Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients. AIM: To investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications. METHODS: The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed. RESULTS: In this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin. CONCLUSION: In this study, we identified the timing, the common species, and site of infection in patients with NP.

Changes in pathogen spectrum and antimicrobial resistance development in the time-course of acute necrotizing pancreatitis.

BACKGROUND AND AIM: In contrast to the first peak of multi-organ failure in acute pancreatitis, the second peak is mostly triggered by septic complications. Our aim was to analyze the spectrum of pathogens and antimicrobial resistance development in relation to the time-course of the disease and its clinical outcome. METHODS: One hundred twenty-two patients with acute necrotizing pancreatitis undergoing pancreas puncture at two tertiary academic medical centers in Germany were retrospectively analyzed. RESULTS: At species level, there was a change in spectrum from Enterococcus faecalis (∆d150 - d1 = 14.6% - 16.7% = -2.1%) to Enterococcus faecium (∆d150 - d1 = 93.1% - 16.3% = 76.8%) (P < 0.001) and from Candida albicans (∆d150 - d1 = 39.7% - 23.6% = 16.1%) to non-albicans Candida spp. (∆d150 - d1 = 43.5% - 6.4% = 37.1%) (P = 0.005). Time-to-event analysis of acquired antimicrobial resistance showed that the overall number of patients with Enterobacteriaceae presented an antimicrobial susceptibility decrease by 59.7% (∆d1 - d100 = 87.0% - 27.3% = 59.7%). The cumulative incidence of multi-resistant bacteria increased with length of hospital stay (∆d150 - d1 = 49.1% - 3.1% = 46.0%) (P = 0.004). Multivariable logistic regression analysis in relation to the pathogen spectrum and antimicrobial resistance development showed a significantly higher mortality for non-albicans Candida spp. (P = 0.039, odds ratio [OR] = 3.32 [95% confidence interval [CI]: 1.07-10.35]), E. faecium (P = 0.009, OR = 3.73 [95% CI: 1.38-10.05]), and multi-resistant bacteria (P = 0.007, OR = 5.08 [95% CI: 1.55-16.66]). CONCLUSIONS: Antimicrobial treatment of infected pancreatic necrosis becomes more challenging over time, owing to a change in spectrum favoring difficult-to-treat pathogens and an increase in multi-resistant bacteria associated with worse clinical outcomes (World Health Organization trial registration number: DRKS00014785).

Therapeutic intranodal lymphangiography for refractory chylous ascites complicating acute necrotic pancreatitis.

Chylous ascites is a rare complication of acute pancreatitis. However, the incidence of intraperitoneal chyle leakage related to severe pancreatitis may be much higher. This is probably the result of direct damage to the cisterna chyli or its tributaries by pancreatic enzymes. In this case, conservative treatment failed to resolve the chyle leak. For the first time, to our knowledge, ultrasound guided therapeutic intranodal lymphangiography was shown to be a successful, minimally invasive treatment option in chylous ascites complicating acute necrotic pancreatitis.

Effects of Tempol on Experimental Acute Necrotizing Pancreatitis Model in Rats.

AIM: We aimed to investigate the effects of Tempol on local organ damage in an experimental acute pancreatitis model. METHODS: This experimental study was conducted on 40 male Wistar- albino rats. The animals were randomly allocated into four groups: (i) Sham-operated group, laparotomies and cannulations of the pancreatic duct without acute necrotizing pancreatitis (ANP) (n=10); (ii) Sham + Tempol group, identical to group 1 except for intravenous tempol treatment for 4 hours (n = 10); (iii) ANP group, glycodeoxycholic acid was infused into the pancreatic duct and cerulein was infused intravenously for 6 hours for development of ANP (n=10); and (iv) ANP + Tempol treated group, in addition to the procedure in group 3, rats were administered tempol intravenously for 4 hours (n = 10). Injury of the pancreas was evaluated histopathologically. Malondialdehyde and myeloperoxidase levels of the pancreatic tissue, blood gas analysis, leukocyte and hematocrit levels were measured. Wet/dry weight of pancreatic tissue was also measured. RESULTS: Serum amylase levels, pancreatic tissue malondialdehyde and myeloperoxidase levels, wet/dry weight ratio, pancreatic edema, acinar necrosis, fat necrosis and hemorrhage, inflammation and perivascular infiltration were significantly lower in the ANP + Tempol group compared with the ANP group. CONCLUSION: Tempol infusion reduced local organ damage due to acute necrotizing pancreatitis in this experimental study. These findings demonstrate that tempol has protective effects on local organ damage due to acute necrotizing pancreatitis in rats.

Últimos avances en páncreas y vías biliares / Pancreas and biliary tract: recent developments

La pancreatitis aguda (PA) es una enfermedad frecuente, asociada a una importante morbilidad y con una mortalidad considerable. En el presente artículo se revisan las novedades acerca de esta enfermedad presentadas en la Digestive Disease Week 2014. La esteatosis pancreática podría ser causa de PA recurrente. Los pacientes con diabetes mellitus tienen una incidencia aumentada de PA y cáncer de páncreas. El uso de fármacos anti-TNF en la enfermedad inflamatoria intestinal podría proteger frente al desarrollo de PA. La presencia de pancreas divisum protege frente a PA de origen biliar. El sistema PANCODE, para describir complicaciones locales de PA, tiene una buena variabilidad interobservador adaptada a las nuevas definiciones de la clasificación revisada de Atlanta. El uso de antibioterapia profiláctica precoz en PA predispone al desarrollo de infecciones intraabdominales fúngicas. El secuestro de fluidos en PA se asocia a edad joven, etiología alcohólica y criterios de síndrome de respuesta inflamatoria sistémica. La causa más frecuente de mortalidad en PA es el fallo multiorgánico precoz, no la infección de necrosis pancreática. Pacientes con PA y déficit de vitamina D podrían beneficiarse de suplementos de esta vitamina. La administración moderada de fluidos en urgencias (500 a 1.000 ml) podría asociarse a mejor evolución de PA

Acute pancreatitis (AP) is a common disease that is associated with significant morbidity and considerable mortality. In this article, developments relating to this disease that were presented in DDW 2014 are reviewed. Pancreatic steatosis could be a cause of recurrent AP. Patients with DM have an increased incidence of AP and pancreatic cancer. The use of anti-TNF drugs in inflammatory bowel disease may protect against the occurrence of AP. The presence of pancreas divisum protects against acute biliary pancreatitis. The PANCODE system for describing local complications of AP has good interobserver agreement, when the new definitions of the revised Atlanta classification are applied. The use of prophylactic antibiotics in early-stage AP predisposes the development of intra-abdominal fungal infections. Fluid sequestration in AP is linked with young age, alcoholism and indicators of systemic inflammatory response syndrome. The most common cause of mortality in AP is early onset of multiple organ failure, not pancreatic necrosis infection. Patients with AP and vitamin D deficiency could benefit from taking vitamin D supplements. Moderate fluid administration in emergencies (500-1000 mL) could be associated with better AP development

[Diagnosis, follow-up, and treatment policy making in patients with acute pancreatitis (CT and MRI evidence)].

The paper deals with the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis, followup, and treatment policy making in patients with severe acute severe pancreatitis with manifestations as pancreatic necrosis, fluid collections (exudate accumulations in peripancreatic and retroperitoneal spaces), as well as that complicated by infection, abscess, and pseudocysts. The results of examining 502 patients with acute pancreatitis (AP) with different complications, who had been treated at the S.P. Botkin City Clinical Hospital in 2007 to 2010, were used to analyze the data of the study, to detail tactics in the diagnosis and follow-up of patients with AP, by using bolus contrast-enhanced CT in combination with MRI, which allows one to reveal the nature and severity of the disease with a high accuracy, to make its prognosis, and to determine the effective procedure of treatment. Substantiation of the imperfection of the 1992 Atlanta classification and its specifying Balthazar classification figures high in the paper.

Asociación entre nutrición enteral precoz y la evolución clínica en pacientes con pancreatitis aguda grave. Hospital Nacional Hipólito Unanue / Association between early enteral nutrition and the clinical evolution in patients with severe acute pancreatitis. National Hospital Hipolito Unanue

INTRODUCCION: La pancreatitis aguda grave (PAG), se caracteriza por la presencia de complicaciones como el Síndrome de Disfunción Orgánica Múltiple (sDOM) y/o la presencia de complicaciones locales (necrosis pancreática infectada, absceso pancreático, pseudoquiste pancreático agudo). Estudios realizados postulan que la nutrición enteral (NE) precoz prevendría o disminuiría las complicaciones de la PAG, reduciendo la mortalidad y la estancia hospitalaria. OBJETIVO: Determinar la asociación entre la NE precoz y la evolución clínica en pacientes con PAG. TIPO DE ESTUDIO: Descriptivo correlacional, observacional, retrospectivo. LUGAR: Hospital Nacional Hipólito Unanue (HNHU), MINSA, Lima Perú. INTERVENCION: Se realizó un censo de historias clínicas de pacientes con pancreatitis aguda entre los años 2008 al 2010 del HNHU, luego se revisó exhaustivamente los datos de las historias clínicas de los pacientes con PAG, El instrumento utilizado fue una ficha de recolección de datos. PRINCIPALES MEDIDAS DE RESULTADOS: Asociación entre la NE precoz y la evolución clínica de los pacientes con PAG. RESULTADOS: Se incluyeron en el estudio 38 historias clínicas de pacientes con PAG donde el 36.8 por ciento (n=14) recibieron NE precoz (Grupo I) y el 63.2 por ciento (n=24) recibieron NE tardía (Grupo II). El promedio de edad fue de 46 años +/- 17.3, más de la mitad era de sexo femenino y la etiología predominante fue biliar. No se encontró diferencia significativa en cuanto a gravedad inicial entre los grupos de estudio. Durante la primera semana de evolución todos presentaron algún grado de sDOM, medido por Score SOFA, donde el grupo I alcanzó Score SOFA de 2 (1-3), mientras que el grupo II alcanzó Score SOFA de 4 (3-4.8), p=0.001, sin embargo durante la segunda semana se observó una disminución del Score SOFA en los dos grupos llegando a "0", p=0.56. Se evidenció correlación positiva entre la NE precoz y el Score SOFA tomado en la primera semana de evolución, coeficiente...

BACKGROUD: Severe acute pancreatitis (SAP) is characterized by the presence of complications such as Multiple Organ Dysfunction Syndrome (MODS) and/or the presence of local complications (infected pancreatic necrosis, pancreatic abscess, pancreatic pseudocyst acute). Studies postulate that enteral nutrition (EN) prevent or decrease early complications of the PAG, reducing mortality and hospital stay. OBJECTIVE: To determine the association between NE and early clinical outcome in patients with SAP. TYPE OF STUDY: Descriptive correlational, observational, retrospective study. SETTING: National Hospital Hipolito Unanue (HNHU), MINSA, Lima Peru. INTERVENTION: A census of medical records of patients with acute pancreatitis between 2008 and 2010 the HNHU, then thoroughly reviewed data from medical records of patients with SAP, The instrument used was a data collection sheet. MAIN OUTCOME MEASURES: Association between the NE and early clinical, course of patiens with SAP. RESUL TS: This study included 38 medical records of patients with SAP in which 36.8 per cent (n=14) had received early EN (Group I) and 63.2 per cent (n=24) had received late EN (Group II). The average age was 46 years +/- 17.3, more than half the patients were female and the etiology predominant was biliary. There was no significant difference in terms of initial severity between groups. In the first week of evolution all patients had had some kind of DOMS which was measured by SOFA Score, the Group I had reached SOFA score of 2 (1-3) whereas the Group II had reached SOFA Score 4 (3-4.8), p=0.001, however during the second week there was a decrease of SOFA Score in both groups which had reached "0", p=0.56. Positive correlation was found between early NE and SOFA Score which was taken in the first week of evolution, correlation coefficient=0.47, p=0.03, that is to say, the early EN was associated with lower levels of DOMS. Mediate complications (infected pancreatic necrosis, pancreatic...

[The influnence of dachengqi tang on acute lung injury and intra abdominal hypertension in rats with acute pancreatitis].

OBJECTIVE: To test the hypothesis "lung and large intestine are interior exteriorly related" through investgating into the effect of Dacheng qi tang (DCQT) on intra abdominal hypertension (IAH) and acute lung injury (ALI) in rats with acute pancreatitis. METHODS: Male SD rats were randomly divided into three groups with ten rats for each group: rats with sham-operations (SO); rats with acute necrosis pancreatitis (ANP); rats with ANP plus DCQT treatment. ANP was induced by retrograde infusion of 5% taurocholic acid into pancreatic duct. Two hours after operations, 10 mL/kg of normal saline was orally adminstered to the rats in both SO and ANP groups, whereas 10 mL/kg DCQT was adminstered to the rats in the treatment group. Aterial blood, pancreas and lung tissues were collected for biomarkers and histopathology 24 hours after operations. Intra-abdominal pressure and intestinal propulsion rate were also measured. RESULTS; DCQT treatment reduced intra-abdominal pressure and improved intestinal propulsion rate compared with those treated with saline (P < 0.05). The ANP rats treated with DCQT had lower wet to dry weight ratio, and milder myeloperoxidase activity and histopathology changes in pancreas and lung than those treated with saline (P < 0.05). Higher pressure of oxygen (PO2) was found in the rats treated with DCQT, while no difference in PCO2 was found between the DCQT and ANP groups (P > 0.05). Only two rats in the ANP group died. CONCLUSION: DCQT can effectively relieve IAH and cure ALI at the same time in rats with acute pancreatitis. The result provides evidence to support the hypothesis "lung and large intestine are interior exteriorly related".

Correlation between protection against sepsis by probiotic therapy and stimulation of a novel bacterial phylotype.

Prophylactic probiotic therapy has shown beneficial effects in an experimental rat model for acute pancreatitis on the health status of the animals. Mechanisms by which probiotic therapy interferes with severity of acute pancreatitis and associated sepsis, however, are poorly understood. The aims of this study were to identify the probiotic-induced changes in the gut microbiota and to correlate these changes to disease outcome. Duodenum and ileum samples were obtained from healthy and diseased rats subjected to pancreatitis for 7 days and prophylactically treated with either a multispecies probiotic mixture or a placebo. Intestinal microbiota was characterized by terminal-restriction fragment length polymorphism (T-RFLP) analyses of PCR-amplified 16S rRNA gene fragments. These analyses showed that during acute pancreatitis the host-specific ileal microbiota was replaced by an "acute pancreatitis-associated microbiota." This replacement was not reversed by administration of the probiotic mixture. An increase, however, was observed in the relative abundance of a novel bacterial phylotype most closely related to Clostridium lituseburense and referred to as commensal rat ileum bacterium (CRIB). Specific primers targeting the CRIB 16S rRNA gene sequence were developed to detect this phylotype by quantitative PCR. An ileal abundance of CRIB 16S rRNA genes of more than 7.5% of the total bacterial 16S rRNA gene pool was correlated with reduced duodenal bacterial overgrowth, reduced bacterial translocation to remote organs, improved pancreas pathology, and reduced proinflammatory cytokine levels in plasma. Our current findings and future studies involving this uncharacterized bacterial phylotype will contribute to unraveling one of the potential mechanisms of probiotic therapy.

[Selenium supplementation in patients with severe acute pancreatitis]. / Suplementácia selénu u pacientov s t'azkou akútnou pankreatitídou.

UNLABELLED: Selenium supplementation improves antioxidant status in critically ill patients with severe acute pancreatitis. It depends on quantum of dosage and supplementation time. The aim of this analysis is point out on benefit of antioxidant therapy by supplementing selenium. METHODS: Patient with severe acute pancreatitis and developing septic shock was admitted on anesthesiology and intensive care department. Adjuvant supplementation therapy with selenium was started in continual infusion 750 mg/24 h during next six days. Activity of antioxidant enzyme glutathione peroxidase and others inflammatory markers were decrease. A case report presents the possibility to affect on systemic inflammatory response syndrome pathogenesis in initial phase. It has to improve therapeutic progress in patients with severe acute pancreatitis.

Probiotic agent Saccharomyces boulardii reduces the incidence of lung injury in acute necrotizing pancreatitis induced rats.

BACKGROUND: Acute necrotizing pancreatitis is a severe acute inflammatory disease of the pancreas that can lead to extrapancreatic organ involvement. Supervening lung injury is an important clinical entity determining the prognosis of the patient. Probiotics are dietary supplements known to reduce or alter inflammation and inflammatory cytokines. In the present study, we hypothesize that probiotics may reduce lung injury by reducing bacterial translocation, which results in reduced infection, inflammation, and generation of proinflammatory cytokines in an experimental model of acute necrotizing pancreatitis. METHODS: Pancreatitis was induced by concomitant intravenous infusion of cerulein and glycodeoxycholic acid infusion into the biliopancreatic duct. Saccharomyces boulardii was used as the probiotic agent. Rats were divided into three groups: sham, pancreatitis-saline, which received saline via gavage at 6 and 24 h following the pancreatitis, pancreatitis-probiotics, which received probiotics via gavage method at 6 and 24 h following the pancreatitis. The rats were sacrificed at 48 h, venous blood, mesenteric lymph node, pancreatic and lung tissue samples were obtained for analysis. RESULTS: Serum pancreatic amylase, lactate dehydrogenase, secretory phospholipase A(2), and IL-6 were found to be increased in pancreatitis-saline group compared with the other groups (P < 0.05). Histological analyses revealed that edema, inflammation, and vacuolization as well as polymorphonuclear leukocyte infiltration in the lung tissue was significantly reduced in the probiotic treated group. Bacterial translocation was significantly reduced in the probiotic treated group compared with the other groups (P < 0.05). CONCLUSION: These results suggest that Saccharomyces boulardii reduce the bacterial translocation. As a result of this, reduced proinflammatory cytokines and systemic inflammatory response was observed, which may be the reason underlying reduced lung injury in acute necrotizing pancreatitis.

[Effect of an early application of chaiqin chengqi decoction in treating severe acute pancreatitis complicated with acute respiratory distress syndrome].

OBJECTIVE: To investigate the therapeutic effects of an early application of Chaiqin Chengqi Decoction (CQCQD) on severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). METHODS: Forty patients of SAP-ARDS were equally randomized into the early-treated group (ET) and the late-treated group (LT), CQCQD was administered to them immediately and 3 days later after hospitalization respectively. Baseline materials in the two groups at the entry were insignificantly different (P > 0.05), and the same conventional Western medical therapy were available to them all. The Acute Physiology and Chronic Heath Evaluation II (APACHE I) scores, the incidence and sustained time of complications, the occurrence of infection, requirement of operation shifting on day 7, as well as the duration resided in hospital and mortality in patients were observed and compared. RESULTS: Comparisons of the above-mentioned clinical indexes between groups showed that the APACHE II score was lower (5.1 +/- 2.0 scores vs 9.3 +/- 4.3 scores, P < 0.01); the incidence of shock was lesser (1/20 vs 7/19); the duration of ARDS, renal failure, cardiac insufficiency, hepatic dysfunction, cerebropathy and enteroplegia, as well as the duration in hospital and the requirement of operation shifting were all shorter significantly (P < 0.05) in the ET group than those in the LT group, but no statistical difference (P > 0.05) was shown in terms of the infection incidence and the mortality. CONCLUSION: An early application of CQCQD in the treatment of SAP could shorten the duration of complications and the couse of disease, lower the requirement of operation shifting. But further study with large samples for explore its impact on the infection incidence and the mortality is needed.

Wernicke's encephalopathy and pancreatic encephalopathy after necrotic-hemorrhagic pancreatitis. A case report.

This case report describes a case of acute necrotic-hemorrhagic pancreatitis complicated by Wernicke's encephalopathy (WE) and stresses the importance of a correct dietetic regimen. A 39-year-old Chinese male patient with negative remote pathological anamnesis was hospitalized in the Medical Department with a diagnosis of gallstones. The clinical course was complicated with the onset of acute pancreatitis. Enteral fasting was imposed with intravenous feeding without vitamin supplementation. The progressive worsening of the clinical, radiodiagnostic and laboratory profile combined with deterioration in the state of consciousness promoted, on the 36th day exploratory laparotomy revealed necrotic-hemorrhagic pancreatitis. The patient was, therefore, admitted to the Intensive Care Unit in a deep coma. The recent medical history, neurological examination, and encephalic computed tomography suggested a revealing diagnosis of WE combined with pancreatic encephalopathy.

Regulation of omega-3 fish oil emulsion on the SIRS during the initial stage of severe acute pancreatitis.

The aim of this study was to explore the effects of parenteral supplementation with omega-3 fish oil emulsion (Omegaven) on systemic inflammatory response syndrome (SIRS) during the initial stage of severe acute pancreatitis (SAP). In a prospective, randomized and controlled trial, 60 patients with SAP were randomized either to treat with conventional therapy (Con group, n=30) or conventional therapy plus intravenous supplementation with omega-3 fish oil emulsion 0.2 g/kg every day (FO group, n=30). The effects were analyzed by the SIRS-related indexes. The results showed that APACHE-II scores in FO group were significantly lower, and the gap increased much farther after the 4th day than those in Con group (P<0.05). Fluid equilibrium time became shorter markedly in FO group than in Con group (5.1+/-2.2 days vs 8.4+/-2.3 days). In FO group, SIRS scores were markedly decreased and the SIRS state vanished after the 4th day; Plasma level of TNF-alpha was significantly reduced, while IL-10 decreased markedly, most prominently between the 4th and 7th day, and the ratio of IL-10/TNF-alpha raised as compared with Con group (P<0.05). During the initial stage of SAP, parenteral supplementation with omega-3 fish oil emulsion could efficiently lower the magnitude and persistence time of the SIRS, markedly retrieve the unbalance of the pro-/anti-inflammatory cytokines, improve severe condition of illness and may provide a new way to regulate the SIRS.

Fiebre y pústulas en paciente con pancreatitis aguda grave / No disponible

No disponible

A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis.

BACKGROUND: The use of prophylactic antibiotics in acute severe necrotizing pancreatitis is controversial. METHODS: Prospective, randomized, placebo-controlled, double-blind study was carried out at Bellvitge Hospital, in Barcelona, Spain. Among 229 diagnosed with severe acute pancreatitis, 80 had evidence of necrotizing pancreatitis (34/80 patients were excluded of the protocol). Forty-six patients without previous antibiotic treatment with pancreatic necrosis in a contrast-enhanced CT scan were randomly assigned to receive either intravenous ciprofloxacin or placebo. Five patients were secondarily excluded, and the remaining 41 patients were finally included in the study (22 patients received intravenous ciprofloxacin and 19 patients placebo). RESULTS: Comparing the 22 with intravenous ciprofloxacin and 19 with placebo, infected pancreatic necrosis was detected in 36% and 42% respectively (p = 0.7). The mortality rate was 18% and 11%, respectively (p = 0.6). No significant differences between both treatment groups were observed with respect to variables such as: non-pancreatic infections, surgical treatment, timing and the re-operation rate, organ failure, length of hospital and ICU stays. CONCLUSION: The prophylactic use of ciprofloxacin in patients with severe necrotizing pancreatitis did not significantly reduce the risk of developing pancreatic infection or decrease the mortality rate. The small number of patients included in this study should be considered.

Ethyl pyruvate ameliorates liver injury secondary to severe acute pancreatitis.

BACKGROUND: Ethyl pyruvate (EP) is capable of significantly decreasing serum alanine aminotransferase and reducing hepatic necrosis in a murine model of severe acute pancreatitis (SAP); however, the working mechanism is still unclear. This study aims to elucidate the underlying mechanism of EP solution ameliorating SAP-induced liver injury and provide a new therapeutic agent to treat liver injury. MATERIALS AND METHODS: Acute necrotizing pancreatitis was induced in C57Bl/6 male mice by feeding the animals a choline-deficient diet supplemented with 0.5% ethionine for 24 h; then the animals were challenged with 7 hourly 50 mug/kg cerulein i.p. injections and a single i.p. injection of Escherichia coli lipopolysaccharide (4 mg/kg). Two hours after the injection of lipopolysaccharide, 40 mg/kg EP, the same volume of Ringers lactate solution (RLS), or saline solution were i.p. injected to animals of EP, RLS, and control groups every 6 h for a total 48-h period. RESULTS: When mice were treated with EP, hepatic mRNA expression of tumor necrosis factor-alpha, interleukin-6, inducible nitric oxide synthase, and cyclooxygenase-2 was significantly lower than that in pancreatitis mice treated with RLS. Compared to RLS treatment, treatment with EP significantly decreased the number of inflammatory cell infiltration and markedly inhibited hepatic nuclear factor-kappa B DNA binding; EP therapy dramatically inhibited high motility group B1 release from inflamed hepatic tissue and significantly decreased the concentration of hepatic tissue malondialdehyde, an oxidative stress parameter. EP treatment also significantly improved body circulating blood volume. CONCLUSION: EP is a potent anti-inflammatory and anti-oxidative agent to ameliorate hepatic local inflammatory response and resultantly decreases liver injury secondary to SAP.

Regulation of omega-3 fish oil emulsion on the SIRS during the initial stage of severe acute pancreatitis / 华中科技大学学报（医学）（英德文版）

The aim of this study was to explore the effects of parenteral supplementation with omega-3 fish oil emulsion (Omegaven) on systemic inflammatory response syndrome (SIRS) during the initial stage of severe acute pancreatitis (SAP). In a prospective, randomized and controlled trial, 60 patients with SAP were randomized either to treat with conventional therapy (Con group, n=30) or conventional therapy plus intravenous supplementation with omega-3 fish oil emulsion 0.2 g/kg every day (FO group, n=30). The effects were analyzed by the SIRS-related indexes. The results showed that APACHE-II scores in FO group were significantly lower, and the gap increased much farther after the 4th day than those in Con group (P<0.05). Fluid equilibrium time became shorter markedly in FO group than in Con group (5.1+/-2.2 days vs 8.4+/-2.3 days). In FO group, SIRS scores were markedly decreased and the SIRS state vanished after the 4th day; Plasma level of TNF-alpha was significantly reduced, while IL-10 decreased markedly, most prominently between the 4th and 7th day, and the ratio of IL-10/TNF-alpha raised as compared with Con group (P<0.05). During the initial stage of SAP, parenteral supplementation with omega-3 fish oil emulsion could efficiently lower the magnitude and persistence time of the SIRS, markedly retrieve the unbalance of the pro-/anti-inflammatory cytokines, improve severe condition of illness and may provide a new way to regulate the SIRS.

[Ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy: a mini-invasive strategy for peripancreatic necrotizing infection].

OBJECTIVE: To establish "an integrative therapy" of drainage and debridement on peripancreatic necrotizing infection (PPNI) with minimally invasive technique, and to detect its clinical effects. METHODS: There were 17 patients who accepted ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy from March 2006 to January 2008. Percutaneous puncture and catheter (6 - 8 F) drainage were adopted on the patients suffering from PPNI with B-us guidance, then the drainage sinus was expanded progressively from 8 F to 24 F in diameter with Cook fascia dilator by degrees, and the 22 F or 24 F tube was easily placed into the interior of PPNI instead of the prior catheter. So a better drainage effect was achieved. One week later, the necrotizing tissue of PPNI could be observed and debrided with choledochoscope under a directly-viewed way through the enlarged new sinus. Thus, with the continuous tube drainage and repeated debridement, the focus was absorbed and covered gradually. RESULTS: Seventeen cases accepted the mini-invasive therapy, 15 cases were saved finally with cure rate of 88.2%, and 2 cases conversion to laparotomy because of some technical reasons. The mean healing time was 73 days, and the mean hospitalization time was 57 days. Bleeding was occurred in 2 cases localized in sinus and the inside of PPNI, digestive tract fistula was detected in 2 cases, and these patients with the complications were cured under nonoperative management. All the patients were still alive with following-up, neither remains nor recurrence of the PPNI was found in our group. CONCLUSIONS: Ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy, as a mini-invasive therapy, could complete the goal-directed therapy of PPNI, meanwhile, realize the modern surgery ideal of damage control.