Mild Form Of Acute Pancreatitis Research Articles

The possibilities of cytoreductive operations in recurrent abdominal pain syndrome in cancer patients, occurring under the mask of acute pancreatitis

Among the diseases of urgent pathology, the leading place belongs to acute pancreatitis, which is inferior to such nosologies as acute appendicitis and acute cholecystitis. Moreover, the lion’s share is occupied by light forms, which make up 85%. The aim of the work is to demonstrate a clinical case of recurrent abdominal syndrome occurring under the mask of acute pancreatitis in a patient with oncopathology identified using a diagnostic algorithm used in outpatient practice. Material and methods. Patient F., 60 years old, repeatedly sought medical help in a network of polyclinics and hospitals providing emergency specialized medical care with recurrent abdominal syndrome. Results and discussion. Against the background of conservative treatment, the patient had a short-term positive dynamics characteristic of a mild form of acute pancreatitis. After taking the patient to the dispensary and conducting an in-depth diagnostic examination according to the algorithm developed by our group of researchers, cancer of the stomach stump T2N0M0 was detected. Conclusion. Patients with recurrent abdominal pain syndrome need dispensary observation on an outpatient basis to identify other pathology occurring under the guise of acute pancreatitis and to conduct adequate treatment.

Acute Pancreatitis in Patients After Liver Transplantation.

BACKGROUND Acute pancreatitis (AP) is a relatively rare but serious complication that can occur after organ transplantation. MATERIAL AND METHODS The aim of this study was to evaluate the incidence, potential risk factors, and course of AP in patients following liver transplantation at a single large-volume transplant center. RESULTS Out of a total of 1850 transplanted patients, 49 (2.8%) were diagnosed with AP. Of this group, 37 (75.5%) had a mild form of AP and 12 (24.5%) had a severe form of AP. The mortality rate was 10% overall and 42% in the group of patients with severe AP. An early form of AP (<30 days from transplantation) occurred in 13 patients (26.5%), most of whom presented with severe AP (10 patients, 76.9%); 4 patients died (40%). A late form of AP was diagnosed in 36 patients (73.5%), most of whom had mild AP (34 patients, 94.4%); 1 of 2 patients with severe AP died. The most common AP etiologies were post-ERCP (38.8%), idiopathic (34.7%), and postoperative (18.4%). Chronic HBV infection was a risk factor for development of AP (P=0.01). CONCLUSIONS AP in liver transplant recipients was more frequent and more severe than in the general population. This unfavorable course was associated with the occurrence of AP in the early post-transplant period. Liver transplantation due to complications of HBV infection was a risk factor for the development of AP.

ACUTE PANCREATITIS in HELSINKI in 2016−2018: INCIDENCE, ETIOLOGY and RISK FACTORS - analysis of 1378 acute pancreatitis episodes in a Finnish normal population

Objectives Updated population-based studies on acute pancreatitis (AP) in Finland are lacking. Our aim was to evaluate the current data for AP in Helsinki. Materials and methods We performed an electronic health care records (EHRs) search on AP patients treated at Helsinki University Hospital between the years 2016 − 2018. Incidence was calculated, etiological and potential risk factors, as well as severity of AP were documented and analyzed. Results Between 2016 and 2018 we found 1378 AP episodes on 1084 patients, 35% of the patients had several AP episodes, i.e., recurrent AP (RAP). The domicile-adjusted incidence was 42.2/100 000. 47% of the patients had alcohol etiology (59% men, 27% women) and 23% had biliary etiology, 21% were idiopathic and 2.9% were post-ERCP pancreatitis. 13.1% of the patients had passed at the end of September 2021. 45% of the patients were currently smoking, 11% were ex-smokers, and the highest percentage of smokers was in the group of alcohol-caused AP with 74% ever-smokers. Biliary AP had the highest amount of overweight patients. 24% of the patients used anticoagulation (AC) medication, and the percentage was significantly higher with idiopathic AP (48%). RAP, female sex and normal BMI associated with a mild form of AP. Conclusions Incidence of AP and the percentage of alcohol etiology are lower than earlier reported for Finland although still higher than in other Nordic countries. Smoking and the use of AC medication associate with AP.

Severe Forms of Acalculous Acute Pancreatitis in Young Female Patients. A Preliminary Study.

Acute pancreatitis (AP) is a severe disease that usually involves hospitalization and a customized therapy. To date, remarkable progress has been made in establishing the etiology, diagnosis and therapy of this condition. For example, it is well documented that the AP course consists of two distinct pathophysiological phases. The first phase lasts about 1-2 weeks, involving only local inflammatory changes and possibly a transient SIRS syndrome, which require conservative therapy. The second phase is represented either by disease remission in patients with mild forms of AP, or by the persistence of SIRS syndrome and the occurrence of local complications in patients with moderate forms. Local complications therefore often occur in the second phase, when therapy must be customized according to the complications of the pancreatic area, as well as to provide adequate systemic support. Methods/ Results: Severe forms are less common and generally associate MSOF, which can develop at any time in the evolution of AP. MSOF worsens preexisting SIRS syndrome and local complications, making treatment more difficult and significantly increasing morbidity and mortality. This study presents the evolution of a group of patients with acalculous AP, who did not present in the first phase any systemic determinant of SIRS syndrome. Consequently, our initial prognosis was favorable, but the evolution of some patients was unexpectedly severe. Conclusions: Such surprising cases in terms of the evolution may suggest that increased caution is required in all AP patients, even if preliminary data suggest a mild form of the disease. Additional studies are necessary in the near future on this topic, both to improve therapy and to establish a better prognostic score by using new diagnostic tools.

Predictors of prolonged hospitalization in patients with mild and moderate pancreatitis presenting to the emergency department.

Patients with acute pancreatitis often present to the emergency department (ED) and usually require hospital admission. The aim of this study was to determine predictors of prolonged hospital stays in patients with mild forms of acute pancreatitis. This retrospective cohort study was conducted in patients diagnosed in the ED with mild and moderate acute pancreatitis according to the revised Atlanta classification. Patients with available data between 2007 and 2017 were included and were divided based on their admission duration. Eight days or more was considered along hospitalization. Amultivariate logistic regression model was constructed to determine the independent predictors of prolonged hospital stays. Of the 485 evaluated patients, 335 were included in the analysis. Baseline characteristics, determined by vital signs and laboratory parameters, were similar between the short and long hospitalization groups. However, the long hospitalization group received more intravenous crystalloid in the ED, and this group used more diuretics and more angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker (ACEI/ARB) drugs than the other group. Diuretic use was present in 8patients (4.8%) in the short hospital length of stay group and in 26patients (15.3%) in the long hospital length of stay group. Age, gender, ACEI/ARB use, diuretic use, total amount of intravenous crystalloid administered in the ED, aPTT, BUN, creatinine, and presence of biliary pathology were included in the multivariate analysis. Regarding the final analysis, diuretic use was an independent predictor of prolonged hospitalization (odds ratio 2.89, 95% confidence interval 1.05-8.00, p = 0.041). Diuretic use is an independent predictor of long hospitalization in patients with mild and moderate pancreatitis. Drugs affecting total volume balance may prolong hospital stays in these patients.

PGI14 PHARMACOECONOMIC ASPECTS OF TREATMENT OF ACUTE PANCREATIS IN CENTRAL PART OF SERBIA - COST OF ILLNESS STUDY BASED ON DATA FROM TERTIARY REFERRAL HOSPITAL

Acute pancreatitis is a progressive inflammatory pancreatic disease and one of the most common reasons for hospitalization in patients with gastrointestinal diseases. Due to various clinical forms of acute pancreatitis and the fact that this disease is treated mostly in the hospital, the pharmacoeconomic effect of this disease is significant, especially in countries with recent history of socio-economic transition. Determination of total hospital costs of treatment of acute pancreatitis from perspective of the Health Insurance Fund and identifying the main determinants of these costs. This research was conducted as a pharmacoeconomic retrospective cost of illness study with “from bottom to the top“ approach from perspective of the Republic Health Insurance Fund. This study included 92 patients who were treated due to acute pancreatitis at the General Surgery Clinic of the Clinical Center Kragujevac from October 2016 to October 2018. The total hospital costs were expressed in Republic Serbia Dinars (RSD) and were presented as the total hospital costs and average hospital costs per patient per year. The total hospital costs of treating acute pancreatitis for the examined population were estimated to 35,923,574.65 RSD. The average costs of treating mild form of acute pancreatitis were amounted to 200,239.58 ± 340,864.40 RSD and for patients with severe form this average costs were higher with value of 1,229,741.55 ± 772,294.30 RSD. Medication costs had the greatest impact in total hospital costs in all analysed populations. The total hospital costs of the treating acute pancreatitis in the Republic of Serbia are lower than in European countries. These differences can be explained by the policy of determining the prices of health services since these costs are significantly lower in the Republic of Serbia than in regional countries and other European countries.

Tempol, a Membrane-Permeable Radical Scavenger, Exhibits Anti-Inflammatory and Cardioprotective Effects in the Cerulein-Induced Pancreatitis Rat Model.

To date, it remains unclear whether mild form of acute pancreatitis (AP) may cause myocardial damage which may be asymptomatic for a long time. Pathogenesis of AP-related cardiac injury may be attributed in part to ROS/RNS overproduction. The aim of the present study was to evaluate the oxidative stress changes in both the pancreas and the heart and to estimate the protective effects of 1-oxyl-2,2,6,6-tetramethyl-4-hydroxypiperidine (tempol) at the early phase of AP. Cerulein-induced AP led to the development of acute edematous pancreatitis with a significant decrease in the level of sulfhydryl (–SH) groups (oxidation marker) both in heart and in pancreatic tissues as well as a substantial increase in plasma creatine kinase isoenzyme (CK-MB) activity (marker of the heart muscle lesion) which confirmed the role of oxidative stress in the pathogenesis of cardiac damage. The tempol treatment significantly reduced the intensity of inflammation and oxidative damage and decreased the morphological evidence of pancreas injury at early AP stages. Moreover, it markedly attenuated AP-induced cardiac damage revealed by normalization of the –SH group levels and CK-MB activity. On the basis of these studies, it is possible to conclude that tempol has a profound protective effect against cardiac and pancreatic damage induced by AP.

Plasma Pentraxin 3 Concentrations in Patients with Acute Pancreatitis

Pentraxin 3 (PTX3) belongs to the acute phase proteins; its concentration increases significantly in the early stages of inflammation. In nearly 20% of patients with acute pancreatitis (AP) escalated inflammation leads to the development of severe forms of the disease. The aim of this study was to evaluate the pattern of changes in PTX3 concentration in patients with AP at the early stage of the disease (first 5 days from admission) and to assess the relationship between PTX3 and other inflammatory markers. The study included 40 patients with AP (16 women and 24 men)--12 with severe and 28 with mild form of AP. Concentrations of PTX3, serum amyloid A (SAA), C-reactive protein (CRP), hepatocyte growth factor (HGF), procalcitonin (PCT), polymorphonuclear elastase (PMN-elastase), interleukin 6 (IL-6), interleukin 18 (IL-18), and soluble receptor for TNFalpha (sTNFR75) were measured in samples collected on the 1st, 3rd, and 5th day of the hospital stay. Plasma PTX3 was measured also in the control group, consisting of 37 age and sex-matched healthy subjects. The highest concentrations of PTX3 were noted on the first day after admission. The concentrations were higher in patients with the severe compared to those with the mild form of AP (median 17.2 vs. 4.0 ng/mL on day 1, p = 0.03; 6.1 vs. 2.2 on day 5, p = 0.044). On each of the study days significant correlations were found between PTX3 and SAA, IL-6, and PMN-elastase (p < 0.05). The pattern of changes in PTX3 concentration in the early phase of AP is similar to that of IL-6, and its peak levels are achieved earlier compared to CRP. Our findings suggest that PTX3 may be useful in early evaluation and prediction of the severity of AP.

PAR2 exerts local protection against acute pancreatitis via modulation of MAP kinase and MAP kinase phosphatase signaling

During acute pancreatitis, protease-activated receptor 2 (PAR2) can be activated by interstitially released trypsin. In the mild form of pancreatitis, PAR2 activation exerts local protection against intrapancreatic damage, whereas, in the severe form of pancreatitis, PAR2 activation mediates some systemic complications. This study aimed to identify the molecular mechanisms of PAR2-mediated protective effects against intrapancreatic damage. A mild form of acute pancreatitis was induced by an intraperitoneal injection of caerulein (40 microg/kg) in rats. Effects of PAR2 activation on intrapancreatic damage and on mitogen-activated protein (MAP) kinase signaling were assessed. Caerulein treatment activated extracellular signal-regulated kinase (ERK) and c-Jun NH(2)-terminal kinase (JNK) within 15 min and maintained phosphorylation of ERK and JNK for 2 h in the rat pancreas. Although PAR2 activation by the pretreatment with PAR2-activating peptide (AP) itself increased ERK phosphorylation in rat pancreas, the same treatment remarkably decreased caerulein-induced activation of ERK and JNK principally by accelerating their dephosphorylation. Inhibition of ERK and JNK phosphorylation by the pretreatment with MAP/ERK kinase (MEK) or JNK inhibitors decreased caerulein-induced pancreatic damage that was similar to the effect induced by PAR2-AP. Notably, in caerulein-treated rats, PAR2-AP cotreatment highly increased the expression of a group of MAP kinase phosphatases (MKPs) that deactivate ERK and JNK. The above results imply that downregulation of MAP kinase signaling by MKP induction is a key mechanism involved in the protective effects of PAR2 activation on caerulein-induced intrapancreatic damage.

Effectiveness of MR imaging for diagnosing the mild forms of acute pancreatitis: Comparison with MDCT

To assess the usefulness of MRI and determine which MR sequence is most effective for diagnosing the mild forms of acute pancreatitis. Forty subjects (20 normal volunteers and 20 patients with a mild form of acute pancreatitis) underwent MRI with fat-suppressed T1-weighted fast low-angle shot (FLASH), half-Fourier acquisition single-shot turbo spin-echo (HASTE), and TSE short TI inversion recovery (TSE-STIR) sequences. The 20 patients with a mild form of acute pancreatitis underwent multidetector CT (MDCT) and MRI within a 24-hour interval. We qualitatively analyzed all of the images by assessing inflammatory changes in the pancreas and peripancreatic fat. We quantitatively compared differences in pancreas-liver contrast between the control and patient groups for each MR sequence by measuring the signal intensities of the pancreas and liver. TSE-STIR was the best of the four modalities for delineating peripancreatic and pancreatic inflammation (P < 0.01). TSE-STIR depicted definitive peripancreatic and pancreatic inflammation in 18 and 15 patients, respectively. MDCT depicted only three cases of peripancreatic inflammation. TSE-STIR was also produced the best the best quantitative results of the MR sequences (P = 0.09). MRI is helpful for diagnosing the mild forms of acute pancreatitis. We recommend the use of TSE-STIR imaging as part of the routine protocol for evaluating pancreatitis.

Pancreatic endocrine function and glucose transporter (GLUT)-2 expression in rat acute pancreatitis.

Impairment in pancreatic endocrine function is believed to play an important role in the development of glucose intolerance in acute pancreatitis. To investigate the functional aspects of endocrine cells in acute pancreatitis and the expression of glucose transporter (GLUT) 2 in the pancreatitis islet. A mild form of acute pancreatitis was induced in rats by an injection of a sodium taurocholate solution via a cannulated biliopancreatic duct. Isolated islets were stimulated by glucose, and insulin secretion was analyzed by radioimmunoassay. Immunohistochemical detection of GLUT2 with use of a specific antibody was attempted to determine GLUT2 expression in pancreatic islets. A marked elevation of glucose levels observed in the current rat pancreatitis model confirmed that glucose intolerance can occur even in a mild form of pancreatitis. The architecture of the islets, however, remained intact despite marked inflammatory changes in the neighboring exocrine region. Insulin secretion studies revealed that the ability of islets to secrete insulin in response to glucose was markedly reduced in pancreatitis islets. GLUT2 immunoreactivity in endocrine cells was found to be intact in pancreatitis islets. The amount of insulin released from isolated islets following glucose stimulation is reduced in acute edematous pancreatitis, although pancreatic islets remain histologically intact. On the basis of the present findings, it appears that although the mechanisms responsible for this functional deficiency remain to be determined, the decrease in insulin secretion is possibly caused by impairment of some pancreatic B-cell functions rather than GLUT2-mediated glucose transportation.

Soluble thrombomodulin plasma levels are an early indication of a lethal course in human acute pancreatitis

Background. The potential to predict severe disease and lethality by using plasma soluble thrombomodulin (sTM) and C-reactive protein (CRP) levels in 73 patients with acute pancreatitis was analyzed in a prospective 5-year investigation performed at a single institution. Methods. According to the Atlanta criteria, pancreatitis was classified as mild in 23 patients and as severe in 50 patients. Blood was collected on days 1, 3, 5, 7, 10, 14, 21, and 28 after the onset of pain and analyzed for sTM and CRP. Results. During the period between days 3 and 10 of acute pancreatitis when most of the admissions occurred, sTM levels at a cutoff of 75 ng/mL on day 3 (sensitivity, 100%; specificity, 77%; positive predictive value, 38%; negative predictive value, 100%) and 71 ng/mL on day 10 (sensitivity, 100%; specificity, 77%; positive predictive value, 41%; negative predictive value, 100%) were predictive of a lethal outcome. With sTM levels, it was not possible to differentiate patients with mild pancreatitis from those with severe pancreatitis (Atlanta classification). In contrast, CRP levels at a cutoff of 113 mg/L on day 3 differentiated severe from mild courses with a diagnostic sensitivity of 84%, a specificity of 60%, a positive predictive value of 78%, and a negative predictive value of 69%. CRP levels at a cutoff of 122 mg/L on day 10 differentiated mild from severe courses (nonsurvivors) with a diagnostic sensitivity of 72%, a specificity of 72%, a positive predictive value of 86%, and a negative predictive value of 53%. In contrast, differentiation of mild forms of acute pancreatitis from severe pancreatitis (survivors) on day 10 was not possible. Conclusions. CRP is a valuable marker of disease severity in acute pancreatitis especially in the first period of pancreatitis, whereas sTM identifies early those patients with the most severe courses and a high risk of dying (negative predictive value, 100%). Determination of sTM in addition to CRP offers the opportunity of identifying early those patients who require intensive care most urgently. Of course, further investigations of sTM in acute pancreatitis are indicated to confirm our results. (Surgery 2002;131:424-32.)

Effects of MCI-727 on pancreatic exocrine secretion and acute pancreatitis in two experimental rat models.

The effects of a newly developed compound having antiulcer action, (Z)-2-(4-methylpiperazin-1-yl)-1-[4-(2-phenyl-ethyl)phenyl]-eth anone oxime hydrochloride monohydrate (MCI-727), on pancreatic exocrine secretion were studied in anesthetized rats and evaluated its preventive and therapeutic effects on acute pancreatitis in two experimental rat models. Intraduodenal administration of MCI-727 [25, 50, or 100 mg/kg body weight (wt)] stimulated a dose-dependent increase in pancreatic juice and bicarbonate output without increasing the protein output or plasma cholecystokinin concentration. MCI-727-stimulated pancreatic exocrine secretion was completely abolished by antisecretin serum but not by the cholecystokinin receptor antagonist loxiglumide (50 mg/kg body wt/h) or cholinergic receptor antagonist atropine (100 mu g/kg body wt/h). In rats with acute pancreatitis induced by four subcutaneous injections of 20 mu g/kg body wt cerulein at hourly intervals over 3 h, MCI-727 administered orally at a dose of 100 mg/kg body wt 30 min before the first cerulein injection significantly reduced the increases in serum amylase and lipase activity and pancreatic wet weight and induced improvements in the results of histologic examination. Moreover, when given 30 min before and 90 min after the first cerulein injection, MCI-727 had even more dramatic protective effects on all these parameters. In addition, even when administered immediately after the last cerulein injection, MCI-727 effectively ameliorated all these alterations of acute pancreatitis. However, MCI-727 had no apparent beneficial effects on the biochemical and histologic alterations of acute pancreatitis in the severe form induced by retrograde intraductal injection of 1.0 ml/kg body wt of 4% sodium taurocholate. These findings suggest that oral administration of MCI-727 stimulates pancreatic exocrine secretion by endogenous secretin release and that it has therapeutic as well as preventive effects on mild forms of acute pancreatitis in rats.