Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: A prospective study with systematic review

Introduction

Reliability of serum pancreatic enzyme levels in predicting pancreatic injuries has been a parameter of interest and the present recommendations on its utility are based primarily on anecdotal observations. The aim of this study was to evaluate the utility of serum pancreatic enzyme assessment in predicting blunt pancreatic injury with imaging and surgical correlation and compare our results with a systematic review of literature till date.

Methods

A prospective cohort study conducted over 4 years in a tertiary care referral centre with 164 consecutive patients who presented to the emergency department with a history of blunt abdominal trauma and had serum pancreatic enzyme assessment, USG and subsequent diagnostic CECT were analyzed. The CT findings and AAST grade of pancreatic injury, various intra-abdominal injuries and time elapsed since injury and other associated factors were correlated with serum pancreatic enzyme levels. For systematic review of literature MEDLINE database was searched between 1940 and 2012, also the related citations and bibliographies of relevant articles were analyzed and 40 articles were included for review. We compared our results with the systematic critique of literature till date to formulate recommendations.

Results

33(21%) patients had pancreatic injury documented on CT and were graded according to AAST. Statistically significant elevated serum amylase levels were observed in patients with pancreatic and bowel injuries. However, elevated serum lipase was observed specifically in patients with pancreatic injury with or without bowel injury. Combined serum amylase and lipase showed 100% specificity, 85% sensitivity in predicting pancreatic injury. Elevated (n = 28, 85%) vs. normal (n = 5, 15%) serum amylase and lipase levels showed sole statistically significant association with time elapse since injury to admission, with a cutoff of 3 h.

Conclusions

Based on our results and the systematic review of the literature till date we conclude, persistently elevated or rising combined estimation of serum amylase and lipase levels are reliable indicators of pancreatic injury and is time dependent, nondiagnostic within 6 h or less after trauma. In resource constrained countries where CT is not available everywhere it may support a clinical suspicion of pancreatic injury and can be reliable and cost-effective as a screening tool.     

Treatment of facial telangiectasia with narrow-band intense pulsed light in Chinese patients

Objective: To evaluate the efficacy and safety of narrow-band intense pulsed light (DPL) in treating facial telangiectasia. Method: Thirty patients with facial telangiectasia underwent five sessions of treatment with DPL (500 nm～600 nm) at 4-week interval. The erythema index (EI), temperature, transepidermal water loss (TEWL), and lightness of the skin (L) were measured before each treatment session and at each follow-up. Result: Thirty cases completed treatment and follow-ups. Twenty-seven cases (90%) got more than 50% clearance post-treatment and among them eight cases (27%) got more than 75% clearance. The average of the mean EI value decreased with the number of treatment sessions; the EI observed after two treatment sessions was significantly different from that observed before treatment (P = 0.012, P < 0.05). The decrease in skin temperature and TEWL values post-treatment was statistically significant (P = 0.000, P = 0.027, P < 0.05), while the L value increased significantly (P = 0.025, P < 0.05). Thirty percent cases had reccurence at 6-month follow-up. While burning sensation, erythema, and swelling were usually seen during the treatment, no severe side effects were observed during treatment and follow-ups. Conclusion: Narrow-band intense pulsed light DPL is effective and safe in treating facial telangiectasia.     

皮病性淋巴结病临床病理研究及文献复习

目的:复习文献对皮病性淋巴结病（dermatopathic lymphadenopathy,DPL）的病理形态特点、组织发生、诊断和鉴别诊断、治疗及预后等做一初步探讨。方法:利用4例DPL患者的淋巴结标本,采用常规石蜡切片,HE染色。另对石蜡切片采用EnVision免疫组化二步法染色。结果:淋巴结皮质及髓质结构尚存,淋巴滤泡变小,呈压迫萎缩状态,副皮质区极度扩张,被膜下淋巴窦及髓窦开放、组织细胞增生,增生的组织细胞胞质内和细胞间有黑色素颗粒沉积。被膜下淋巴窦和副皮质区有结节状分布的淡染区,其内可见胞质丰富的大细胞,细胞胞界不清、胞质空亮,核细长、扭曲、分叶状,染色质细腻,有的可见核沟。副皮质区内可见一定数量的嗜酸性粒细胞、浆细胞浸润和免疫母细胞增生。免疫组化示淡染区内胞质丰富的大细胞表达S100(+)、CD1α(+)、CD4(+)、Ki67 (约5％+),而HMB45、CD8、CD163、CD23、CD68、Bcl-6、CD20、CD3、CD10、CD21、CD30、CXCL13、CD35及PD-1均为阴性。结论:DPL较为少见,易误诊为转移性恶性黑色素瘤或T细胞淋巴瘤,病理诊断需结合病史及临床表现。     

What are the ten new commandments in severe polytrauma management?

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1) Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2) Five stratified levels for DAM have replaced the non-specific conventional Plans A & B. 3) CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4) DPL has virtually been replaced by the FAST USG. 5) Direct whole-body MDCT provides rapid imaging diagnosis & expedites the definitive treatment but carries high radiation hazards. 6) The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7) DCR comprising of permissive hypotension, hemostatic resuscitation & DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP & platelet concentrates improves the outcome in massive blood transfusion. 8) DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9) A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP (pre-peritoneal pelvic packing) may further reduce mortality coupled with the necessary TCAE. 10) Injury prevention is equally important if not more than the trauma resuscitation & operation.KEY WORDS: Polytrauma, Priorities, DAM, CT, MDCT, DPL, FAST, Fluid resuscitation responder, DCR, DCS, Pre-PPP, Injury preventionPolytrauma management has undergone tremendous evolution in the past decade in the assessment, diagnosis, treatment and team approach algorithms. This article aims to highlight the important changes in a concise manner.     

瘢痕疙瘩的光电治疗

皮肤瘢痕疙瘩是以真皮内成纤维细胞过度增生、细胞外基质大量沉积、表皮结构异常为特点的皮肤纤维增生性疾病。其病因不清,临床上缺乏特异性的治疗手段。传统的治疗方法有外科手术、冷冻、压迫疗法、局部注射药物(激素、5-Fu等),但效果均不尽如人意。近年来,随着激光理论及技术的完善,光电治疗越来越多地应用于瘢痕的治疗,尤其是IPD/DPL、PDL等技术,可选择性作用于瘢痕疙瘩中毛细血管内的血红蛋白损伤血管内皮细胞,从而引起血管闭塞,起到使瘢痕组织"褪红"的效果,结合其他瘢痕治疗手段,可较好地抑制瘢痕疙瘩的生长。其他作用于瘢痕疙瘩基质的光电治疗手段,由于有刺激瘢痕疙瘩进一步增生的风险,临床上并不建议使用。     

Interaction of the chlorinated hydrocarbon insecticide lindane or DDT with lipids--a differential scanning calorimetry study

The interaction of DDT and lindane with glycosphingolipids and phospholipids was investigated by employing differential scanning calorimetry. The degree of perturbation produced by lindane is stronger than that of DDT and depends also on the lipid.     

两种强脉冲光治疗玫瑰痤疮的疗效观察

目的:比较宽谱强脉冲光OPT-IPL与窄谱强脉冲光DPL治疗玫瑰痤疮相关红斑及毛细血管扩张的疗效和安全性。方法:回顾2016年10月至2019年12月于中国医学科学院皮肤病医院激光科确诊并接受强脉冲光治疗的54例玫瑰痤疮患者,年龄19~56岁,病程0.2~10年。22例采用OPT-IPL治疗,32例DPL治疗,所有患者...     

窄谱强脉冲光联合长脉冲1 064 nm Nd∶YAG激光用于婴幼儿鲜红斑痣的疗效观察

 目的:探讨窄谱强脉冲光DPL(500～600 nm)联合长脉冲1 064 nm Nd∶YAG激光用于婴幼儿鲜红斑痣的疗效及安全性。方法:纳入98例婴幼儿鲜红斑痣患者,随机分为两组：观察组58例,采用DPL联合长脉冲1 064 nm Nd∶YAG激光治疗;对照组40例,仅采用DPL治疗。连续治疗3~5次,每次间隔4周。所有治疗结束后1个月门诊随访观察。结果:观察组治愈13例(22.41%),显效16例（27.58%）,有效12例(20.68%),总有效率70.69％;对照组治愈2例(5.00%),显效8例（20.00%）,有效5例(12.50％),总有效率37.50％,两组总有效率差异有统计学意义（ X²=10.65,P<0.05）。观察组中有5例（8.62%）出现水疱、结痂反应,对照组有3例（7.50%）出现水疱、结痂反应,两组间不良反应发生率比较,差异无统计学意义（ X²=0.04,P=0.842)。结论:DPL联合长脉冲1 064 nm Nd∶YAG激光治疗婴幼儿鲜红斑痣效果良好,不良反应无明显增加,值得临床推广应用。