Hyperbaric oxygen therapy for severe acute pancreatitis

Despite improvements in the supportive management of severe acute pancreatitis over the last decade, the morbidity and mortality rate remains high. The main feature of this condition is pancreatic necrosis leading to sepsis, with both localized and systemic inflammatory response syndromes. Early pathophysiological changes of the pancreas include alterations in microcirculation, ischemia reperfusion injury, and leukocyte and cytokine activation. The efficacy of hyperbaric oxygen (HBO) therapy in improving these pathophysiological disturbances is documented for various conditions. However, its effect in the treatment of severe acute pancreatitis is undetermined. This report documents the case of a 56-year-old woman presenting with severe acute pancreatitis treated by HBO therapy. The severity of disease was based on an Acute Physiology and Chronic Health Evaluation (APACHE II) illness grading score of 11 and a Baltazar based computed tomography severity index (CTSI) score of 9. Administration of 100% oxygen was commenced within 72 h of presentation at a pressure of 2.5 atmospheres for 90 min and given twice daily for a total of 5 days. Therapy was well tolerated with improvements in APACHE II and CTSI grading scores. HBO therapy for severe acute pancreatitis appeared to be safe and may have a role in improving treatment outcomes. Further study is required.     

Thymosin alpha 1 improves severe acute pancreatitis in rats via regulation of peripheral T cell number and cytokine serum level

AIM: The aim of this study was to investigate the effect of thymosin alpha 1 (TA1) on severe acute pancreatitis (SAP) in rats. METHODS: Healthy Sprague-Dawley rats (n = 72) were randomly divided into four groups: control group, SAP group, and two TA1 treated groups. SAP was induced by injection of 5% sterile sodium taurocholate into the biliopancreatic duct (BPD), after which TA1 was given subcutaneously at 0 and 2 h at a dose of 100 microg/kg. The rats were killed at 3, 6 and 12 h, respectively. Serum amylase and lipase, interleukin (IL)-1beta, tumor necrosis factor-alpha (TNF-alpha), pancreatic wet/dry weight ratio and the percentage of CD3/CD4+/CD8+ T cells in peripheral blood mononuclear cells (PBMC) were measured. Next, 30 rats were randomly divided into three groups (each group containing 10 animals): SAP group (S) and two TA1 treated groups. The effects of TA1 on the survival of SAP were assessed 72 h after the induction of SAP. RESULTS: There was no significant change in the serum amylase and lipase levels after TA1 administration. Levels of serum IL-1beta, TNF-alpha and pancreatic wet/dry weight ratio were significantly reduced after TA1-treatment. Application of TA1 significantly balanced CD3/CD4+/CD8+ T cells of PBMC and improved histological scores and the survival rate. CONCLUSION: TA1 can reduce pancreatic inflammation by regulating differentiation of CD3/CD4+ T cells and decreasing the release of cytokines, thus attenuates pancreatic severity in SAP rats.     

Effects of octreotide in acute hemorrhagic necrotizing pancreatitis in rats

BACKGROUND AND AIM: Octreotide is considered to reduce exocrine pancreatic secretion in acute hemorrhagic necrotizing pancreatitis decreasing pancreatic autodigestion. The aim of this study was to determine whether octreotide also has antioxidative effects in acute pancreatitis. Additionally time and dose of application were of interest. METHOD: Ninety male Sprague-Dawley rats were randomized into six groups (n = 15). Group 1 underwent a laparotomy, and animals in groups 2-6 received intraductal glycodeoxycholic acid followed by intravenous cerulein. Groups 3 and 4 were injected with 0.5 mg octreotide, while groups 5 and 6 received continuous intravenous infusion of 0.05 mg octreotide/h for 10 h. Treatment was initiated 6 hours after induction of pancreatitis (IP) in groups 3 and 5, and 14 h after IP in groups 4 and 6. At 24 h after IP all animals were killed and each pancreas was analyzed histopathologically. In addition, levels of pancreatic lipid peroxidation protective enzymes glutathione-peroxidase (GSH-Px) and superoxide dismutase (SOD) as well as lipid peroxidation via thiobarbituric acid reactive substances (TBARS) were determined. RESULTS: Early bolus application of octreotide reduced severity of histopathological changes in acute pancreatitis and decreased lipid peroxidation in pancreatic tissue samples; however, late bolus application and continuous intravenous infusion did not influence pancreatitis or lipid peroxidation. CONCLUSION: Octreotide seems to have a dose- and time-dependent effect on histopathology and lipid peroxidation in a model of pancreatitis in rats.     

Hemodynamic effect of iopromide in pancreas-duodenum transplanted rats

Background: Radiological contrast media (CM) have been suggested to be able to impair pancreatic microcirculation, especially in acute pancreatitis.

Purpose: To evaluate the effects of the low-osmolar CM iopromide on total pancreatic and especially islet blood perfusion after whole pancreas transplantation.

Material and Methods: Rats receiving a pancreas-duodenum transplantation 2 days earlier, i.e., with graft pancreatitis, were injected with iopromide. Blood perfusion measurements were then made with a microsphere technique.

Results: The graft blood perfusion was decreased in control rats when compared to the endogenous pancreas. Administration of iopromide increased both total pancreatic and islet blood perfusion in the grafted pancreas, but not in the endogenous gland. No effects on blood perfusion to either the native or transplanted duodenum were seen after iopromide administration.

Conclusion: Iopromide increases the blood perfusion of a whole pancreas transplant 2 days after implantation, i.e., when graft pancreatitis is present. The consequences of this CM-induced hyperperfusion for graft pancreatic function remain to be established.     

尿胰蛋白酶原-2与尿液淀粉酶早期诊断急性胰腺炎的循证评估

目的采用循证医学的方法评估尿胰蛋白酶原-2（TPS-2）和尿液淀粉酶（UAmy）早期诊断急性胰腺炎（AP）的诊断价值与诊断效能,为临床医生和检验人员选择AP生化标志物提供最佳临床决策证据。方法检索MEDLINE、EMBASE、中国生物医学文献数据库（CBMDISC）、中国生物医学期刊文献数据库（CMCC）、中文期刊全文数据库（CNKI）等数据库,按照纳入标准收集TPS-2与UAmy诊断AP的研究文献,采用QUADAS量表进行严格的文献质量评价,利用MetaDisc软件进行异质性分析及定量合成,绘制SROC曲线,计算相应的验后概率。结果39篇TPS-2与UAmy诊断AP的研究结果异质性分析,前者无明显异质性（P=0.5641,I2=0%）;后者有中等程度的异质性（P=0.0086,I2=38.5%）。合并敏感度Sen分别为93%（95%CI：92%～94%）与81%（95%CI：79%～83%）;合并特异度Spe分别为94%（95%CI：94%～95%）与82.0%（95%CI：81%～83%）;SROCAUC分别为0.9788（SE=0.0024）与0.8680（SE=0.0084）,差异有统计学意义,前者的综合诊断效能优于后者。TPS-2与UAmy结果阳性时诊断AP的验后概率分别约为56.88%与26.62%,阴性验后概率分别为0.69%与2.38%。结论检测尿液TPS-2诊断AP比UAmy具有更高的诊断价值,可作为AP诊断的过筛试验,阴性结果有99.31%的概率可排除AP的可能性。     

Diagnosis of autoimmune pancreatitis by core needle biopsy: application of six microscopic criteria

Autoimmune pancreatitis (AIP) has been established as a special entity of chronic pancreatitis (CP). However, its clinical distinction from pancreatic cancer and other types of CP is still difficult. The aim of this study was to evaluate the efficacy of pancreatic core needle biopsy for the diagnosis of AIP. In 44 core needle biopsy specimens, we assessed the following microscopic features: granulocytic epithelial lesions (GELs), more than ten IgG4-positive plasma cells/HPF, more than ten eosinophilic granulocytes/HPF, cellular fibrosis with inflammation, lymphoplasmacytic infiltration, and venulitis. All biopsies that showed four or more of the six features (22 of 44) were obtained from 21 of 26 patients whose clinical diagnosis and follow-up were consistent with AIP. All non-AIP CP patients (n = 14) showed three or less than three of the features in their biopsies. GELs were only observed in biopsy specimens from AIP patients. In conclusion, our data indicate that the six criteria we applied were able to recognize AIP in 76% of biopsy specimens using a cut-off level of four. When the specimens that revealed only three features but showed GELs were added, the sensitivity rose to 86%. Pancreatic core needle biopsy can therefore make a significant contribution to the diagnosis of AIP.     

柴芍承气汤加味银杏叶对重症急性胰腺炎大鼠血PAF、TNF-α、IL-8的影响

目的通过动物实验方法探讨柴芍承气汤加味银杏叶对重症急性胰腺炎（SAP）大鼠模型胰腺损伤及血中PAF、TNF-α、IL-8水平的影响。方法将72只成年雄性Wistar大鼠随机分为4组：假手术组（J组）、SAP模型组（M组）、柴芍承气汤组（C组）、加味柴芍承气汤组（Z组）,各组又按制模后规定时间分为6、12、24h3个亚组,每组6只。采用牛黄胆酸钠胰胆管注射法制备SAP大鼠模型,J组大鼠仅于剖腹手术后轻轻翻动胃与十二指肠。制模后,C组给予柴芍承气汤灌胃,Z组给予柴芍承气汤加味银杏叶鼻饲,J组与M组给予生理盐水灌胃。大鼠处死后取胰腺组织,标本用10%福尔马林固定,石蜡包埋,切片,HE染色,光镜观察各组胰腺组织损伤情况。制模后,按规定时间点取大鼠动脉血,分别测定各组血中PAF、TNF-α、IL-8水平变化。结果 M组胰腺组织损伤随着时间延长逐渐加重,血中PAF、TNF-α、IL-8水平逐渐增高;C组较M组胰腺组织损伤减轻,血中PAF、TNF-α、IL-8水平均降低;Z组较C组血PAF水平下降。结论柴芍承气汤加味银杏叶可通过降低SAP大鼠血TNF-α、IL-8和PAF水平,对胰腺组织起到保护作用,其较柴芍承气汤具有更好的治疗作用。     

1例IgG4相关硬化性疾病临床病理分析及文献复习

目的 报告1例罕见的IgG4相关硬化性疾病多器官受累病例,提高该病的认识水平.方法 分析我院2010年11月诊治并经病理学确诊的IgG4相关硬化性疾病1例,并结合国内外文献,对本病的临床表现、诊断、治疗及预后进行分析讨论.结果 患者临床表现为糖尿病、肾功能受损,颈部、腹股沟等全身淋巴结肿大;血清IgG、IgG4异常增高,CT检查胰腺肿大、间质性肺炎,淋巴结活检可见IgG4阳性浆细胞浸润,肾脏活检病理为局灶硬化性肾小球肾炎;激素治疗3周肾功能正常,胰腺及淋巴结形态明显缩小,20周血IgG、IgE正常,糖尿病控制良好.结论 IgG4相关硬化性疾病是一种非常罕见的全身系统性疾病,及时应用糖皮质激素可控制病情.     

急性胆源性胰腺炎的外科治疗

目的：探讨急性胆源性胰腺炎（ABP）的外科治疗方法。方法：回顾性分析165例ABP病例的临床资料。将首次住院期间接受手术治疗病例设为手术组,出院3月以后再入院行胆道手术者设为对照组,比较手术组/对照组的平均总住院时间（D）,12月内复发数,死亡病例数,术后并发症发生情况。结果：手术组与对照组相比,死亡率无统计学意义,平均总住院时间相比差异有统计学意义（t=18.582,P〈0.05）,12月内复发率相比差异有统计学意义（χ2=4.714,P〈0.05）,术后出现并发症率相比差异亦有统计学意义（χ2=9.731,P〈0.05）。结论：ABP的外科治疗应遵循个体化治疗原则,选择合适的手术时机在治疗过程中起关键作用。