Screening of Sera from Patients with Pancreatitis by an Apoptosis Assay of Skin-derived Cells / 대한소화기학회지

BACKGROUND/AIMS: An excessive inflammatory response is typical in acute pancreatitis and a significant cause of early mortality in severe acute pancreatitis. This is believed to be caused by inflammatory molecules or upregulated cytokine levels in the serum of patients. The aim of this study was to identify the serum-mediated apoptosis-inducing effects in acute pancreatitis patients. METHODS: A skin tissue-derived cell line, BJ, was treated for 24 hours with the sera of 22 healthy volunteers (control) and 71 acute pancreatitis patients (22 with gallstone pancreatitis, 16 with alcoholic pancreatitis, and 11 with pancreatitis with other causes) collected at the time of hospital admission (active) and discharge (resolved). Apoptosis was analyzed by flow cytometry. RESULTS: The average percentage of living cells, early apoptotic cells, and late apoptotic cells ranged from 78.8% to 85.0%, 5.5% to 7.3%, and 7.7% to 13.1%, respectively. The number of live cells increased significantly using the serum from the resolved state of gallstone-induced pancreatitis. In addition, the number of early apoptotic cells increased significantly using the serum from the resolved state of pancreatitis with other causes. The number of late apoptotic cells decreased significantly with the serum from the resolved state compared to the active state of gallstone- and alcohol-induced pancreatitis. CONCLUSIONS: Serum samples from patients with pancreatitis induced a change in the apoptosis profiles of skin-derived cells. These results indicate changes in the serum components in patients with acute pancreatitis.

Screening of Sera from Patients with Pancreatitis by an Apoptosis Assay of Skin-derived Cells / 대한소화기학회지

BACKGROUND/AIMS: An excessive inflammatory response is typical in acute pancreatitis and a significant cause of early mortality in severe acute pancreatitis. This is believed to be caused by inflammatory molecules or upregulated cytokine levels in the serum of patients. The aim of this study was to identify the serum-mediated apoptosis-inducing effects in acute pancreatitis patients.METHODS: A skin tissue-derived cell line, BJ, was treated for 24 hours with the sera of 22 healthy volunteers (control) and 71 acute pancreatitis patients (22 with gallstone pancreatitis, 16 with alcoholic pancreatitis, and 11 with pancreatitis with other causes) collected at the time of hospital admission (active) and discharge (resolved). Apoptosis was analyzed by flow cytometry.RESULTS: The average percentage of living cells, early apoptotic cells, and late apoptotic cells ranged from 78.8% to 85.0%, 5.5% to 7.3%, and 7.7% to 13.1%, respectively. The number of live cells increased significantly using the serum from the resolved state of gallstone-induced pancreatitis. In addition, the number of early apoptotic cells increased significantly using the serum from the resolved state of pancreatitis with other causes. The number of late apoptotic cells decreased significantly with the serum from the resolved state compared to the active state of gallstone- and alcohol-induced pancreatitis.CONCLUSIONS: Serum samples from patients with pancreatitis induced a change in the apoptosis profiles of skin-derived cells. These results indicate changes in the serum components in patients with acute pancreatitis.

Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases / Tratamento endovascular de pseudoaneurisma decorrente de pancreatite crônica: relato de dois casos

Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.

Resumo O pseudoaneurisma decorrente de pancreatite crônica consiste em complicação rara, porém com alta taxa de mortalidade. Está etiologicamente associado à pancreatite crônica, e seu diagnóstico é feito mais comumente após ruptura, manifestando-se através de sinais clínicos de hemorragia aguda. A tomografia computadorizada desempenha papel importante no diagnóstico; contudo, a angiografia por subtração digital mantém-se como método padrão-ouro para confirmação diagnóstica e direcionamento do tratamento. O presente artigo relata dois casos de pseudoaneurisma em pacientes com pancreatite crônica alcoólica, sendo um da artéria esplênica e outro da artéria gastroduodenal, complicados com sangramento torácico e abdominal respectivamente. Ambos foram submetidos a tratamento endovascular minimamente invasivo com sucesso, através de implante de molas e de stent-grafts.

Alcoholic chronic pancreatitis: A quality of life study / Pancreatite crônica alcoólica: um estudo de qualidade de vida

ABSTRACT Objective: To compare the quality of life between patients with alcoholic chronic pancreatitis and controls, and between diabetic and non-diabetic patients, correlating clinical, sociodemographic, and nutritional factors with their quality of life scores. Methods: Forty-three outpatients of the pancreas and biliary tract clinic diagnosed with alcoholic chronic pancreatitis were assessed. Quality of life was measured by the Brazilian version of the Short Form-36. The control group consisted of 43 healthy companions. Nutritional status was classified according to body mass index and triceps, biceps, suprailiac, and subscapular skinfold thicknesses, using the appropriate methods. The percentage of body fat was given by adding the four skinfold thicknesses and by bioelectrical impedance analysis. The statistical tests included the Chi-square, Mann-Whitney, and Spearman's correlation tests, with the significance level set at p<0.05. Results: The sociodemographic variables of the case and control groups did not differ. Quality of life was lower in alcoholic chronic pancreatitis patients than in controls. The only quality of life domain that differed between diabetics and non-diabetics was functional capacity, lower in diabetics (p=0.022). Smoking duration, alcohol intake in grams, and time since pancreatic surgery correlated negatively with the quality of life of alcoholic chronic pancreatitis patients. Old age, skinfold thicknesses, and percentage of body fat correlated positively with quality of life. Conclusion: Quality of life is low in alcoholic chronic pancreatitis patients because of the negative influence of certain factors, such as smoking duration, amount of alcohol consumed, and time since pancreatic surgery.

RESUMO Objetivo: Avaliar a qualidade de vida dos pacientes com pancreatite crônica alcoólica, comparando-os aos participantes de um grupo-controle e entre pacientes com e sem diabetes. Métodos: Avaliaram-se 43 pacientes do ambulatório de pâncreas e vias biliares diagnosticados com pancreatite crônica alcoólica. A qualidade de vida foi verificada por meio do Short Form-36, versão brasileira. O grupo-controle para a qualidade de vida foi composto por 43 acompanhantes sem doenças conhecidas. Para avaliação do estado nutricional, foi calculado o índice de massa corporal e dobras cutâneas do tríceps, bíceps, suprailíaca e subescapular, de acordo com a metodologia adequada. Para obtenção da porcentagem de gordura corporal, utilizou-se o somatório das quatro dobras e a medida obtida por meio da bioimpedância. Para análise estatística, foi utilizado teste de Qui-quadrado, Mann-Whitney e correlação de Spearmam, com p<0,05. Resultados: Não houve diferença entre o grupo-caso e o grupo-controle para as variáveis sociodemográficas. A qualidade de vida dos pacientes com pancreatite crônica alcoólica mostrou-se diminuída quando comparada aos membros do grupo-controle. Ao serem comparados os domínios de qualidade de vida dos pacientes com e sem diabetes, somente o quesito capacidade funcional apresentou diferença: menor para o grupo com diabetes (p=0,022). A correlação mostrou que o tempo de tabagismo, a quantidade de etanol em gramas e o tempo de cirurgia pancreática incidiram negativamente na qualidade de vida do grupo com pancreatite crônica alcoólica. Idade avançada, pregas cutâneas e porcentagem de gordura corporal se correlacionaram positivamente com qualidade de vida. Conclusão: A qualidade de vida está diminuída no grupo com pancreatite crônica alcoólica devido à influência negativa de fatores como tempo de tabagismo, quantidade de etanol e tempo de cirurgia pancreática.

Etiology, pathology, management and prognosis of chronic pancreatitis in Chinese population: A retrospective study / 华中科技大学学报（医学）（英德文版）

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis (50.70%), 19 cases of alcoholic chronic pancreatitis (13.38%), 14 cases of autoimmune pancreatitis (9.86%) and 37 cases of undetermined etiology (26.06%). Pathologically, the average inflammatory mass diameter was 3.8 ± 3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head (n=97), neck (n=16), body (n=12), tail (n=15) and whole pancreas (n=2) influenced the choice of surgical procedures. Ninety-four patients (66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer (QLQ-C30) a decrease from 76 ± 22 to 14 ± 18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.

Avaliação da frequência de doença osteometabólica entre portadores de pancreatite crônica alcoólica e sua correlação com os hábitos alimentares e a composição corporal / Frequency of osteometabolic disease among patients with alcoholic chronic pancreatitis and its correlation with eating habits and body composition

O tecido ósseo é extremamente complexo que, juntamente com a cartilagem, constitui o sistema esquelético. Tanto os ossos quanto a cartilagem são compostos por tecido metabolicamente ativo com duas funções básicas para o organismo, uma mecânica e outra bioquímica. O impacto do déficit calórico e da perda de peso pode reduzir a massa óssea e mudar a composição corpórea. Na pancreatite crônica alcoólica o paciente relata ingestão alcoólica por longo período, além da referência do alto consumo de cigarros e de uma alimentação deficiente. Os objetivos do presente estudo foram avaliar a frequência da doença osteometabólica, os hábitos alimentares, a frequência de deficiência de vitamina D assim como, se os achados de massa corpórea por densitometria de corpo total se relacionam à deficiência de massa óssea, em indivíduos portadores de pancreatite crônica de etiologia alcoólica. Foram avaliados três grupos de pacientes do sexo masculino com pancreatite crônica alcoólica. Foram divididos de acordo com o resultado da densitometria óssea: 5 pacientes no grupo da osteoporose, 26 no grupo da osteopenia e 8 no grupo normal. Todos os pacientes foram submetidos ao registro alimentar de três dias, mensuração de peso, altura, cintura e quadril, Índice de Massa Corpórea (IMC) e exames laboratoriais. A composição corpórea foi avaliada pela densitometria óssea por raios X de dupla energia (DXA) e por bioimpedância elétrica. 79% dos pacientes do sexo masculino com pancreatite crônica alcoólica tiveram densidade mineral óssea comprometida. Os pacientes que tinham vitamina D prescrita foram excluídos porém nos nossos resultados a maioria dos pacientes apresentavam níveis normais da vitamina. Em relação ao tabagismos, dos pacientes fumavam. Os pacientes com maior comprometimento ósseo eram mais magros,contudo, não houve diferença entre os pacientes de acordo com o IMC. Os pacientes classificados pelo DXA como normais eram mais jovens do que os pacientes com osteopenia e osteoporose....

The bone tissue is extremely complex, along with cartilage constitutes the skeletal system. Both bones as cartilage are composed of metabolically active tissue with two basic functions for the body, mechanical and biochemistry. The impact of the caloric deficit and weight loss can reduce bone mass and change body composition. In chronic alcoholic pancreatitis patients alcohol intake over a long period, in addition to reference the high consumption of cigarettes and poor nutrition. The objectives were to evaluate the frequency of osteometabolic disease, eating habits, the frequency of vitamin D deficiency and how the body mass found by total body densitometry relate to bone deficiency in individuals with chronic pancreatitis of alcoholic etiology . We evaluated three groups of male patients with chronic pancreatitis alcoholic. They were according to the results of bone densitometry. 5 in osteoporosis group, 26 in the osteopenia group and 8 in the normal group. All patients underwent three-day food record, measurements of weight, height, waist and hip, body mass index (BMI) and laboratory tests. The body composition was evaluated by densitometry by dual energy X-ray absorptiometry (DXA) and electrical bioimpedance. 79% of male patients with alcoholic chronic pancreatitis had compromised bone mineral density. Patients were prescribed vitamin D were excluded however results in the majority of patients had normal levels of the vitamin. Half of all patients smoking. Patients with higher bone involvement were thinner, there was no difference between patients according to BMI. Patients classified as normal by DXA were younger than patients with osteopenia and osteoporosis. In summary, osteoporosis and osteopenia are undervalued sources of morbidity in patients with chronic pancreatitis and necessary health management guidelines bone in this group of patients.

Pancreaticothoracic Fistula Presenting with Hemoptysis and Pneumothorax in a Chronic Alcoholic Patient / 결핵및호흡기질환

Pancreaticothoracic fistula is a rare complication of acute or chronic alcoholic pancreatitis. It may present with various symptoms, like dyspnea, abdominal pain, cough, chest pain, fever, back pain, hemoptysis, fatigue, or orthopnea. Pancreaticothoracic fistula can be detected by magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or computed tomography. MRCP has high sensitivity and fewer side effects, and thus it has recently been recommended as the first choice for the detection of pancreaticothoracic fistula. On the other hand, ERCP enables the detection and treatment of pancreaticothoracic fistula and allows for stent insertion; for this reason it is a commonly used modality in pancreaticothoracic fistula cases. Herein, the authors describe a case of pancreaticothoracic fistula detected by ERCP and MRCP that manifested only respiratory symptoms, namely hemoptysis and pneumothorax without abdominal pain, which commonly accompanies pancreatitis.

Total Cholesterol Level for Assessing Pancreatic Insufficiency Due to Chronic Pancreatitis

BACKGROUND/AIMS: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. METHODS: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. RESULTS: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). CONCLUSIONS: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis.

A Case of Duodenal Intramural Hematoma Caused by Acute Alcoholic Pancreatitis / 대한췌담도학회지

Intramural duodenal hematoma (IDH) is a rare disease which defined a hematoma formation localized within the wall of the duodenum. The most common cause of IDH is due to blunt abdominal trauma while most of other cases of IDH are more related to the use of anticoagulants or coagulation disorders such as haemophilia and Von Willebrand disease. We report a very rare case of a large IDH caused by acute alcoholic pancreatitis without any kind of anticoagulation therapies nor coagulopathies. The patient was recovered by only medical treatment and observation without surgical intervention.

Hemorragia digestiva por fístula gástrica de pseudoaneurisma de artéria esplênica: relato de caso / Gastric bleeding from splenic artery pseudoaneurysm: case report

Hemorragia digestiva por ruptura de pseudoaneurisma de artéria esplênica (PAAE) é incomum. Pancreatite é a responsável pela maioria dos PAAEs. Tomografia computadorizada de abdome é um bom método não-invasivo para identificar complicações vasculares de pancreatite. Angiografia localiza o sítio arterial sangrante. Tratamento de PAAE é mandatório, independentemente do tamanho do pseudoaneurisma ou sintomas associados. Embolização transarterial percutânea da artéria esplênica é tratamento padrão-ouro em pacientes hemodinamicamente estáveis. Cirurgia está indicada para pacientes hemodinamicamente instáveis ou com falha terapêutica angiográfica. Relatamos um caso de paciente com hemorragia digestiva alta por fístula gástrica de pseudoaneurisma de artéria esplênica, associada a quadro de pancreatite alcoólica.

Gastrointestinal hemorrhage due to rupture of splenic artery pseudoaneurysm (SAPA) is unusual. Pancreatitis is responsible for most SAPAs. Computed tomography of the abdomen is a good noninvasive method to identify vascular complications of pancreatitis. Angiography located arterial site bleeding. Treatment of SAPA is mandatory, regardless of size or symptoms associated pseudoaneurysm. Percutaneous transarterial embolization of the splenic artery is the gold standard treatment in hemodynamically stable patients. Surgery is indicated for hemodynamically unstable patients or angiographic treatment failure. We report a case of a patient with upper gastrointestinal bleeding by gastric fistula of splenic artery pseudoaneurysm associated with alcoholic pancreatitis.

Nutritional profile of asymptomatic alcoholic patients / Perfil nutricional de pacientes alcoólatras assintomáticos

CONTEXT: Alcoholism may interfere with nutritional status, but reports are often troubled by uncertainties about ingested diet and organ function, as well as by ongoing abuse and associated conditions. OBJECTIVE: To identify nutritional and body compartment changes in stable alcoholics without confounding clinical and dietetic variables, a prospective observational pilot study was designed. Three well-matched populations were considered: subjects with chronic alcoholic pancreatitis, alcoholics without visceral disease, and healthy never-drinking adults (controls). METHODS: Subjects (n = 60) were asymptomatic males with adequate diet, no superimposed disease or complication, and alcohol-free for at least 6 months. After exclusions, 48 patients were compared. Variables encompassed dietary recall, bioimpedance analysis, biochemical profile and inflammatory markers. Main outcome measures were body fat, lean body mass, serum lipids, C-reactive protein, and selected minerals and vitamins. RESULTS: Both alcoholic populations suffered from reduced lean body mass (P = 0.001), with well-maintained body fat.Magnesium was depleted, and values of vitamin D and B12 correlated with alcohol abuse. LDL and total cholesterol was increased in alcoholics without pancreatitis (P = 0.04), but not in those with visceral damage. C-reactive protein and serum amyloid A correlated with duration of excessive drinking (P = 0.01). CONCLUSIONS: Undernutrition (diminished lean body mass, risk of magnesium and vitamin deficiencies) contrasted with dyslipidemia and increased cardiovascular risk. This second danger was masked during chronic pancreatitis but not in alcoholics without visceral disease. Further studies should focus special requirements of this population.

CONTEXTO: O alcoolismo pode interferir no estado nutricional, todavia, os relatos frequentemente sofrem com o viés das incertezas sobre dieta consumida, danos orgânicos subjacentes e persistência do abuso. OBJETIVO: Para identificar alterações nutricionais e de compartimentos corpóreos em alcoólatras estáveis sem variáveis de confusão clínica e dietética, foi desenhado o presente estudo piloto observacional prospectivo. Três populações bem pareadas foram consideradas: casos de pancreatite crônica alcoólica, alcoólatras sem enfermidade visceral e adultos que nunca consumiram etanol (controles). MÉTODOS: Os pacientes (n = 60) eram homens assintomáticos com dieta satisfatória, nenhuma evidência de enfermidade ou complicação exceto as do protocolo e afastados do etanol por no mínimo 6 meses. Após exclusões, 48 pacientes foram comparados. As variáveis abrangeram recordatório alimentar, análise de bioimpedância, perfil bioquímico e marcadores inflamatórios. Os principais resultados buscados foram gordura corporal, massa magra, lípides séricos, proteína C reativa e vitaminas e minerais selecionados. RESULTADOS: Os dois grupos que ingeriam álcool exibiram redução da massa magra (P = 0,001) com gordura corporal bem conservada. O magnésio estava diminuído e as taxas de vitamina D e B12 se correlacionaram com o abuso de álcool. O colesterol total e LDL estavam aumentados nos alcoólatras sem pancreatite (P = 0,04), porém, não naqueles com dano pancreático. A proteína C reativa e o seroamilóide A correlacionaram-se com a duração do excesso etílico (P = 0,01). CONCLUSÕES: A desnutrição (menor massa magra, possibilidade de carência de magnésio e vitaminas) contrastou com a dislipidemia e o risco cardiovascular elevado. Este segundo perigo permaneceu mascarado na vigência de pancreatite crônica, porém, não nos alcoólatras sem lesão visceral. Estudos adicionais deverão focalizar as necessidades nutricionais específicas desta população.

Pancreatic stellate cells and alcohol induced chronic pancreatitis in albino rats: histological and immunohistochemical study

Pancreatic stellate cells [PaSCs] are myofibroblast-like cells found in the areas of pancreas that have exocrine function. The aim of the present work was to study the pancreatic stellate cells in the exocrine pancreas and to explain their role in pancreatic fibrosis associated with chronic alcoholic pancreatitis. Forty adult male rats were used in this study. The animals were divided into two groups; control and experimental. The experimental group was given alcohol by intragastric tube daily for 8 weeks. At the end of the experiment the animals were sacrificed and the pancreatic tissue was taken, processed and semithin and paraffin sections were obtained. Paraffin sections were stained with H and E, Mallory trichrome and immunohistochemical stains for detection of alpha smooth muscle actin [alpha-SMA] in PaSCs. Eight weeks after alcohol administration, the pancreatic tissue was traversed by thick connective tissue septa. The interlobular ducts were thickened, distorted and dilated. Some pancreatic acini were distorted, dilated and showed vacuolation and degeneration of their acinar cells. PaSCs were detected in three main sites like in control pancreas; periacinar, periductal and perivascular, but they showed an apparent increase in their number, decrease in their lipid droplets and transformtion into myofibroblast like cells with marked expression of alpha-SMA especially in the fibrotic areas. From the present work it was concluded that the cells which were detected seem to be the pancreatic stellate cells which could play an important role in the development of pancreatic fibrosis associated with alcoholic chronic pancreatitis. Therefore, understanding the biology of PaSCs may offers potential therapeutic targets for the treatment and prevention of these diseases

A case of subcapsular splenic hematoma complicated by alcoholic pancreatitis, improved with conservative care / 대한내과학회지

Splenic complications may occur during the course of pancreatitis, as the pancreas and spleen lie adjacent to each other. However, splenic complications associated with pancreatitis are rare, including splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. The management for subcapsular splenic hematoma with pancreatitis remains controversial. We report a case of a 51-year-old man with alcoholic pancreatitis and the rare complication of a large subcapsular splenic hematoma, which was managed conservatively with a good outcome.

A prospective study of the aetiology, severity and outcome of acute pancreatitis in Eastern India.

BACKGROUND: Acute pancreatitis is a common cause of hospital admission. The aim of this study was to evaluate the aetiology, severity and outcome of acute pancreatitis in our tertiary referral center. METHODS: Between August 2002 and December 2003, 45 cases of acute pancreatitis were admitted to the hospital. Diagnosis was ascertained by clinical examination and investigations (hyperamylasaemia). The severity was assessed by the Acute Physiology and Chronic Health Evaluation scoring system and contrast enhanced computed tomography scan. The patients were treated according to a designed protocol. The data related to aetiology, severity and outcome were noted for subsequent analysis. RESULTS: Of the 45 patients, 33 were male and 12 were female. The mean age was 30 years. Of the 45 patients, 34 patients had mild pancreatitis and 11 had severe pancreatitis. The aetiology spectrum of mild pancreatitis included the following: alcoholism in 14 (41.1%), gallstones in 8 (23.5%), trauma in 6 (17.6%), idiopathic in 4 (11.7%) and post-endoscopic retrograde cholangiopancreatography in 2 (5.8%). The causes of severe acute pancreatitis came under the following headers: trauma in 3 (27.2%), idiopathic in 2 (18.1%), gallstones in 2 (18.1%), alcoholism in 2 (18.1%) and post-endoscopic retrograde cholangiopancreatography in 2(18.1%). Mild pancreatitis led on to the following: pancreatic abscess in 1, pseudocyst in 3 and readmission for pain relapse within 6 months in 10 patients. The remainder had uneventful recoveries. There was no mortality in this group. Severe acute pancreatitis led on to the following: symptomatic sterile pancreatic necrosis in 2, infected pancreatic necrosis in 2, pancreatic abscess in 2 and presentation 8 months later with colonic stricture in 1 patient. There were 2 deaths in this group due to multi-organ failure. CONCLUSION: Although gallstones have largely been implicated as a common cause of acute pancreatitis our study found alcoholism as the main aetiological factor. Blunt abdominal trauma was also seen as a common cause of acute severe pancreatitis, particularly severe acute pancreatitits, as seen in our series. The outcome in mild pancreatitis was good, severe acute pancreatitis leads to more complications and greater mortality, thus requiring careful medical and surgical management.

Prevalence of alcoholism in the Punjab, Pakistan

Alcoholism is a type of addiction, causing both physical and psychological dependence. It is a major social, economical and health problem. A total of 1560 cases of alcohol intake were studied at the office of Surgeon Medico legal Punjab. Most of them at the time of examination were showing visible clinical evidence of alcoholic intake. Victims were mostly males. Examination was conducted on the request of police. A wide range of symptoms of different duration was observed. Psychological element was also seen in some victims

Abscesso hepático tardio em paciente com pancreatocistojejunostomia em Y de Roux / Late hepatic abscess in a patient with Roux-en-Y pancreatocysto Jejunostomy

Abscessos hepáticos piogênicos usualmente decorrem de doenças biliares ou infecções hematogênicas. Relata se um caso de abscesso hepático em homem com anastomose em Y de Roux realizada há mais de duas décadas para tratamento de pseudocisto pancreático. O paciente relatou etilismo, hipertensão portal, pancreatite crônica e diabetes. Os estudos microbiológicos e exames histopatológicos não revelaram agentes infecciosos, e o tratamento consistiu de drenagem cirúrgica e antibioticoterapia. Enfatizam-se as dificuldades para estabelecer o diagnóstico etiológico e a possibilidade de um abscesso hepático tardio ocorrer em associação com pancreatocistojejunostomia e anastomose em Y de Roux.

Pyogenic liver abscesses are usually due to biliary diseases or hematogenic infections. A case of liver abscessis reported in a male with a Roux-en-Y anastomosis performed more than two decades before treating a pancreaticpseudocyst. The patient reported alcoholism, portal hypertension, chronic pancreatitis and diabetes. Microbiologic and histopathology studies did not reveal infectious agents and the treatment consisted of surgical drainage and antibiotic course. Diagnostic challenges in etiologic diagnosis and the possible occurrence of a late hepatic abscess associated with pancreatocystojejunostomy and Roux-en-Y anastomosis are emphasized.

A Case of Colon Obstruction Developed as a Complication of Acute Pancreatitis / 대한소화기학회지

In acute pancreatitis, colonic complications such as mechanical obstruction, ischemic necrosis, hemorrhage, and fistula are rare but their outcomes are fatal. It is known that colonic obstruction in acute pancreatits is more likely found in splenic flexure and transverse colon caused by severe inflammation of body and tail of pancreas leading to pressure necrosis. A 43-year-old man presented with abdominal distension lasting for 2 weeks. The patient had been admitted to our institution 6 weeks prior to the current admission, and the abdominal CT scan performed during the first admission revealed the pancreatic enlargement with peri-pancreatic fatty infiltration and fluid collection. At that time he was diagnosed as acute pancreatitis. The conservative management resulted in clinical improvent so that the patient was discharged. Upon the second admission, abdominal CT scan revealed multiple pseudocysts in the tail portion of pancreas with concominant wall thickening and narrowing of the proximal descending colon, and a dilatation of the bowel proximal to the splenic flexure. An obstruction of the descending colon as a complication of acute pancreatitis was suspected and the patient underwent left hemicolectomy. Abdominal distension was relieved after the operation and he was discharged on the 15th hospital days.

Wernicke's encephalopathy in a patient with acute alcoholic pancreatitis / 대한내과학회지

Wernicke's encephalopathy is a serious neurological disorder caused by thiamine deficiency that is characterized by the triad of ocular abnormalities, ataxia, and global confusional state. It is most often seen in alcoholics, but it can be seen in disorders associated with malnutrition and with prolonged intravenous feeding without appropriate vitamin supplementation. We report the case of a 51-year-old man with acute alcoholic pancreatitis and chronic alcoholism with an intraperitoneal abscess, who presented with Wernicke's encephalopathy. He was initially treated by fasting, intravenous fluid replacement, and intermittent vitamin infusion for 3 weeks. After subsequently starting a high carbohydrate oral diet, the patient developed diplopia, orientation disturbance, ataxia, a confusional state, and nystagmus. His neurologic signs and symptoms normalized gradually after intravenous thiamine supplementation.

A Case of Intrahepatic Pseudocyst Complicating Acute Pancreatitis / 대한소화기학회지

Although most of pseudocysts as one of complications of pancreatitis occur primarily within the pancreas, the extrapancreatic locations of pseudocysts, especially in the liver, are rare events. With advanced technology of imaging studies including abdominal computed tomography, ultrasonography, and magnetic resonance imaging, their frequency seems to be increasing. We report here a case of left intrahepatic pancreatic pseudocyst following acute pancreatitis. Percutaneous puncture revealed a high level of amylase and lipase in the collection, confirming the diagnosis of intrahepatic pseudocyst. Symptomatic intrahepatic pseudocysts can be managed surgically, transcutaneously or endoscopically, and asymptomatic intrahepatic pseudocysts can be treated conservatively. We report this case with a review of literature.

Hepatitis aguda alcohólica asociada a pancreatitis aguda grave / Acute alcoholic hepatitis and severe acute pancreatitis

Alcohol is a common cause of hepatic and pancreatic damage. Despite the widespread alcohol consumption simultaneous presentation of acute alcoholic hepatitis and pancreatitis is uncomnon. We describe a case of a patient with alcoholic hepatitis in association acute pancreatitis, who developed multiorgan failure and died. The association of liver and pancreatic disease in clinical practice is discussed.

El alcohol es un factor etiológico común de daño hepático y pancreático. A pesar de su extenso consumo la presentación simultánea de hepatitis y pancreatitis aguda alcohólica es excepcional. Se presenta un caso de esta situación, que evolucionó hacia la falla orgánica múltiple con desenlace fatal. Se discute la asociación de daño hepático y pancreático agudo en la práctica Clínica.