Elevated Serum Amylase Levels Research Articles

Mesna Alleviates Cerulein-Induced Acute Pancreatitis by Inhibiting the Inflammatory Response and Oxidative Stress in Experimental Rats.

Acute pancreatitis (AP) is a sudden inflammation of the pancreas that may be life-threatening disease with high mortality rates, particularly in the presence of systemic inflammatory response and multiple organ failure. Oxidative stress has been shown to be involved in the pathophysiology of acute pancreatitis. This study is designed to investigate the possible effect of mesna on an experimental model of cerulein-induced acute pancreatitis. Animals were divided into five groups: Group 1 served as a control group given the saline; group II (mesna group) received mesna at a dose of (100mg/kg per dose, i.p.) four times; group III (acute pancreatitis group) received cerulein at a dose of (20µg/kg/dose, s.c.) four times with 1-h intervals; group VI, cerulein + mesna, was treated with mesna at a dose of (100mg/kg, i.p.) 15min before each cerulein injection. Animals with acute pancreatitis showed elevated serum amylase and lipase levels. Biochemical parameters showed increased pancreatic tumor necrosis factors-α (TNF-α) and interleukin-1β (IL-1β) levels. A disturbance in oxidative stress markers was evident by elevated pancreatic lipid peroxides (TBARS) and decline in pancreatic antioxidants' concentrations including reduced glutathione (GSH); superoxide dismutase (SOD); and glutathione peroxidase (GSH-Px). Histological examination confirmed pancreatic injury. Pre-treatment with mesna was able to abolish the changes in pancreatic enzymes, oxidative stress markers (TBARS, SOD, GSH and GSH-Px), pancreatic inflammatory markers (TNF-α, IL-1β) as well as histological changes. Mesna mitigates AP by alleviating pancreatic oxidative stress damage and inhibiting inflammation.

Loss of RE-1 silencing transcription factor accelerates exocrine damage from pancreatic injury

Regulation of pancreas plasticity is critical for preventing injury and promoting regeneration upon tissue damage. The intricate process of pancreatic differentiation is governed by an orchestrated network of positive and negative transcription factors for appropriate gene expression. While the transcriptional repressor REST is well characterized as a silencer of neuronal genes in non-neuronal cells, the role of REST in regulating exocrine pancreas cell identity remains largely unexplored. Rest expression is increased upon injury in the mouse pancreas, such as induced acute and chronic pancreatitis and ductal adenocarcinoma. At the cellular level, Rest expression is lower in mature acinar cells compared with pancreas progenitor and ductal cells. To investigate the role of REST activity in pancreatic transdifferentiation and homeostasis, we developed a novel mouse model (Cre/RESTfl/fl) with conditional knockout (KO) of Rest expression within pancreas cells. The high Cre-mediated excision efficiency of Rest exon two KO caused decreased Rest expression and activity within the pancreas. Short-term organoid cultures of pancreatic acini to undergo acinar-to-ductal metaplasia (ADM) showed that loss of REST impedes induced ADM, while overexpression of REST increases ADM. Interestingly, REST ablation accelerated acute pancreatitis in mice treated with the cholecystokinin analog caerulein, as indicated by cellular morphology, elevated serum amylase levels and pancreatic edema. Furthermore, Cre/RESTfl/fl mice were more sensitive to acute pancreatitis injury and displayed augmented tissue damage and cellular lesions. These results suggest REST has a novel protective role against pancreatic tissue damage by acting as a regulator of exocrine cell identity.

Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography

The aim of this study was to determine if the difference in serum amylase levels prior to, and two hours following, an endoscopic retrograde cholangiopancreatography (ERCP), or the ratio of the two-hour post-ERCP amylase level to the pre-ERCP amylase level was a better predictor of post-ERCP pancreatitis (PEP). This was a retrospective, single-center study of consecutive patients, who underwent ERCP between April 2015 and August 2018. Serum amylase was measured before and two hours following ERCP. We compared the difference and the ratio of the two levels in predicting PEP using a receiver operating characteristic (ROC) curve analysis. A total of 1029 patients underwent ERCP, with PEP occurring in 118 (11.5%). Multivariate analysis revealed that an elevated two-hour post-ERCP serum amylase level was a significant predictor of PEP. ROC analysis of the difference and the ratio of the two levels found good performance for both parameters, with an area under the curve (AUC) of 0.861 (95% confidence interval [CI], 0.823-0.900) and 0.847 (95% CI, 0.809-0.886), respectively. The difference between the values was a significantly more effective predictor of PEP, based on the AUC analysis (P = 0.011). The difference between pre and two-hour post-ERCP amylase levels is a better predictor of PEP than the ratio of the two.

Makroamilazemija kao razlog hiperamilazemije u klinički nejasnim stanjima - prikaz slučaja

Macroamylasemia is a rare condition characterized by elevated serum amylase levels due to the existence of macromolecules - complex amylase that cannot be secreted normally by the kidneys due to their size. It is a benign condition that is usually free of marked clinical symptoms and signs. The prevalence of macroamylasemia in the population is between 1 and 2%. The main clinical significance of macromylasemia is that it is often a diagnostic problem because it requires differentiation of this condition from other causes of hyperamylasemia. Therefore, it is rational to avoid unnecessary diagnostics and treatment, which burden both the patient and the health system. Macromalasemia as a diagnosis should be considered in any patient with elevated serum amylase activity in whom serum lipase and urine amylase levels are normal. Laboratory confirmation of the diagnosis of amylasemia rests on tests: electrophoresis or polyethylene glycol precipitation test. This paper presents a patient who has been routinely treated clinically due to non-specific gastrointestinal problems. During laboratory treatment, the patient's serum was found to have elevated amylase values. Additional diagnostics did not identify organic pancreatic diseases or other diseases that may be related to hyperamylasemia, and by calculating the ratio of renal amylase clearance to creatinine clearance of less than 1%, we conclude that it is most likely a macroamylasemia. Specific treatment was not required. The patient comes for a check-up once every 6 months.

Pseudo-Wellens syndrome, acute pancreatitis, and an anomalous coronary artery: a case report

BackgroundChest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies.Case presentationA 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features.ConclusionsClinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.

Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease-A Cross Sectional Study.

Background and Objectives: The aim of the study was to determine the association between presences of fatty pancreas (FP) with the features of metabolic syndrome (MeS) in patients with non–alcoholic fatty liver disease (NAFLD) and to establish a new noninvasive scoring system for the prediction of FP in patients with NAFLD. Material and Methods: 143 patients with NAFLD were classified according to FP severity grade into the two groups and evaluated for diagnostic criteria of MeS. All patients underwent sonographic examination with adiposity measurements and the liver biopsy. Liver fibrosis was evaluated semi-quantitatively according to the METAVIR scoring system and using non-invasive markers of hepatic fibrosis. Results: Waist circumference (WC) was predictive for increased risk of FP in NAFLD patients. Elevated fasting plasma glucose, total cholesterol, serum amylase and lipase levels were associated with presence of severe FP (p value = 0.052, p value = 0.007, p value = 0.014; p value = 0.024, respectively). Presence of increased amounts of mesenteric fat was associated with severe FP (p value = 0.013). The results of this study demonstrated highly significant association between NAFLD and presence of FP. The model for predicting the presence of FP was designed with probability value above 6.5. Conclusion: Pancreatic fat accumulation leads to worsening of pancreatic function which in turns exacerbates severity of metabolic syndrome associated with both, NAFLD and NAFPD.

Management of Acute Necrotizing Pancreatitis through Ayurveda Regimen: A Case Report

Necrotizing pancreatitis is an extreme complication of acute pancreatitis. Acute pancreatitis is an inflammation of the pancreas. Pancreas sits behind the stomach. One of its main functionsis to make enzymes that help in digest the food. Normally, those enzymes flow through a small opening into small intestines. If pancreas becomes inflamed, the enzymes can start to leak into parts of the pancreas instead. These enzymes can sometimes kill pancreatic tissue, resulting in necrotizing pancreatitis. The dead tissue can get infected and cause life-threatening complications. Cardinal symptoms are abdominal pain (boring nature), nausea, vomiting, and tenderness in abdomen, pain worsened after eating, steatorrhea and weight loss. Assessments were made using Elevated levels of Serum Amylase and Lipase. In modern science, management is Lifelong enzymes, Periodical Emergency hospitalisation, IV fluids, painkillers, anti-inflammatory, andantibiotics, ERCP stunting, surgical intervention. It involves high cost, side effects and in many cases, there is progression of disease leading to fear, frustration and debility among sufferers. In Ayurveda three doshas are described as Vata, Pitta, Kapha. Pitta dosha we have substances exactly similar to enzymes. The features of acute pancreatitis are similar to the features of pitta where tikshna and ushna guna of pitta are aggravated. The observations reveal that, Ayurvedic regimen can play a key role in the management of conditions like pancreatitis. A 25years old male patient diagnosed with acute necrotizing pancreatitis. At the end of the treatment, there was considerable improvement in the subjective and objective criterias. The treatment strategies followed in this study can be safely adopted under the supervision of competent specialist.

Laparoscopic rendezvous surgery for cholecystocholedocholithiasis

To present a modified technique of laparoscopic surgery (Rendezvous technique) for cholecystocholedocholithiasis. There were 41 patients with cholecystocholedocholithiasis who underwent hybrid single-stage laparoscopic surgery (Rendezvous technique) as an alternative to conventional two-stage approach. Two (4.8%) patients had elevated serum amylase level without signs of pancreatitis in postoperative period. Other 2 patients required redo transpapillary intervention due to residual stones. Laparoscopic interventions were successful in 95.2% of cases.

Serum amylase level measurement in acute abdominal pain

Acute abdominal pain is a frequent symptom to the emergency department, can be caused by various pathologic processes. The aim of this study was to appraise the role of serum amylase level in diagnostic workup of non-traumatic adult patients presented with acute abdominal pain to surgical emergency department (ED). Our study is based on data collected retrospectively from patients’ medical records admitted to Shar Emergency Surgical Unit, Sulaimani, Iraq from 10th January 2019 to 20th May 2019. All non-traumatic adult patients with acute abdominal pain within twenty-four hours before admission were included and serum amylase levels were measured on admission using Enzyme-Linked Immunosorbent Assay (ELISA) available at (ED). Overall, 68 patients were included, with mean age of 45.9 years over the aforementioned time period, 44 females (64.7%) and 24 males (35.3%), of which 37 patients had normal serum amylase level (14 male and 23 female patients), defined as levels between (35 IU/L-115 IU/L) by the laboratory (ELISA) device used for all the tests, while the other 31 patients (10 males and 21 females) had high serum amylase levels due to different disease processes, the most common two with equal frequencies were acute calculous cholecystitis (41.9%) and acute pancreatitis (41.9%). Elevated serum amylase levels can be observed with several medical and surgical problems in patients with acute abdominal pain, but high values are usually associated with acute inflammatory pancreatic and gallbladder conditions, with very high levels in the former, making it one of the important diagnostic tools that can be used by health-care providers when evaluating patients suspected to have acute pancreatitis or acute calculous cholecystitis.

PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE

Abstract Background Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature. Methods We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature. Results 1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis. Conclusion The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment. Disclosure All authors have declared no conflicts of interest.

Risk factors for acute pancreatitis in patients with accidental hypothermia

BackgroundPancreatic damage is commonly observed as a consequence of accidental hypothermia (core body temperature below 35 °C). We aimed to investigate the risk factors for pancreatic damage and the causal relationship in patients with accidental hypothermia. MethodsThis retrospective, single-center, observational case-control study was conducted in the emergency department of a tertiary care medical center. We investigated patients who were admitted for accidental hypothermia over a course of ten years (January 2008 to December 2017). ResultsOf the 138 enrolled patients, 70 had elevated serum amylase levels (51%). We observed a correlation between initial core body temperature and serum amylase level (Spearman's rank correlation coefficient −0.302, p < 0.001). Patients who developed acute pancreatitis had a significantly lower initial core body temperature than those who did not develop it (odds ratio = 0.76; 95% confidence interval [CI] = 0.61–0.94; p = 0.011). Receiver operating characteristic analysis showed that a body temperature lower than 28.5 °C at the time of visit was predictive of acute pancreatitis (area under the curve = 0.71, 95% CI = 0.54–0.88, sensitivity = 0.67, specificity = 0.69, p = 0.017). ConclusionsWe concluded that an initial core body temperature lower than 28.5 °C was a risk factor for acute pancreatitis in accidental hypothermia cases. In such situations, careful follow-up is necessary.

A retrospective study of clinical efficacy of serum lipase/amylase ratio in predicting etiology of acute pancreatitis

Background: The serum lipase/amylase (L/A) ratio had been proposed to distinguish the etiology of pancreatitis, the efficacy to predict the etiology of acute pancreatitis is assessed in our study as it may need different therapeutic approaches.Methods: From January 2017 to December 2017, 54 patients with acute pancreatitis were included 48 (88.9%) men and 6 (11.1%) women with a mean age of 39.2 years, ranging from 18 to 90 years. They were divided into 2 subgroups as alcohol (n=27), nonalcoholic (n=27), and their serum L/A ratio level were compared with a mean age 39.42±9.9 years in alcoholic group versus 39.04 ± 7.7 years in nonalcoholic group.Results: Male predominance in alcoholic and nonalcoholic group and all female patients (100%) etiology is nonalcoholic. The elevation of serum amylase level in nonalcoholic group on average is 600 versus in alcoholic group 512 and serum lipase level average in nonalcoholic group 766 versus in alcohol group 629. Instead, the serum L/A ratio showed no significant changes among each group. In this study, the alcoholic acute pancreatitis is more severe than nonalcoholic pancreatitis. There was also no statistically significant (p=0.90) difference in serum L/A ratio in alcoholic and nonalcoholic pancreatitis.Conclusions: The serum amylase and lipase concentrations are not able to establish etiology acute pancreatitis as assessed by imaging techniques. The L/A ratio is not a good predictive factor in distinguishing acute episode of alcoholic and non-alcoholic acute pancreatitis.

Fluorouracil, leucovorin and irinotecan combined with intra-arterial hepatic infusion of drug-eluting beads preloaded with irinotecan in unresectable colorectal liver metastases: side effects and results of a concomitant treatment schedule. Clinical investigation.

Safety evaluation of concomitant systemic chemotherapy and liver chemoembolization in patients with colorectal cancer. Seven patients with metastases confined to the liver were included and stratified into two groups, depending of dosage of systemic chemotherapy. The first group received systemic chemotherapy (FOLFIRI) with 20% dose reduction, and the second group received the full dose of the same chemotherapy. In both groups, chemoembolization of liver metastases with drug-eluting bead irinotecan (DEBIRI) was performed following the application of systemic chemotherapy. The toxicity profiles of the two groups were compared. Of the 7 patients included, 4 received the reduced systemic chemotherapy dose and 3 received the full chemotherapy dose. DEBIRI was performed in all 7 patients. The main toxicities observed in the reduced chemotherapy dose group were leukopenia (25%), anorexia (75%), diarrhea (25%), vomiting (25%), right upper abdominal quadrant pain (100%) and elevated serum amylase level (25%). Main toxicities observed in the full chemotherapy dose group were anorexia (66.6%), vomiting (33.3%), right upper abdominal quadrant pain (100%), and elevated serum amylase level (66.6%). There were no significant differences between the two groups ( P = 0.78541). Patients with isolated liver metastases from a colorectal primary can safely be treated with DEBIRI chemoembolization and a full dose of systemic chemotherapy (FOLFIRI).

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center.

Background: In trauma patients, pancreatic injury is rare; however, if undiagnosed, it is associated with high morbidity and mortality rates. Few predictive models are available for the identification of pancreatic injury in trauma patients with elevated serum pancreatic enzymes. In this study, we aimed to construct a model for predicting pancreatic injury using a decision tree (DT) algorithm, along with data obtained from a population-based trauma registry in a Level I trauma center. Methods: A total of 991 patients with elevated serum levels of amylase (>137 U/L) or lipase (>51 U/L), including 46 patients with pancreatic injury and 865 without pancreatic injury between January 2009 and December 2016, were allocated in a ratio of 7:3 to training (n = 642) or test (n = 269) sets. Using the data on patient and injury characteristics as well as laboratory data, the DT algorithm with Classification and Regression Tree (CART) analysis was performed based on the Gini impurity index, using the rpart function in the rpart package in R. Results: Among the trauma patients with elevated amylase or lipase levels, three groups of patients were identified as having a high risk of pancreatic injury, using the DT model. These included (1) 69% of the patients with lipase level ≥306 U/L; (2) 79% of the patients with lipase level between 154 U/L and 305 U/L and shock index (SI) ≥ 0.72; and (3) 80% of the patients with lipase level <154 U/L with abdomen injury, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophil percentage ≥76%; they had all sustained pancreatic injury. With all variables in the model, the DT achieved an accuracy of 97.9% (sensitivity of 91.4% and specificity of 98.3%) for the training set. In the test set, the DT achieved an accuracy of 93.3%, sensitivity of 72.7%, and specificity of 94.2%. Conclusions: We established a DT model using lipase, SI, and additional conditions (injury to the abdomen, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophils ≥76%) as important nodes to predict three groups of patients with a high risk of pancreatic injury. The proposed decision-making algorithm may help in identifying pancreatic injury among trauma patients with elevated serum amylase or lipase levels.

Efficacy and Safety of Pancreas-Targeted Hydrodynamic Gene Delivery in Rats.

Development of an effective, safe, and convenient method for gene delivery to the pancreas is a critical step toward gene therapy for pancreatic diseases. Therefore, we tested the possibility of applying the principle of hydrodynamic gene delivery for successful gene transfer to pancreas using rats as a model. The established procedure involves the insertion of a catheter into the superior mesenteric vein with temporary blood flow occlusion at the portal vein and hydrodynamic injection of DNA solution. We demonstrated that our procedure achieved efficient pancreas-specific gene expression that was 2,000-fold higher than that seen in the pancreas after the systemic hydrodynamic gene delivery. In addition, the level of gene expression achieved in the pancreas by the pancreas-specific gene delivery was comparable to the level in the liver achieved by a liver-specific hydrodynamic gene delivery. The optimal level of reporter gene expression in the pancreas requires an injection volume equivalent to 2.0% body weight with flow rate of 1 mL/s and plasmid DNA concentration at 5 μg/mL. With the exception of transient expansion of intercellular spaces and elevation of serum amylase levels, which recovered within 3 days, no permanent tissue damage was observed. These results suggest that pancreas-targeted hydrodynamic gene delivery is an effective and safe method for gene delivery to the pancreas and clinically applicable.

Protective effects of tropisetron on cerulein-induced acute pancreatitis in mice

Acute pancreatitis (AP) causes morbidity and mortality. The aim of the present study was to investigate the protective effect of tropisetron against AP induced by cerulein.Cerulein (50μg/kg, 5 doses) was used to induce AP in mice. Six hours after final cerulein injection, animals were decapitated. Hepatic/pancreatic enzymes in the serum, pancreatic content of malondialdehyde (MDA), pro-inflammatory cytokines and myeloperoxidase (MPO) activity were measured.Tropisetron significantly attenuated pancreatic injury markers and decreased the amount of elevated serum amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MPO activities and pro-inflammatory cytokines levels caused by AP in mice. Tropisetron didn’t affect the pancreatic levels of MDA.Our results suggest that tropisetron could attenuate cerulein-induced AP by combating inflammatory signaling. Further clinical studies are needed to confirm its efficacy in patients with AP.

Clinical features and treatment of residual gallbladder lesions after cholecystectomy

Objective To investigate the clinical features and treatment of residual gallbladder lesions after cholecystectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 83 patients with residual gallbladder lesions after cholecystectomy who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between January 2009 and April 2016 were collected. Among the 83 patients, 74 had residual gallbladder (41 combined with bile duct stones and 33 with simple residual gallbladder) and 9 had simple residual bile duct stones. Patients received laboratory and imaging examinations, and then selected suitable surgery according to residual lesions. Observation indicators included: (1) clinical features: medical history, clinical manifestation, features of laboratory and imaging examinations; (2) surgical and postoperative situations: surgical procedure, operation time, volume of intraoperative blood loss, time of drainage-tube removal, postoperative complications and duration of postoperative hospital stay; (3) postoperative pathological examination; (4) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and recurrence of lesions using abdomen color Doppler ultrasound up to October 2016. Measurement data with normal distribution were represented as ±s. Results (1) Clinical features: ① medical history: all the 83 patients had histories of cholecystectomy, including 57 with emergency operation and 26 with selective operation. ② Clinical manifestation: initial clinical manifestation occurred at 1-324 months postoperatively, with an average time of 96 months. Of 83 patients, 49 had right upper abdominal colic associated with right shoulder or back rediating pain, fever, nausea and vomiting, 24 had jaundice as the main symptoms, 8 had gradually worse conditions, with right upper quadrant abdominal pain, chills and fever associated with jaundice in the advanced stage and 2 had abdominal discomfort associated with incomplete intestinal obstruction. ③ Laboratory examination: elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels were detected in 48 patients, elevated total bilirubin (TBil) level in 28 patients and elevated serum and urinary amylase level in 4 patients, respectively. ④ Imaging examination: of 83 patients, 77 had positive results of magnetic resonanced cholangio-pancreatography (MRCP), 43 had positive results of abdominal color Doppler ultrasound and 39 (4 combined with pancreatitis) had positive results of abdominal computed tomography (CT). (2) Surgical and postoperative situations: all the 83 patients underwent surgery. Of 74 patients with residual gallbladder, 72 underwent residual gallbladder resection (of 41 combined with bile duct stones, 35 undergoing residual gallbladder resection + bill duct exploration and removing the stone + T-tube drainage, 6 initially undergoing endoscopic sphincterotomy for removing bile duct stones and then residual gallbladder resection and 31 undergoing simple residual gallbladder resection), 1 combined with residual gallbladder cancer underwent residual gallbladder resection + common bile duct resection + hepatic duct-jejunum internal drainage and 1 combined with residual gallbladder cancer and common bile duct space-occupying lesion underwent palliative biliary-enterostomy. Nine patients with simple residual bile duct stones underwent endoscopic sphincterotomy for removing bile duct stones. Operation time, volume of intraoperative blood loss, time of drainage-tube removal and duration of postoperative hospital stay were (92±39)minutes, (63±12)mL, (5±4)days and (9±5)days in 74 patients with residual gallbladder, respectively. There was no severe postoperative complication. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were (57±33)minutes, (25±9)mL and (5±3)days in 9 patients with simple residual bile duct stones, respectively. No severe complication was occurred in 9 patients. (3) Postoperative pathological examination: the length of residual cystic duct in 74 patients with residual gallbladder was (2.8±1.0)cm, combining with stones. Of 74 patients, simple hyperplasia of residual gallbladder were detected in 54 patients, dysplasia in 14 patients, tumor-like hyperplasia and benign tumor in 4 patients and adenocarcinoma in 2 patients. (4) Follow-up situation: all the 83 patients were followed up for 6-71 months, with a median time of 33 months. Eighty-one patients were healthy survival, without recurrence of lesions. One patient had recurrence of bile duct stones at 34 months postoperatively, and then was cured by choledochojejunostomy, without recurrence up to the end of follow-up. One patient with residual gallbladder cancer complicated with common bile duct space-occupying lesion died at 9 months postoperatively. Conclusions Patients have recurrent right upper abdominal colic associated with right shoulder or back rediating pain, fever and jaundice after cholecystectomy, and lesions of residual gallbladder or bile duct stones should be considered. Reoperation is safe and feasible for patients, with a good clinical outcome. Key words: Remnant gallbladder; Cholelithiasis; Cholecystectomy

English

INTRODUCTION : Acute pancreatitis is one of the important causes of acute abdomen. The aim of the study is to analyse the etiologies, the varying clinical presentations and prognosis of acute pancreatitis and to validate the clinical, biochemical and radiological signs in diagnosing acute pancreatitis. METHODS : Total of sixty patients include both male and female of adult age group admitted in the emergency ward at Tirunelveli medical college hospital with the symptoms of acute pancreatitis and evaluation confirmed the presence of the illness, between February 2015 to August 2016. Severity assessment was based on clinical, biochemical and radiological findings. RESULTS : In this study of 60 patients, most of the patients were alcoholic (90%). Abdomen pain (100%) and abdomen distension (42%) were the most common complaints. From this study, we can conclude that most of the attacks of acute pancreatitis were milder forms. In one patient the CT abdomen showed normal pancreas associated with elevated serum amylase and lipase levels. Grades A and B accounted for more than 75% of the patients. Both CT grading and Ranson’s number are correlating directly with the severity of the disease. Total mortality was 8 out of 60 patients. All had Ranson’s score of 2 and 3. CONCLUSION : Serum amylase and lipase has only role in diagnosis of acute pancreatitis. Ranson’s scoring and CT scan play a very important role in both diagnosis and assessment of severity of the disease.

Predictive value of serum amylase level in outcome of multiple trauma patients

Introduction: The early detection of injury in multiple trauma patients can lead to decreased mortality, length of stay, and improved clinical status of the patient. It is shown that there is a relation between increased level of serum amylase and pancreatic injury in trauma patients. The aim of this study is to evaluate serum amylase level in hospital outcomes of patients with abdominal blunt trauma. Methods: This study was a cross-sectional survey that was conducted at the emergency room of Imam Reza (AS) Medical and Educational Center in Tabriz, Iran, during a year (April 2014-April 2015) on 101 patients with blunt abdominal trauma. Serum amylase levels were measured 6 hours after injury. The outcome of patients during hospitalization including the need for laparotomy and mortality were followed. Data were analyzed by SPSS software. P < 0.050 was considered significant. Results: A significant relationship between elevated serum amylase level by laparotomy and mortality was observed (P < 0.001). 15 patients had serum amylase higher than 100 U/L. All patients with abnormal serum amylase died. Conclusion: Determination of serum amylase level can be valuable in the prognosis of patients with blunt abdominal trauma, especially in determining mortality and proceed to laparotomy. However, studies with larger research community are required to investigate the precise role of amylase in the diagnosis and prognosis of patients with blunt abdominal trauma.

Predicting pseudocyst formation following pancreatic trauma in pediatric patients.

There are insufficient data on pre-screening for pancreatic pseudocysts (PC) following pancreatic trauma. This study investigated the use of radiological and laboratory testing for predicting the development of pancreatic pseudocysts after trauma. The clinical records of all pediatric patients presenting with pancreatic trauma between January 2003 and December 2014 were reviewed retrospectively. Patients with American Association for the Surgery of Trauma (AAST) scores of Grade 3-5 were enrolled. The patients were divided into groups that developed [Group 1 (n=20)] and did not develop [Group 2 (n=18)] PC. The patients were evaluated in terms of their baseline characteristics, additional injuries, Injury Severity Score (ISS), pancreatic injury site, blood amylase levels 2h and 10-15days after the trauma, clinical presentation, and duration of intensive care unit (ICU) stay. We followed 38 patients. Of the patients in Group 1, 70% had an injury to the tail of the pancreas. The ISS trauma scores and durations of hospitalization and ICU stay were significantly greater in Group 2 (p<0.05). The mean blood amylase level on Day 1 was 607 U/L (range 183-801 U/L) in Group 1 and 314 U/L (range 25-631 U/L) in Group 2; the respective levels on Day 10 were 838 U/L (range 123-2951 U/L) and 83.2 U/L (range 35-164 U/L). The serum amylase levels were significantly higher (p<0.001) in Group 1 than in Group 2 on Days 1 and 10. Four patients developed complications and two patients died. Pancreatic pseudocyst formation is more likely in patients with AAST Grade 3 pancreatic injury, also serum amylase levels ten times greater than normal 2h after the trauma, and persistently elevated serum amylase levels 10-15days following the trauma.