Acute pancreatitis--the current status in management

Acute gallstone pancreatitis: a constant challenge for the surgeon

INTRODUCTION

Acute pancreatitis is an inflammation of the pancreas caused by autodigestion of the gland by its enzymes. It includes a broad spectrum of pancreatic disease, which varies from parenchymal edema to necrosis. The objective of the current study was to describe the symptoms of the patients with gallstone-associated pancreatitis and to reinforce the opinion that operation, within the first 72 hours after the onset of the disease, has many advantages and has to be considered as a treatment option when ERCP is not available.

METHODS

The present retrospective study concerns all patients that were hospitalized in Mamatsio Hospital of Kozani during the period between Jan 1, 1997 and Dec 1, 2002 under the diagnosis of gallstone-associated acute pancreatitis. From the records 108 cases were identified (43 males and 65 females). The mean age was 62.93 (SD 15.85 years), ranging from 17 to 91 years.

RESULTS

24 patients (22.22%) fulfilled more than 3 of Ranson's criteria. 20 patients (18.52%) presented necrotizing pancreatitis. All patients underwent open cholecystectomy and common bile duct exploration. Necrosectomy concomitantly with cholecystectomy was performed in 7 patients (6.48%). The mean hospitalization was 10.53 days (S.D. 6.38 days), ranging from 2 to 36 days. The associated mortality reached 5.55% (6 patients) and no patient died in the operating theater. During the 12-month follow-up period, 2 patients (1.85%) developed pancreatic pseudocysts.

Ethanol augments elevated-[Ca2+]C induced trypsin activation in pancreatic acinar zymogen granules

It has been long recognized that significant percentage of patients with acute pancreatitis often presents with a history of excessive alcohol consumption; however, the patho-physiological effect of ethanol on acute pancreatitis remains poorly understood. Abnormally elevated cytosolic Ca2+ ([Ca2+]C) has been found to be a shared phenomenon in acute pancreatitis that could induce trypsin premature activation. Here, we present the effects of ethanol to sensitize zymogen granules (ZGs) of pancreas acinar cells to elevated [Ca2+]C leading to zymogen premature activation that could result in acute pancreatitis. The pH fluctuations ([pH]G), Ca2+ concentration ([Ca2+]G), and premature trypsin activation inside the ZGs were monitored directly with specific fluorescence indicators. Our results showed that ethanol could act directly on ZGs and cause ZGs more receptive to elevated [Ca2+]C that could induce premature activation of zymogen (trypsin). This alcohol-induced effect is concentration dependent and strongly influenced by the surrounding [Ca2+]C. The K+ channels on ZGs membranes are required in the sensitization process. Our observations provide a mechanistic understanding of the role of ethanol in the initiation phase of alcoholic pancreatitis.

Tumor necrosis factor α antibody prevents brain damage of rats with acute necrotizing pancreatitis

AIM: To study the protective effects of tumor necrosis factor α (TNFα ) antibody on pancreatic encephalopathy in rats.

METHODS: One hundred and twenty SD rats were randomly divided into normal control group, acute necrotizing pancreatitis group and TNFα antibody treated group. Acute hemorrhage necrotizing pancreatitis model in rats was induced by retrograde injection of 50 g/L sodium taurocholate into the pancreatobiliary duct. Serum TNFα was detected and animals were killed 12 h after drug administration. Changes in content of brain water, MDA and SOD as well as leucocyte adhesion of brain microvessels were measured.

RESULTS: In TNFα antibody treated group, serum TNFα level was decreased. Content of brain water, MDA and SOD as well as leucocyte adhesion were decreased significantly in comparison with those of acute necrotizing pancreatitis group (P < 0.05).

CONCLUSION: TNFα antibody can alleviate the brain damage of rats with acute hemorrhage necrotizing pancreatitis.

Expression of TREM-1 mRNA in acute pancreatitis

AIM: To explore the expression of triggering receptor expressed on myeloid cells (TREM-1) mRNA in acute pancreatitis (AP).

METHODS: Using the reverse transcription polymerase chain reaction (RT-PCR), we examined the expression of TREM-1 mRNA in 10 cases of mild acute pancreatitis (MAP), 8 cases of severe acute pancreatitis (SAP), and 10 cases of healthy control subjects. And we also examined the expression of TREM-1 mRNA in 14 cases of AP (including 10 MAP and 4 SAP) before treatment, after successful therapy and clinically cured.

RESULTS: The expression of TREM-1 mRNA in the groups of MAP, SAP patients and healthy control subjects was 0.771 ± 0.274, 1.092 ± 0.331 and 0.459 ± 0.175, respectively; there was a significant difference among the three groups (P < 0.05). And there was also a significant difference between the AP patients (0.914 ± 0.341) and healthy control subjects (0.459 ± 0.175) (P < 0.05). Moreover, in the 14 cases of AP, before treatment, after successful therapy and clinically cured, the expression of TREM-1 mRNA was 0.905 ± 0.226, 0.739 ± 0.169 and 0.633 ± 0.140, respectively, and there was a significant difference among the three stages (P < 0.05).

CONCLUSION: The expression of TREM-1 mRNA in the patients with AP increases obviously, and correlates with the degree of AP. Furthermore, the expression of TREM-1 mRNA is distinctly different at the different stages of AP. It indicates TREM-1 may play an important role in the occurrence and development of AP.