Factors contributing to infectious diarrhea-associated pancreatic enzyme alterations

Prevalence of increased canine pancreas-specific lipase concentrations in young dogs with parvovirus enteritis

BACKGROUND

Pancreatic abnormalities during canine parvovirus (CPV) enteritis have not been studied prospectively.

OBJECTIVES

The objective of this study was to evaluate the diagnostic significance of canine serum pancreas-specific lipase (Spec cPL) concentration in dogs with CPV enteritis for the presence of acute pancreatitis (AP). Puppies with naturally occurring CPV enteritis were recruited and prospectively allocated into 2 groups according to normal or increased serum Spec cPL concentration. Clinical signs, laboratory findings, and pancreas-associated variables were compared between groups, and the impact of possible AP on disease course, duration of hospitalization, and outcome was assessed.

RESULTS

Serum Spec cPL concentration in 35 puppies was above the upper limit of the RI in 17/35 (48.6%) dogs (Group A) and within the RI in 18 dogs (Group B). An increased serum lipase activity was present in 29/35 (82.9%) dogs, and Group A dogs had a higher serum lipase activity than Group B (P = .006). Serum Spec cPL in Group A dogs was positively correlated with serum lipase activity at the day of presentation (r = .667; P = .003) and day of discharge (r = .628; P = .007). No statistically significant difference was found between groups (P = .233) for the presence of systemic inflammatory response syndrome (SIRS) (6/17 or 35.3% dogs Group A, and 8/18 or 44.4% dogs Group B), the disease course, duration of hospitalization, or outcome between groups.

CONCLUSIONS

Increased serum Spec cPL is relatively common in dogs with CPV enteritis. However, such increases do not seem to correlate with the outcome of disease.

Pancreatic hyperenzymemia is associated with bacterial culture positivity, more severe and right-sided colitis

BACKGROUND/AIM

Several studies reported pancreatic hyperenzymemia (PHE) related to acute colitis. However, there is no consensus on its clinical significance. This study was addressed to find the clinical significance of PHE in acute colitis.

METHODS

Pancreatic hyperenzymemia was defined as abnormal increase in serum concentrations of the pancreatic enzymes by three times of normal upper range without definite pancreatic symptoms and evidence of pancreatitis at abdominal CT imaging of pancreatic disease. And clinical and laboratory and biologic parameters of PHE group and normal pancreatic enzymemia (NPE) group were compared.

RESULTS

A total of 1,069 patients admitted to hospitals due to acute colitis were analyzed. Of these patients, 2.99 % (32/1,069) showed PHE. PHE group showed more severe symptoms and had longer hospital stays than the NPE group (12.15 vs. 4.59 days; P < 0.001). Multivariable analysis showed that right-sided colitis (OR 2.846; 95 % CI 1.122-7.224; P = 0.028) and culture positivity (OR 3.346; 95 % CI 1.119-10.008; P = 0.031) are associated with PHE during acute colitis. Also, PHE group was more common when a microorganism could be identified in the cultures (28.1 vs. 7.0 %; P = 0.003), especially blood culture. Among patients with positive cultures, Salmonella spp. had a positive correlation with the right-sided colitis and PHE (amylase P = 0.002; lipase P = 0.029), Salmonella serovar typhimurium (group B) was especially related to increased serum lipase but not to increased serum amylase (lipase; P = 0.041: amylase; P = 0.485).

CONCLUSION

Pancreatic hyperenzymemia is associated with right-sided colitis, bacterial culture positivity, and severe acute colitis.

Phase 1 study of oxaliplatin and irinotecan in pediatric patients with refractory solid tumors: a children's oncology group study

BACKGROUND

For this report, the authors estimated the maximum tolerated dose (MTD) and investigated the toxicities of oxaliplatin combined with irinotecan in children with refractory solid tumors.

METHODS

Oxaliplatin was administered on Days 1 and 8 in combination with irinotecan on Days 1 through 5 and Days 8 through 12 of a 21-day cycle. An oral cephalosporin was administered daily to ameliorate irinotecan-associated diarrhea. Pharmacokinetic studies of oxaliplatin and uridine diphosphate glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) genotyping were performed.

RESULTS

Thirteen patients were enrolled. Dose-limiting diarrhea (n = 3), serum lipase elevation (n = 3), serum amylase elevation (n = 2), colitis, abdominal pain, and headache (n = 1 each) occurred at the first dose level (oxaliplatin at a dose of 60 mg/m(2); irinotecan at a dose of 20 mg/m(2)). Only 1 of 7 patients who received reduced doses of both agents (40 mg/m(2)/dose oxaliplatin; 15 mg/m(2)/dose irinotecan) experienced a dose-limiting toxicity (DLT): diarrhea. When the oxaliplatin dose was re-escalated (60 mg/m(2)) with irinotecan at a dose of 15 mg/m(2), 2 of 3 patients had a DLT (1 episode of diarrhea, 1 episode of hypokalemia). Myelosuppression was minimal. One patient had a complete response, and another patient had stable disease for 6 cycles of therapy. The median oxaliplatin area under the concentration versus time curve (AUC(0-->infinity)) was 5.9 microg . hour/mL (range, 1.8-7.6 microg . hour/mL). The frequency of the 6/6, 6/7, and 7/7 UGT1A1 promoter genotypes was 5 of 10, 4 of 10, and 1 of 10, respectively.

CONCLUSIONS

The oxaliplatin MTD was 40 mg/m(2) per dose on Days 1 and 8 in combination with irinotecan 15 mg/m(2) per dose on Days 1-5 and Days 8-12. There was some evidence of antitumor activity; however, severe toxicity, both expected (diarrhea) and unexpected (elevation in pancreatic enzymes), was observed.

Etiology and outcome of acute pancreatitis in infants and toddlers

OBJECTIVE

To determine the etiologic factors and outcome of acute pancreatitis in children under age 3 years.

STUDY DESIGN

This was a retrospective study of children under age 3 years with acute pancreatitis between January 1995 and December 2004. Stringent diagnostic criteria were used. Demographic and clinical data were collected, and etiology and outcome were recorded. The study was approved by the University of Pittsburgh's Institutional Review Board.

RESULTS

Of 109 cases, 87 met the diagnostic criteria. Median age was 20 months (range, 1 week to 35 months). AP was associated with multisystem disease in 29 cases (34%), with hemolytic uremic syndrome (HUS) being common. Pancreatitis was associated with systemic infections in 16 cases (18%) and was idiopathic in 15 cases (17%). Biliary disease played an important etiologic role (9%), as did trauma (8%). Pancreatitis was mild in 76 cases (87.3%) and severe in 3 cases (3.4%).

CONCLUSIONS

AP is commonly associated with multisystem disease, particularly with HUS. Idiopathic pancreatitis and pancreatitis associated with biliary disease are seen in children under age 3 years. Trauma is a less frequent cause of pancreatitis, and severe pancreatitis is rare in this age group.

Current perceptions of travelers' diarrhea treatments and vaccines: results from a postal questionnaire survey and physician interviews

BACKGROUND

Travelers' diarrhea (TD) occurs at high frequency in individuals from industrialized countries visiting destinations in nonindustrialized countries and may result in chronic complications such as Guillain-Barré syndrome.

METHODS

We distributed a questionnaire requesting information on physicians' perceptions of currently available TD products, hypothesized TD vaccines, and aspects of travelers' behavior. Some physicians also were interviewed by telephone.

RESULTS

We obtained completed questionnaires from named individuals at 68 UK/US clinics. These individuals reported seeing a total of approximately 76,500 travelers per year, and estimated that 61% (UK) and 77% (US) of travelers present 2 weeks or more predeparture. More US (92%) than UK (43%) travelers are advised to purchase TD products. In both countries, 85% of travelers would be prescribed an ideal TD vaccine, but only approximately 47% (UK) and approximately 65% (US) would purchase this vaccine. About 80% of physicians would recommend an hypothesized 100% effective Campylobacter vaccine for travelers visiting regions where 30% of TD cases are caused by Campylobacter.

CONCLUSIONS

Physicians support the concept of TD vaccines, including campylobacteriosis vaccines. An ideal TD vaccine might be purchased by up to 16% (UK) and 28% (US) of relevant travelers. A 100% effective Campylobacter vaccine might be purchased by over 2 million UK/US travelers per year.