Effect of Puerarin on mechanism of endothelinin in biliary pancretitis with renal impairment / 国际外科学杂志

Objective To investigate the mechanism of endothelin (ET) in acute biliary pancretitis (ABP)with renal impairment, and examine the improvement of renal function by puerarin. Methods Thirty-two patients of ABP with renal impairment were selected and were randomly divided into group A and group B. Group A were given puerarin post-operatively, while group B were given common manegement postoperatively. Meanwhile, 16 ABP patients without renal impairment were selected as group C, and 16 nonABP patients who had common hepatic or biliary diseases were selected as group D. The levels of plsma ETand creatinine clearance rate(Ccr) of renal function in each group were observed pre-operation and 1 week post operation. Results In pre-operation the ET level in group A, B and C were higher than in group D(P ＜0.001), and the ET level in group A,B was higher than in group C(P＜0.001). Post operation after I week the ET level in group A was lower than in group B(P =0.014), while the Ccr level in group A was higher thanin group B ( P = 0.002). Conclusions The function of endothelin is an important mechanism in biliary pancretitis with renal impairment. Puerarin might reduce the ET level and increase the Ccr level in patients of ABP with renal impairment, improve the renal function of such patients.

Diagnosis and Therapy of Colonic Fistulas after Operation of Severe Acute Pancreatitis / 医学研究杂志

Objective To investigate the causes and measurement of the colonic fistulas after severe acute pancreatitis(SAP),so as to increase its cure rate.Method A retrospective study was made on 19 SAP cases complicated with colonic fistulas after drainage operation in order to find out the risk factors,the location and the time of complicated colonic fistulas,and to sum up the experiences of earlier diagnosis and comprehensive treatment.Results Most patients occurred colonic fistulas within 4~6 weeks postoperation.Seventeen patients recovered,the cure rate being 89.5%(17/19),and two case died of serious systemtic infection and multiple organ systemtic failure.Conclusions Colonic fistulas complicated by SAP is related to anatomic factors,the degree of local inflammation,the way of draingic tube putted away,and improper surgical therapy.Comprehensive therapy including taking double cannula to drainage in active,earlier jejunostomy nutrition support or colostomy,supplementing with recombinant human growth hormone can lead to better results.

The replacement therapy of pancreatic enzyme / 肠外与肠内营养

Pancreatic enzyme replacement therapy is given to manage pancreatic exocrine insufficiency (PEI) in cystic fibrosis (CF) and following pancreatectomy, total gastrectomy or chronic pancreatitis. The article reviews on aspects of pancreatic enzyme replacement therapy containing the assement of pancreatic exocrine function, the pathogenesis of exocrine pancreatic insufficiency, pancreatic enzyme preparations and their efficiency, dosing of pancreatic enzymes, enteral nutrition and pancreatic enzyme replacement, the modulation of pancreatic exocrine and adverse reactions to pancreatic enzyme.

Estenosis duodenal, secundaria a pancreatitis aguda. Comunicación de un paciente / Duodenal stenosis secondary to acute pancreatitis. Patient report

Se informó un caso con estenosis duodenal secundaria a pancreatitis aguda en un paciente de 78 años, ingresado con diagnóstico de síndrome pilórico por neoplasia gástrica; después de los exámenes imagenológicos se decide su intervención con el diagnóstico de obstrucción duodenal por neoplasia de páncreas. El diagnóstico definitivo se realizó durante la operación y se confirma con los estudios necrópsicos, ya que el paciente fallece a los siete días del postoperatorio. A pesar de ser ésta una complicación poco frecuente de la pancreatitis aguda debe tenerse en cuenta por ser una entidad grave.

A case with duodenal stenosis secondary to an acute pancreatitis in a 78 years old patient is reported , he was admitted with a diagnosis of pyloric syndrome for gastric neoplasia; after imaging exams; it was decided his intervention with the diagnosis of duaodenal obstruction for pancreatic neoplasia. The definite diagnosis was performed during operation and confirmed with necropsic studies because the patient died seven days postoperatory. Eventhough it was an unfrequent complication of the acute pancreatitis; it should be taken into account with the aim of calling the attention towards this severe entity.

Dual Phase Spiral CT of the Pancreas: Comparison of Arterial and Portal Phase

PURPOSE: To compare the images of arterial phase (AP) and portal venous phase (PVP) in the evaluation of conspicuousness of lesion and peripancreatic arterial and venous opacification in pancreatic diseases. MATERIALS AND METHODS: Dual-phase spiral CT was performed in 37 patients with pancreatic adenocarcinoma and 21 patients with pancreatitis. CT scans were performed with 5mm collimation at 1 : 1 pitch table feed. Images of AP and PVP were obtained at 30 and 65 seconds after administration of contrast material, was initiated. Using a gradingsystem, images were analalysed for conspicuousness of lesion and vascular opacification(grade 1=good, grade2=fair, grade 3=poor). RESULTS: In pancreatic adenocarcinoma, 35 and 36 of 37 cases showed low attenuation on APand PVP, respectively. With regard to conspicuousness of tumour, PVP(mean grade : 1.24) was superior AP(mean grade: 1.43), but not significantly(p=0.0745). In arterial opacification, AP(mean grade : 1.03) was significantly superior to PVP(mean grade : 1.30, ; p=0.0051). In venous opacification, PVP(mean grade : 1.19) was significautlyto AP(mean grade : 2.41 ; p<0.0001). In pancreatitis, 14 and 15 of 21 cases showed localized hypo-attenuating lesion indicating necrosis or fluid collection, on AP and PVP, respectively. With regard to conspicuousness oflesion, PVP(mean grade : 1.61) was superior to AP(mean grade : 1.81), but not significantly(p=0.1088). In arterial opacification, AP(mean grade : 1.05) was significantly superior to PVP(mean grade: 1.38 ; p=0.0180). In venous opacification, PVP(mean grade : 1.10) was significantly superior to AP(mean grade : 2.33 ; p=0.0005). CONCLUSION: For the diagnosis and staging of pancreatic disease, dual-phase spiral CT in arterial and portal venous phase maybe recommendable. The portal venous phase of spiral CT seems, however, to be superior to the arterial phase because the lesion is more conspicuous and there is venous opacification.

A Case of Idiopathic Fibrosing Pancreatitis

We experienced a case of chronic fibrosing pancreatitis in an 18/12-year-old girl, which was idiopathic because there were no familial back ground, no cystic fibrosis of pancrease, no ductal anomalies and obstruction. The patient presented intermittent colicky abdominal pain and progressive obstructive jaundice, but T-tube drainage and removal of the lymph nodes around the common bile duct relieved her symptoms and disease process. This seems to be the first case reported in a Korean child. Idiopathic fibrosing pancreatitis should be considered in the differential diagnosis of abdominal pain with obstructive jaundice in children.