The aim of this study was to investigate the role of tumor necrosis factor (TNF), interleukin-6(IL-6), C-reactive protein (CRP) in pancreatitis and its systemic complications. Thirty six patients with acute pancreatitis were studied, 12 with mild disease, and 24 severe disease, of whom 9 developed systemic complications. TNF, IL-6, CRP in these patients with pancreatitis was assessed during the first, 4th, 8th days of admission. The serum concentration of TNF, IL-6, CRP were significantly increased, and significantly higher in complicated group than in mild group and severe group. These findings suggest that proinflammatory cytokines play a central role in the pathophysiology of the disease, the host systemic response to pancreatic inflammation and the level of the response did relate to the development of organ dysfunction.
This study aimed to assess the therapeutic effect of mannital administration on acute hemorrhagic necrotizing pancreatitis (AHNP), 28 Wistar rats were randomily divided into therapeutic group and control group after induction of AHNP by retrograde intraductal injection of 5 percent sodium taurocholate. The rats of therapeutic group received intravenous 20% mannital (1g/kg) through tail vein, once in 12 hours, until the end of experiment; control group received saline (5.0 ml/kg) with the same way. Blood of all the rats were collected from heart and the rats were killed after 96 hours. Results: lipid peroxide (LPO) in pancreatic tissue, LPO in serum, lactate dehydrogenase (LDH), alpha-1-antitrypsin (α1-AT), glutamicoxalacetic transaminase (GOT), necrotizing square of pancreatic tissue in the therapeutic group were significantly less than those in control group (Ｐ＜0.05 or Ｐ＜0.01). The damage to pancrease, heart, liver, kidney in the therapeutic group were lighter than those of the control group and the mortality was lower (Ｐ＜0.05).Conclusions: Mannital can scavenge the oxygenderived free radicals and play a therapeutic role in AHNP.
Objective To evaluate the effect of early clinical interference strategies on preventing the conversion of acute pancreatitis to the severe form and aggravation of severe acute pancreatitis (SAP). Methods The patients with acute pancreatitis admitted to this hospital were divided into two therapeutic phases by different therapeutic methods from January 2001 to December 2008. Patients in the first phase (from January 2001 to December 2004) were treated by the routine management, and the second phase (from January 2005 to December 2008) by the routine management combined with early clinical interference strategies. Then, the ratio of conversion from acute pancreatitis to SAP and prognosis of SAP between two phases were compared. Results Compared with the first phase, the rate of aggravation of acute pancreatitis was significantly decreased in the second phase (4.48% vs. 21.18%), the average healing time of SAP, the incidences of systemic and local complications and the mortality of pancreatitis were reduced (P＜0.05). When early clinical interference strategies were performed, some adverse reaction and complications occurred in 35 cases, but without severe consequence. Conclusion Early clinical interference strategies may serve as a beneficial strategy on preventing the progression of mild acute pancreatitis to the severe form or halting the aggravation of acute pancreatitis.
In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.
Objective To investigate the effect of nitroglycerin on preventing post-endoscopic retrograde cholangiopancreatograph (ERCP) pancreatitis (PEP) and hyperamylasemia. Methods One hundred patients diagnosed as common bile duct stones by CT or MRI and planned to undergo ERCP, EST and stones removal under endoscopy were selected from January to December 2008 in Shandong Jiaotong Hospital. These patients were randomly divided into 2 groups: nitroglycerin group (n=50), in which 0.5 mg nitroglycerin was given sublingually in 5-10 min before ERCP; control group (n=50), in which no nitroglycerin was given. The levels of serum amylase of all the patients before ERCP and at 3 h, 24 h after ERCP were detected and the incidence of hyperamylasemia and PEP were also observed. Results The level of serum amylase between 2 groups before ERCP was not significantly different (P＞0.05). The levels of serum amylase at 3 h and 24 h after ERCP were significantly higher than that before ERCP in 2 groups. The level of serum amylase in nitroglycerin group were respectively lower than that in control group at 3 h and 24 h after ERCP 〔3 h: (108.88±152.07) U/L vs. (196.30±244.41) U/L; 24 h: (97.02±113.38) U/L vs. (234.22±406.05) U/L〕， P＜0.05. The incidence of hyperamylasemia (12.00%, 6/50) and PEP (2.00%, 1/50) in nitroglycerin group was respectively significantly lower than that in control group (hyperamylasemia: 30.00%, 15/50; PEP: 14.00%, 7/50）， P＜0.05. Conclusion Sublingual nitroglycerin can decrease the level of serum amylase and prevent PEP and hyperamylasemia.
Objective To investigate the relationship between gene expression of endothelin-3 (ET-3） and inflammation of acute pancreatitis （AP） in rats. Methods Fifty-four rats were divided randomly into 4 groups: sham operation group, AP group, arterial injection group and vein injection group. AP was induced by reverse intra-bile duct infusion 4.5% sodium taurocholate, treated with low dose dopamine 〔5 μg/（kg·min）〕 by injecting arterial or tail vein. Rats were sacrificed at 1， 6 and 24 h after the induction of AP. The mRNA expression of ET-3 was evaluated by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and pathological changes was observed in rats. Results Expression of ET-3 mRNA could be detected from 1 up to 24 h after the induction of pancreatitis. Expression of ET-3 mRNA of sham operation group was decreased significantly compared with other three groups. Expression of ET-3 mRNA showed a significant decrease by arterial injection dopamine than that by tail vein (P＜0.05， P＜0.01). The pathologic score in AP group was the highest, vein injection group was the next one, and score in sham operation group was the lowest. Conclusion There are significant relationship between inflammation of AP and expression of ET-3 mRNA. Dopamine administration by arterial injection is more effective than that by tail vein injection.
【Abstract】Objective To study the liver injury and effects of aescin on liver in rats with acute pancreatitis. Methods The rats were divided into 3 groups (control group, AP group and aescin group). The serum alanine aminotransferase （ALT）, serum lactate dehydrogenase (LDH), hepatic cellular energy charge (EC) and adenosine triphosphate (ATP) were detected. The pathologic changes in pancreas and liver were also observed. Results The serum levels of ALT and LDH in aescin group were significantly lower than those of the AP group. The EC and ATP levels were significantly higher in aescin group than that of the AP group. Conclusion Introvenous injection of aescin can alleviate the liver injury in rats with acute pancreatitis.
ObjectiveTo investigate the clinical characteristics of pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome).
MethodsA patient with PPP syndrome in July 2013 was reported. The clinical features of 33 cases of PPP syndrome at home and abroad were reviewed.
ResultsOur patient with panniculitis and arthritis as the first manifestation had few abdominal symptoms despite high serum levels of pancreatic enzymes. In the 34 PPP cases, 70.6% (24/34) had absent or mild abdominal symptoms, easily leading to misdiagnosis. Multi-joint involvement was more common, and in almost 1/3 of the patients, joint symptoms with poor NSAIDs and/or hormonal responses predated the identification of pancreatic disease. Panniculitis biopsy found characteristic "ghost cells". Ten patients died of complications of pancreatic disease (including 2 cases of cancer), and the mortality rate was as high as 29.4% (10/34).
ConclusionPPP syndrome with mild abdominal symptoms and high mortality should be taken for the treatment of pancreatic disease, to prevent misdiagnosis and mistreatment.
Objective To investigate a new way for the treatment of severe acute pancreatitis (SAP). Methods The clinical data of 59 cases of SAP were analyzed, and they were divided into two groups: LAI group and control group. In LAI group, 30 cases were treated mainly by local arterial infusion (LAI). In control group, 29 cases were treated by intravenous infusion. Results Compared with control group, the results of LAI group were much better in abdominal pain relief, recovery of intestinal function, reducing the complications, shorter antibiotictime, decreasing the incidence of secondary systemic infection. The mortality of SAP class Ⅱ in LAI group and control group were 35.71% and 66.67% respectively. Conclusion LAI is a new way for the treatment of SAP.
Objective To evaluate the predicted value of APACHEⅡ score at admission for deep fungal infection（DFI） in patients with severe acute pancreatitis （SAP）.Methods The clinical data of 132 patients with SAP from January 2006 to June 2011 in our hospital were analyzed retrospectively. The receiver operating characteristic curve （ROC） was used for evaluating the predicted value.Results Thirty-nine patients with SAP infected DFI （29.5%）,of which 36 patients （92.3%） infected with Candida albicans,2 patients （5.1%） with Candida tropicalis,1 patient （2.6%） with pearl bacteria.And,among these 39 patients,27 patients （69.2%） infected at single site,12 patients （30.8%） infected at multi-site. The APACHEⅡ score in 39 patients with DFI was higher than that of 93 patients without DFI （17.1±3.8 versus 9.7±2.1, t=14.316,P=0.000）.The ROC for APACHEⅡ score predicting DFI was 0.745（P=0.000）, 95%CI was 0.641－0.849.When the cut off point was 15,it showed the best forecast performance,with specificity 0.81, sensitivity 0.72,Youden index 0.53. Conclusions The APACHEⅡ score at admission can preferably predict DFI in patients with SAP； when the APACHEⅡ score is greater than 15,it prompts highly possible of DFI,so preventive anti-fungal treatment may be necessary.
