Humans ; Pancreatitis, Acute Necrotizing ; pathology ; therapy ; Time Factors

Acute pancreatitis is one of the common surgical acute abdominal diseases. Since people first recognized acute pancreatitis in the middle of the nineteenth century, a diversified minimally invasive treatment model with standardization has been formed today. According to the main line of surgical intervention of acute pancreatitis treatment,this period can be roughly divided into five stages:exploration stage, conservative treatment stage, pancreatectomy stage, debridement and drainage of the pancreatic necrotic tissue stage, and minimally invasive treatment as the first choice led by the multidisciplinary team mode stage. Throughout history, the evolution and progress of surgical intervention strategies for acute pancreatitis cannot be separated from the progress of science and technology, the update of treatment concepts and the further understanding of the pathogenesis. This article will summarize the surgical characteristics of acute pancreatitis treatment at each stage to explain the development of surgical treatment of acute pancreatitis,to help investigate the development of surgical treatment of acute pancreatitis in the future.
Humans ; Acute Disease ; Treatment Outcome ; Debridement ; Pancreatitis, Acute Necrotizing/pathology* ; Drainage

OBJECTIVE: To compare the pathomorphologic changes between the pancreas in acute necrotizing pancreatitis (ANP) and that in acute deaths of rats (within 48 hours) so as to find the distinctions. METHODS: The animal models of ANP and other acute deaths (electroshock, mechanic asphyxia/strangle, and acute poisoning with tetramine) were established according to the criteria. Half-quantitative grading and image quantitative analysis methods were employed to observe the gross and microscopic changes of the pancreases. RESULTS: Three features including inflammation infiltrate, fat necrosis and calcium deposit in the ANP group were considerably different from that in other acutely died rat group (P<0.05). CONCLUSION Inflammation infiltrate, fat necrosis and calcium deposit are the most important pathologic features found in ANP by common light microscope, distinguishing ANP from postmortem pancreatic autolysis.
Animals ; Autolysis ; Female ; Forensic Pathology ; Male ; Pancreas/pathology* ; Pancreatitis, Acute Necrotizing/pathology* ; Poisoning/pathology* ; Postmortem Changes ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo analyze the pathological reports and clinical data of the cases with pancreatic damage in critically ill children, and summarize the clinical features and biological markers of critically ill children with pancreatic damage or pancreatic necrosis so as to provide the basis for early diagnosis and treatment in children complicated with pancreatic damage.

METHODSThe clinical data of 13 patients treated in our hospital from 2003 to 2009 whose autopsy confirmed pancreatic damage existed and the pathological results of all organs were collected and analyzed.

RESULTSAll the cases had acute onset; 7 cases had fever, 2 had abdominal pain, the other cases had abdominal distention, hepatosplenomegaly, hypoactive bowel sounds, ascites, intestinal obstruction and gastrointestinal bleeding, etc. All these cases had abnormal liver function, especially elevated ALT or AST level and significantly decreased albumin, 9 cases had abnormal blood glucose, 5 cases had elevated C-reactive protein (CRP). In abdominal B-mode ultrasonography, no case showed abnormal pancreas acoustic image. Autopsy confirmed that 7 cases had varying degrees of necrosis of the pancreas, other 6 cases showed edematous, hemorrhagic or inflammatory changes, which may be associated with adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other damage. All these children died within 36 hours after the patients' conditions worsened.

CONCLUSIONSPancreatic damage or necrosis in critically ill children had acute and ferocious onset, short course and were prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.

Child ; Child, Preschool ; Critical Illness ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pancreas ; pathology ; Pancreatitis, Acute Necrotizing ; diagnosis ; pathology ; therapy ; Retrospective Studies

The role of PACAP (pituitary adenylate cyclase activating polypeptide), a peptidergic transmitter, in the pathogenesis of acute pancreatitis is not yet clear. This experiment was conducted to examine the action of exogenous PACAP on rat pancreas and on the course of experimental acute pancreatitis. The results showed that 5-30 microg/kg of PACAP slightly raised the serum amylase level, induced pancreatic edema (23.88% +/- 2.532%-25.86% +/- 1.974% of experiment groups versus 29.21% +/- 5.657% of control group), inflammatory cell infiltration, vacuolization of acinar cells, and occasionally fatty and parenchymal necroses. 15-30 microg/kg of PACAP aggravated cerulein-induced acute pancreatitis; the pancreatic edema became more marked (13.45% +/- 2.045%-17.66% +/- 4.652% of expreiment groups versus 21.83% +/- 3.013% of cerulein group, P<0.05), the serum amylase level became higher; and ascites, pancreatic bleeding, fatty and parenchymal necroses, and extensive vacuolization of acinar cells appeared. For sodium taurocholate-induced pancreatitis, 5-10 microg/kg of PACAP mildly attenuated the pancreatic edema, reduced the serum amylase level (1986.91 +/- 710.97-2944.33 +/- 1182.47 IU/L vs 3690.87 +/- 2277.99 IU/L, P<0.05), whereas it caused multifocal hemorrhage and prominent necrosis in pancreas. Except the cerulein-induced pancreatitis groups, other groups were found to have reduced pancreatic functional capillary density (FCD); when pancreatic edema was taken into consideration and calibrated FCD was introduced (FCD weighted against pancreatic wet/dry ratio), all groups revealed increases in pancreatic functional capillaries when compared with normal control. In conclusion, PACAP is proinflammatory in the pathogenesis of acute pancreatitis, PACAP plus cerulein can induce acute hemorrhagic/necrotizing pancreatitis, and the action of PACAP on cerulein-induced panceatitis may differ from that on sodium taurocholate-induced one. In this experiment, pancreatic FCD was underestimated due to pancreatic edema.
Amylases ; blood ; Animals ; Capillaries ; pathology ; Ceruletide ; Disease Models, Animal ; Male ; Pancreas ; blood supply ; Pancreatitis, Acute Necrotizing ; chemically induced ; enzymology ; pathology ; Rats ; Rats, Wistar

OBJECTIVETo investigate the strategy of controlling fluid resuscitation for severe acute pancreatitis (SAP) in acute phase.

METHODSFrom March 2001 to January 2006, 83 patients meeting for experimental criteria were included in this clinical trial. They were divided into early fluid expansion group (Group I, within 24 h after admission, 21 patients), middle fluid expansion group (Group II, within 25 - 48 h, 35 patients) and late fluid expansion group (Group III, within 49 - 72 h, 27 patients). Parameters of treatment of fluid therapy within 4 d after admission were observed. Serum lactic level was measured on admission and on meeting for criteria of fluid expansion. APACHEII scores, operation rate within 2 weeks, rate of mechanical ventilation, rate of ACS and survival rate were observed.

RESULTSTime interval for meeting fluid expansion criteria in Group I, Group II, Group III was (13 +/- 6) h, (38 +/- 5) h and (61 +/- 8) h, respectively. And there was statistical significance among them (P < 0.05). HCT (%) in Group I (33 +/- 6)% was lower than that of Group II (40 +/- 6)% and Group III (42 +/- 11)% significantly (P < 0.01) at the first day after admission; and there was no statistical significance between Group II and Group III. The amount of crystal and colloid infused in Group I (4014 +/- 2887) ml and (1220 +/- 705) ml at the day of admission was more than those of Group II (2366 +/- 1959) ml and (821 +/- 600) ml and Group III (2615 +/- 1574) ml and (701 +/- 585) ml (P < 0.01); but there was not different between Group II and Group III (P > 0.05). The ratio of colloid and crystal in Group III at the day of admission was lower than those of Group I and Group II (P < 0.05). The total amount of fluid infused was not different among 3 groups for the 4 d (P > 0.05). And infusion rate at the day of admission in Group I was more rapid than those of Group II and Group III (P < 0.05); and there was no difference between Group II and Group III (P > 0.05). The total amount of fluid sequestration in Group II for the 4 d was lower than those of Group I and Group III (P < 0.05); and there was no statistical significance between Group I and Group III (P > 0.05). At the first to the third day after admission APACHEII scores in Group I were higher than those of Group II and Group III (P < 0.05); and at the second and third day, APACHEII scores in Group III were higher than those of Group II (P < 0.05). Rate of mechanical ventilation in Group I (85.7%) was higher than those of Group II (37.1%) and group III (63.0%) (P < 0.05); and rate of ACS was most lowest in Group II (37.1%) (P < 0.05). Survival rate in Group I (38.1%) was lower than those of Group II (85.7%) and Group III (66.7%) (P < 0.05); and Group III was lower than that of Group II (P = 0.075).

CONCLUSIONSWithin 72 h after onset of the disease, survival rate is improved significantly through controlling fluid resuscitation and prevention of body fluid sequestration.

APACHE ; Adult ; Aged ; Female ; Fluid Therapy ; methods ; Humans ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; mortality ; pathology ; therapy ; Resuscitation ; methods ; Severity of Illness Index ; Survival Rate ; Treatment Outcome

This study preliminarily investigated the mechanism by which chloroquine (CQ) relieves acute lung injury (ALI) complicated in acute hemorrhagic necrotizing pancreatitis (AHNP). Sixty male Wistar rats were randomized into sham-operated group (group A, n=10), AHNP group (group B, n=10), L-arginine-treated group (group C, n=10), L-N-nitro-L-arginine methyl ester (NAME)-treated group (group D, n=10), CQ-treated group (group E, n=10) and CQ+L-NAME-treated group (group F, n=10). TLR4 expression was measured by using real time-PCR and Western blotting respectively. The results showed that, in the group B, the expression of TLR4 and the levels of TNF-α and IL-6 in the lungs were significantly increased, and the nitric oxide (NO) concentration was reduced, as compared with those in the group A (P<0.05 or P<0.01). Lung injury was aggravated with the increased expression of TLR4. When the inhibitor and stimulator of TLR4, namely L-Arg and L-NAME, were added respectively, lung injury was correspondingly relieved or aggravated (P<0.05 or P<0.01). In the group E, TLR4 expression was substantially lower and NO concentration higher than those in the group B (P<0.05 or P<0.01). However, in the group F, NO concentration was markedly decreased, and the inhibitory effect of CQ on TLR4 expression and the relief of lung injury were weakened when compared with those in the group E (P<0.05 or P<0.01). It was concluded that TLR4 may play an important role in the pathogenesis and development of ALI complicated in AHNP. CQ could relieve ALI by decreasing the TLR4 expression and increasing the NO release.
Acute Lung Injury ; drug therapy ; immunology ; pathology ; Animals ; Chloroquine ; therapeutic use ; Cytokines ; immunology ; Male ; Pancreatitis, Acute Necrotizing ; complications ; pathology ; Rats ; Rats, Wistar ; Toll-Like Receptor 4 ; immunology ; Treatment Outcome

OBJECTIVETo investigate the relationship between mRNA expression of inducible nitric oxide synthase (iNOS) and organ injury, and the effect of Salviae Miltiorrhizae on iNOS mRNA in severe acute pancreas (SAP) rats.

METHODSForty-five Wistar rats were randomly divided into 3 groups, the model group (MG), the Salviae Miltiorrhizae group (SMG), and the control group (CG), with 15 rats in each group. Rats in MG and SMG were established to SAP model by intraductal injection with 5% sodium taurocholate in a dose of 1.0 ml/kg, while rats in CG were merely performed sham-operation. Immediately after modeling, rats in SMG were injected with Salviae Miltiorrhizae injection (SMI) 2 ml/kg every 6 h for 4 times in total, but to rats in other two groups same volume of normal saline were administered. The level of serum amylase (AMY), nitric oxide (NO) and the volume of ascites of rats were determined 24h after modeling, and intensity of iNOS mRNA expression in pancreas, lung and kidney were detected in the same time using in situ hybridization and image analysis. The pathologic change was observed as well.

RESULTSThe volume of ascites and serum levels of AMY and NO in MG were significantly higher then those in SMG and CG (P < 0.05 and P <0.01). The expression of iNOS mRNA in pancreas, lung and kidney increased in MG and SMG, it was significantly higher in MG than that in SMG. And the pathological change of pancreas, lung and kidney in SMG was milder than that in MG.

CONCLUSIONSOver-expression of iNOS mRNA could cause excessive synthesis of NO, and lead to injury of pancreas, lung and kidney in SAP. Salviae Miltiorrhizae in early stage of the disease can inhibit the over-expression of iNOS mRNA to ameliorate the injury of the pancreas, lung and kidney.

Animals ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Kidney ; pathology ; Lung ; pathology ; Male ; Nitric Oxide Synthase Type II ; biosynthesis ; genetics ; Pancreas ; pathology ; Pancreatitis, Acute Necrotizing ; drug therapy ; enzymology ; pathology ; Phytotherapy ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Wistar ; Salvia miltiorrhiza

Animals ; Apoptosis ; Female ; Gene Transfer, Horizontal ; Genetic Therapy ; Hemorrhage ; pathology ; therapy ; Hepatocytes ; pathology ; Interleukin-10 ; genetics ; Male ; Pancreatitis, Acute Necrotizing ; pathology ; therapy ; Proto-Oncogene Proteins c-bcl-2 ; physiology ; Rats ; Rats, Wistar ; bcl-2-Associated X Protein

OBJECTIVETo investigate the effect of resveratrol on the apoptosis of pancreatic acinar cells in rats with severe acute pancreatitis (SAP) and explore the mechanism of such effect.

METHODSD rats with 3.5% sodium taurocholate-induced SAP were treated with resveratrol, and the serum amylase was detected with automatic biochemistry analyzer. The apoptosis of the pancreatic acinar cells in the rats was detected by TUNEL assay, and the expression of Fas and FasL genes was determined by RT-PCR and Western blotting. The pathological changes of the pancreas were observed under optical microscope.

RESULTSCompared with SAP group, the resveratrol-treated rats showed obviously decreased serum amylase and scores for pancreatic histopathological lesions. Resveratrol treatment significantly increased the apoptotic indices of pancreatic acinar cells and the levels of FasL mRNA and protein in rats with SAP.

CONCLUSIONResveratrol produces important therapeutic effect on SAP in rats by inducing pancreatic acinar cell apoptosis possibly as a result of up-regulated FasL gene expression.

Animals ; Apoptosis ; drug effects ; Fas Ligand Protein ; drug effects ; genetics ; metabolism ; Male ; Pancreas, Exocrine ; pathology ; Pancreatitis, Acute Necrotizing ; chemically induced ; drug therapy ; pathology ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Stilbenes ; therapeutic use ; Taurocholic Acid ; Up-Regulation