[Prognosis of the disease severity in patients with acute pancreatitis]

Estimation of the severity state in patient, suffering an acute pancreatitis, while admitting him into a hospital, constitutes a significant part of diagnosis and complex treatment. Application of a highly accurate scales and markers, which are used to prognosticate the disease course severity and to determine the inflammation grade, may influence the results of complex treatment of the patients. In the investigation a high diagnostic accuracy in prognosis of an acute pancreatitis course severity was noted for APACHE II scale (24 hours) and Ranson scale (48 hours). There was established, that determination of a C-reactive protein content has less diagnostic accuracy, but it may be applied as a less complex and more rapid test for prognostication of an acute pancreatitis course severity after admitting the patient to hospital.

[Effect of liquid resuscitation on homeostasis of patients with severe acute pancreatitis]

OBJECTIVE

To evaluate the effect of liquid resuscitation on acid-base balance and electrolytes of patients with severe acute pancreatitis (SAP).

METHODS

According to the target of liquid resuscitation, 22 patients with SAP involved in this self-controlled prospective study received sufficient liquid resuscitation in acute stage of acute pancreatitis. The results of blood gas analysis, acid-base balance and electrolytes were compared before and after liquid resuscitation. The correlation between the volume of liquid used in resuscitation and the level of blood chlorine was analyzed.

RESULTS

The mean resuscitation duration was (15.0±2.4) hours, and the volume of liquid resuscitation was 3 4594 203 ml, with mean volume (3 910± 102) ml in 22 patients; blood sodium (mmol/L) and chlorine (mmol/L) levels were both significantly higher after resuscitation compared with those before resuscitation (Na(+): 145.83±1.85 vs. 139.67±2.25, Cl(-): 117.33±1.64 vs. 101.83±1.77, both P<0.05). Blood pH value, hematocrit (Hct), anion gap (AG, mmol/L), blood lactic acid (mmol/L) were slightly lowered after resuscitation (pH value: 7.39±0.02 vs. 7.42±0.02, Hct: 35.63±1.58 vs. 46.85±2.38, AG: 8.02±1.21 vs. 14.47±0.89, blood lactic acid: 1.10±0.18 vs. 1.97±0.15, P<0.05 or P <0.01). In addition, the level of blood chlorine was significantly correlated with the volume of liquid used in resuscitation (r=0.720 8,P<0.01).

CONCLUSION

The target of liquid resuscitation in patients with SAP should be cautiously determined, including control of the volume of liquid for resuscitation, in order to avoid acid-base imbalance or hyperchloraemia. At the same time, the change in internal environment should be monitored.

Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin, soluble CD14, endotoxin-neutralizing capacity and cytokines in acute necrotizing pancreatitis

BACKGROUND

We sought to study the effect of a combination therapy comprised of hyperbaric oxygen (HBO) and ulinastatin on the plasma levels of endotoxin, soluble CD14 (sCD14), endotoxin neutralizing capacity (ENC) and cytokines in acute necrotizing pancreatitis (ANP) in rats.

METHODS

We randomly allocated 90 Sprague-Dawley rats into 6 groups: group 1 (ordinary control), group 2 (sham operation), group 3 (ANP), group 4 (ANP with HBO), group 5 (ANP with ulinastatin) and group 6 (ANP with HBO and ulinastatin). We induced ANP by retrograde injection of 3.5% sodium taurocholate (2.5 mL/kg) via the pancreatic duct. Five minutes after induction, animals in groups 5 and 6 were infused with ulinastatin (20 000 U/kg) via the portal vein. Thirty minutes after induction, animals in groups 4 and 6 received HBO therapy. We collected samples 3, 6 and 10 hours after induction of ANP.

RESULTS

We found that the plasma level of endotoxin in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3 h, p < 0.001; 6 h, p = 0.014) and group 6 (both p < 0.001). The level of plasma sCD14 in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3, 6 h, both p = 0.001) and group 6 (3 h, p < 0.001; 6 h, p = 0.001). The plasma endotoxin and sCD14 levels in group 6 were significantly lower than in groups 4 and 5. The plasma ENC level in group 6 was significantly higher than in groups 3, 4 and 5 (p < 0.001). The ENC level in groups 4 and 5 were higher than in group 3, but there was no significant difference. The plasma level of tumour necrosis factor-alpha (TNF-alpha) and IL-6 in group 6 were significantly lower than in groups 3, 4 and 5 (p < 0.001). The TNF-alpha and IL-6 levels in groups 4 and 5 were lower than in group 3, but there was no significant difference.

CONCLUSION

The use of an early combination therapy of HBO and ulinastatin was more effective than either therapy alone in the treatment of ANP.

[Necrotic acute pancreatitis in the intensive care unit: a comparison between conservative and surgical medical treatment]

OBJECTIVE

To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments.

SUMMARY

The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy in due time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery.

METHODS

A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately.

RESULTS

Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infected necrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p<0.05) while the total hospital stay was 46.47 vs. 57.26 days (p<0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p<0.05) for conservative medical treatment vs. surgical treatment, respectively. Between the first and the twelfth month the evaluated patients who attended consultation, after discharge, showed: pancreatic pseudocyst 9/36 (25%) vs. 8/34(23.5%); recurring abdominal pain 3/36 (8.3%) vs. 4/34 (11.8%); and relapsing acute pancreatitis 3/36 (8.3%) vs. 2/34 (5.8%); while 4/36 (11.1%) vs. 3/34 (8.8%) did not show any problem. There were not significant differences between the conservative and the surgical medical treatment, respectively.

CONCLUSIONS

Patients suffering acute pancreatitis with sterile necrosis can undergo conservative medical treatment which will result in a lower mortality rate, while the hospital stay, in comparison with acute pancreatitis with infected necrosis, will not be affected.

Effect of diet-induced obesity on acute pancreatitis induced by administration of interleukin-12 plus interleukin-18 in mice

Obesity is associated with increased severity of acute pancreatitis (AP). We recently developed a model of AP induced by administration of interleukin (IL)-12+IL-18, two cytokines that are elevated in patients with AP. In this model, severe AP develops in obese leptin-deficient ob/ob mice compared to lean littermates. In the present report, we evaluated the pancreatic response of diet-induced obesity (DIO) mice to IL-12+IL-18. Body weight loss and adipose tissue necrosis were more severe and prolonged in cytokine-injected DIO compared to lean mice. Edematous AP developed in lean mice, whereas DIO mice developed necrotizing AP. Obese DIO mice developed more severe hypocalcemia, increased liver damage and a heightened acute-phase response compared to lean mice, although leukopenia and thrombocytopenia were of comparable severity in lean and DIO mice. Serum levels of IL-6, IL-10, and IL-22 were significantly higher in DIO compared to lean mice, whereas interferon-gamma and tumor necrosis factor-alpha did not differ between the two groups. In conclusion, obesity induced by high-fat diet is associated with increased disease severity and duration in the model of AP induced by administration of IL-12+IL-18.

Serum fetuin A concentrations in patients with acute pancreatitis

BACKGROUND

Acute pancreatitis (AP) is a mild and self-limiting disease in most patients, but necrotizing pancreatitis develops in up to 20 - 30% of the cases. Early recognition of severe AP has been considered as a key determinant of successful therapy. The aim of this study was to evaluate the clinical value of fetuin A as the new predictor of complications and fatal outcome during acute pancreatitis (AP).

METHODS

The study included 40 patients with AP of diverse severity (28 mild, 12 severe), assessed during the early phase of AP (1st - 7th day of hospitalization). Fetuin A level was measured by ELISA kit (BioVendor).

RESULTS

Median serum fetuin A concentrations had a tendency to decrease during examination from 0,371 g/L at admission to 0,288 g/L on the 7th day of hospitalization. In each of 7 days of observation, correlation between the increase in fetuin A and the absolute number of RBC was found (R = 0,34: 1st day R = 0,35: 3rd day, p < 0,05; R = 0,57: 5th day, p < 0,001; R = 0,65: 7th day, p < 0,01). Additionally, we observed the reverse relationship between the decrease in fetuin A and the increase in some inflammatory markers (IL-6: R = -0,61, p < 0,0001; SAA: R = -0,58, p < 0,001; HGF: R = -0,60, p < 0,01; PCT: R = -0,475, p < 0,01). The strongest positive correlation was noticed on the 5th day of hospitalization between decreased levels of fetuin A and albumin (R = 0,83; p < 0,0001).

CONCLUSIONS

Fetuin A level monitoring is potentially a new marker for non-invasive and accurate prediction status for the hospitalization of patients with AP similar to other negative acute phase proteins like albumin.

Improvement of immune dysfunction in patients with severe acute pancreatitis by high-volume hemofiltration: a preliminary report

OBJECTIVE

The aim of this study was to investigate the effect of high-volume hemofiltration (HVHF) on ameliorating immune dysfunction in patients with severe acute pancreatitis (SAP).

METHODS

Twelve patients diagnosed with SAP admitted to the intensive care unit of general surgery, Jinling Hospital, from January 2004 to December 2006 were included in this study. They were assigned to the standard medical therapy group (SMT group, n=4) or HVHF group (n=8) immediately after enrollment, in a 1:2 ratio. The SMT group were given standard treatment for SAP, while the HVHF group were given standard as well as 72-hour HVHF treatment initiated within 2 hours after enrollment. Patients in the 2 groups were comparable for the baseline clinical parameters. All patients were monitored over a 72-hour observation period for continuous clinical status, blood cell counts including monocytes, CD4+ and CD8+ T cells, and HLA-DR expression on monocytes. Blood samples were collected from those patients at 0, 6, 12, 24, 48, and 72 hour after enrollment for measurement of plasma Th1-type cytokines (interleukin-1 [IL-1], IL-2, interferon-gamma [IFN-gamma], and tumor necrosis factor-alpha [TNF-alpha]) and Th2-type cytokines (IL-4, IL-5, IL-6, IL-IO, and IL-13) using ELISA.

RESULTS

Within 72 hours, all measured cytokines except IL-4 were maintained at high levels, accompanied with a low level of peripheral monocytes, CD4+ and CD8+ T cell counts, and HLA-DR expression. Seventy-two hours later, plasma cytokines IFN-gamma, IL-1, IL-2, IL-5, IL-10, and IL-13 (p<0.05), but not TNF-alpha and IL-6, in patients in the HVHF group were significantly reduced, while there was no change for these parameters in the SMT group. Plasma levels of IFN-gamma, TNF-alpha, IL-1, IL-2, IL-5, and IL-13 in the HVHF group were significantly lower than those in the SMT group. Peripheral CD4+ and CD8+ T cells, monocyte count, and HLA-DR expression were increased significantly (p<0.05) only in the HVHF group, not in the SMT group. HLA-DR expression in the HVHF group was significant higher than that in the SMT group (p<0.05).

CONCLUSIONS

HVHF significantly reduced plasma inflammatory cytokine concentrations including those of IFN-gamma, TNF-alpha, IL-1, IL-2, IL-5, and IL-13, while it increased monocyte HLA-DR expression in patients with SAP. The association of plasma cytokine reduction and cellular immune function recovery and clinical outcome needs further investigation.

[Effect of qingyi decoction in treating severe acute pancreatitis and its impacts on blood level of tumor necrosis factor-alpha, interleukin-6 and inteleukin-8]

OBJECTIVE

To observe the effect of Qingyi Decoction (QYD) in treating severe acute pancreatitis (SAP) and its impacts on blood levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 and 8 (IL-6 and IL-8).

METHODS

One hundred and ten patients of SAP were equally randomized into the treated group and the control group, they were treated with the same therapeutic program excepting that QYD was given only to the treated group. The post-treatment incidence of severe complication, mortality and operation transferring rate, as well as the changes of APACHE II scores and blood levels of TNF-alpha, IL-6 and IL-8 in patients of both groups were observed.

RESULTS

The incidences of the two severe complications, acute respiratory distress syndrome and intestinal paralysis, in the treated group was 3.6% and 5.4% respectively, while in the control group, 12.7% and 18.2%, showing statistical significance between groups (P < 0.05). The APACHE II score in the treated group decreased significantly on the 7th day, which was better than that in the control group (8.14 +/- 2.30 scores vs 3.35 +/- 2.20 scores, P < 0. 05). In addition, the efficacy in the treated group was also superior to that in the control group in terms of reducing mortality, operation transferring rate, and blood levels of TNF-alpha, IL-6 and IL-8 on the 7th and 9th day (P < 0. 05).

CONCLUSION

QYD could markedly improve the prognosis of SAP patients by way of lowering the blood levels of TNF-alpha, IL-6 and IL-8.

[Non-specific factors of defense in patients with various forms of acute pancreatitis]

In patients, suffering an acute pancreatitis with purulent-septic complications, there are observed: the blood neutrophils metabolic activity raising in spontaneous NST--test, the reserve index of the blood neutrophils metabolic activity is secured, but the phagocytic number is lowered, raised or normal. In patients, who have died, the blood neutrophils metabolic activity in stimulated NST--test is raised, but preservation reserve of their metabolic activity is lowered, in comparison with such in a control group. Trustworthy raising of the blood neutrophils metabolic activity in stimulated NST--test was observed in patients, suffering infected pancreonecrosis, in comparison with such in aseptic necrosis, the phagocytic number in them was trustworthy reduced. In patients, suffering an acute pancreatitis, who have died, there was established the reversed correlation dependence between the formazanpositive blood neutrophils quantity in spontaneous NST--test and preservation reserve.

[Interleukin 17--prognostic marker of severe acute pancreatitis]

OBJECTIVE

The evaluation of the interleukin 17 capacity as precociously predictive marker of the severe forms of acute pancreatitis.

MATERIAL AND METHOD

This prospective and diagnosis study took place during 01.01.2006-31.03.2008 on a sample of 83 subjects hospitalized with acute pancreatitis. Among these, 48 have submitted forms mild disease and formed batch A. Subjects with severe acute pancreatitis formed batch B (n=16), to whom it was applied peritoneal lavage extended by laparoscopic method and batch C (n=19), who have used conventional methods of treatment. Were determined serum concentrations of interleukin 17 in the first and tenth days of admission for the subjects of A and C lots and in the first, third and tenth day at then subjects of B lot, they were dosage and levels peritoneal or lavage fluid in the third, sixth and tenth days of admission. At the same time were determined interleukin 6 levels.

RESULTS

Interleukin 17 has proved a sensitivity of 97% and a specificity of 94% in early identification forms of severe acute pancreatitis, the correlation coefficient is 0.81. The correlation was good even in combination with organic disfunction (0.66) and the risk of death (0.54). The predictive capacity of sepsis has been reduced (0.44). The dynamics of this cytokines show a significant decrease in concentrations forms mild disease (batch A) and in severe forms treated with peritoneal extended lavage (lot B). In conversely, the subjects treated by conventional methods (lot C) the decrease was not significant between the first and tenth days of admission. A similar dynamic has been recorded after short peritoneal lavage, lasting three days. At large in, the concentrations of interleukin 17 have evolved in parallel with those of interleukin 6.

CONCLUSIONS

Interleukin 17 is an important predictive marker of early forms of severe acute pancreatitis. Also, serum concentrations are correlated with the risk of organic disfunction development and the fatal evolution. The dynamics of this cytokine is depending on the therapeutic measures that attenuates the body's inflammatory response.

[Effect of Chaihu Shihuang soup on blood serum level TNF, IL-6 and IL-10 of severe acute pancratitis (SAP)]

OBJECTIVE

To make a study of the effect of Chaihu Shihuang soup on blood serum level TNF, IL-6 and IL-10 of severe acute pancratitis.

METHOD

Sixty SAP cases were divided at random into treatment group and control group (30 cases each). The treatment group were given chai-hu-shi-huang-soup once a day; the control group were given Dachaihu soup once daily, with both treatment period for 7 days. The tumor necrosis factor-alpha (TNF-alpha), interleukin level 6 (IL-6) and 10 (IL-10) of both groups were determined before and after the treatment. We also had 30 healthy cases.

RESULT

IL-10 level in both groups was lower than healthy group while TNF-alpha and IL-6 were higher than healthy group (P < 0.01). After treatment, the treatment group's TNF-alpha, IL-6 level were comparatively lower than that in the control group (P < 0.01), and IL-10 level were clearly higher than that of the control group (P < 0.01), comparison of the treatment group before treatment (P < 0.01).

CONCLUSION

Chaihu Shihuang soup can significantly regulate cytokine and improve early recovery of SAP.

Protective effects of baicalin and octreotide on intestinal mucosa of rats with severe acute pancreatitis

BACKGROUND/AIMS

To compare the protective effects of baicalin and octreotide on intestinal mucosa of rats with severe acute pancreatitis and to explore the application value of baicalin as a new drug.

METHODS

Severe acute pancreatitis rats were randomly divided into a model control group, baicalin-treated group and octreotide-treated group. An equal number of normal rats were included in a sham-operated group. At 3, 6 and 12 hours (h) after operation, mortality rate, pathological changes in the intestinal mucosa of the terminal ileum, expression levels of nuclear factor (NF)-kappaB, Bax and Bcl-2 proteins, and apoptosis indices in the rats in each group were evaluated. Endotoxin and tumor necrosis factor (TNF)-alpha contents in blood were also determined.

RESULTS

At 12h after operation, the survival rates in both the baicalin-treated group and octreotide-treated group were higher than in the model control group, and the difference was significant (p<0.05). At all time points after the operation, endotoxin and TNF-alpha values as well as the expression levels of NF-kappaB protein and pathological severity scores in the intestinal mucosa in the two treated groups were, to varying degrees, significantly lower than those in the model control group (p<0.05, p<0.01 and p<0.001, respectively). Moreover, the expression level of Bax protein at 3h postoperatively as well as the expression level of Bax protein and apoptosis indices at 6h postoperatively in the two treated groups were significantly higher than those in the model control group (p<0.01).

CONCLUSIONS

Baicalin and octreotide exert significant protective effects on severe acute pancreatitis-induced intestinal mucosa injury via a mechanism that is associated with inhibiting inflammatory mediators and inducing apoptosis. In comparison with the pharmacological action of octreotide, we believe that baicalin, as a new drug, has similar protective effects on the intestinal mucosa of severe acute pancreatitis rats, and therefore deserves further study and development.

[Evaluation of endogenous intoxication from average molecular weight peptides during emergency situations]

Determination of the serum content of average molecular weight peptides that are markers of endogenous intoxication in the burnt, patients with acute poisoning by psychopharmacologicals, pancreatic necrosis, generalized peritonitis, small pelvic inflammation may serve as an additional laboratory criteria for rating the severity of critical conditions, predicting the development of complications, the outcome of diseases, and evaluating the efficiency of treatment.

[Specific changes of the thrombocyte aggregation function in acute pancreatitis]

On the basis of investigations of thrombocyte aggregation in 126 patients with acute pancreatitis it was shown that independent of the severity of the pancreatitis the aggregation function of thrombocytes decreased. The effective treatment resulted in its normalization not earlier than within 15 days.

[Improvement of differential diagnostics and prognostication of the course of destructive forms of acute pancreatitis]

A complex dynamic investigation of the state of oxidative homeostasis in patients with different forms of acute pancreatitis has shown that a reliable reduction of the indices of maximal intensity of chemiluminescence and the coefficient of blood serum antioxidative activity can be considered as an additional criterion for early diagnosis of infected pancreatonecrosis. The absence of a tendency to increased peroxide erythrocyte resistance in the postoperative period in pancreatonecrosis patients speaks of unfavorable prognosis of the disease. Improvement of differential diagnostics allows optimization of the surgical strategy and minimization of the number of early traumatizing surgical interventions.

[Use of perftoran in complex treatment of acute pancreatitis]

Efficiency of using perftoran in acute pancreatitis was determined by studying the dynamics of the level of lactic acid, ascorbic acid, one of the terminal metabolites of lipid peroxidation--TBA-active products in blood serum. Using perftoran was shown to considerably reduce manifestations of hypoxia and the degree of free radical processes that is evidence of antiischemic effect of perftoran in treatment of acute pancreatitis.

[Influence of continuous high-volume hemofiltration on IRAK-4 protein expression in severe acute pancreatitis]

OBJECTIVE

To investigate the influence of continuous high-volume hemofiltration (CHVHF) on interleukin 1 receptor-associated kinase-4 (IRAK-4) and tumor necrosis factor-alpha (TNF-alpha) levels in patients with severe acute pancreatitis (SAP).

METHODS

Forty-one patients with SAP were randomly divided into two groups to receive treatment with CHVHF plus conventional therapy (21 patients) and conventional therapy only (20 patients). Venous blood samples were taken before and 12, 24, and 72 h after the treatment for evaluation of APACHE II scores. The mRNA and protein levels of IRAK-4 in the monocytes were determined by real-time PCR and Western blotting, respectively, and serum TNF-alpha levels was detected using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Among the 21 patients receiving CHVHF, 18 survived and 3 died, and in the conventional therapy group, death occurred in 5 cases. In the surviving patients of CHVHF group, the APACHE II scores, IRAK-4 mRNA and protein levels and TNF-alpha levels were all significantly lowered after the treatment, and these indices were also significantly lower than those in the conventional group after treatment (P<0.05).

CONCLUSION

CHVHF is effective in reducing monocyte IRAK-4 levels and serum TNF-alpha level in SPA patients, and thus alleviates the symptoms and improves the prognosis of SAP, possibly by reducing the level of the activators that induce monocyte activation via the Toll-like receptor.

[Effects of Salvia miltiorrhiza on serum levels of inflammatory cytokines in patients with severe acute pancreatitis]

OBJECTIVE

To study the effects of Salvia miltiorrhiza on serum levels of cytokines including interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) in patients with severe acute pancreatitis (SAP).

METHODS

Thirty-six SAP patients were randomly divided into Salvia miltiorrhiza-treated group and non-Salvia miltiorrhiza-treated group with eighteen patients in each group. Fourteen age-matched healthy volunteers were assigned to control group. Serum levels of IL-6, IL-8, and TNF-alpha were tested within 24 hours of admission and 7 days after admission.

RESULTS

Compared with those of the healthy volunteers, serum levels of the three cytokines of the SAP patients were significantly elevated (P<0.05). Serum levels of the three cytokines were significantly decreased in both Salvia miltiorrhiza-treated group and non-Salvia miltiorrhiza-treated group after 7-day treatment (P<0.05). The declining of the serum levels of the three cytokines in Salvia miltiorrhiza-treated group was more obvious than that in non-Salvia miltiorrhiza-treated group.

CONCLUSION

Salvia miltiorrhiza can treat SAP patients by reducing the serum levels of IL-6, IL-8, and TNF-alpha.

[Effect of glutamine on serum interleukin-8 and tumor necrosis factor-alpha levels in patients with severe pancreatitis]

OBJECTIVE

To observe the changes in serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) after intravenous administration of alanyl-glutamine (Gln) in patients with severe pancreatitis.

METHODS

Fifty patients with severe pancreatitis were randomized equally into 2 groups and received standard total parenteral nutrition (TPN) with intravenous infusion of Gln or normal saline (control) for 1 week. The plasma glutamine level was measured with high-performance liquid chromatography (HPLC) in these patients one day before and on day 7 of Gln administration, and the serum IL-8, TNF-alpha and heat shock protein 70 (Hsp70) were detected with enzyme-linked immunosorbent assay.

RESULTS

On day of Gln administration, the plasma glutamine level in patients of Gln group increased significantly (P<0.01), and serum IL-8 and TNF-alpha levels decreased significantly (P>0.05) in comparison with those of the control group. The patients receiving Gln supplementation had significantly higher serum albumin level and greater body fat content with shorter hospital stay than those in the control group (P<0.05), and the mortality rate in Gln group was also significantly lower (P<0.05).

CONCLUSION

Gln-enriched TPN may improve the clinical outcomes of patients with severe pancreatitis probably by decreasing serum IL-8 and TNF-alpha levels.

[Diagnosis of acute destructive biliary pancreatitis]

The article presents an analysis of results of examinations and treatment of 98 patients and an assessment of the clinical picture, laboratory and instrumental findings. The significance of USI as a method of screening diagnosis is stressed. The indications and possible endoscopic and videolaparoscopic interventions for the diagnosing and treatment of acute destructive biliary pancreatitis (ADP) are determined. The author proposes an algorithm of the diagnosing and treatment of ADP. The use of the algorithm allowed the postoperative lethality after ADP to be decreased from 20.8% to 14%.

[The use of cryosupernatant plasma in complex treatment of pancreonecrosis]

Comparative study of results of complex treatment of pancreonecrosis in 60 patients using cryosupernatant plasma (CSNP) and fresh frozen plasma was carried out. Better positive dynamics in some laboratory indices, less lethality and better outcomes were marked with use of CSNP. It can be used instead of fresh frozen plasma in complex treatment of pancreonecrosis and concomitant DIC syndrome.

[Serum D-dimer changes and prognostic implication in acute pancreatitis]

OBJECTIVE

To investigate the role of D-dimer in human acute pancreatitis (AP) and its relation to the severity of the disease.

METHODS

Plasma concentration of D-dimer was measured in 31 patients with mild AP (MAP), 30 patients with severe AP (SAP) and 30 normal people as a control group. The results of routine laboratory tests, 48-hour Ranson and 24-hour APACHE II scores were all recorded. We attempted to find a relationship between D-dimer level and the results of routine laboratory tests, 48-hour Ranson scores and 24-hour APACHE II scores.

RESULTS

(1) As compared with the control group, the plasma concentration of D-dimer was much higher in MAP (0.21 +/- 0.21) mg/L (P = 0.029) and SAP patients (0.69 +/- 0.32) mg/L (P = 0.000). The D-dimer level in the SAP group was higher than that in the MAP group (P = 0.000). (2) The rise in the D-dimer level was directly related to 48-hour Ranson (P = 0.000) and 24-hour APACHE II scores (P = 0.000). (3) The rise in the D-dimer level was directly related to leukocyte count, blood glucose, creatinine, prothrombin time and partial thromboplastin time (P < 0.05) and inversely related to hematocrit, albumin and calcium (P < 0.05).

CONCLUSIONS

Plasma concentration of the D-dimer rises in AP patients; D-dimer level is related to the disease severity.

Computed tomography versus Acute Physiology and Chronic Health Evaluation II score in predicting severity of acute pancreatitis: a prospective, comparative study with statistical evaluation

OBJECTIVE

The aim of the study was to compare Acute Physiology and Chronic Health Evaluation II score and C-reactive protein as a clinical index and computed tomography-based severity index (CTSI) in predicting the course of acute pancreatitis.

METHODS

One hundred forty-eight patients with acute pancreatitis were enrolled in the study during a 2-year period. All data concerning etiology, Atlanta classification, CT findings, Acute Physiology and Chronic Health Evaluation score, C-reactive protein levels, stay in the intensive care unit, length of hospital stay, treatment, complications, and deaths were analyzed with Mann-Whitney U, Wilcoxon, Pearson, and Spearman statistical tests. The CT was performed on a spiral unit after intravenous administration of contrast material. Images were graded according to the Balthazar-CTSI scoring system.

RESULTS

A very good correlation was noticed between Balthazar-CTSI scores and local complications, whereas no statistically significant correlation was found between CT scores and stay in the intensive care unit. Among survivors and nonsurvivors, there were no statistically significant differences as far as CT scores were concerned.

CONCLUSIONS

Although the extent of necrosis as defined on contrast-enhanced CT examinations is considered as a risk factor for a negative prognosis, our findings suggest that the initially documented disease severity according only to imaging parameters is not highly important for the final patient outcome.

The therapeutic effect of oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine in rodents with acute necrotizing pancreatitis and its mechanism

OBJECTIVES

This study aims to investigate the therapeutic effect of oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (OXPAPC) in rodents with acute necrotizing pancreatitis (ANP) and its mechanism.

METHODS

The ANP model was induced by cerulein challenged by lipopolysaccharide in mice and taurocholic acid in Sprague-Dawley rats. Both ANP models were treated with OXPAPC. Twenty animals of each group were separated to investigate mortality. Detection included serum levels of amylase and lactate dehydrogenase, histological changes of pancreas, activity of myeloperoxidase in pancreas, mRNA expression of inflammatory factors, expression of signal transduction factor proteins, and binding activity of transcriptional factors.

RESULTS

After treatment with OXPAPC, survival rate was improved in the rat model. In both models, OXPAPC significantly decreased serum amylase and lactate dehydrogenase levels. Histologically, OXPAPC reduced the severity of pancreatic injury. There was a significant decline of myeloperoxidase activity. The mRNA levels of intrapancreatic inflammatory factors were depressed. Activated p38, C-jun N-terminal kinase 1, and inhibitor of kappa-B kinase beta proteins were down-regulated. Electrophoretic mobility shift assay showed that the binding activity of nuclear factor-kappaB and activator protein 1 to DNA was inhibited.

CONCLUSIONS

The OXPAPC decreased the severity of experimental ANP in rodents. The protective effect of OXPAPC was mediated, at least in part, through blocking the lipopolysaccharide signal pathway.