Nationwide epidemiological survey of chronic pancreatitis in Japan

The aim of this study was to estimate the number of patients treated for chronic pancreatitis in 1994 in Japan and to explore the clinico-epidemiological features of chronic pancreatitis. Two surveys were conducted. Stratified random sampling was used to select departments in which patients with chronic pancreatitis were treated, and two different questionnaires were administered to obtain relevant information. From the first survey, the total number of patients treated for chronic pancreatitis in Japan in the year 1994 was estimated as 32,000 (95% confidence interval, 25,000-39,000). Clinico-epidemiological features, based on the 2,523 patients reported from the second survey, were subsequently clarified. The sex ratio (male/female) of the patients was 3.5. Alcoholic pancreatitis was the most common type in males (68.5%), and idiopathic pancreatitis in females (69.6%). Compared with the findings in the last survey in 1985, the proportion of patients with alcoholic pancreatitis has decreased slightly, from 58.7% to 55.5%, while that of idiopathic chronic pancreatitis has increased in both males and females. Patients diagnosed by advanced techniques such as computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) accounted for 68.1% of the total. The number of patients with chronic pancreatitis treated in 1994 in Japan, was estimated as 32,000, with an overall prevalence rate of 45.4 per 100,000 population in males and 12.4 per 100,000 population in females.     

Left atrial booster-pump function as a predictive parameter for new-onset postoperative atrial fibrillation in patients with severe aortic stenosis

Postoperative atrial fibrillation (POAF) is associated with increased risk of embolic events and heart failure, but its associated factors remains unknown. Left atrial (LA) subclinical mechanical dysfunction caused by the acute stress of surgery may be clinically manifested as POAF. The purpose of our study was therefore to test the hypothesis that preoperative LA subclinical myocardial dysfunction is a potential predictor of development of POAF in patients with aortic stenosis (AS). We studied 27 patients with severe AS undergoing aortic valve replacement (AVR) with left ventricular (LV) ejection fraction of 63 ± 11 %. All patients were in sinus rhythm and had no history of atrial fibrillation (AF). LA reservoir (SR-LAs), conduit (SR-LAe), and booster-pump (SR-LAa) functions were determined as the averaged global LA speckle-tracking longitudinal strain rates from apical four- and two-chamber views. POAF, defined as any episode of AF within 30-day after AVR, was observed in 15 patients (56 %). There were no differences in clinical characteristics, LA and LV volumes, and global LV function between patients with and without POAF. Multivariate logistic regression analysis identified SR-LAa as the only independent predictor of POAF. Furthermore, SR-LAa >0.79 s^?1 predicted POAF with 60 % sensitivity, 92 % specificity, and area under the curve of 0.828 (p < 0.0001). Of the 15 patients with POAF, one developed paroxysmal AF during long-term follow-up. In conclusions, SR-LAa helped to detect subtle LA booster-pump dysfunction and was associated with new-onset POAF in patients with severe AS. These findings may be useful for risk stratification and management of such patients.     

Evaluation of global circumferential strain as prognostic marker after administration of β-blockers for dilated cardiomyopathy

The use of β-blockers has improved the prognosis of dilated cardiomyopathy (DCM) and the appearance of left ventricular (LV) reverse remodeling is generally thought to result in a more favorable prognosis. While there are many prognostic predictors, not all of them are applicable to individual patients. Global circumferential strain (GCS) was identified as a powerful prognostic marker, which appears to be a better parameter than LV global function for patients with depressed left ventricular (LV) ejection fraction. Seventy consecutive patients with newly-diagnosed DCM with LVEF of 28 ± 8 % (all <45 %) were retrospectively recruited. Either carvedilol or bisoprolol was titrated to a dose that was tolerable for each of the patients. GCS was determined as the peak global speckle-tracking circumferential strain from the mid-LV short-axis view. LV reverse remodeling was defined as an absolute increase in LVEF of at least 10 % during 8.1 ± 5.2-month follow-up after initiation of the maintenance dose of β-blockers. GCS ≥ 5.4 % was identified as the best predictor of LV reverse remodeling with 91 % sensitivity and 82 % specificity, and an area under the curve of 0.896 (p < 0.0001). An important finding of multivariate logistic regression analysis was that GCS was the best independent predictor of LV reverse remodeling (OR 7.692; 95 % CI 2.292–25.82; p = 0.001). It should be noted that only 1.3 ± 0.4 min per patient was needed to analyze GCS. In conclusions, GCS could result in further improvements in predicting LV reverse remodeling after β-blocker administration, and have clinical implications for better management in daily clinical practice.     

The diagnostic value of serum pancreatic phospholipase A2 (PLA2) in pancreatic diseases

The diagnostic significance of serum immunoreactive pancreatic phospholipase A₂ (PLA₂) was studied in 119 patients with pancreatic disease, 200 with various non-pancreatic disease, and 203 healthy controls using radioimmunoassay (RIA) specific to human pancreatic PLA₂. This newly developed RIA using monoclonal antibody was satisfactorily sensitive and reliable. Serum PLA₂ was elevated in all six patients with acute pancreatitis. Frequency of abnormal serum PLA₂ levels was 60% in chronic pancreatitis (n=52) and 67% in pancreatic cancer (n=61). Serum PLA₂ levels were low in chronic pancreatitis with severe exocrine insufficiency and advanced pancreatic cancer. In chronic pancreatitis, patients with low serum PLA₂ level showed lower enzyme output in secretin test than patients with normal or high serum PLA₂ level. Frequency of abnormal PLA₂ levels was 27% in non-pancreatic disease and, in particular, patients with renal failure showed high PLA₂ levels. Sensitivity (62%) and efficiency (69%) of serum PLA₂ assay in pancreatic disease were superior to those of amylase. In conclusion, serum PLA₂ determination using RIA was useful for the diagnosis of acute pancreatitis by high serum PLA₂ levels and the diagnosis of severe exocrine pancreatic insufficiency by low serum PLA₂ levels. This work was supported in part by a research grant for intractable pancreatic disease and a pancreatic cancer grant from the Ministry of Health and welfare of Japan.     

Prospective trial for early detection of pancreatic cancer by elevated serum immunoreactive elastase

Early detection of pancreatic cancer was prospectively evaluated by measuring serum immunoreactive elastase (IRE) in 722 patients in two hospitals during the past 18 months. Patients included in the study were over 40 years of age and had symptoms suggestive of pancreatic disease such as upper abdominal pain, discomfort or mass, jaundice, weight loss, or diabetes. Among the 722 patients, 171 exhibited elevation of serum IRE. Pancreatic diseases were subsequetly found in 42% of the 171 patients. Pancreatic cancer was found in 22 patients, among which 17 had elevated serum IRE. Among the 17 pancreatic cancer patietns with elevated IRE, 10 underwent radical resection of the cancer but in none of the five patients with normal serum IRE could radical resection be carried out. Three of the 10 patients had a small cancer less than 2 cm in diameter and two of them survivied for more than three years. Patients over 40 or 45 years of age complaining of upper abdominal pain of recent onset that cannot be explained by diseases other than that of the pancreas would be candidates for measurement of serum elastase, and this is an effective way to detect pancreatic cancer at an early stages. This work was supported in part by a research grant for intractable pancreatic disease and a cancer grant from the Ministry ot Health and Welfare, Japan.     

Enzyme immunoassay for serum pancreatic lipase in the diagnosis of pancreatic diseases

To evaluate the diagnositc utility of serum immunoreactive lipase (IRL), serum lipase was determined using an enzyme immunoassay and a turbidimetric method along with total serum amylase in 41 healthy controls, 76 patients with pancreatic disease and 60 with nonpancreatic disease. Serum IRL was elevated in 12 of 13 patients with acute pancreatitis, 12 of 44 with chronic pancreatitis and in 12 of 19 with pancreatic cancer. The IRL was low in 9 of the 44 patients with chronic pancreatitis, which coincided with advanced exocrine pancreatic insufficiency. Overall sensitivities in pancreatic diseases were 59% for serum IRL, 38% for turbidimetric lipase and 51% for amylase, specificities in healthy controls and nonpancreatic diseases were 80% for serum IRL, 86% for turbidimetric lipase and 88% for serum amylase. Serum IRL determination is useful for diagnosis in pancreatic diseases when compared with the conventional determination of serum lipase. This work was supported in part by a research grant for intractable pancreatic diseases and a cancer grant from the Ministry of Health and Welfare, Japan.     

Anti-lymphoma effect of naproxen and indomethacin in a patient with relapsed diffuse large B-cell lymphoma

A 77-year-old man with relapsed non-Hodgkin's lymphoma, diffuse large B-cell type, was treated with naproxen, a nonsteroidal anti-inflammatory drug (NSAID), for paraneoplastic fever. A dramatic disappearance of not only the fever but also generalized lymphadenopathy was observed. Naproxen was continued, and he maintained remission for 10 months. When relapse of lymphoma occurred in spite of continuous naproxen administration, indomethacin, another type of NSAID, was tried. Surprisingly, rapid regression of lymphoma occurred again and was maintained for almost 1 year. These results indicate that NSAIDs are effective in some patients with non-Hodgkin's lymphoma.