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Objective To investigate the diagnosis and disease assessment of serum pancreatic stone protein(PSP/reg) in ventilator-associated pneumonia(VAP) by a prospective study.Methods The blood sample was collected in patients with mechanical ventilation(MV) from September 2012 to October 2015.Then the concentration of PSP/reg was detected by ELISA method and the time of MV and the outcome of VAP were recorded,while the patients who did not have VAP occurred in the same period regarded as control group.Results Compared with the control group,there was no significant difference in the serum concentration of PSP/reg in VAP group(P>0.05).From continuous monitoring,compared with the start time of MV,there was a significant increase in the concentration of PSP/reg in VAP group(P0.05).Conclusion PSP/reg can be used as one of the indicators for diagnosis of VAP,and may be related to the severity of VAP.
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Objective To determine the levels of blood pancreatic stone protein/ regenerating protein(PSP/reg)and to explore the value of PSP/ reg in assessing severity and predicting prognosis of sepsis with or without panc-reatic damage. Methods In this prospective study,the clinical data and blood samples to measure PSP/ reg levels in 1,3 and 7 days after admission in the Pediatric Intensive Care Unit,Hunan Children's Hospital,from the children with sepsis from September 2013 to September 2014 were collected. According to levels of pancreatic trypsin(amylase or li-pase),the children were divided into normal group,mildly elevated group(1 - 3 times),and severely elevated group (more than 3 times);based on the condition of sepsis,the children were divided into sepsis group and severe sepsis group. Chi - square test,nonparametric rank sum test,Spearman correlation and area under the receiver operating cha-racteristic curve(AUC),Kaplan - Meier survival curves were used for statistical analysis. Results (1)A total of 226 children with sepsis were included in this study,among them pancreatic trypsin was normal in 159 cases(70. 4% ), pancreatic trypsin mildly elevated in 44 cases( 19. 4% ),and pancreatic trypsin severely elevated in 23 cases (10. 2% );125 cases(55. 3% )were sepsis,and 101 cases(44. 7% ,of which 29 cases were sepsis shock)were severe sepsis.(2)The correlation between PSP/ reg and serum amylase was maximum,while PSP/ reg had some correlation with serum lipase,but there was no correlation with C - peptide,insulin,glucose.(3)When pancreatic trypsin was normal or mildly elevated,severe sepsis group had higher levels of PSP/ reg than that of sepsis group(Z = - 7. 627,- 2. 965,P =0. 000,0. 003);while pancreatic trypsin was severe elevated,there was no significant difference in PSP/ reg levels be-tween sepsis group and severe sepsis group(Z = - 0. 134,P = 0. 894).(4)The AUC of PSP/ reg and procalcitonin to assess severity of sepsis were greater than 0. 7 in the children whose pancreatic trypsin was normal or mildly elevated, and there was no significant difference between them(P ﹥ 0. 05);while the AUC of C - reactive protein and WBC were less than 0. 7.(5)PSP/ reg levels gradually increased in non - survival children in 3 and 7 days,while survival children gradually declined. The AUC of PSP/ reg to predict prognosis was 0. 775,and 60 μg/ L was viewed as the critical point, sensitivity 89% ,specificity 67% . Children with PSP/ reg levels ≤60 μg/ L had higher rate of survival than children with ﹥ 60 μg/ L(χ2 = 36. 874,P = 0. 000). Conclusions PSP/ reg is closely associated with pancreatic exocrine func-tion,but PSP/ reg still can assess severity and predict prognosis in children with sepsis and pancreatic damage.
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Pancreatic stone protein (PSP) is the product of exocrine pancreas mainly synthesized and secreted by the pancreas acinar cells, a small amount secreted by gastrointestinal cells. PSP is one of stress protein family members secreted in the pancreas. PSP increased in acute and chronic pancreatitis, diabetes, inlfammatory bowel disease and gastrointestinal tumors. In recent years, some studies showed that PSP has potential clinical value in pancreatic injury and sepsis. In this article, we reviewed the progress of pancreatic stone protein in pancreatic injury and sepsis.
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Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.
Subject(s)
Humans , Middle Aged , Atrophy , Bile , Cholangitis , Dilatation , Duodenoscopy , Emergencies , Hand Strength , Head , Jaundice, Obstructive , Needles , Pancreatic Ducts , Pancreatitis, Chronic , Sphincterotomy, Endoscopic , Surgical InstrumentsABSTRACT
Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.
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Pancreatic duct stones are commonly associated with recurrent pancreatitis. They are believed to develop as a result of the calcification of an intraductal protein plug. A choledochal cyst is a relatively rare anomaly usually presenting with abdominal pain, jaundice and palpable mass. APBDU (anomalous pancreaticobiliary ductal union) is frequently associated with various pancreatobiliary diseases, including choledochal cyst, biliary tumor, pancreatitis and pancreas divisum. We report a 48-year-old woman who presented with right upper quadrant pain with a pancreatic duct stone, a choledochal cyst and APBDU. She underwent endoscopic pancreatic sphincterotomy, a surgical choledochal cyst excision and Roux-en-Y choledochojejunostomy.
Subject(s)
Female , Humans , CystsABSTRACT
Hereditary pancreatitis (HP) appears as an autosomal dominant trait. If the patient has (1) more than 2 affected relatives in different generations and (2) no known etiological factors such as alcohol or gallstones, or has R122H or N29I mutation in the cationic trypsinogen (CT) gene, the diagnosis of HP can be applied. Risk of pancreatic cancer is estimated to be 53-fold higher than in a general population after the age of 50 years. We report a kindredof HP, involving three of its family together; two siblings (14 years old, 13 years old) and cousin (26 years old). The patient had complicating chronic pancreatitis and pancreatic stone, and was treated with amodified Puestow-Gillesby procedure. Her sisters showed chronic pancreatitis. Her cousin underwent a drainage procedure of the pancreatic duct for chronic pancreatitis during the high school period. All the three members showed the R122H mutation of the CT gene.
Subject(s)
Humans , Diagnosis , Drainage , Family Characteristics , Gallstones , Pancreatic Ducts , Pancreatic Neoplasms , Pancreatitis , Pancreatitis, Chronic , Siblings , TrypsinogenABSTRACT
Hereditary pancreatitis (HP) appears as an autosomal dominant trait. If the patient has (1) more than 2 affected relatives in different generations and (2) no known etiological factors such as alcohol or gallstones, or has R122H or N29I mutation in the cationic trypsinogen (CT) gene, the diagnosis of HP can be applied. Risk of pancreatic cancer is estimated to be 53-fold higher than in a general population after the age of 50 years. We report a kindredof HP, involving three of its family together; two siblings (14 years old, 13 years old) and cousin (26 years old). The patient had complicating chronic pancreatitis and pancreatic stone, and was treated with amodified Puestow-Gillesby procedure. Her sisters showed chronic pancreatitis. Her cousin underwent a drainage procedure of the pancreatic duct for chronic pancreatitis during the high school period. All the three members showed the R122H mutation of the CT gene.
Subject(s)
Humans , Diagnosis , Drainage , Family Characteristics , Gallstones , Pancreatic Ducts , Pancreatic Neoplasms , Pancreatitis , Pancreatitis, Chronic , Siblings , TrypsinogenABSTRACT
Chronic pancreatitis is a rare problem in childhood and sometimes shows pancreatic calcification. The most common symptom is recurrent upper abdominal pain with or without associated nausea or vomiting. Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis. In our case, however, chronic pancreatitis caused by multiple pancreatic stones in dilated pancreatic duct, which was very rare in childhood. Endoscopic retrograde cholangiopancreaticography (ERCP) is valuable in confirming the diagnosis and decision making process for further medical or surgical management of pancreatic disease. We experienced a case of chronic relapsing pancreatitis with pancreatic stones in 13-year-old girl who presented with recurrent upper abdominal pain. She was investigated with ERCP and treated by endoscopic sphincterotomy of sphincter of Oddi and by some stone removal with endoscopic basket. We report this case and review related literatures briefly.
Subject(s)
Adolescent , Female , Humans , Abdominal Pain , Cholangiopancreatography, Endoscopic Retrograde , Decision Making , Diagnosis , Nausea , Pancreatic Diseases , Pancreatic Ducts , Pancreatitis , Pancreatitis, Chronic , Sphincter of Oddi , Sphincterotomy, Endoscopic , VomitingABSTRACT
The article presented a first 52-year woman with chronic pancreatitis and pancreatic stone who underwent Frey’s procedure at ViÖt - §øc Hospital in January 2002. This patient had admitted to hospital due to abdominal pain with vomiting. The general condition was poor; body weight was 35 kg. Skin and mucous membrane was not yellow. The patient had not edema or subcutaneous hemorrhage, blood pressure was 150/100 mmHg, and pulse was 85 rates per minute. She had history of uncontrolled hypertension. The postoperative outcome was good. The patient could eat light meal by 3 days after operation. Drain catheters were removed after 72 hours. She was free from pain. Sutures were removed after 7 days and she was released after 12 days. After 2-month follow-up, she had normal diet and activities
Subject(s)
Pancreatitis, Chronic , General Surgery , TherapeuticsABSTRACT
A 40-year-old man was presented with recurrent abdominal pain. An ERCP (Endoscopic RETROGRADE Cho-langiopancreatography) revealed complete pancreas divisum and pancreatic duct stricture with a stone. Initially, endoscopic stone removal through the minor papilla origice was unsuccessful due to an impacted pancreatic stone associated with a dominant stricture at the dorsal pancreatic duct. Extracorporeal shock wave lithotripsy (ESWL) was performed twice and the impacted pancreatic stone was fragmented. After ESWL, endoscopic stone removal became possible and pancreatic stenting was performed for the correction of the dorsal duct stricture. This case in herein reported in which ESWL was successful in treating an impacted dorsal pancreatic duct stone associated with pancreas divisum.