摘要:

Twelve patients with acute pancreatitis admitted to our department between January 1993 and December 1994 were studied prospectively and classified into two groups (severe group, five patients; mild group, seven patients), according to the criteria for grading severity of acute pancreatitis proposed by the Research Committee for Intractable Diseases of the Pancreas, Japanese Ministry of Health and Welfare (1990). To evaluate markers for early estimation of the severity of acute pancreatitis, we measured serum changes in various parameters. In the severe group interleukin-6 (IL-6) levels were increased significantly 5, 24, 72, and 120 h after the onset (p< 0.01), compared with the mild group. C-reactive protein (CRP), thrombin antithrombin III, and α2-plasmin inhibitor plasmin complex levels were significantly increased only at the 72-h time point. Peak values of interleukin-8 (IL-8) and soluble human E selectin were observed at 5 and 72 h, respectively, after the onset. There was a significant correlation between IL-6 at 5 h and both pancreatic secretory trypsin inhibitor (r= 0.85) and CRP (r= 0.94) at 72 h. We therefore conclude that IL-6 is a useful marker for assessment of the severity of acute pancreatitis in its early stages.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Fifty-five leukocyte scintigraphies were performed. Thirty-five patients (group 1) with acute pancreatitis in the early phase and 20 patients (group 2) with pancreatic chronic pseudocysts following acute pancreatitis were tested. The clinical features, laboratory parameters, and Ranson classifications were registered during hospitalization. In group 1, most of the cases with a severe clinical outcome gave positive leukocyte scintigraphic results (10/12). Leukocyte accumulation was also detected in patients with mild acute pancreatitis (4/23), but at a lower frequency. In the acute phase, significant differences in laboratory parameters (sedimentation rate and leukocyte count) were found in the leukocyte scintigraphy-positive versus -negative cases. The scintigraphic activity correlated with the sedimentation rate, leukocyte count, fever, and duration of hospitalization. In group 2 there were five cases with a positive leukocyte scan. A pancreatic abscess was found in four of them during surgery. In seven patients with a normal scintigram, surgery revealed a noninfected pancreatic pseudocyst. Leukocyte infiltration of the pancreas can be demonstrated by leukocyte scintigraphy. A positive leukocyte scan indicated a severe course of acute pancreatitis. The method also seems useful for differentiation between infected and noninfected chronic pancreatic pseudocysts.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A striking pancreatic juice reflux toward the biliary tree (PR) has frequently been found in subjects with common bile-pancreatic conduit (CBPC) and gallstone-induced acute pancreatitis (SAP). Our aim was to determine the role of the CBPC functional diameter as a potential trigger of PR. The CBPC was calibrated in three groups of patients: (A) patients with gallbladder stones using intraoperative direct cholangiometry (n= 24), (B) patients after surgical removal of common bile duct stones using postoperative cholangiometry via T-drain (n= 6), and (C) patients with SAP using the same procedures as in group B (n= 6). In all patients in groups B and C, aliquots of bile were collected and assayed for pancreatic amylase content. The mean functional diameter of the CBPC varied from 0.80 mm in patients in groups A and B to 0.47 mm in group C (p< 0.001). The bile samples of group B contained low concentrations of amylase, whereas high values could be found in all samples of group C. We conclude that PR is a frequent event occurring after bile duct revision concerning small amounts of pancreatic juice. However, CBPC functional stenosis as seen in patients with SAP obviously induces PR with high amounts of pancreatic juice.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Lysosomal cathepsins D (CD), B (CB), and L (CL) serum levels were determined by immunoassays in patients with chronic (CHP) or acute (AP) pancreatitis and in patients with ductal pancreatic carcinoma (DPC) and correlated with some biological and clinical parameters of this tumor. CB serum concentrations significantly higher than those measured in healthy subjects (NS) were observed in CHP, AP, and DPC patients (p< 0.01). However, no significant difference was noted among these groups. Increased CL serum levels were evident only in cancer patients compared to NS, AP, or CHP groups (p< 0.05), while no difference was observed among these groups. Elevated CD serum values were observed in CHP and AP patients compared to healthy subjects or cancer patients (p< 0.01). In cancer patients no correlation between CD, CB, and CL and clinical stage or tumor size was found. However, significant correlations were observed only between serum CD and CA50 (p< 0.02) and between CD and CL (p< 0.05). No further relationship among the biochemical parameters examined was observed. The present data suggest that the different serum patterns of CD, CB, and CL in patients with pancreatitis and pancreatic cancer may be of clinical interest as additional biochemical parameters for the differential diagnosis of these diseases. However, further prospective clinical studies are needed to assess better their potential value as prognostic parameters to identify patients with pancreatitis at increased risk to develop pancreatic cancer.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of the present prospective study was to investigate whether endoscopic sphincterotomy may be useful in preventing recurrence of acute pancreatitis in patients with gallstones and a high anesthesiological risk of cholecystectomy. Twenty-six elderly patients with severe cardiopulmonary, hepatic, and renal diseases were considered. Endoscopic sphincterotomy was successful in 19 cases (group A: mean age, 78.4 years; range, 71–87) and failed in 7 patients (group B: mean age, 79.8 years; range 73–85). In the follow-up period biliary pain without an increase in pancreatic serum enzymes occurred in six patients in group A and in all patients in group B (p= 0.002); recurrence of acute biliary pancreatitis with a need for hospitalization occurred in one patient in group A and in four patients in group B (p= 0.01). These results suggest that endoscopic sphincterotomy may be considered a very useful option in reducing the recurrence of acute biliary pancreatitis in elderly patients with gallstones and a high anesthesiological risk of cholecystectomy.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Pancreatic hyperstimulation with simultaneous duct obstruction does not cause the typical features of acute pancreatitis, therefore the role of an additional challenge, such as either ethanol intoxication or short-term ischemia, was studied. Alcoholic pancreatitis was induced in 28 rats by acute ethanol intoxication (0.25 LD50) and an obstruction/hyperstimulation mechanism (clip of the biliopancreatic duct for 20 min and intravenous stimulation with 5 U of cholecystokinin and secretin each). Ischemic pancreatitis was performed by obstruction/hyperstimulation and subsequent pancreatic ischemia by clamping the supplying arteries for 40 min. The macro- and microscopic alterations were evaluated and graded by a scoring system. Additionally, the pancreas was removed in 50% of the animals and the pancreatic acini were prepared. From those acini the intracellular enzymes trypsinogen, kallikreinogen, amylase, lipase, glucuronidase, and acidic phosphatases were determined. While obstruction/hyperstimulation, 40 min of ischemia, or ethanol alone did not induce acute pancreatitis, a combination of obstruction/hyperstimulation with either ethanol or ischemia resulted in acute pancreatitis in 68 and 60% of treated rats, respectively. Similarly, both models were characterized by extrapancreatic fat necrosis and acinar necrosis at the periphery of the lobules. Almost all intracellular enzymes were elevated in both pancreatitis models compared to sham-operated controls. Both alcohol and ischemia were insults that sensitize the pancreas to develop acute pancreatitis after obstruction/hyperstimulation. Since the observed morphologic and enzymatic alterations in both models are very similar, alcohol and ischemia might have some common pathways by which they make the pancreas vulnerable to enzymatic attacks.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

It has been recognised in mammals that after pancreatic duct obstruction, acinar cells progressively disappear and pancreatic islets are preserved. Previous studies by electron microscopy have suggested the involvement of apoptosis in acinar cell deletion. In the present study, we employed molecular biological methods and investigated whether acinar cell deletion is due to apoptosis. In male Sprague-Dawley rats, pancreatic duct ligation was performed through a left paramedian incision. Pancreatic tissue was studied at each of the following intervals after ligation: 3, 6, 12, 18, and 24 h and 2, 3, 5, and 7 days. DNA fragmentation was determined by in situ labeling of DNA strand breaks on tissue sections [fluorescein-labeled terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method (TUNEL)] and by electrophoretic detection of the fragments of extracted DNA. Tissue sections were also examined by hematoxylin/eosin staining and immunohistochemical staining of insulin. Pancreatic duct ligation induced acinar cell deletion by day 5. Pancreatic tissue from control rats demonstrated no TUNEL-positive nuclei. In contrast, acinar cells from rats 12 h to 5 days after duct ligation showed TUNEL-positive nuclei. The number of TUNEL-positive nuclei was maximum 2 days after duct ligation. Electrophoresis showed DNA fragmentation after duct ligation. Control rats showed a genomic DNA pattern. Islets were preserved throughout the experimental period in duct-ligated rats and control rats. The results suggest that apoptosis may be the dominant form of acinar cell death in the rat pancreatic duct ligation model.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We demonstrated previously that pancreatic secretion of individual enzymes is specifically regulated (1). In the present study, we investigated and defined contributing roles of cholinergic and cholecystokinin tones to the specific regulation of rat pancreatic secretion of digestive enzymes. Animals were provided with pancreatic, biliary, duodenal, and jugular vein cannulas allowing separate drainage of bile and pure pancreatic juice, as well as intravenous infusions of MK329 or atropine sulfate along with SMS 201–995 (SMS). Rats kept in restraint cages were divided into four groups. The first rat group was infused with 5 μg kg−1h−1SMS alone; the second group was infused with a mixture of SMS and MK329 (5 μg kg−1h−1:0.5 mg kg−1h−1); the third group received a mixture of SMS and atropine (5 μg kg−1h−1); and rats in the fourth group were administrated a mixture of SMS, MK329, and atropine (5 μg kg−1h−1:0.5 mg kg−1h−1:100 μg kg−1h−1). Food, but not water, was denied rats 10 h before the experiment and throughout the 6-h experimental period. During the experiment, pancreatic juice was continuously collected every 15 min from each rat, and a 15-μl aliquot of the pancreatic juice sample was removed for total protein, amylase, lipase, trypsinogen, chymotrypsinogen, and proelastase assays. Pancreatic juice previously collected from a donor rat was mixed with the fresh bile and the mixture was recirculated into the duodenum. The secretory patterns over the 6-h experimental period showed that during the first hour of drug infusion, MK329 alone did not alter the SMS-induced inhibitory process of total protein and amylase, trypsinogen, and proelastase secretion, and there was no marked change in total protein and enzyme outputs. Adding atropine to SMS did not alter the secretory pattern during the first hour of drug infusion, but a significantly greater decrease in protein and enzymes outputs occurred. Correlations between paired enzyme outputs greatly increased with SMS alone, but some changed when either MK329 or atropine was infused along with SMS. When all drugs were infused together, enzyme outputs became strongly correlated. These results suggest that under fasting conditions, somatostatin and atropine can neutralize basal pancreatic enzyme outputs, leading to a constitutive type of secretion characterized by parallel secretion of the digestive enzymes. Furthermore, it is proposed that under basal secretion conditions, acetylcholine and cholecystokinin reaching the pancreatic acinar cells may act to dissociate pancreatic secretion of individual digestive enzymes originating from heterogeneous secretory granules.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We have studied the postnatal development of the endocrine pancreas from normal female Syrian golden hamsters 1, 8, and 24 weeks of age. The observations were made by (a) analysis of insulin secretion in response to glucose using isolated pancreatic islets and (b) identification and quantitation of insulin-, glucagon-, somatostatin-, and pancreatic polypeptide-secreting cells. Glucose-induced insulin secretion showed typical dose-response curves. However, whereas in 24-week-old animals maximal secretion was already present with 8 mMglucose, in younger hamsters such a response was attained only with 20 mMglucose. The volume density of the endocrine pancreas and the number of islets were increased in 1-week-old hamsters compared to the older animals. The islet volume average in 8-week-old hamsters was almost three times higher than that measured in 1-week-old animals. However, the proportion and size of each cell type in the islets did not present significant differences among the groups studied. Our results show that, in hamsters, the endocrine pancreas reaches the adult general characteristics late afterbirth. Furthermore, the definite morphological pattern is attained far earlier than the secretory response. These observations provide basic information for further studies regarding the mechanisms and factors that control both the growth and the differentiation of endocrine cell populations as well as glucose-induced insulin secretion in a simple experimental model.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The effects of the nonmetabolizable amino acid a-aminoisobutyric acid (AIB) on insulin release were evaluated using β cell-rich pancreatic islets fromob/obmice. Both AIB and L-alanine promptly induced transient insulin release during column perifusion of islet cells. The secretory response was dependent on an elevated level of glucose and effectively suppressed by removal of Na+. The insulin release elicited by AIB fulfilled the criteria of a physiological event in being suppressed by clonidine or lowering of the temperature to 22°C.AIB effectively promoted the increase in sodium (total as well as ionized cytoplasmic) obtained with ouabain blockage of the Na/K pump. When added to a medium containing 11 mMglucose, AIB altered cytoplasmic Ca2+in terms of both an initial transitory rise and transformation of existing oscillations into a sustained elevation. It is concluded that amino acids can stimulate insulin release from mature β cells by virtue of being cotransported with Na+.

ISSN:0885-3177    

出版商:OVID    

年代:1997

数据来源: OVID