Hepatitis A and acute pancreatitis

Acute pancreatitis in association with acute viral hepatitis A in uncommon. We present the case of a young girl with acute pancreatitis complicating acute viral hepatitis A. The finding of IgM anti-HAV and exclusion of a vast array of other etiologies implicates hepatitis A the cause.     

Two cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice

We recently treated two cases of chronic pancreatitis with obstructive jaundice due to compression of the common bile duct by pancreatic pseudocyst. The two cases were males admitted with the complaint of icteric skin color. The first, a 46-year-old male, admitted with the complaint of icteric skin color. He was treated by operative cystojejunostomy after percutaneous drainage of the pseudocyst and percutaneous transhepatic biliary drainage. The other case was a 58 year-old male who admitted with the complaint of icteric skin color. He had an infected pseudocyst in the pancreas and was endoscopically treated. Both of them were discharged with favorable clinical course and normal laboratory findings after the treatment. The former patient remained well 11 months after treatment, but the latter patient died from necrotizing pancreatitis and septic shock 6 months after treatment. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct rather than due to compression of the bile duct by the pseudocyst. In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, differentiating between these two conditions is an important aspect of accurate diagnosis and therapy. Herein we report two unusual cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice.     

Involvement of exosomes in lung inflammation associated with experimental acute pancreatitis

A frequent complication of acute pancreatitis is the lung damage associated with the systemic inflammatory response. Although various pro‐inflammatory mediators generated at both local and systemic levels have been identified, the pathogenic mechanisms of the disease are still poorly understood. In recent years, exosomes have emerged as a new intercellular communication system able to transfer encapsulated proteins and small RNAs and protect them from degradation. Using an experimental model of taurocholate‐induced acute pancreatitis in rats, we aimed to evaluate the role of exosomes in the extent of the systemic inflammatory response. Induction of pancreatitis increased the concentration of circulating exosomes, which showed a different proteomic profile to those obtained from control animals. A series of tracking experiments using PKH26‐stained exosomes revealed that circulating exosomes effectively reached the alveolar compartment and were internalized by macrophages. In vitro experiments revealed that exosomes obtained under inflammatory conditions activate and polarize these alveolar macrophages towards a pro‐inflammatory phenotype. Interestingly, the proteomic analysis of circulating exosomes during acute pancreatitis suggested a multi‐organ origin with a relevant role for the liver as a source of these vesicles. Tracking experiments also revealed that the liver retains the majority of exosomes from the peritoneal cavity. We conclude that exosomes are involved in the lung damage associated with experimental acute pancreatitis and could be relevant mediators in the systemic effects of pancreatitis. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Organ failure associated with acute pancreatitis in African-American and Hispanic patients

OBJECTIVE: We studied the relationship between acute pancreatitis and organ failure in African-American and Hispanic patients. METHODS: The medical records of 760 (417 African-American and 343 Hispanic) patients aged 19-85 years diagnosed with acute pancreatitis over 15 years were reviewed retrospectively. We abstracted and analyzed data related to demographics, etiology, type of pancreatitis, organ failure and mortality. RESULTS: Of the 760 patients, 24% had organ failure. Of the 182 patients with organ failure, 125 patients (69%) had multiple organ failure, whereas 57 patients (31%) had single type. Cardiovascular system failure was the common organ dysfunction (28%). Of the 760 patients, 14% died. Patients with organ failure had a higher mortality (40%) compared with those without it (6%) (OR=9.6, 95% CI: 6.0-15.3) (P=0.001). Mortality was higher among those with multiple organ failure (46%) compared with those with single type (25%). Mortality was highest among those with pulmonary failure (57%). CONCLUSION: The prevalence of organ failure in our study was slightly higher than the general population (20%). Mortality from single type was higher than that reported in previous studies (8-11%), especially mortality from pulmonary failure (18%). Prevention, early diagnosis and prompt treatment of organ failure may improve the clinical outcome.     

Fatal pancreatic panniculitis associated with acute pancreatitis: a case report

Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.     

Severe thrombocytopenia associated with acute hepatitis E virus infection

We describe here what is, to the best of our knowledge, the third reported case of severe thrombocytopenia associated with acute hepatitis E virus infection. The patient was a 72-year-old French woman. It seems likely that the cause of the thrombocytopenia was acute hepatitis E virus infection, possibly occurring via an immune mechanism. No complications were noted, in contrast to the two previous reports.     

急性坏死性胰腺炎肠粘膜损害与NK-IR的过度表达相关

目的:研究神经激肽-1受体(NK-1R)和神经激肽-2受体(NK-2R)在急性坏死性胰腺炎(ANP)大鼠末端回肠组织中的表达, 探讨该受体的表达与ANP肠粘膜损害的关系。方法:健康成年Sprague-Dawley大鼠随机分为假手术对照组(50只)和ANP组(80只)。假手术对照组开腹后只翻动胰腺, ANP组大鼠胰胆管恒速逆行注射5%牛磺胆酸钠, 制成ANP大鼠模型。应用逆转录聚合酶链反应(RT-PCR)检测末端回肠组织NK-1R和NK-2R的mRNA水平, 应用Westernblot检测NK-1R的蛋白表达水平。结果:与假手术对照组相比, ANP末端回肠组织中NK-1R和NK-2R的mRNA水平过度表达。NK-1R的表达水平分别与肠粘膜的病理学评分(r=0.77, P＜0.01)和肠粘膜通透性(r=0.68, P＜0.01)呈明显正相关。结论:ANP时, 肠组织中NK-1R和NK-2R的表达水平明显上调, P物质的过度作用加剧ANP时肠粘膜的病理损害, 损害肠粘膜屏障的功能。     

Hepatitis E virus

Hepatitis E virus (HEV) is a positive-stranded RNA virus with a 7.2 kb genome that is capped and polyadenylated. The virus is currently unclassified: the organisation of the genome resembles that of the Caliciviridae but sequence analyses suggest it is more closely related to the Togaviridae. Hepatitis E virus is an enterically transmitted virus that causes both epidemics and sporadic cases of acute hepatitis in many countries of Asia and Africa but only rarely causes disease in more industrialised countries. Initially the virus was believed to have a limited geographical distribution. However, serological studies suggest that HEV may be endemic also in the United States and Europe even though it infrequently causes overt disease in these countries. Many different animal species worldwide recently have been shown to have antibodies to HEV suggesting that hepatitis E may be zoonotic. Although two related strains have been experimentally transmitted between species, direct transmission from an animal to a human has not been documented. There are four currently recognised genotypes and two of the four contain viruses isolated from swine as well as from humans. Regardless of country of origin or genotype of the virus, most, if not all, strains belong to a single serotype. A promising recombinant vaccine candidate comprised of a truncated capsid protein is currently under evaluation in Nepal.     

妊娠期急性胰腺炎与普通人群急性胰腺炎诊治分析

目的 探讨妊娠期急性胰腺炎与正常人群急性胰腺炎的发病机制、对母婴的影响、诊治特点及治疗效果.方法 回顾性分析我院近2年来收治的20例妊娠期合并急性胰腺炎患者的临床资料,根据病因不同分为胆石症组(A组)与高脂血症组(B组),分析比较A组与B组急性胰腺炎的治疗特点及治疗效果,并从我院近2年来收治的普通人群组(C组)急性胰腺炎病例中随机选取20例,与妊娠组(D组)急性胰腺炎做对照,观察其治疗特点及疗效.结果 妊娠期急性胰腺炎患者A组与B组各临床观察指标比较有显著差异性(P＜0.05),普通人群组与妊娠组急性胰腺炎治愈率无明显差异,各个临床观察指标无明显差异性(P＞0.05).结论 早期及时诊断妊娠合并急性胰腺炎并适时终止妊娠,可降低母婴死亡率;内镜下鼻胆管置入术可显著缩短治疗时间,需合理选择药物,加贝酯与生长抑素对胎儿有不良影响应慎用.     

Baculovirus Expression of Chimeric Hepatitis B Virus Core Particles with Hepatitis E Virus Epitopes and Their Use in a Hepatitis E Immunoassay

Two hepatitis B core proteins bearing the immunodominant region of the hepatitis E virus (HEV) capsid protein, one at the C terminus of hepatitis B virus core antigen (HBcAg) and the other within the HBcAg immunodominant loop, were constructed. Both chimeric proteins exhibited HEV reactivity, but only the first construct retained HBcAg reactivity. The second construct was used to develop an anti-HEV test which is equivalent to a commercial test for the detection of anti-HEV immunoglobulin G (IgG) but is more sensitive for the detection of anti-HEV IgM.     

Hepatitis E Virus Infection

SUMMARY

Hepatitis E virus (HEV) infection is a worldwide disease. An improved understanding of the natural history of HEV infection has been achieved within the last decade. Several reservoirs and transmission modes have been identified. Hepatitis E is an underdiagnosed disease, in part due to the use of serological assays with low sensitivity. However, diagnostic tools, including nucleic acid-based tests, have been improved. The epidemiology and clinical features of hepatitis E differ between developing and developed countries. HEV infection is usually an acute self-limiting disease, but in developed countries it causes chronic infection with rapidly progressive cirrhosis in organ transplant recipients, patients with hematological malignancy requiring chemotherapy, and individuals with HIV. HEV also causes extrahepatic manifestations, including a number of neurological syndromes and renal injury. Acute infection usually requires no treatment, but chronic infection should be treated by reducing immunosuppression in transplant patients and/or the use of antiviral therapy. In this comprehensive review, we summarize the current knowledge about the virus itself, as well as the epidemiology, diagnostics, natural history, and management of HEV infection in developing and developed countries.     

Diffuse large B-cell lymphoma associated with chronic inflammation arising in a renal pseudocyst

Primary renal lymphomas are very rare, and primary kidney-limited lymphomas with cystic presentation have never been described before. This study reports a case of diffuse large B-cell lymphoma associated with chronic inflammation occurring in a renal pseudocyst: an infrequent neoplasm with an unusual and subtle clinical presentation.