Increased Serum Amylase Levels Research Articles

Effect of Nanoknife Ablation Therapy in Patients with Pancreatic Cancer

This study was established to explore the therapeutic effect of nanoknife ablation in the treatment of pancreatic cancer with comprehensive perioperative nursing. The clinical data of 92 patients with pancreatic cancer who underwent nanoknife ablation surgery in The First Affiliated Hospital, Sun Yat-sen University and Sun Yat-sen University Cancer Center from January 2015 to December 2018 were retrospectively studied. These 92 patients were randomly and equally divided into a group with comprehensive perioperative nursing care and a group with routine nursing care. After the intervention period, the satisfaction with the nursing, serum albumin, total protein, and hemoglobin levels, length of hospital stay, and incidence of postoperative complications were compared between the two groups. Meanwhile, blood biochemical indicators and related immune indicators of 30 patients in the comprehensive nursing group were analyzed and compared between before and after the operation. Results: The hospitalization time of patients in the routine care group was significantly longer than that in the comprehensive care group (P < 0.05). Meanwhile, the levels of albumin, total protein, and hemoglobin in the serum of patients in the comprehensive care group were significantly higher than those in the routine care group (P < 0.05). All patients exhibited a certain increase in serum amylase level on the day after the operation, which then gradually decreased. There was no statistically significant difference in myocardial enzyme indexes at different time points before and after the operation. The glycoprotein antigen tumor markers carbohydrate antigen (CA)-19-9 and CA-242 increased on the 1st day after surgery, and gradually decreased thereafter. This study indicated that the safety of nanoknife ablation in patients with pancreatic cancer is relatively high. In addition, there is a clear clinical effect of comprehensive nursing care in the perioperative period, which can effectively improve the levels of albumin, total protein, and hemoglobin, shorten the hospitalization time, and reduce the incidence of postoperative complications. Such nursing care also relieved the tumor-related immunosuppression after surgery and significantly decreased the levels of tumor markers.

Acute Pancreatitis After Percutaneous Metallic Stent Insertion for Malignant Biliary Obstruction: A Retrospective 2-Center Study.

The current study investigated the incidence, risk factors, and outcomes of acute pancreatitis after percutaneous transhepatic biliary stenting for malignant biliary obstruction. From March 2016 to May 2020, a total of 425 patients who underwent percutaneous transhepatic biliary stent- ing for malignant biliary obstruction were included in this 2-center study. After the procedure, we analyzed the incidence, risk factors, and outcomes of acute pancreatitis. On follow-up, 79 (18.6%) patients showed increased serum amylase levels, of whom 41 (9.6%) developed pancreatitis. On binary logistic regression analysis, stent across the duodenal papilla (odds ratio = 8.54; 95% CI = 3.54-20.62; P < .001) and visualization of the pancreatic duct (odds ratio = 9.87; 95% CI = 4.67-20.86; P < .001) were significant risk factors of pancreatitis after the procedure. Using conservative therapy, all patients were successfully managed at a mean of 3.5 days (range 1-6 days), and no severe pancreatitis happened. Acute pancreatitis is a relatively common complication after percutaneous transhepatic biliary stenting. Stent across the duodenal papilla and visualization of the pancreatic duct are independent risk factors.

Serum amylase a prognostic indicator in acute organophosphorous compound poisoning

Background: OPC is being considered as the most important agent of self-poisoning among the younger generation people because of its easy availability. Recent studies have reported an early increase in serum amylase levels among patients with OP compound poisoning and found hyperamylasemia to be closely associated with the clinical signs and symptoms and more so with respiratory failure. Aim: To study the serum amylase levels among patients with OPC poisoning and correlate its levels with the clinical features on the day of presentation. Methodology: A prospective longitudinal study was conducted for a period of two years in a Government medical college hospital at TamilNadu. A total of 278 patients reported to our hospital with history of OPC poisoning during the said period among which 157 patients satisfying our inclusion and exclusion criteria are selected as our study subjects. Severity of OPC intoxication was measured using POP (Peradeniya OP poisoning) scale and it was graded as mild, moderate and severe. Serum amylase level was measured for all the patients on the day of admission.

Ginsenoside Rg3 ameliorates acute pancreatitis by activating the NRF2/HO‑1‑mediated ferroptosis pathway.

Acute pancreatitis (AP) is an inflammatory disorder that has been associated with systemic inflammatory response syndrome. Ginsenoside Rg3 is a major active component of Panax ginseng, which has been demonstrated to exert potent protective effects on hyperglycemia and diabetes. However, it remains to be determined whether Rg3 ameliorates AP. Thus, an in vitro AP cell model was established in the present study by exposing AR42J cells to cerulein (Cn). AR42J cell viability was increased in the Rg3-treated group as compared with the Cn-exposed group. Simultaneously, the number of dead AR42J cells was decreased in the Rg3-treated group compared with the group treated with Cn only. Furthermore, following treatment with Rg3, the production of malondialdehyde (MDA) and ferrous ion (Fe2+) in the AR42J cells was reduced, accompanied by increased glutathione (GSH) levels. Western blot analysis revealed that the decrease in glutathione peroxidase 4 (GPX4) and cystine/glutamate transporter (xCT) levels induced by Cn were reversed by Rg3 treatment in the AR42J cells. Mice treated with Cn exhibited increased serum amylase levels, as well as increased levels of TNFα, IL-6, IL-1β, pancreatic MDA, reactive oxygen species (ROS) and Fe2+ production. Following Rg3 treatment, ROS accumulation and cell death were decreased in the pancreatic tissues compared with the AP group. Furthermore, in the pancreatic tissues of the AP model, the expression of nuclear factor-erythroid factor 2-related factor 2 (NRF2)/heme oxygenase 1 (HO-1)/xCT/GPX4 was suppressed. In comparison, the NRF2/HO-1/xCT/GPX4 pathway was activated in pancreatic tissues following Rg3 administration. Taken together, the present study, to the best of our knowledge, is the first to reveal a protective role for Rg3 in mice with AP by suppressing oxidative stress-related ferroptosis and the activation of the NRF2/HO-1 pathway.

Therapeutic Methylprednisolone and Infimab Decrease the Severity of Organ Dysfunction in Pancreatic Duct Ligation Model of Severe Acute Pancreatitis in Wistar Rats

Introduction: There is no standardized, widely used model of severe acute pancreatitis (SAP) with organ failure. This may limit drug development in SAP. Dysregulated and hyperimmune responses are the root cause for organ failure in SAP. We established a rat model of SAP with organ failure and evaluated directly translatable, clinically relevant parameters of organ dysfunction. We also evaluated the effects of therapeutic administration of methylprednisolone (MP) and TNF-α antibody infimab (Infliximab biosimilar) on the severity of experimental SAP induced by the ligation of the main pancreatic duct in rats. Methods: SAP was induced in adult male Wistar rats (250-350 g) by ligating the main pancreatic duct proximal to the biliopancreatic junction. One-hour after the procedure, therapeutic medication was administered intraperitoneally. Experiments were done in duplicate(batches of 3 rats/group) in sham surgery, SAP, SAP+MP, and SAP+infimab groups. At 0 (pre-intervention) and 48 hours (post-intervention), invasive BP, heart rate, serum amylase, lactate, paO2, SpO2, pH, renal and liver function were measured. Rats were sacrificed at 48 hours and the harvested pancreas, kidney and lung tissues were assessed histopathologically. Results: There was a significant increase in serum amylase level (p=0.019) and histopathological scores (p=0.003) in the SAP group as compared to sham surgery with no significant effect of either MP or Infimab (amylase:p = 0.211, histopathological score:p = 0.103). Both MP and Infimab significantly prevented a fall in BP and decrease in SpO2 following induction of SAP compared to the vehicle control (Table1). Conclusions: Therapeutic administration of MP or Infimab ameliorates the systemic inflammation and organ dysfunction associated with SAP in rats.Tabled 1EP02A-024SAP (Vehicle control)SAP + IP MethylprednisoloneSAP + IP Infimabp value for between group comparison of change following intervention (vehicle control vs MP vs Infimab )Change* following Interventionp value of change*Change following Interventionp value of change*Change* following Interventionp value of change*Amylase (IU/L)2681 (1072 to 3753)0.0043260 (1490 to 9960)0.0621457.5 (370 to 2350)0.0310.211Mean BP (mmHg)-15.4 (-17 to -13.4)0.004-3.6 (-6 to 6)0.688-19.3 (-28.6 to -3.9)0.0940.023Heart Rate (beats/min)-47 (-57.1 to -36.5)0.004-6.4 (-31.3 to -2.3)0.313-15.1 (-37.3 to 1.8)0.4380.133Blood Lactate (mmol/L)2.3 (0.7 - 2.7)0.0091.8 (1.2 - 2.3)0.0312.05 (0.2 - 2.3)0.0630.845SpO2 (%)-3.5 (-9.5 to -1.9)0.008-0.5 (-5.9 to 2.9)0.688-0.4 (-0.2 to 0)0.5840.176pO2 (mmHg)-5 (-31.9 to -0.9)0.074-3.7 (-65.6 to 9.5)0.563-6.7 (-16.1 to 1.9)0.2190.786*change refers to difference between the pre - intervention and post - intervention values Open table in a new tab *change refers to difference between the pre - intervention and post - intervention values

Positive Predictive Value of Serum Amylase in Predicting Acute Appendicitis taking Histopathology as Gold Standard

Background: Worldwide acute appendicitis is one of the most commonly encountered abdominal emergencies. Despite recent advances in imaging and laboratory parameters, the diagnosis still remains clinical. This study was carried out to determine positive predictive value of serum amylase in diagnosing acute appendicitis taking into account histopathology as gold standard. Methods: Total 103 patients of both genders aged between 15-40 years presenting with pain and tenderness in right iliac fossa and vomiting having raised serum amylase &gt; 85U/L were included. These patients underwent appendectomy followed by histopathology of excised tissue. Diagnosis of appendicitis was confirmed on histopathology postoperatively and results of increased serum amylase levels were interpreted accordingly as true positive/ false positive. Informed consent was taken from all enrolled patients. Results: Mean age of the enrolled patients was 27.8±7.5 years. There were 59 (57.3%) male and 44 (42.7%) female patients, with a male to female ratio of 1.3:1. The BMI of enrolled patients ranged from 22.0 Kg/m2 to 34.4 Kg/m2 with a mean of 26.9±3.4 Kg/m2. Diagnosis of appendicitis was confirmed in 93 (90.3%) patients on histopathology. Thus there were 93 true positive and 10 false positive cases. It yielded a positive predictive value of 90.3% for serum amylase in predicting acute appendicitis taking histopathology as gold standard. Similar positive predictive value was noted across various subgroups based on age, gender and BMI. Conclusion: In the present study, the positive predictive value of raised serum amylase was found to be 90.3% in predicting acute appendicitis which along with simplicity and routine availability of the test and low cost advocate the preferred use of this novel biomarker in the diagnostic workup of such patients in future surgical practice. Keywords: Appendicitis, Serum Amylase, Positive Predictive Value

Role of Alanine Aminotransferase in Determining the Biliary Etiology in Acute Pancreatitis

Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to &gt;150 IU/L is a predictive factor for biliary cause of acute pancreatitis.&#x0D; Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis.&#x0D; Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography.&#x0D; Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001).&#x0D; Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.

Selective inhibition of soluble TNF using XPro1595 relieves pain and attenuates cerulein-induced pathology in mice

BackgroundSymptoms associated with acute pancreatitis can be debilitating, and treatment remains a challenge. This study aimed to investigate the efficacy of selectively inhibiting the soluble form of TNF (solTNF) using the biologic XPro1595 in a mouse model of acute pancreatitis.MethodsAcute pancreatitis was induced in adult male C57Bl/6J mice by administering cerulein (8 injections of 50 µg/kg I.P., spaced an hour apart), with XPro1595 (10 mg/kg, S.C.) or vehicle being administered approximately 18 h after the last injection. Serum was collected 6 or 18 h after the last cerulein injection, pancreatic tissue was collected 2 and 7 days post-induction, and brain hippocampal tissue was collected at 7 days post-induction. The animal’s pain level was assessed 3, 5 and 7 days post-induction.ResultsThe induction of acute pancreatitis promoted a strong increase in serum amylase levels, which had receded back to baseline levels by the next morning. XPro1595 treatment began after amylase levels had subsided at 18 h, and prevented pancreatic immune cell infiltration, that subsequently prevented tissue disruption and acinar cell death. These improvements in pathology were associated with a significant reduction in mechanical hypersensitivity (neuropathic pain). XPro1595 treatment also prevented an increase in hippocampal astrocyte reactivity, that may be associated with the prevention of neuropathic pain in this mouse model.ConclusionOverall, we observed that selectively inhibiting solTNF using XPro1595 improved the pathophysiological and neurological sequelae of cerulein-induced pancreatitis in mice, which provides support of its use in patients with pancreatitis.

Correlation of serum amylase level with the severity of acute organophosphorus compounds poisoning

Background: Organophosphorus (OP) poisoning is a common mode of suicidal poisoning in our country and is associated with significant mortality and morbidity. Serum amylase has shown a promising role in the assessment of the severity of OP poisoning. We conducted this study to see the association of serum amylase level with acute OP poisoning severity.Methods: This cross-sectional study was conducted among 150 patients admitted with acute OP poisoning to the inpatient department of medicine of a tertiary hospital in Bangladesh from July 2016 to June 2018. Peradeniya organophosphorus poisoning scale was used to detect clinical severity. Serum amylase was measured on the day of admission.Results: The patients' mean age was 23.68±6.80 years, and 65.3% were male. As assessed by the POP scale, 56.7%, 34.7%, and 8.7% of patients had mild, moderate, and severe grades of OP poisoning, respectively. The median serum amylase level was 103.50 (IQR 73.75-156.0) IU/l; 44.7% of the subjects had normal, and 53.3% had an elevated serum amylase. A progressive increase in serum amylase level was observed with the increasing severity of OP poisoning; 77.0 IU/l (IQR 58.0-97.0) in mild grade, 154.0 IU/l (IQR 125.25-162.5) in moderate grade, and 298.0 IU/l (IQR 289.5-305.0) in severe grade and the differences in the median amylase across the three groups were statistically significant (p&lt;0.001). A significant positive correlation between serum amylase level and POP scale score (r=0.970; p&lt;0.001) was also observed.Conclusions: Serum amylase level may be used as a readily available marker of the severity of acute OP poising in resource-poor settings.

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.&#x0D; Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.&#x0D; Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.&#x0D; Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

Risk factors of complications after laparoscopic pancreatoduodenectomy

Endoplasmic reticulum (ER) stress in the pancreas is closely associated with the development of acute pancreatitis. However, the role of the protein kinase RNA-like ER kinase (PERK) in this disease is not fully understood. We investigated whether an inhibitor of the dephosphorylation of eukaryotic initiation factor 2α, salubrinal, could improve murine experimental pancreatitis through the amelioration of ER stress.Acute pancreatitis was induced by the intraperitoneal administration of cerulein (50 μg/kg) six times at 1-h intervals followed by lipopolysaccharide (10 mg/kg). Salubrinal was administered intraperitoneally immediately after lipopolysaccharide injection and 3 h later. Mice were sacrificed 24 h after the first injection of cerulein, and serum amylase and proinflammatory cytokines were measured. The severity of pancreatitis was evaluated histologically using a scoring system. The expression levels of ER stress-related proteins were evaluated by Western blotting.The administration of salubrinal significantly attenuated the increase in serum amylase levels and improved histologically assessed pancreatitis. The serum levels of proinflammatory cytokines were significantly suppressed in salubrinal-treated mice, as was the expression of glucose-regulated protein 78, CCAAT/enhancer-binding protein homologous protein, and cleaved caspase-3.The amelioration of ER stress through augmentation of the PERK-signaling pathway may be a therapeutic target for the treatment of acute pancreatitis.

Inhibition of the dephosphorylation of eukaryotic initiation factor 2α ameliorates murine experimental pancreatitis

BackgroundEndoplasmic reticulum (ER) stress in the pancreas is closely associated with the development of acute pancreatitis. However, the role of the protein kinase RNA-like ER kinase (PERK) in this disease is not fully understood. We investigated whether an inhibitor of the dephosphorylation of eukaryotic initiation factor 2α, salubrinal, could improve murine experimental pancreatitis through the amelioration of ER stress. MethodsAcute pancreatitis was induced by the intraperitoneal administration of cerulein (50 μg/kg) six times at 1-h intervals followed by lipopolysaccharide (10 mg/kg). Salubrinal was administered intraperitoneally immediately after lipopolysaccharide injection and 3 h later. Mice were sacrificed 24 h after the first injection of cerulein, and serum amylase and proinflammatory cytokines were measured. The severity of pancreatitis was evaluated histologically using a scoring system. The expression levels of ER stress-related proteins were evaluated by Western blotting. ResultsThe administration of salubrinal significantly attenuated the increase in serum amylase levels and improved histologically assessed pancreatitis. The serum levels of proinflammatory cytokines were significantly suppressed in salubrinal-treated mice, as was the expression of glucose-regulated protein 78, CCAAT/enhancer-binding protein homologous protein, and cleaved caspase-3. ConclusionsThe amelioration of ER stress through augmentation of the PERK-signaling pathway may be a therapeutic target for the treatment of acute pancreatitis.

Effects of Octreotide and Allopurinol on Liver Histology and Functions in Surgical Jaundice: An Experimental Study

Aim: Mechanical jaundice may lead to adverse metabolic effects in surgical patients. Our aim was to investigate the effects of octreotid and allopurinol on liver histology and functions in rats with experimantally created mechanical jaundice.&#x0D; Methods: The subjects were divided into five main groups. The rats in Group I (Control) received no interventions. In Group II, common bile duct ligation (CBDL) was performed. In Group III, the same ligation procedure was performed followed by the administration of octreotid. In Group IV, the rats received allopurinol following CBDL and in Group V (Sham), the common bile duct was dissected and left intact. After sacrification of each rat on the seventh postoperative day, blood samples were collected for serum hematocrit, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, and albumin measurements in addition to the histopathologic examinations of the collected tissue specimens from the liver, terminal ileum, and pancreas. According to statistical analysis, a value of p&lt;0.05 was considered as significant.&#x0D; Results: The direct bilirubin, AST and ALT levels were detected to be significantly elevated in the groups II, III and IV, in which CBDL was performed (p&lt;0.05). While significant reductions of serum direct bilirubin, AST and ALT levels were detected in the octreotide group, these parameters were significantly elevated in the allopurinol group (p&lt;0.05 and p&lt;0.05, respectively). There was no significant difference of hematocrit and albumine levels among the study groups (p&gt;0.05). Additionally, in the allopurinol group four rats were found to have increased serum amylase levels and the histopathologic evaluations of their pancreatic samples revealed findings of pancreatitis. According to the histopathologic examinations, significant alterations were detected between the control and sham groups (groups I, V) and the CBDL groups (groups II, III, IV). However, these histopathological findings revealed no significant differences within the subgroup of subjects including CBDL alone (Group II), and CBDL along with the administration of either octreotide (Group III), or allopurinol (Group IV).&#x0D; Conclusion: The use of octreotide in mehanical jaundice may have protective metabolic effects. Further studies are considered necessary to be carried to support these findings.

Cathelicidin-related antimicrobial peptide modulates the severity of acute pancreatitis in mice.

The present study aimed to investigate the immunomodulatory effects of mouse cathelicidin-related antimicrobial peptide (CRAMP) on experimental acute pancreatitis (AP). AP is a common clinical condition characterized by acute abdominal inflammation. Innate immune cells and mediators are intrinsically linked to the pathogenesis of AP. Cathelicidins are innate immunity-derived antimicrobial peptides that exert immunomodulatory effects on various host cells. However, how cathelicidins are involved and modulate the severity and inflammatory responses of AP remains unclear. In the present study, the mouse CRAMP gene-deficient cnlp−/− mice and their wild-type C57BL/6J littermates were induced with AP by multiple hourly injections of supramaximal doses of caerulein. Serum amylase levels, pancreatic myeloperoxidase activity and histological examination were performed in order to determine the disease severity and the levels of inflammatory cytokines. Disease severity and inflammatory markers were subsequently evaluated in the control mice, cnlp−/− C57BL/6J mice with AP, and wild-type C57BL/6J mice with AP. The results demonstrated that cnlp−/− mice exhibited a more severe phenotype and inflammatory response following AP induction compared with the wild-type mice, as evidenced by increased serum amylase levels, pancreatic myeloperoxidase release, and early inflammatory mediator tumor necrosis factor-α production. Histological examination confirmed that CRAMP deficiency worsened the pancreatic inflammatory condition. These results indicate that CRAMP may be considered a novel modulatory mediator in mouse experimental AP.

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

OBJECTIVE The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. METHODS Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. RESULTS A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). CONCLUSIONS The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

The role of Toll-like receptor polymorphisms in acute pancreatitis occurrence and severity.

Toll-like receptors (TLRs) are damage-associated molecular patterns receptors, which are essential in the activation of the inflammasome cascade, required for the initiation of inflammation. We hypothesized that changes in the function of these receptors caused by genetic polymorphisms in their encoding genes could determine acute pancreatitis (AP) incidence or severity. Two hundred sixty-nine patients and 269 controls were included. Acute pancreatitis diagnosis criteria were abdominal pain, increased serum amylase levels, and positive findings on abdominal imaging. The patients were observed until discharge. Blood samples were obtained, determining the following TLRs: TLR1 rs5743611, TLR2 rs5743704, TLR3 rs3775291, TLR3 rs5743305, TLR4 rs4986790, TLR4 rs4986791, TLR5 rs5744174, TLR6 rs5743795, TLR7 rs2302267, TLR9 rs352140, and TLR10 rs4129009. No TLR polymorphism was related to AP incidence. Regarding severity, CC genotype patients in TLR3 rs3775291 had an increased risk for severe pancreatitis (CC odds ratio [OR], 2.426; P = 0.015). In addition, TLR6 rs5743795 GG genotype patients had a lower risk for severe AP (GG OR, 0.909; P < 0.05). Intensive care unit admission was related to TLR5 rs5744174 homozygote TT carriers (TT OR, 3.367; P = 0.036). Our article points to genetic polymorphisms in TLR3 and TLR6 as having a plausible role in the occurrence of severe AP.

Routine Measurement of Serum Amylase in Acute Abdomen

Acute abdominal pain is a common condition presenting to both the emergency department (ED) and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. A prospective observational study was performed from 15th May 2014 - 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L). Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.

Radiofrequency Pancreatic Ablation and Section of the Main Pancreatic Duct Does Not Lead to Necrotizing Pancreatitis

The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

Effect of Milrinone Therapy on Splanchnic Perfusion after Heart Transplantation

Milrinone is a selective inhibitor of the cAMP-specific phosphodiesterase III isoenzyme in myocardium and vascular smooth muscle. Milrinone administration following heart transplantation is routine practice. The purpose of this study was to evaluate the influence of milrinone therapy on splanchnic perfusion following heart transplantation. There were 12 patients (10 males and 2 females) with a mean age of 42 ± 12 who underwent heart transplantation. Milrinone parenteral following surgery was started after surgery and continued for the next 67 ± 4 h. Repeated Swann-Ganz measurements and control transthoracic echocardiography were performed. Blood samples were taken to estimate level of lactic acid (LA), liver transaminases, serum amylase, and GFR ratio. The mean time of milrinone administration was 67 ± 4 h. The serum LA increase following milrinone discontinuation was 1.7 ± 0.7 mmol/dm(3) vs. 3.8 ± 0.9 mmol/dm(3), (p<0.0001). The serum AST increase following milrinone discontinuation was 79 ± 30 IU/L vs. 135 ± 55 IU/L, p<0.04). We found a significant increase of blood ALT (29 ± 9 IU/L vs. 60 ± 23 IU/L) (p<0.0002) after milrinone withdrawn. There was a progressive increase in serum amylase levels after milrinone was withdrawn (80.6 ± 29 IU/L vs. 134 ± 45 IU/L, p<0.05). Milrinone withdrawal during the postoperative period was associated with deterioration of splanchnic perfusion, as shown by a transient increase in lactic acid and serum increase of aminotransferases (ALT/ASP) concentration and amylase activity. The study results show the extracardiac effects of milrinone therapy.

Diamine oxidase in diagnosis of acute mesenteric ıschemia

ObjectiveAcute mesenteric ischemia (AMI) is an important clinical condition with a high mortality rate in abdominal emergencies due to delay in diagnosis in spite of the new strategies in the management. We have studied the role of diamine oxidase (DAO) in the early diagnosis of AMI. MethodsIn the study, 21 New Zeland rabbits were used. Subjects were named as the groups of controls, sham, and ischemia. No intervention was performed in the subjects in the control group. In the subjects from sham and ischemia groups, laparotomy was performed with middle line incision. However, superior mesenteric artery was found and tied in those from ischemia group after the performance of laparotomy. From the animals in 3 groups, blood was drawn at the hours of 0, 1, 3, and 6, and DAO and amylase were studied in these samples. ResultsThe increase in serum amylase levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). The decrease in serum DAO levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). Diamine oxidase levels were found to decrease, beginning from the 1 hour after ischemia had been developed, and this rise was found to continue for 6 hours (P < .05). ConclusionSerum DAO levels were decreased in ischemia. Further clinical and experimental investigations would be valuable to confirm the probable role of DAO in AMI.