Serum Pancreatic Amylase Research Articles

Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single-center, observational cohort study.

Pancreas transplantation (PT) is a radical treatment for diabetes mellitus (DM). Although the results of PT have been improving, surgical complications remain. Few reports have focused on complications associated with pancreatic fluid (CAPF) after PT. We aimed to investigate the risk factors and predictors for CAPF after PT. Sixty-nine patients, who underwent deceased-donor PT for type 1 DM at our institution from August 2001 to May 2020, were retrospectively studied. We identified CAPF from those with Clavien-Dindo Classification ≥grade III and assessed risk factors by univariate and multivariate analyses using logistic regression. Twenty-one (30.4%) patients had complications with Clavien-Dindo Classification ≥grade III. Eleven (16.0%) patients were diagnosed with CAPF. Median serum pancreatic amylase (P-AMY) levels with CAPF on postoperative day (POD)1 and POD2 were significantly higher than those without CAPF (P=.019 and P=.027, respectively). In multivariable analysis, serum P-AMY levels on POD1 were an independent predictive factor for CAPF (odds ratio 1.83, 95% confidence interval 1.07-3.14, P=.008). Complications associated with pancreatic fluid after PT is associated with high serum P-AMY in the early postoperative period. Serum pancreatic enzymes in the first few postoperative days after PT may be a significant predictive factor for CAPF.

Impaired exocrine pancreatic function in different stages of type 1 diabetes

IntroductionAim of this study was to investigate the pancreatic exocrine function in patients with type 1 diabetes (T1D) by multiple non-invasive tests.Research design and methodsThe study is a single-center, cross-sectional...

Early and sustained elevation in serum pancreatic amylase activity: a novel major predictor of morbidity after pancreatic surgery?

Purpose: A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications. The objective is to characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections. Method: Patients who consecutively underwent pancreatectomies from 2016 to 2019. spAMY were assessed from POD 0 to 3. The following patterns were identified: (#1) spAMY values always < the lower limit of normal/within the reference range (10-52 U/l)/a single increase in spAMY > upper limit of normal at any POD; (#2) Sustained increase in spAMY activity on POD 0+1; (#3) Sustained increase in spAMY activity including POD 1+2. Pattern #3 was stratified according to the upper limit (> 52 U/l) and 3-times spAMY upper limit of normal (> 156 U/l). Results: Shifting through spAMY patterns was associated with increase morbidity (21% in #1 to 68% in #3; log rank <0.001) (Figure 1). Almost all severe complications occurred in patients with pattern #3 (15% vs. 3% vs. 5% in #1 and #2, P=0.006), without difference considering >3-times or >the spAMY normal limit (P=0.85). POPF (9% in #1 vs. 48% in #3, p<0.001) progressively increased across patterns. Pre-operative diabetes (OR 0.19), neoadjuvant therapy (OR 0.22), pancreatic texture (OR 8.8), duct size (OR 0.78), and final histology (OR 2.2) were independent predictors of pattern #3. Conclusion: A sustained increase in spAMY activity including POD 1+2 (#3) represents the earliest postoperative predictor of overall and severe early morbidity. An early and dynamic evaluation of spAMY could crucially impact the subsequent clinical course with relevant prognostic implications.

Gullo's syndrome - what do we know?

Benign pancreatic hyperenzymemia (Gullo’s syndrome) is characterized by a more than threefold increase of the serum pancreatic enzymes lipase and amylase activity in the absence of any pancreatic disease. Recently, there is an increase in describing cases of Gullo’s syndrome in medical literature. Gullo’s syndrome is a diagnosis of exclusion, and clinicians should be aware of various other conditions which can cause elevation of pancreatic enzymes. However, the diagnostic pathway should be done with the right accuracy to avoid unnecessary examinations.

BIOCHEMICAL STUDIES RELATED TO ACUTE CHOLECYSTITIS IN LIBYAN SUBJECTS

Acute cholecystitis and cholelithiasis are one of common health problems of Libyans. [1] Acute cholecystitis or bile gallbladder stones are one of the major surgical problems in the Libyan population and account for many hospital admissions and surgical interventions. This study was done to estimate causes and risk factors of AC among general population of Benghazi city in Libya. Reflux of pancreatic secretions into the biliary duct due to a defect in motility of gallbladder or biliary tree or spastic episodes of Sphincter Oddi may cause injury to gallbladder mucosa and biliary tract which may precipitate acute cholecystitis. Pancreatic biliary reflux (PBR) therefore may cause such reflux of pancreatic juice into gallbladder and biliary tract. This problem is probably related to obesity, cardiovascular disorders (CVD), metabolic syndrome, and dietary habits. Studies on gallstone composition carried out a close link with dietary habits and ethnicity. The biliary composition has been demonstrated by many researches for several years. Gallstone formation is relatively increased with consumption of dietary fats, age and gender.2-3 Estimation of pancreatic amylase in gallbladder bile as well as in serum of patients with acute cholecystitis (AC) may be considered as a biomarker of PB reflux. Serum and bile pancreatic amylase levels as marker for diagnosis of acute cholecystitis" by investigate biliary composition especial alpha amylase pancreatic, total amylase, liver enzymes estimation the correlation between (AST, ALT, ALP and Bilirubin total, C-RP and lipid profile in gallstone disease patients and estimate the correlation between (Cholesterol, HDL, LDL, VLDL) concentration in serum and biliary gallbladder, presence of gallstones, age, in both gender patient with gallbladder diseases.

Increase in pancreatic enzymes following spinal alignment changes in the thoracolumbar junction: Potential for acute pancreatitis after kyphosis correction

BackgroundDespite the identification of various risk factors for pancreatitis and hyperamylasemia following spinal surgery, no report has investigated the relationship between spinal alignment changes and elevated serum amylase levels. The purpose of this study was to investigate the relationship between spinal alignment changes and hyperamylasemia after spinal fusion. MethodsA total of 222 patients whose serum pancreatic amylase levels were measured before and after spinal surgery from December 2017 to May 2019 were included. Inclusion criteria were (1) spinal fusion including the thoracolumbar junction (T10-L2) and (2) serum pancreatic amylase measurements before, immediately after surgery (day 0), the day after surgery (day 1), and 1 week after surgery. Ultimately, 37 patients who met the criteria were analyzed. Patients with hyperamylasemia at day 0 and/or day 1 (H group) were then compared with those without hyperamylasemia (N group). ResultsNo significant differences in age, sex, surgical procedure, number of fused segments, intraoperative blood loss, operative time or American Society of Anesthesiologists physical status classification were observed between both groups. The H group had significantly larger preoperative thoracolumbar kyphosis (TLK) (H group: 22.6°, N group: 6.4°), postoperative TLK (H group: 16.8°, N group: 7.6°), and preoperative T12–L1 kyphosis angles (H group: 16.2°, N group: 7.9°) compared with the N group. Moreover, the H group demonstrated a significant decrease in TLK after surgery (H group: −5.8°, N group: 1.6°). ConclusionsRisk factors for hyperamylasemia included a large preoperative TLK angle and a greater postoperative decrease in TLK. Thus, decreased TLK after spinal fusion surgery should prompt careful attention to abdominal symptoms and elevated pancreatic amylase levels.

Acute pancreatitis in diabetics: a twoyear retrospective study in a tertiary care hospital in Peshawar, Pakistan

Introduction: Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas. After diagnosis the initial management is preferably done in intensive care unit along with 4-6 hourly insulin sliding scale monitoring for hyperglycemia. Individuals with type II DM are more prone to develop AP. Glycosylated hemoglobin (HbA1c) reflects the blood glucose levels of over past two months and daily glucose levels do not affect its levels in the blood.Objectives: To find out the frequency of acute pancreatitis in diabetic patients both in type 1 and type 2.Study Design: Cross-sectional, comparative studyMethodology: This was a retrospective cross-sectional, comparative study based on 154 patients with acute pancreatitis in our tertiary care hospital over the duration of two years i.e. from January 2016 to December 2017. The data were entered and coded where necessary and statistically analyzed using SPSS version 20. Descriptive analysis was done to summarize data in the form of percentages and numbers for categorical data while continuous variables were shown by using mean and standard deviation.Results: The mean age was 48.6 year with a standard deviation of 16.9 years, the total cases were 154 for the duration two years from January 2016 to December 2017. Out of 147 patients, 72 (44.4%) were male and 75 (46.3%) were female. Only 13 (8.8%) out of 154 patients were diabetics. Total serum pancreatic lipase and serum pancreatic amylase levels were significantly higher in non-diabetic subjects as compared to diabetics. Also, high serum lipase levels were seen in slightly more females than males.Conclusion: The results of our study documented that the prevalence of acute pancreatitis is more common in non-diabetics as compared to diabetics, and those who were diabetic were between 41 to 60 years of age. We recommend further studies in this area to reach a general agreement on the prevalence of acute pancreatitis and factors affecting its prevalence as well as on the relation of diabetes and severity of acute pancreatitis.Citation: Khan ZA, Baig KS, Ahmad Z, Afridi M. Acute pancreatitis in diabetics: a twoyear retrospective study in a tertiary care hospital in Peshawar, Pakistan. Anaesthesia, pain &amp; intensiv care 2019;23(2):211-216

Serum Serine Peptidase Inhibitor Kazal-Type 1, Trypsinogens 1 to 3, and Complex of Trypsin 2 and α1-Antitrypsin in the Diagnosis of Severe Acute Pancreatitis.

We explored prediction of severe acute pancreatitis (AP) and development of organ dysfunction (OD). Serum concentrations of serine peptidase inhibitor Kazal type 1 (SPINK1), trypsinogen 1, trypsinogen 2, and trypsinogen 3, complex between trypsin 2 and α1-antitrypsin, serum C-reactive protein, creatinine, and pancreatic amylase were measured in 239 AP patients with disease onset within 72 hours. SPINK1 distinguished most accurately patients who later developed severe AP. The area under the receiver operating characteristic curve for SPINK1 was 0.742, followed by trypsinogen 2 (0.726), complex between trypsin 2 and α1-antitrypsin (0.657), creatinine (0.656), trypsinogen 1 (0.652), trypsinogen 3 (0.557), and C-reactive protein (0.499). With a cutoff of 166 μg/L, SPINK1 had a specificity of 93%, a sensitivity of 48%, and diagnostic odds ratio of 11.52. In multivariate logistic regression analysis, only SPINK1 was an independent predictor of severe AP among patients presenting without OD on admission (P < 0.001). Plasma levels of the biomarkers and creatinine correlated with the severity of AP and development of OD. In patients presenting without OD at admission, SPINK1 was an independent marker for later development of severe AP.

Pancreatic injury due to blunt abdominal trauma in children

The diagnosis and management of pediatric pancreatitis is often difficult. Blunt abdominal trauma is one of the most common causes of pancreatitis in childhood. This is a review of patients with blunt pancreatic trauma. Medical records of all children with blunt pancreatic trauma who were admitted to our clinic between July 2007 and December 2017 were analyzed retrospectively. There were 17 patients (7 girls, 10 boys) with a mean age of of 9.89±2.57 years (range, 3-14 years). The time from trauma to admittance to the clinic was mean 17±21.43 days (range, 0-63 days). The mechanism of injury was bicycle injuries in 7 (41.66%), a fall from height in 6 (35.29%), motor vehicle accidents in 3 (17.64%), and a fall from a horse in 1 (5.88%). All patients had serum pancreatic amylase elevation on admission (average, 1002.71±966.36 IU/L; range, 116-3163 IU/L). All the childen were initially managed non-operatively. In 8 patients (52.94%) the traumatic pancreatitis was complicated by development of a pseudocyst. The average diameter of the pseudocyst was 11.5±3.45 cm. The pseudocysts were resolved in 5 cases with percutaneous ultrasonography-guided fluid drainage and the remaining 3 required open surgery (2 cystogastrostomy, 1 surgical drainage). The average length of hospital stay was 18±15.91 days (range, 2–48 days). There were no deaths and no complications in any patients. Non-operative management of traumatic pancreatitis in the absence of complete duct transection is safe in children. Percutaneous drainage of traumatic pancreatic pseudocysts can be used as an effective and useful treatment option.

Postoperative Acute Pancreatitis Following Pancreaticoduodenectomy: A Determinant of Fistula Potentially Driven by the Intraoperative Fluid Management.

The aim of the study is to characterize postoperative acute pancreatitis (POAP). A standardized definition of POAP after pancreaticoduodenectomy (PD) has been recently proposed, but specific studies are lacking. The patients were extracted from the prospective database of The Pancreas Institute of Verona. POAP was defined as an elevation of the serum pancreatic amylase levels above the upper limit of normal (52 U/L) on postoperative day (POD) 0 or 1. The endpoints included defining the incidence and predictors of POAP and investigating the association of POAP with postoperative pancreatic fistula (POPF). The study population consisted of 292 patients who underwent PD. The POAP and POPF rates were 55.8% and 22.3%, respectively. POAP was an independent predictor of POPF (OR 3.8), with a 92% sensitivity and 53.7% specificity (AUC 0.79). Preoperative exocrine insufficiency (OR 0.39), neoadjuvant therapy (OR 0.29) additional resection of the pancreatic stump margin (OR 0.25), soft pancreatic texture (OR 4.38), and Main Pancreatic Duct (MPD) diameter ≤3 mm (OR 2.86) were independent predictors of POAP. In high-risk patients, an intraoperative fluid administration of ≤3 ml/kg/h was associated with an increased incidence of POAP (24.6 vs. 0%, P = 0.04) and POPF (27.6 vs. 11.4%, P = 0.05). This study represents the first clinical application of the only available definition of POAP as a specific complication of pancreatic surgery. POAP is associated with an increased occurrence of POPF and overall morbidity and could potentially be avoided through a specific intraoperative fluid regimen in high-risk pancreas.

The correlation between pancreatic dysfunction markers and selected indices of periodontitis.

Periodontitis is a major risk factor of systemic diseases with inflammatory etiology. Numerous studies have established the connection between periodontal condition and diabetes, but there are no reports in the literature on the relationship between periodontitis and other pancreas conditions. The activity of pancreatic enzymes is an important parameter of pancreatic damage, and is also a diagnostic marker of acute and chronic pancreatitis, and the bleeding index determines the periodontitis activity. To date, the periodontal status in both of the above-mentioned conditions has not been examined. The objective of the study was to provide a clinical evaluation of oral cavity hygiene and the condition of periodontal tissues in patients diagnosed with pancreatic adenocarcinoma or chronic pancreatitis and in the control group, and to assess the correlation between the activity of periodontitis and the concentration of glycated hemoglobin HbA1c, lipase activity and pancreatic amylase in serum from the examined groups. The serum activity levels of amylase, lipase and HbA1c concentration were correlated with periodontitis activity markers in patients diagnosed with chronic pancreatitis (n = 41), pancreatic cancer (n = 29) and in the control group (n = 50). In the group with chronic pancreatitis, we have found a positive association between the bleeding on probing (BOP) and the amylase activity (r = 0.64) as well as the lipase (r = 0.62; p < 0.05). The patients diagnosed with pancreatic cancer evinced a higher value of the inflammatory response index, namely 1.51, than the other studied groups (H = 24.94; p = 0.01). Patients diagnosed with chronic pancreatitis evinced the highest periodontitis activity indices: BOP: 62.53% (H = 61.31; p = 0.01) and probing depth (PD): 4.14 ±0.89 mm (H = 22.43; p < 0.0001). The study showed that periodontitis in patients with pancreatic cancer is independent of the state of oral hygiene. In the group of patients with chronic pancreatitis, the observed positive correlation between the bleeding index and the enzyme activity suggests interaction between the examined diseases.

Identification of Small Proteins and Peptides in the Differentiation of Patients with Intraductal Mucinous Neoplasms of the Pancreas, Chronic Pancreatitis and Pancreatic Adenocarcinoma.

There are a limited number of studies investigating the type of serum proteins capable of differentiating intraductal papillary mucinous neoplasms from benign or malignant diseases of the pancreas. To select proteins able to differentiate intraductal papillary mucinous neoplasms from benign and malignant pancreatic disease using semiquantitative proteomics. Serum samples were obtained from 74 patients (19 with type II intraductal papillary mucinous neoplasms, 8 with type I/III intraductal papillary mucinous neoplasms, 24 with chronic pancreatitis, 23 with pancreatic ductal adenocarcinomas) and 21 healthy subjects. Small proteins and peptides were assayed by matrix-assisted laser desorption/ionization for the detection of differentially abundant species possibly related to tumor onset. Serum pancreatic amylase, lipase, carcinoembryonic antigen and carbohydrate antigen 19-9 (CA 19-9) were also assayed. Twenty-six of 84 peaks detected were dysregulated (7 more abundant and 19 less abundant in the type II intraductal papillary mucinous neoplasms, p<0.05). Of the differentially abundant peaks, 17 were commonly dysregulated (3 peaks more abundant and 13 less abundant in type II intraductal papillary mucinous neoplasms, and one at m/z= 9961 at variance), indicating a protein fingerprint shared by types I/III and type II intraductal papillary mucinous neoplasms and pancreatic ductal adenocarcinomas. These results suggest that our approach can be used to differentiate type II intraductal papillary mucinous neoplasms from type I/III neoplasms, and type II intraductal papillary mucinous neoplasms from pancreatic ductal adenocarcinomas.

Locally advanced pancreatic cancer: treatment with Nanoknife percutaneously under guidance of ultrasound and effectiveness evaluated by contrast enhanced ultrasonography

Objective To explore the treatment of locally advanced pancreatic cancer(LAPC) by Nanoknife, and the demonstrations on contrast enhanced ultrasonography (CEUS) after the procedures. Methods Four patients were enrolled. Each of them was percutaneously inserted 3-5 Nanoknife electrodes to ablate the lesions with 2-3 sessions under the guidance of ultrasound. After the procedures, CEUS, contrast enhanced CT, contrast enhanced MRI or computed tomography angiography (CTA) were performed to assess the efficacy. Results All patients uneventfully were able to tolerate the high-voltage Nanoknife procedures.However, the endurable pain or discomfort in abdomen was complained. For one patient with obstructive jaundice and mild liver dysfunction, pancreatic amylase in serum increased slightly at the first day after treatment. Furthermore, C response protein in serum elevated, and biliary tract infection happened at the third day. Moreover, thromboses in portal and splenic vein were found at the seventh day. The survival time for all cases were 3-8 months. According to the findings of CEUS, a well-defined no contrast enhancement was detected at ablative zone for all the patients within one week. Yet, contrast enhancement was sporadically detected at the periphery in 3 patients 1-2 months late. Meanwhile, on contrast enhanced CT or MRI, an area of absent enhancement was also depicted at the ablation zone with heterogeneously decreased enhancement at periphery of the lesion. Base on CTA findings, local stenosis of splenic vein and superior mesenteric vein with varices of collateral vascularity were found in one patient at the fiftieth day, and superior mesenteric vein obstruction accompanied by varices of collateral vascularity was also found in another patient at the seventieth day. Conclusions For patients with LAPC, Nanoknife treatment is a safe and convenient procedure that can be percutaneously completed under the guidance of ultrasound. Along with enhanced CT, MRI or CTA, CEUS is a promising way to evaluate the efficacy of this procedure. Key words: Ultrasonography, interventional; Contrast enhanced ultrasonography; Pancreatic neoplasms; Nanoknife; Electroporation

The Expression of Activating Receptor Gene of Natural Killer Cells (KLRC3) in Patients with Type 1 Diabetes Mellitus (T1DM).

To identify the possible role of natural killer (NK) cells in the pathogenesis of type 1 diabetes mellitus (T1DM) through studying the expression of the KLRC3 gene, which encodes the NK cell activating receptor (NKG2E). This study was conducted at Alexandria University Children's Hospital from April to October 2015. The study was conducted with 30 newly diagnosed T1DM patients (15 males and 15 females), aged 7-13 years (10.6±1.8 years) and 20 non-diabetic subjects served as age- and sex-matched controls. The patients were further sub-divided into two groups; group I included patients who first presented with classical symptoms of DM (polyuria, polydipsia, and polyphagia) without diabetes ketoacidosis (DKA) and group II included patients who first presented with DKA. The expression of the KLRC3 gene was measured in each group using the real-time polymerase chain reaction. KLRC3 gene expression was significantly downregulated in T1DM cases compared to healthy controls (p = 0.001). Expression was more downregulated in group I patients (p = 0.008). Moreover, there was higher mean value of glycated heamoglobin and lower C-peptide levels in group I than group II. Serum pancreatic amylase showed no significant difference between the two groups. KLRC3 gene expression was downregulated in patients with T1DM compared to healthy controls. Downregulation of expression was greater in DKA patients compared to those who presented with classical symptoms. Expression of KLRC3 in T1DM might play a role in the pathogenesis of T1DM and could be a predictor of its severity.

Early Postoperative Prediction of Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: usefulness of C-reactive Protein

BackgroundAn early recognition of clinically relevant pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is essential. MethodsAll consecutive patients who underwent PD in two institutions were included (2013–2015). In all patients amylase value in drains (AVD) was evaluated in postoperative day 1 (POD1). White-blood cell count (WBC), serum pancreatic amylase (SPA) and C-reactive protein (CRP) were routinely evaluated in POD1, POD2, and POD3. Receiver operator characteristic (ROC) curves were performed. Significant diagnostic cut-offs were tested in a multivariate model. ResultsOverall, 463 patients underwent PD. Postoperative morbidity and mortality were 58% and 4%, respectively. Sixty-four patients (14%) had a clinically relevant PF (grade B or C). ROC curve analyses revealed that AVD on POD1 had the greatest area under the curve value (0.881, P < 0.0001) followed by CRP on POD3 (0.796, P < 0.0001). Multivariable analysis identified male gender (OR 2.29 95%CI: 1.12–4.70, P = 0.023), AVD on POD1>500 U/l (OR 21.72, 95%CI: 7.41–63.67, P < 0.0001), CRP on POD2 > 150 mg/l (OR 3.480, 95%CI: 1.21–9.99, P = 0.021), and CRP on POD3 > 185 mg/l (OR 6.738, 95%CI: 1.91–23.78, P = 0.003) as independent predictors of clinically relevant PF. ConclusionThe combination of CRP and AVD was effective in the early prediction of clinically relevant POPF after PD.

MicroRNA biomarkers of pancreatic injury in a canine model

Pancreas-enriched microRNAs have been experimentally investigated in rodents as candidate serum biomarkers of pancreatic injury with several different acute pancreatic injury models. In the present study, temporal and magnitude responses of exocrine pancreas-enriched miR-216a, miR-216b, and miR-217 and endocrine-enriched miR-375 and miR-148a were measured by droplet digital PCR in serum in a caerulein model of pancreatic injury in the dog. All 5 microRNAs followed a similar time course that mirrored the responses of the conventional serum pancreatic injury biomarkers, amylase and lipase. Detection was improved through the use of assays designed against microRNA isomers (isomirs) identified by sequencing. Serum biomarker increases were concordant with histopathology defined acinar cell injury. Minimal islet cell changes were noted. The pancreas-enriched microRNAs demonstrated similar or greater sensitivity, a larger range of response, and a higher correlation to acinar cell injury compared to amylase and lipase. Our results further support the translational potential of pancreas-enriched microRNAs as sensitive biomarkers of acinar cell injury with evidence from an additional non-clinical model system.

Acute obstructive pancreatitis after pancreas-sparing total duodenectomy in a patient with pancreas divisum: a case report.

BackgroundPancreas-sparing total duodenectomy (PSTD) is an ideal recommended procedure for patients with multiple duodenal adenomas or early duodenal cancer. We herein report a rare but serious complication of PSTD.Case presentationA 20-year-old woman with duodenal adenocarcinoma underwent PSTD. On postoperative day one, she complained of severe abdominal pains. Her serum amylase and serum pancreatic amylase levels were extremely elevated (Amy, 1296 IU/L; P-Amy, 1273 IU/L). With contrast enhanced CT, acute obstructive pancreatitis with pancreas divisum due to the ligation of the dorsal pancreatic duct was highly suspected. An emergency operation was performed to relieve the pancreatic duct obstruction, and an additional anastomosis between the dorsal pancreatic duct and jejunum was performed. The patient’s postoperative course was mostly uneventful, and her discomfort improved immediately.ConclusionWhen we perform pancreas-sparing total duodenectomy, some form of pancreatography is necessary to exclude pancreas divisum.

Can Serum Pancreatic Amylase and Lipase Levels Be Used as Diagnostic Markers to Distinguish Between Patients With Mucinous Cystic Lesions of the Pancreas, Chronic Pancreatitis, and Pancreatic Ductal Adenocarcinoma?

This study aimed to assess the presence of pancreatic hyperenzymemia in patients with pancreatic cystic lesions as compared to other chronic diseases of the pancreas. Ninety-one patients were studied: 32 had mucinous cystic lesions, 35 had chronic pancreatitis (CP), and 24 had pancreatic ductal adenocarcinoma (PDAC). Surgery was carried out in 10 of the 32 patients with mucinous cystic lesion (7 of them had severe dysplasia), in 5 patients with CP, and in 9 patients with PDAC. Abnormally high serum pancreatic isoamylase activity was present in 11 (34.4%) patients with mucinous cystic lesions, in 14 (40.0%) patients with CP, and none in patients with PDAC (P = 0.002); whereas serum lipase activity was abnormally high in 8 (25.0%) patients with mucinous cystic lesion, in 17 (48.6%) patients with CP, and in 3 (12.5%) patients with PDAC (P = 0.009). In 7 patients with mucinous cystic lesions and histologically confirmed severe dysplasia, abnormally high levels of both serum pancreatic amylase and lipase were present in 3 (42.9%) patients. High serum concentrations of pancreatic amylase and lipase were found in no more than half of the patients with mucinous cystic lesions. High levels of pancreatic enzymes were not associated with a greater risk of malignancy.

Predictive value of low serum pancreatic enzymes in invasive intraductal papillary mucinous neoplasms

BackgroundDespite evidence suggesting a role of chronic pancreatitis in pancreatic carcinogenesis, its relationship with invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. Low levels of pancreatic enzymes are predictive markers of advanced chronic pancreatitis. We investigated whether low pancreatic enzyme levels were associated with a higher incidence of invasive IPMN. MethodsThis study included 146 consecutive patients who underwent surgical resection of IPMN between April 2001 and October 2014. Multivariable logistic regression analysis was conducted to assess the association between serum pancreatic enzymes and the incidence of invasive IPMN, with adjustment for clinical characteristics including alcohol consumption. The association of serum pancreatic enzymes with pathological pancreatic atrophy and inflammation in areas adjacent to or distant from the tumor was also evaluated. ResultsLow serum levels of pancreatic amylase and lipase were associated with a higher incidence of invasive IPMN (multivariable odds ratio [OR] = 9.6, 95% confidence interval [CI] = 2.99 to 35.1, P = 0.0001; OR = 14.2, 95% CI = 2.77 to 112, P = 0.001, respectively). Low serum pancreatic amylase and lipase levels were also associated with higher grade pancreatic atrophy in areas adjacent to the tumor (P = 0.011 and P = 0.017, respectively) and in areas distant from the tumor (P = 0.0002 and P = 0.001, respectively). Furthermore, low serum pancreatic amylase and lipase levels were associated with higher grade inflammation in areas distant from the tumor (P < 0.0001 and P = 0.001, respectively). ConclusionsLow serum pancreatic enzymes may be a predictive marker of invasive IPMN. Excessive alcohol consumption did not influence the association of low pancreatic enzyme levels with invasive IPMN.

Protective effect of Mimosa pudica L. in an l-arginine model of acute necrotising pancreatitis in rats

Mimosa pudica is used in traditional medicine for treating various disorders such as inflammatory conditions, diarrhoea, insomnia, alopecia, urogenital infections and wounds. The present study investigated the effect of M. pudica extract (MPE) on L-arginine-induced acute necrotising pancreatitis in rats. The ethanolic extract of M. pudica leaves was studied for the presence of quercetin and gallic acid using high-performance liquid chromatography. Four groups were employed-normal control rats, L-arginine control rats (two intraperitoneal [i.p.] injections of 2g/kg at an interval of 1h), MPE-treated rats (400mg/kg orally) and melatonin-treated rats (positive control 10mg/kg i.p.), which were further divided into subgroups according to time points (24h, 3 days and 14days). Serum amylase, lipase, tumour necrosis factor-α (TNF-α), pancreatic amylase, nucleic acid content, protein, transforming growth factor-β1 (TGF-β1), thiobarbituric reactive substances, glutathione, nitrite/nitrate, collagen content and histopathological examination were carried out. MPE significantly improved acute necrotising pancreatitis by modulating diagnostic markers of pancreatitis such as serum lipase and pancreatic amylase, inflammation (TNF-α), and oxidative and nitrosative stress. Moreover, MPE administration induced regenerative changes in the pancreas evidenced by increased levels of pancreatic proteins, nucleic acid content and histopathology report. In addition, MPE improved TGF-β1 and collagen levels thereby preventing fibrosis. The current investigation indicates the novel role of MPE in reducing the severity of acute necrotising pancreatitis by plausible mechanisms such as anti-inflammatory and anti-fibrotic activity and by promoting repair and regeneration of the pancreas.