Severe Form Of Acute Pancreatitis Research Articles

Severe Vascular Complications Of Acute Pancreatitis.

Acute pancreatitis (AP) develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%. The study included 10 patients treated due to acute pancreatitis in two surgical departments run by one of the authors (S.G.) in the years 2004-2014, who developed a serious complication in the form of haemorrhage into the inflammatory tumour/pancreatic cyst or an adjacent organ. Haemorrhage was diagnosed based on the clinical picture, most often a sudden drop in blood pressure, peritonitis symptoms and imaging findings--abdominal ultrasound and abdominal computed tomography. Therapeutic methods included conservative treatment, endovascular embolisation and, in the absence of efficacy of the above mentioned methods, surgical treatment. Patients age and gender, the etiological factor, comorbidities, Atlanta Classification, treatment outcomes and mortality rate were assessed. Alcohol was the most common etiological factor in the investigated AP cases. The patients received conservative treatment, interventional radiology treatment (endovascular embolisation) or surgical treatment. In the study group, 6 patients required surgical treatment, 3 patients received invasive radiology treatment, and conservative treatment was used in one patient. The mortality rate in the study group was 30%. Haemorrhages into the inflammatory cisterns or adjacent organs (stomach, transverse colon mesentery) secondary to AP are the most severe complications, which are difficult to manage. The successful use of interventional radiology methods to inhibit and prevent the recurrence of bleeding in some of the patients is a significant milestone.

Early prediction of persistent organ failure by soluble CD73 in patients with acute pancreatitis*.

New biomarkers are needed to better predict the severity of acute pancreatitis. CD73/ecto-5'-nucleotidase is an enzyme that generates adenosine, which dampens inflammation and improves vascular barrier function in several disease models. CD73 also circulates in a soluble form in the blood. We studied whether levels of soluble form of CD73 predict the development of organ failure in acute pancreatitis. A prospective cohort study of patients with acute pancreatitis from 2003 to 2007. Admissions to the biggest tertiary care hospital in Finland. One hundred sixty-one patients with acute pancreatitis, of which 107 were subclassified according to the revised Atlanta criteria into mild, 29 into moderately severe and 25 into severe. None. Serum and blood cell samples were collected at admission. Protein levels of soluble form of CD73 in serum were determined using a novel enzyme-linked immunosorbent assay, activity of soluble form of CD73 using radioactive enzyme assays, and CD73 messenger RNA levels from leukocytes using quantitative polymerase chain reaction. Activity and protein concentration of soluble form of CD73, and messenger RNA level of CD73 all decreased along with the disease severity (p ≤ 0.01 for all). The activity of soluble form of CD73 at admission predicted the development of the severe pancreatitis in different groups of the patients. The area under the receiver-operating characteristic curve value for activity of soluble form of CD73 was 0.65 (95% CI, 0.51-0.80) among a subgroup of patients comprising moderately severe and severe disease, 0.79 (95% CI, 0.69-0.88) among all patients including mild pancreatitis, and 0.75 (95% CI, 0.60-0.89) among patients who had no signs of organ failure (modified Marshall score < 2) at admission. Especially, in the last-mentioned group, activity of soluble form of CD73 was better than C-reactive protein or creatinine in predicting the severe pancreat : Activity of soluble form of CD73 at admission to hospital has prognostic value in predicting the development of the severe form of acute pancreatitis.

Necrotizing pancreatitis: diagnosis, imaging, and intervention.

Acute necrotizing pancreatitis is a severe form of acute pancreatitis characterized by necrosis in and around the pancreas and is associated with high rates of morbidity and mortality. Although acute interstitial edematous pancreatitis is diagnosed primarily on the basis of signs, symptoms, and laboratory test findings, the diagnosis and severity assessment of acute necrotizing pancreatitis are based in large part on imaging findings. On the basis of the revised Atlanta classification system of 2012, necrotizing pancreatitis is subdivided anatomically into parenchymal, peripancreatic, and combined subtypes, and temporally into clinical early (within 1 week of onset) and late (>1 week after onset) phases. Associated collections are categorized as "acute necrotic" or "walled off" and can be sterile or infected. Imaging, primarily computed tomography and magnetic resonance imaging, plays an essential role in the diagnosis of necrotizing pancreatitis and the identification of complications, including infection, bowel and biliary obstruction, hemorrhage, pseudoaneurysm formation, and venous thrombosis. Imaging is also used to help triage patients and guide both temporizing and definitive management. A "step-up" method for the management of necrotizing pancreatitis that makes use of imaging-guided percutaneous catheter drainage of fluid collections prior to endoscopic or surgical necrosectomy has been shown to improve clinical outcomes. The authors present an algorithmic approach to the care of patients with necrotizing pancreatitis and review the use of imaging and interventional techniques in the diagnosis and management of this pathologic condition.

Acute pancreatitis

ZusammenfassungBei der akuten Pankreatitis handelt es sich um eine potenziell tödlich verlaufende Erkrankung mit individuell unterschiedlich ausgeprägter systemischer Beteiligung. Aus diesem Grund kommen der frühzeitigen Diagnose und nachfolgenden Risikostratifikation im klinischen Management dieser häufigen gastroenterologischen Erkrankung entscheidende Rollen zu. Schwere Verlaufsformen treten in etwa 20 % der Fälle auf und bedürfen zumeist intensivmedizinischer Überwachung und interdisziplinärer Behandlung. Therapeutisch stehen in der Akutphase die adäquate Flüssigkeitssubstitution und suffiziente Schmerztherapie im Vordergrund. Im Hinblick auf den Einsatz von Antibiotika und die Anpassung der Ernährung hat sich in den letzten Jahren ein Paradigmenwechsel vollzogen. Je nach Schwere der Erkrankung und möglichen Komplikationen können auch endoskopisch-/radiologisch-interventionelle Maßnahmen oder eine operative Versorgung notwendig werden.

Mean platelet volume (MPV) as prognostic factor in acute pancreatitis (AP)

Introduction: Mean platelet volume (MPV) is a machine-calculated measurement of the average size of platelets and is typically included in blood tests as part of the complete blood count. Vascular thrombosis and systemic hypercoagulable states are well documented complications of acute pancreatitis (AP). Higher values of MPV have been associated with thrombotic disorders. According to the literature, only few studies have investigated the association between AP and MPV. Objectives: To determine whether the value of MPV at admission correlates with the occurrence of local and systemic complications of AP ; lethal outcomes ; and severe form of AP, according to modified Atlanta criteria. Patients and methods: 53 patients (35 male and 18 female) were enrolled in this retrospective study. MPV values were obtained on an automated hematology analyzer (Olympus AU 640, Tokio, Japan). Student’s t-test was used for statistical analysis. Results: There were no statistically significant differences in the average values of MPV regarding local complications (7.51±0.99 vs. 7.91±1.24, p=0.22), systemic complications (7.60±1.05 vs. 7.72±1.22, p=0.76), severe form of AP (7.47±0.97 vs. 7.94±1.22, p=0.13) or lethal outcomes (7.58±1.03 vs. 7.97±1.38, p=0.41). Conclusion: Our study did not confirm the value of MPV in predicting complications in the course of AP.

Retrospective analysis of clinical problems concerning acute pancreatitis in one treatment center.

IntroductionSevere acute pancreatitis is still a difficult clinical problem, it is a challenge for medical teams, which should include the strategy of personalized medicine. In clinical observations, among patients with the fulminating course of acute pancreatitis developed during the first hours leading to irreversible multiorgan failure and death.AimTo evaluate the frequency of occurrence and analyze the progression and treatment of severe acute pancreatitis (AP) in patients hospitalized during the years 2004–2010 at the Clinical Surgery Ward.Material and methodsOne thousand and fifty patients treated for AP were included in the study; 97 patients with severe AP were subjected to a detailed clinical analysis.ResultsThe average age of the patients was 52.8 years. Relapses occurred in 14.9% of patients. The severe form of acute pancreatitis was diagnosed in 97 patients, which accounts for 9.2% of all the illnesses, and occurred significantly more often in male patients (p < 0.01). The most frequent etiological factors were cholelithiasis (46.4%), and idiopathic pancreatitis (27.8%); alcohol consumption was responsible for 22.7% of the cases; the occurrence of both a bile-derivative and alcoholic factor was found in 3.1% of the cases. A worsening clinical state resulted in laparotomy in 26 patients (26.8%), and re-laparotomy in 5 patients. Necrosectomy was performed on 15 patients, of whom 33.3% died due to complications. The total mortality in severe AP was 38.1%. The average age of the deceased was 66.5. Early deaths within 14 days were noted in 78.4% of patients (n = 29) who died due to severe AP.ConclusionsSevere AP in spite of implementing modern diagnosis and treatment methods is still associated with a high risk of death. Constant clinical observation and use of available prognostic scales are essential in improving AP prognoses.

Minimally Invasive Management of Acute Necrotizing Pancreatitis

About 10% to 20% of patients with acute pancreatitis develop severe disease, which is characterized by intrapancreatic or peripancreatic necrosis [1-6]. Necrotizing pancreatitis is the most severe form of acute pancreatitis associated with high morbidity and mortality due to the development of infected pancreatic necrosis, and multisystem organ failure. In severe necrotizing pancreatitis, the mortality rate ranges from 10% to 40%, and it is especially high (up to 50%) when the necrosis is infected and progressing to sepsis and multiorgan failure [1-3,7]. The appropriate treatment of infected pancreatic necrosis remains the subject of much debate. It is generally accepted that in infected necrotizing pancreatitis the infected non-vital solid tissue has to be removed in order to control the sepsis. For decades, open surgery and immediate surgical necrosectomy was the gold standard treatment for patients with infected pancreatic necrosis [1,3,7,8]. However, several reports have shown that early surgical intervention for pancreatic necrosis could result in a worse prognosis compared to cases where surgery is delayed or avoided [9-13]. It has been suggested that the invasiveness of open surgery in an already critically ill patient may be the cause of high morbidity rates. Therefore, several groups worldwide have developed new minimal invasive approaches using conservative treatment, endoscopic necrosectomy or drainage therapy in the management of infected necrotizing pancreatitis [14-19].

Influence of Obesity on the Severity and Clinical Outcome of Acute Pancreatitis

Background/AimsObesity tends to be associated with increased mortality and morbidity in acute pancreatitis. However, in Asian populations, higher morbidity and mortality have been reported in patients with low body mass indexes (BMIs). This study was undertaken to evaluate the relation between obesity and outcome, and to investigate the occurrence of complications by overweightedness in acute pancreatitis.MethodsThe medical records of 403 patients with acute pancreatitis were reviewed retrospectively, and Ranson's scores, modified Glasgow scores, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and computed tomography severity indexes were calculated. Patients were categorized by BMI for the analysis.ResultsWhen compared with normal patients (BMI 18.5 to 22.9), all categories with a BMI ≥23 had an increased risk of developing a severe form of acute pancreatitis (p=0.003) and all categories with a BMI ≥25 significantly predicted severity (p<0.001). Patients with class 1 obesity (BMI 25 to 29.9) developed significantly more systemic and metabolic complications.ConclusionsOverweightedness and obesity were found to be associated with a higher risk of developing severe pancreatitis. Further studies are needed to establish the precise prognostic value of obesity in members of the population with low BMIs.

Leflunomide

Nuclear factor-kappaB (NF-kappaB) is a potent mediator in several steps of acute pancreatitis. Leflunomide is a novel immunomodulating drug that is also a potent inhibitor of NF-kappaB activation. The aim of this study was to investigate the effects of leflunomide pretreatment in severe necrotizing pancreatitis in rats. Fifty rats were randomly divided into 5 groups. Severe necrotizing pancreatitis was induced by retrograde injection of 3% sodium taurocholate into the common biliopancreatic duct. Leflunomide (10 mg/kg) was given intragastrically for 2 doses before the experiment. Serum amylase activity, pancreatic histopathologic condition, malondialdehyde level, myeloperoxidase enzyme activity, nitric oxide level, and pulmonary changes were assessed. Leflunomide pretreatment significantly ameliorated pancreatic hemorrhage, edema, and neutrophil infiltration and decreased histopathological score compared with the untreated severe necrotizing pancreatitis group (pathological score [mean +/- SEM]: 6.70 +/- 1.19 vs 12.36 +/- 1.08 in the leflunomide treated and untreated groups, respectively, P < 0.01). Pulmonary changes was decreased in the leflunomide treated group (3.90 +/- 0.45 vs 4.75 +/- 0.25, respectively). Change in pulmonary alveolar distention was significant. Although serum amylase levels also decreased, the difference was not significant (5922 +/- 3290 vs 15547 +/- 5090 U/mL). Leflunomide is a beneficial agent in the severe form of acute pancreatitis in rats and should be considered as a potential agent for treatment of acute pancreatitis.

The Interventional Radiological Procedures of the Infections of Pancreas

Infected necrotizing pancreatitis is the most severe form of acute pancreatitis and is related with high rates of morbidity and mortality. The close cooperation and communication, working as a team, among interventional radiologists surgeons and gastroenterologists improves the successful treatment considerably. Therapeutic modalities such as percutaneous CT-guided catheter drainage can be helpful to save lives, changing dramatically the clinical aspect of the patient. The objective of this paper is to review the indications and techniques of image-guided percutaneous treatment of pancreatic infected pseudocysts and to report our clinical experience and observations made during primary CT-guided percutaneous catheter drainage of infected abscesses.

Bernard Organ Failure Score in estimation of most severe forms of acute pancreatitis

Despite intensive research, efforts and clinical investigations on pathogenesis of acute pancreatitis (AP) and system morbidity during the illness onset, mortality is still very high in the group of severe forms. A significantly high number of patients show moderate, self-limited forms of illness, with a minimal degree of systemic or local complications, with full recovery. However, some of them have a severe form, followed by a high percent of morbidity and mortality, and system organ failure. The distinction between mild and severe forms of AP within 24-48 hours of hospital admission is very important for the treatment of these patients. The usage of multifactorial scoring systems holds a lot of promise, reaching reliability in the disease severity estimation of approximately 70-80%. The main purpose of this prospective study was to assess the correlation of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Bernard Organ Failure Score (BOFS) scoring systems in estimation of disease severity and outcome prediction. Sixty patients with AP participated in the study, all of them scored with the APACHE II and BOFS scores. The results were used for integration of laboratory and clinical parameters. In our study, we had a highly significant correlation between the APACHE II and BOFS scores from the disease onset until the end of treatment.There was a highly significant correlation between these two scores and the serum C-reactive protein concentration level. The concept of the BOFS score has more advantages than the APACHE II score in the patients with severe forms of AP with organ dysfunction.

ACUTE NECROTISING PANCREATITIS

Background: Pancreatic necrosis represents a severe form of acute pancreatitis. Opinions vary about the need and exact timing of surgery in patients with necrotising pancreatitis. In these patients we evaluate timing of surgery, and factors affecting the mortality. Patient and methods: This study included 49 consecutive patients of acute necrotising pancreatitis who had undergone surgical management. Age, sex, etiology, organ failure, mortality, ICU stay, hospital stay, different timings of surgery were evaluated. Results: Ethanol abuse (61%) of pancreatitis followed by gall stone (18%), idiopathic (18%). Surgical procedure consisted of pancreatic necrosectomy with post operative closed lavage. There were 46 males and 3 females, median age was 35 years (17-80 years). In 14.2% patients necrosis was sterile. 71% of patients required post of ventilatory support and median ICU stay was 8 (0-48) days. 50% developed post operative complications in the form of pancreatic fistula (32%), biliary fistula (4%), colon fistula (6%), significant haemorrhage (4%). There was 24% mortality. The survivors compared to non survivors as shown in Table below.TABLE 1: Comparison of Survivors and NonsurvivorsConclusion: Necrosectomy and post operative continuous lavage is a safe and effective method for treatment of PN with acceptable morbidity and mortality. Two to four weeks period is "golden period" for necrosectomy.

Blocking of monocyte chemoattractant protein-1 (MCP-1) activity attenuates the severity of acute pancreatitis in rats

Monocyte chemoattractant protein-1 (MCP-1) has been shown to affect the progression of various inflammatory disorders, including pancreatitis. To investigate the role of MCP-1 in acute pancreatitis and to seek possible therapeutic means, we evaluated the effect of a plasmid expression vector containing a dominant-negative mutant MCP-1 gene (mMCP-1). Two rat models of acute pancreatitis were employed that used either cerulein (for mild pancreatitis) or a mixture of 5% taurocholic acid and trypsin (for severe pancreatitis). At 6 h after induction of acute pancreatitis with or without injection of mMCP-1, serum amylase levels and cytokine levels, as well as morphological evaluation of the pancreas, were determined. Survival rates were also evaluated. Severe pancreatitis was significantly reduced by mMCP-1 injection. mMCP-1 decreased serum levels of amylase, IL-6, IL-10, and LDH, and improved the survival rate 48 h after disease onset. Histopathological changes of pancreas and lungs were also improved by mMCP-1. MCP-1 appears to be involved in the progression of severe forms of acute pancreatitis. Our data suggested that MCP-1 is a candidate as a therapeutic target to treat acute pancreatitis.

Plasma ADAMTS13 Activity Markedly Decreases in Patients with Severe Acute Pancreatitis: Its Potential Role on the Development of Multiorgan Failure.

Background: A severe form of acute pancreatitis, severe acute pancreatitis (SAP), frequently develops pancreatitis-associated multiorgan failure (MOF) followed by systemic microcirculatory disturbance with a high mortality. ADAMTS13 has been focused on the occurrence of thrombotic thrombocytopenic purpura (TTP). TTP has been reported to cause acute pancreatitis in a few percents, and recent study indicates that some acute pancreatitis may be a triggering event for TTP. We sequentially determined plasma ADAMTS13 activity (ADAMTS13:AC) and its related parameters in patients with SAP, and thereby, tried to explore their potential role on the development of MOF.Methods: Subjects studied were 13 patients with SAP, who were admitted into the department of emergency and critical care medicine of our hospital. The etiology was alcohol in 7, idiopathic in 3, common bile duct stones in 2, and post endoscopic retrograde cholangiopancreatography in 1. Eleven patients were survivors and two were non-survivors. Two of 4 patients with MOF were non-survivors. The severity was scored according to APACHE-II system. ADAMTS13:AC was determined using a commercially available ADAMTS13-act-ELISA (Kainos Inc., Tokyo). Plasma levels of VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis-α (TNF-α) were measured by ELISA. Unusually large VWF multimer (UL-VWFM) was analyzed by a vertical SDS -1.0% agarose gel electrophoresis system.Results: ADAMTS13:AC significantly decreased at day 1 (mean 39%, p<0.001) and at day 2 (33%, p<0.001) as compared to healthy subjects (99%). The activity, thereafter, gradually recovered (49% at day 5, 58% at day 7, and 70% at day 10) in survivors, whereas in non-survivors, it decreased from 22% at day 1 to 10% at day 2 in one and showed 15% at day 1 in another. The inhibitor against ADAMTS13 was not detected. The VWF:AG increased to 402% at day 1 (p<0.001) and 333% at day 2 (p<0.001) as compared to healthy subjects (100%), and the value, thereafter, remained high (395% at day 5, 428% at day 7, and 382% at day 10). The UL-VWFM could be detected in 7 cases for 3 to 35 days immediately after admission. On admission, patients with detectable UL-VWFM tended to be lower ADAMTS13:AC and higher VWF:Ag than those without, resulting in higher VWF/ADAMTS13 ratio (19.9 vs. 8.9, p<0.01). Patients with MOF showed lower ADAMTS13:AC (20% vs. 40%, p<0.05) and higher VWF:Ag (448% vs. 391%, p<0.05) than those without, resulting in higher VWF/ADAMTS13 ratio (22.9 vs. 11.2, p<0.02). The concentrations of IL-6, IL-8, and TNFα increased, and ADAMTS13:AC correlated with those of IL-6 (r= − 0.51, p<0.05) and IL-8 (r= − 0.66, p<0.02). Furthermore, ADAMTS13:AC negatively correlated with APACHE-II score (r= − 0.67, p<0.02).Conclusion: Markedly decreased ADAMTS13:AC together with increased amounts of UL-VWFM was closely related to the severity of pancreatitis, an intense systemic inflammatory response, and prognosis in patients with SAP. These results indicate that the imbalance between the enzyme and its substrate may involve in the development of acute pancreatitis and subsequent MOF through enhanced thrombogenesis.

ENTERAL CORRECTION OF METABOLIC DISTURBS IN COMPLEX TREATMENT OF SICKS WITH PURULENT COMPLICATIONS OF ACUTE DESTRUCTIVE PANCREATIN

Acute pancreatitis relates to the severe illnesses of gastrointestinal tract and in the frequency of appearance at present occupies the third place among acute surgical diseases after acute appendicitis and acute cholecystitis. Disseminated infected pancreatonecrosis remains the most severe form of acute pancreatitis. In the article our experience of the treatment of this category of patients is presented. Depending on the conducted nutritive support the patients were divided into two groups. The patients of the first group received parenteral nourishment, in the second group early enteral nourishment adapted. The results of inspection make it possible to assert that the including of enteral feed into the complex of treatment leads to reduction in lethality and number of complications in the postoperative period.

Acute necrotizing pancreatitis: role of CT-guided percutaneous catheter drainage

Necrotizing pancreatitis is the most severe form of acute pancreatitis associated with high morbidity and mortality. Percutaneous CT-guided catheter drainage is an important treatment option that can be effective whether used alone, or as an adjunct to operation. Existing literature describing the role of percutaneous catheter drainage of necrotizing pancreatitis is limited. This update reviews techniques, indications, outcomes, and complications of CT-guided percutaneous treatment of acute necrotizing pancreatitis.

Leptin and Adiponectin Levels in Acute Pancreatitis

Obesity is a risk factor for a severe form of acute pancreatitis (AP). Because the underlying mechanisms are poorly known, we studied relationship between the severity of AP and plasma levels of leptin and adiponectin, 2 adipokines regulating the course of systemic inflammation. The study comprises 12 patients with severe AP and 12 control patients with mild AP matched by age (+/-10 years), body mass index (+/-3 kg/m), sex, and etiology of AP. Quantikine Human Adiponectin and Quantikine Human Leptin Immunoassays (R&D Systems, Minneapolis, Minn) were used to measure the adipokine levels in the patients' plasma on admission and during the hospital stay. Median leptin concentrations on admission were 6.1 ng/mL (range, 1.6-72.9 ng/mL) in the severe AP group and 9.0 ng/mL (range, 2.5-36.3 ng/mL) in the mild AP group (P > 0.05). In severe AP, the value at days 2 to 4 (7.7 ng/mL; range, 1.6-13.9 ng/mL) did not differ from respective on-admission value (P > 0.05). In mild AP, the value at days 2 to 4 (3.8 ng/mL; range, 1.6-12.9 ng/mL) was lower than the respective on-admission value (P = 0.005). Adiponectin concentrations on admission were 5642 ng/mL (range, 1201-19,400 ng/mL) for severe AP and 6314 ng/mL (range, 1980-24,340 ng/mL) for mild AP (P > 0.05). Maximum variation of adiponectin level (the highest value minus the lowest value) was greater in severe AP than in mild AP (P = 0.001). In patients matched by age, sex, body mass index, and etiology, the on-admission plasma levels of adiponectin and leptin do not correlate with disease severity, suggesting that the adipokines do not affect the course of AP.

Surgical Management and Complex Treatment of Infected Pancreatic Necrosis: 18-Year Experience at a Single Center

Infected pancreatic necrosis (IPN), the most severe form of acute pancreatitis, is responsible for most cases of pancreatitis-related morbidity and mortality. Since 1986, 220 patients with IPN have been treated. The surgical treatment was performed on average 18.5 days (range, 8-25 days) after the onset of acute pancreatitis and consisted of wide-ranging necrosectomy, combined with widespread drainage and continuous lavage. In 108 of the 220 cases, some other surgical intervention (distal pancreatic resection, splenectomy, total pancreatectomy, cholecystectomy, colon resection, etc.) was also performed. Following surgery, the supportive therapy consisted of immunonutrition (glutamine and arginine supplementation) and modification of cytokine production with pentoxifylline and dexamethasone. Continuous lavage was applied for an average of 44.5 days (range, 21-95 days), with an average of 9.5 L (range, 5-20 L) of saline per day. The bacteriologic findings revealed mainly enteral bacteria, but Candida infection was also frequently detected (21%). Forty-eight patients (22%) had to undergo reoperation. The overall hospital mortality was 7.7% (17 patients died). In our experience, IPN responds well to adequate surgical treatment, continuous, longstanding widespread drainage and lavage, together with supportive therapy consisting of immunonutrition and modification of cytokine production, combined with adequate antibiotic and antifungal medication.

Acute pancreatitis

Acute pancreatitis is an acute inflammatory process of the pancreas mainly due to biliary obstruction or alcohol consumption. Most episodes of acute pancreatitis are mild and resolve under conservative treatment. Severe forms of acute pancreatitis, especially the necrotising form, still have a high mortality rate and can be difficult to treat. The problem today is to identify the few cases that should be treated operatively. Infected necroses are well accepted as an indication for operative treatment. Surgery consists of débridement and necrosectomy followed by closed or open lavage. In biliary pancreatitis, ERCP is performed early in cases of biliary obstruction, with or without cholangitis. In these patients cholecystectomy should be performed electively after clinical recovery.

Analysis of serum catalase activities in pancreatic diseases.

Active oxygen species are thought to be involved in the exacerbation of acute pancreatitis. Therefore, it would be reasonable to speculate that the activity of catalase is increased in the severe form of acute pancreatitis. The aim of the present study was to diagnose the severity of acute pancreatitis, using catalase activity, and to examine the usefulness of this measurement for this diagnosis. METHODS Catalase could be measured quickly in 87 patients with pancreatic disease, using automatic analyzers, and using kits based on UV rate assay methods. In pancreatic disease, catalase activity was higher in acute pancreatitis, particularly in the early stage of the disease. It could be used to diagnose the severity of acute pancreatitis almost as early as the criteria of the Japanese Ministry of Health and Welfare (MHW). When we set 330 U/l as the cutoff value, its sensitivity of diagnosis was 76.9% in the first 4 days of the disease and its specificity was 100%. As catalase activity can be measured quickly using automatic analyzers, serum catalase activity is useful for evaluation of the severity of acute pancreatitis.