud ed that the use of the techniques in the treatment of patients in the case of a combination of EH with CP in outpatient practice is a promising and appropriate for correction of the clinical condi tion, laboratory parameters, vegetative and psycho emotional dis orders.

C-reactive protein as a biomarker of inflammatory process in chronic obstructive pulmonary disease combined with chronic pancreatitis

The level of C-reactive protein in patients with chronic obstructive pulmonary disease with concomitant chronic pancreatitis was examined. In patients with background lesions of the pancreas the greater magnitude of the inflammatory proteins was observed. It was demonstrated that in patients with chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with chronic pancreatitis changes of the C-reactive protein depended on age, sex of patients and severity of diseases.

Improving the Diagnostic Accuracy of Endoscopic Ultrasound–Guided Fine-Needle Aspiration Using MicroRNAs

Brand RE, Adai AT, Centeno BA, et al. A microRNA-based test improves endoscopic ultrasound–guided cytologic diagnosis of pancreatic cancer. Clin Gastroenterol Hepatol 2014;12:1717–1723. Owing to its safety profile, diagnostic accuracy, and low risk of tumor seeding, endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) represents the preferred modality for achieving a tissue confirmation of pancreatic ductal adenocarcinoma (PDAC; J Cancer Res Clin Oncol 2012;138: 1433–1441; Gastrointest Endosc 2003;58:690–595; Endoscopy 2011;43:897–912). In a recent metaanalysis that included 41 studies and 4766 procedures, EUS-FNA had a pooled sensitivity of 87% and specificity 96% for the diagnosis of malignant pancreatic lesions (Pancreas 2013;42: 20–26). However, the sensitivity of EUS-FNA is lower in the setting of chronic pancreatitis (CP), where false-negative rates may be as high as 40% (Gastrointest Endosc 2005;62: 728–736l; Gastrointest Endosc 2009;70:70–79). Thus, there is substantial interest in improving the accuracy of cytopathology for diagnosing PDAC—and potentially informing long-term prognosis of this deadly cancer—using novel molecular markers such as microRNAs (miRNAs; Clin Cancer Res 2011;17:5812–5821). miRNAs are small, noncoding RNAs (17–25 nucleotides long) that regulate gene expression post-transcriptionally. These molecules are stable and easily recovered from tissue or blood, making EUS-FNA specimens suitable for analysis (Clin Chem 2008;54:1716–1724). Unique miRNA “signatures” have been evaluated using formalin-fixed, paraffin-embedded specimens, having >90% accuracy in distinguishing PDAC from CP and normal pancreata in limited studies (Clin Cancer Res 2011;17:5812–5821; Clin Chem 2008;54:1716–1724; Int J Cancer 2012;131:E86–95; Expert Rev Mol Diagn 2011;11:249–257). Using samples (n = 95) derived from formalin-fixed, paraffin-embedded tissues of PDAC and CP, Brand et al (Clin Gastroenterol Hepatol 2014;12:1717–1723) developed a miRNA panel and then analyzed its utility as a diagnostic test using pancreas tissue specimens (n = 229) derived from EUS-FNA. Starting with 11 candidate miRNAs applied to formalin-fixed, paraffin-embedded specimens (PDAC, n =52; CP, n = 43), the authors identified a panel of 5 miRNAs (−24, −130b, −135b, −148a, and −196a) having >95% agreement compared with standard histopathology when the miRNA classifier score was ≥0.5. Then, the authors applied this panel using polymerase chain reaction amplification techniques to EUS-FNA specimens prospectively collected at 8 participating centers. Only 1 FNA pass was dedicated for miRNA analysis, yet the rate of failed polymerase chain reaction amplification was only 1 in 229 (0.4%). Based on standard histopathology, the pretest probability of cancer was 202 in 228 (89%), with 184 of 202 cancers being PDAC (excluding non-PDAC cancers, the pre-test probability of PDAC was 184 of 202 [88%]). Although the prevalence of concomitant CP is not provided—the most common scenario in which the sensitivity of EUS-FNA is diminished—the sensitivity of cytopathology for detecting PDAC was 79% (145/184). By comparison, the miRNA panel correctly diagnosed PDAC in 152 of 184 patients (83%). The combination of cytopathology + miRNA resulted in a sensitivity/specificity of 167 of 184 (91%) and 25 of 26 (96%). Including 1 case of cholangiocarcinoma, the miRNA panel accurately detected adenocarcinoma in 130 of the 146 cases detected by cytopathology, with an 11% false-negative rate. In the setting of negative cytopathology and an miRNA panel score of <0.5, the posttest probability of PDAC (the false-negative rate of EUS-FNA cytopathology + miRNA) was 17 of 43 (40%). Because the sensitivity of achieving a diagnosis of PDAC increased from 79% using cytopathology alone to 91% when cytopathology was combined with an elevated miRNA panel, the authors concluded that a 5-miRNA classifier panel improves the performance characteristics of EUS-FNA.

820 Urinary Peptide Analysis Differentiates Pancreatic Cancer From Chronic Pancreatitis

Objectives: Differentiation of pancreatic cancer (PCA) from chronic pancreatitis (CP) is challenging. We searched for peptide markers in urine to develop a diagnostic peptide marker model. Methods: Capillary electrophoresis–mass spectrometry was used to search for peptides in urine of patients with PCA (n = 39) or CP (n = 41). Statistical different peptides were included in a peptide multimarker model. Peptide markers were sequence identified and validated by immunoassay and immunohistochemistry (IHC). Results: Applied to a validation cohort of 54 patients with PCA and 52 patients with CP, the peptide model correctly classified 47 patients with PCA and 44 patients with CP (area under the curve, 0.93; 87% sensitivity; 85% specificity). All 5 patients with PCA with concomitant CP were classified positive. Urine proteome analysis outperformed carbohydrate antigen 19-9 (area under the curve, 0.84) by a 15% increase in sensitivity at the same specificity. From 99 healthy subjects, only four were misclassified. Fetuin-A was the most prominent peptide marker source for PCA as verified by immunoassay and IHC. In silico protease mapping of the peptide markers' terminal sequences pointed to increased meprin-A activity in PCA, which in IHC was associated with neoangiogenesis. Conclusions: Urinary proteome analysis differentiates PCA from CP and may serve as PCA screening tool.

Spontaneous choledochal cyst rupture in pregnancy with concomitant chronic pancreatitis

Choledochal cysts are rare cystic transformations of the biliary tree that are increasingly diagnosed in adult patients. We report here a case of spontaneous rupture of a choledochal cyst in a pregnant young lady with chronic pancreatitis.

Cytologic Grade Independently Predicts Survival of Patients With Pancreatic Adenocarcinoma

Our objectives were to devise a cytologic grading system and determine whether it would predict survival of patients with solid-type pancreatic adenocarcinoma. We evaluated 116 consecutive patients from July 2000 to November 2002; they were followed up until September 2003. We scored the following features on rapid Romanowsky-stained endoscopic ultrasound-guided fine-needle aspiration smears: cell group architecture, single cells, nuclear grade, mucus, bizarre cells, and necrosis. A cytologic grade (low vs high) was assigned. The Kaplan-Meier estimate of 6-month survival was 76% (SE, 7%) for patients with low-grade tumors vs 50% (SE, 6%) for patients with high-grade carcinoma. The median survival for patients with low-grade vs high-grade tumors was 1 year vs 6 months, respectively (chi2 = 4.45; P = .035). Cox proportional hazards regression showed tumor stage, cancer-specific treatment, and cytologic grade to be independent predictors of survival (P = .001). No other factors (age, mass location, placement of stent, presence of concomitant chronic pancreatitis, race, sex) predicted survival. We devised a grading system that independently predicted survival in patients with pancreatic adenocarcinoma.

An unusual cause of hydropic gallbladder and biliary colic ? Heterotopic pancreatic tissue in the cystic duct: Report of a case and review of the literature

We present herein an unusual case of heterotopic pancreas in the cystic duct with hydrops of the gallbladder and concomitant chronic pancreatitis of the heterotopic tissue. A review of the relevant literature is discussed following the presentation of this case.