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Objective To discuss the diagnosis and treatment of systemic lupus erythematosus(SLE)patients associated with pancreatic pleural effusion and pancreatic:panniculitis.Methods Retrospectively analyzed the clinical data,therapy and experiences.Results A 40-year-old female SLE patient associated with pancreatitis,huge pancreatic pseudocysts,pancreatic pleural effusion,pancreatic panniculitis.Abdominal computed tomography(CT)showed an edematous swelling of the pancreas and several pseudocysts,the biggest one measuring 230 mm×95 am.Markedly elevated amylase (11 327 U/L)was contained in the massive pleural effusion.Erythema nodosum tissue pathology revealed the pancreatic panniculitis.The pscudocyst did not completely resolve with high-dose steroid.Growth hormone release inhibiting hormone (GIH),ulinastatin,nasojejunal feeding,and it was later complicated by infection and rupture.After a surgical percutaneous drainage for the complicated pseudocyst,the clinical symptoms and signs were markedly improved.Conclusion This case shows the importance of performing eady drainage rather than conservative treatment for pancreatic pseudocyst in patients with lupus-associated pancreatitis.
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ObjectiveTo investigate the values of C-reactive protein (CRP) and pleural effusion in predicting the severity in the early stage of severe acute pancreatitis (SAP) . Methods A total of 89patients with acute pancreatitis were collected from October 2008 through October 2010 for retrospective analysis. Patients were divided into two groups, namely mild acute pancreatitis (MAP) group and SAP group as per the Guidelines for Clinical Diagnosis and Classification of Acute Pancreatitis set by the Society of Chinese Medical Association in 2003. The levels of CRP were measured on the 1st, 2nd, 3rd and 7th days after admission. Pleural effusion was also observed on the 1 st day after admission. The data of two groups were analyzed and compared. ResultsThere were significant differences in CRP at all intervals between SAP group and MAP group (P ＜0.05) . The relative risk of increase in CRP ( ＞ 150 mg/L),pleural effusion and increase in CRP along with pleural effusion were analyzed, and each of these three markers can be used as an independent severity factor of SAP. Particularly, increase in CRP along with pleural effusion could be most sensitive in predicting the severity of SAP with relative risk (RR) to be 4. 8 and specificity of predictive value to be 100％. ConclusionsC-reactive protein and pleural effusion are available, simple and economic biomarkers which can help us predict the risk of acute pancreatitis in the early stage.
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Objective To investigate hypolipemic treatment of hyperlipidemic panereatiti(HLP)with integrated traditional Chinese and western medicine.Methods Cinical data of 20 patients of HLP were analyzed retrospectively.Eight patients in the control group were treated with conventional therapies,while 12 patients in the treatment group were treated as follows:①Enema with 180ml solution(50% magnesium sulfate 30 ml.Glycerin 60ml,water 90ml).②Rhubarb gastrogavage with 9 g tid.③Intravenous drip with 24 g salvia miltiorrhiza qd.Results The treatment group had significant difference comparing with the control group in terms of the serum TG in 48 hours(P<0.01),time of autonomous bowel movement recover(P<0.01),days of abdominal pain disappear(P<0.05),days of hospitalization(P<0.01).Conclusion The treatment of Enema with 180 ml solution.Rhubarb gastrogavage with 9g tid,and Intravenous drip with 24 g salvia miltiorrhiza qd can relieve the symptoms of HLP and decrease blood-fat greatly.
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Objective To study the residual gallbladder stones and the relationship between the onset of acute pancreatitis and its surgical treatment.Methods Retrospective analysis was made in 13 patients with residual gallbladder admitted tO the hospital from June 1998 to December 2007,of which 8 cases of residual gallbladder stones and acute pancreatitis were invostigated.Thirteen cases of patients had underovent cholecystectomy 2 to 9 years before,the first symptoms occurred before 1 month to 8 years.Other remnants of the gallbladder were diagnosed by B-ultrasound and CT,magnetic resonance cholangiopancreatography (MRCP).Results Two cases were confirmedas pigment stones;6 cases as cholesterol stones(size0.2 cm ～0.5 cm,an average of 3.2 cm);1 cases as anonlalous pancre-aticobiliary junction(anomalous pancreaticobiliary ductal union,APBDU);5 cases as anomal;8 cases(61.5%)as episode of acute pancreatitis.Au patients underwent resection of residual gallbladder,with line choledochal cyst excision and biliary-enteric Roux-en-Y internal drainage in 1 case.choledocholithotomy T-tube drainage in 3 cases.Postoperative follow-up of residual gallstone was done in 8 cases,no pancreatitis attack in 6 cases,pancreatitis attack in 2 cases.Significant difference was found in onset of acute pancreatitis (P=0.019,P<0.05).Five patients without stones in patients with postoperative all none pancreatitis attack.Conclusion Patients with residual gallbladder stones are prone to acute pancreatitis,and cholecystectomy for patients with residual treatment Can reduce the pancreatitis attack.
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Objective To investigate the effects of Ulinastatin (UTI) on the expression of NF-κB and ET-1 in rats with acute necrotizing pancreatitis (ANP)-associated lung injury and morphology of lung tissue.Methods 60 Sprague-Dawley rats were randomly divided into 3 groups with 20 rats in each group,including sham operation (SO) group,ANP group and UTI group.ANP was induced by injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct;normal saline was injected for SO group with same amount.UTI was injected for UTI group with the amount of 10 000 U/L via tail vein after ANP induction.The rats were sacrificed 24 h later.The contents of serum amylase,TNF-α and wet/dry weight ratio of the lung were measured.The expression of NF-κB and ET-I protein were detected by immunohistochemical method.The level of apoptosis was detected by TUNEL Results The contents of serum amylase,TNF-α,and wet/dry weight ratio of the lungin in UTI group at 24 hours were (5 648±378)IU/L,( 89.19±3.54) ng/L and 4.55 ±0.07,respectively;which were significantly lower than the corresponding (6 799±437 )IU/L,(183.30±8.18) ng/L and 4.89±0.20 in ANP group (P＜0.05 ).There was no NF-κB and ET-1 expression,and no apoptosis was present in SO group.The positive rates of NF-κB and ET-1 in UTI group were (19±3 ) % and(8±1) %,respectively,the corresponding values in ANP group were (25±2) % and (13±1 ) %,respectively (P ＜ 0.05 ).The level of apoptotie index in UTI group was 13.75±1.25,which was higher than that (6.90±0,85) in ANP group ( P ＜ 0.05 ).Conclusions The high expression of NF-κB and ET-1 in lung tissue may cause lung injury.UTI could ameliorate the microcirculation and lung injury caused by inflammation.
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Eight patients with chronic pancreatitis or benign pancreatic head tumors were investigate to evaluate the use of Bern procedure in duodenum-preserving pancreatic head resection.Our data indicated no periopemtive deaths and serious complications.During median follow-up of 10 monks(range,6 to 14 monks),all patients reported impmvod clinical symptoms,and those with chronic pancreatitis had weight increased by 7.9 kg(range,4 to 18 kg).Pancreatic exocfine function wag improved,although the endocrine function showed no change.The Bern procedure might be a relatively safe and effective procedure for the treatment of chronic pancreatitis or benign pancreatic head tumors.
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Objective To investigate the effects of interleukin-18 ( IL-18 ) on M cells of intestinal mucosa in acute pancreatitis (AP) in rats. Methods Seventy SD rats were divided into seven groups: AP 6 hour group, 12 hour group, 24 hour group, IL-18 6 hour group, 12 hour group, 24 hour group, and control group at random. The models of AP were established. Serum, pancreatic tissue, and ileal mucosa were harvested. Serum amylase, glutamate pyruvate transaminse, total bilirubin, endotoxin, IL-27, and TNF-α were detected. Pathologic changes of pancreatic tissue and ileal mucosa were observed. The protein with reverse transcription-polymease chain reaction (RT-PCR). Results The level of serum TNF-α increased obviously in IL-18 6 hour group, 12 hour group, and AP group. The level of serum IL-27 increased in IL-18 6 hour group and AP group and back to normal in IL-18 24 hour group. The in IL-18 group than AP group (P < 0. 05 ). Conclusions IL-18 may affect M cells function and play important roles in intestinal barrier in acute pancreatitis.
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P 12 h and 24 h group was significantly higher than that of control group (P<0.05).Conclusions The percentage and reproductive activity of bone marrow MSCs have changed during the periods of ANP.
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n of IL-6 and TNF-alpha,alleviate the inflammation of ANP.
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damage possibly by inhibiting the activation of NF-κB,accelerating the apoptosis of pancreatic ceils and reducing release of pancreatic enzyme.
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Objective To investigate the clinical characterisitics of chronic panereatitis(CP) with mass.Methods The clinical features,radiologieal and pathologic records of 39 cases of chronic pancreatitis with mass confirmed pathologically between January 2005 to December 2007 were retrospectively reviewed,and compared with 17 surgical pathologically confirmed patients with pancreatic cancer.Results The jaundice was found in 14 of 39 patients with pancreatits and 1 of 17 patients with pancreatic cancer,with significant difference between two groups(χ2=0.111,P=0.045).Elevated serum CEA and CA19-9 were found in 0 and 12 patients with pancreatitis.respectively,and 3 and 11 patients with pancreatic cancer,respectively(P=0.025 and=0.018,respectively).CT examination showed that the atrophy pancreas and the infiltration of surrounding and blood vessels were found in 0 and 5 patients with pancreatitis or 3 and 8 patients with pancreatic cancer,respectively(all P values＜0.05).The magnetic resonance cholangiopanereatography (MRCP) examination revealed that dilation of bile and pancreatic ducts,and calculus in pancreas duct were found in 14,2 and 15 patients with pancreatitis,or 11,6 and 2 patients with pancreatic cancer,respectively(all P values ＜0.05).Pancreatic cancer was confiremed by endoscopic ultrasonography guided fine needle aspiration(EUS-FNA)in 10 of 14 patients with pancreatic cancer,but none in 18 patients with pancreatitis.Conclusions It is difficult to diagnose CP with mass,but it will helpful ifassists diagnosis with clinical features,tumor markers and image examinations,especially with biopsyexamination.
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Objective To investigate the reason of intra-abdominal haemorrhage caused by severe a-cute pancreatitis (SAP) and its nursing experience. Methods A retrospective study was carried out in 19 patients with intra-abdominal haemorrhage after SAP surgery in the Second Affiliated Hospital of Harbin Medical University from March 1998 to March 2007. Results All other patients received good hemosta-sis effect except one case,who showed no effect with hemostatic drug and local compression,but at last showed effect by transfixion under direct vision. Conclusions Intra-abdominal haemorrhage after SAP surgery has high mortality rate. It should be dealt with in a timely manner with a view to improve the prog-nosis of patients.
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Objective To investigate the etiology and clinical characteristics of acute pancreatitis complicated with hyperlipidemia.Methods 497 patients admitted from Jan.2002 to Dec.2007 were screened,60 patients who fulfiHed the inclusion criteria were enrolled,and these patients were divided into two groups according to the level of serum triglyeeride and disease severity respectively.Patients whose serum level of triglyeeride>11.3 mmoVL were defined as severe hyperlipidemia group.while those patients whose serum level of triglyceride between 5.65～11.3 mmol/L with milky serliiH were defined as mild hyperlipidemia group.Patients were classified into mild acute pancreatitis(MAP) and Severe acute pancreatitis(SAP) groups according to the disease severity.The etiology and clinical characteristics in all patients were investigated. Results There were 13 patients in severe hyperlipidemia group,47 patients in mild hyperlipidemia group.5 patients(38.5%)in Severe hyperlipidemia group had history of acute pancreatitis,which wag significantly higher than that of mild hyperlipidemia group(10.6%,P<0.05).The etiology was mainly biliary diseases in the mild hyperlipidemia group,and mainly hyperlipidemia in the severe hyperlipidemia group.The levels of total cholesterol and triglyceride was(8.17±2.76)mmol/L and(13.47±4.12)mmol/L,which were significantly higher than(4.97±1.67)mmol/L and(4.09±2.18)mmol/L of mild hyperlipidemia group(P< 0.01).The Serum amylase,gluc08e,TG,Tc and duration of relief of abdominal pain were(1396±2233) U/L.(14.17±8.37)mmol/L,(7.69±6.56)mol/L,(5.39±3.58)mmol/L and(6.30±3.27)d, respectively,in SAP group;and the corresponding values were(831±1348)U/L,(8.28±3.89)mmol/L, (5.55±3.92)moVL,(5.64±1.79)mol/L and(4.29±2.62)d in MAP group;only the values ofglucose and duration of relief of abdominal pain were statistically different(P<0.05).Conclusions The recurrence rate of acute panereatitis was hisher in patients with severe hyperlipdemia;the severity of hyperlipdemia Was closely associated with the development of acute pancreatitis,but not the severity of acute pancreatitis.
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Objective To evaluate the clinical significance of phural effusion and/or ascites and their prognostic role in patients with acute pancreatitis.Methods The clinical data of 312 patients with acute pancreatitis were collected and analyzed retrospectively.Results Pieural effusion was found in 47 patients and ascites in 18.of 47 cases with pleural effusion,there were 31 cases(65.9%)of severe pancreatitis(P＜0.01)and 27 cases (57.4%)complicated by pseudocyst(P＜0.01).Among 18 cases with ascites,there were 14 cases(77.7%)of severe pancreatitis(P＜0.01).6 cases with pleural effusion and/or ascites died of multiple organs failure.Conclusion Pleural effusion and/or aseites is closely associated with severe pancreatitis.
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Objective To study the significance of acute pancreatitis AP complications by acid-base distur-bance. Methods The arterial blood gas, serum electrolytes parameter and clinical data of 85 patients were analyzed.Results Acid-base disturbance of different types commonly existed in the early stage of AP patients. There are sig-nificant statistical differences in the indices of PaO2, PaCO2, SaO2 between group MAP and group SAP( P < 0.05 or P < 0.01 ). Conclusion Acid-base disturbance are very common in the AP patients and this-will make the condition worse,they should be treated promptly.
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Objective To investigate the effect of prebiotics supplement on intestinal epithelial tight junctions and barrier function of the rats with acute pancreatitis (AP). Methods The AP model in Wistar rat was established by intraperitoneal injection of L-arginine. The rats were randomly divided into 3 groups: control group, AP group, GOS group. GOS was given 4g·kg-1·d-1at 7d before ANP induced. Twelve hours after modeling, the AP rats in each group were sacrificed. 2 ml of blood sample was taken from heart for the analysis of plasma diamine oxidase (DAO) activity. Jejunum was taken for histological examination. The transmembrane binding proteins (occludin) were measured with immunohistochemistry. Results The plasma DAO level in AP group was (7.29±0.68) U/L, and significantly higher than (2.01±0.34) U/L of control group (P＜0.01). The DAO level in GOS group was (3.44±0.59) U/L, and significantly lower than that of AP group. The occludin protein level in AP group was 95.1±9.2, and significantly lower than 44.7±8.2 of control group and 59.7±7.8 of GOS group (P＜0.01). The occludin protein level in COS group was significantly higher than that of control group (P＜0.05). Conclusions The prebiotics may increase the expression of occludin protein, enhance the intestinal epithelial tight junction, maintain the intestinal permeability, and protect the intestinal barrier function.
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Objective To discuss nursing of patients with early severe acute pancreatitis undergoing laparoscopic treatment and in comparison with open surgery. Methods Totally 56 patients with early se-vere acute pancreatitis were admitted from October 2002 to October 2007,among which 30 cases (group A) received laparoscopic.treatment and the other 26 cases (group B) was given open surgery.The average time of hospital stay,incidence of complication and re-operation were compared between the two groups. Re-sults The average time of hospital stay,incidence of complication and re-operation of group A were lower than those of group B (P<0.05). Conclusions Treatment of severe acute pancreatitis with laparoscopy proved to be a desirable method in that it performs good effect with little trauma and low fatality.Other basic treatment,regulation of water and electrolyte balance and acid-base balance,enforcement of nutritional sup-port,fasting and gastrointestinal decompression should not be ignored.
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Objective To analyze and compare thh effect of early surgical treatment and nonsurgical treatment for patients with traumatic severe acute pancreatitis.M~ethods The curative effect,surgical procedures and mortality data in 36 cases were retrospectively analyzed.ResUlts Compared with nonsurgieal treatment,early surgical treatment was associated with a significantly lower incidence of mortality,and with a highter cure rate (9.52% vs 33.33% ,P ＜ 0.05).Conclusion For traumatic severe acute pancreatitis,early operative management should be selected routinely as the first choice of treatment.
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Objective To investigate the effects of methylprednisolone on neurocyte apoptosis in rats with severe acute pancreatitis(SAP).Methods Thirty-six SD rats were divided into sham operation group,SAP group and methylprednisolone group(12 rats in each group).SAP model was constructed by injecting 5%sodium taurodeoxycholate into biliary-pancreatic duct.Serum amylase,interleukin-6(IL-6),tumor necrosis factor α (TNF-α),volume of aseites and histopathological changes of pancreas were determined.The mRNA expressions of Bcl-2 and Bax in brain tissue were analyzed by RT-PCR.and neuroeyte apoptosis was detected by TUNEL method.Results The levels of serum IL-6 and TNF-α were significantly increased:the expression of Bcl-2 mRNA in brain tissue was down-regulated;the expression of Bax mRNA was up-regulated;the Bcl-2/Bax ratio Was decreased:the apoptosis of the neurocytes was increased in SAP group.Compared with SAP group,the levels of serum IL-6 and TNF-α were significantly decreased;the expression of Bcl-2 mRNA was unchanged but the expression of Bax mRNA was down-regulated in brain tissue,so the Bcl-2/Bax ratio was elevated significantly;the rate of the ueurocyte apoptosis in brain tissue were reduced in methylprednisolone group.Conclusions The apoptosis of neurocytes in brain tissue may be one of the factors causing pancreatic encephalopathy.Methylprednisoione can inhibit the release of IL-6 and TNF-α.improve the balance of Bcl-2 and Bax expression and decrease the apoptosis of neurocytes in brain tissue.
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Objective To investigate the effects of pioglitazone,a peroxisome proliferation activated receptor(PPAR)γ agonist on oxidative stress process and the therapeutic effects on severity of acute pancreatitis(AP).Methods Thirty male Sprague-Dawley rats were randomly divided into five groups with 6 in each:control group,eerulein plus pioglitazone group,cerulein group,cerulein plus vehicle group,cerulein plus pioglitazone and GW9662 group.Rats were sacrificed at 30 min after the induction of pancreatitis.Pathologic changes of the pancreas were observed under light microscope.The ratios of pancreatic wet/body weight of rat were determined in each group.Serum amylase,pancreatic nitric oxide synthase(NOS),inducible nitric oxide synthase(iNOS),malondialdehyde(MDA),and myeloperoxidase (MPO)were determined by chromometry.Results The serum amylase,pancreatic wet/body weight and the score of pathologic damage increased after the induction of pancreatitis,AP samples were characterized by increased pancreatic MDA,MPO,NOS and iNOS(P＜0.01).Pioglitazone(20 mg/kg and 40 mg/kg)exhibited a protective effect against oxygen free radicals reflected by lower serum amylase,less severe pancreatic lesions,normal pancreatic MDA,MPO and NOS levels(P＜0.05).GW9662 reversed the effects against oxidative stress of pioglitazone(40 mg/kg)(P＜0.05).Conclusions Pretreatment with pioglitazone may exert its therapeutic effect on AP by lowering pancreatic oxidative free radicals and reducing pancreatic tissue infiltration of neutrophils.