Acute Disease ; Aged ; Amylases ; blood ; Humans ; Lipase ; blood ; Magnetic Resonance Imaging ; Male ; Pancreatitis ; complications ; diagnosis ; diagnostic imaging ; Pancreatitis, Chronic ; complications ; diagnosis ; Panniculitis ; diagnosis ; diagnostic imaging ; etiology ; pathology

A 50-year-old man with a 15-year history of elevated blood glucose and an approximately 2-year history of diarrhea was admitted to the Peking Union Medical College Hospital. The initial diagnosis was type 2 diabetes. After repeated pancreatitis and pancreatoduodenectomy, severe pancreatic endocrine and exocrine dysfunction including alternating high and low blood glucose and fat diarrhea occurred. Tests for type 1 diabetes-related antibodies were all negative, C-peptide levels were substantially reduced, fat-soluble vitamin levels were reduced, and there was no obvious insulin resistance. Therefore, a diagnosis of pancreatic diabetes was clear. The patient was given small doses of insulin and supplementary pancreatin and micronutrients. Diarrhea was relieved and blood glucose was controlled. The purpose of this article is to raise clinicians' awareness of the possibility of pancreatic diabetes after pancreatitis or pancreatic surgery. Timely intervention and monitoring may reduce the occurrence of complications.
Male ; Humans ; Middle Aged ; Blood Glucose ; Diabetes Mellitus, Type 2/complications* ; Pancreaticoduodenectomy/adverse effects* ; Pancreatitis, Chronic/complications* ; Malnutrition/complications*

Arterial pseudoaneurysm is rare but potentially a catastrophic complication of pancreatitis because it can cause massive gastrointestinal bleeding. Since surgical treatment of arterial pseudoaneurysm has a high mortality, percutaneous angiographic embolization of bleeding artery has recently been advocated as the alternative therapy. Acute hemorrhage into the peritoneal cavity or pseudocyst complicating chronic pancreatitis was frequently reported. However, multiple pseudoaneurysmal hemorrhage without pseudocyst complicating acute pancreatitis are extremely rare. Here, we present a case of multiple pseudoaneurysmal hemorrhage secondary to acute pancreatitis, which were managed successfully by percutaneous angiographic embolization.
Acute Disease ; Adult ; Aneurysm, False/*complications ; Duodenum/blood supply ; Hemorrhage/etiology ; Humans ; Male ; Pancreas/blood supply ; Pancreatitis/*complications ; Stomach/blood supply

BACKGROUND/AIMS: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4. METHODS: Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients. RESULTS: UC was confirmed in two cases (type 1 AIP, n=1; suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05). CONCLUSIONS: UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity.
Adult ; Aged ; Colitis, Ulcerative/*blood/complications ; Colon/*chemistry ; Female ; Humans ; Immunoglobulin G/*analysis ; Intestinal Mucosa/*chemistry ; Male ; Middle Aged ; Pancreatitis/*blood/complications ; Retrospective Studies

No abstract available.
Acute Disease ; Amylases/blood ; Humans ; Hyperamylasemia/complications/*diagnosis ; Isoenzymes/analysis ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Pancreatitis/complications/*diagnosis/radiography ; Tomography, X-Ray Computed

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.
Adult ; Aged ; Aged, 80 and over ; Cholesterol/*blood ; Cholinesterases/blood ; Diabetes Mellitus, Type 2/complications ; Exocrine Pancreatic Insufficiency/*blood/etiology ; Female ; Follow-Up Studies ; Humans ; Liver Cirrhosis, Alcoholic/blood ; Male ; Middle Aged ; Nutritional Status ; Pancreas/enzymology ; Pancreatitis, Alcoholic/blood/complications ; Pancreatitis, Chronic/blood/*complications ; Serum Albumin/analysis

Hypertriglyceridemia (HTG) is a rare cause of pancreatitis. However, the relationship between acute pancreatitis and severe HTG is well recognized. We report a case of necrotizing pancreatitis due to severe HTG (type IV) in a patient with poorly controlled diabetes. It was of particular interest that serum pancreatic enzymes were normal even though the imaging studies indicated the presence of necrotizing pancreatitis. Our case clearly demonstrates the various indices of HTG-induced necrotizing pancreatitis with a normal pancreatic enzyme level despite there being a serum triglyceride level < or=1,000 mg/dL. We present this case with a review of literature for hyperlipidemic pancreatitis in Korea.
Adult ; Diabetes Mellitus, Type 2/complications/diagnosis ; Humans ; Hypertriglyceridemia/complications/*diagnosis ; Male ; Pancreatitis, Acute Necrotizing/*diagnosis/etiology ; Tomography, X-Ray Computed ; Triglycerides/blood

Liver infarction and acrodermatitis enteropathica are rare complications of chronic pancreatitis. This report shows the case of a 56-year-old man who developed liver infarction due to portal vein thrombosis from chronic pancreatitis and acrodermatitis enteropathica during the course of his treatment. The rare combination of these complications in a patient with chronic pancreatitis has never previously been reported in the literature.
Acrodermatitis/*etiology/pathology/therapy ; Chronic Disease ; Human ; Infarction/*etiology ; Liver/*blood supply ; Male ; Middle Aged ; Pancreatitis/*complications ; Portal Vein ; Venous Thrombosis/complications/etiology ; Zinc/administration & dosage/deficiency

OBJECTIVETo investigate the clinical features and plasmapheresis treatment outcome of hyperlipidemic acute pancreatitis among Uyghur population.

METHODSThe clinical data of 41 cases (treatment group) diagnosed with acute hyperlipidemic pancreatitis and treated with plasmapheresis from August 2007 to August 2012 was studied, and treatment outcomes were statistically analyzed. Fifty patients during the same period who received medical treatment without plasmapheresis (control group) were collected, and were compared to the treatment group. Clinical data of 72 Han Chinese patients with hyperlipidemic acute pancreatitis from the same study period were compared to 91 Uyghur patients mentioned above. The data were analyzed by t-test or χ2 test.

RESULTSTreatment group and control group were comparable in terms of gender, age, APACHE II score at admission, BMI, and blood lipid levels. Thirty-two patients out of 41 in the treatment group were improved after routine medical treatment and plasmapheresis, but 9 died. In the control group, 28 out of 50 cases were improved, 22 died. The mortality of the treatment group was significantly lower than that of the control group(χ2 = 10. 824, P = 0. 001). Time of hospital stay in treatment group was (17 ± 16) days, and significantly shorter than that of control group ((28 ± 20) days) (t= 2. 851, P = 0. 005). Before plasmapheresis in the treatment group, serum triglyceride and total cholesterol levels were (58 ± 39) mmol/L and (24 ± 8) mmol/L, after plasmapheresis, these values dropped significantly to (10 ± 10) mmol/L and (6 ± 5) mmol/L. APACHE II score of those died were 18 ± 2, and significantly higher than those who survived(11 ± 3) (t = 0. 570, P = 0. 000); Time from hospital admission until plasmapheresis were significantly longer in died patients ((49 ± 9) hours) than in survived patients ((38 ± 8) hours, t = 3. 549, P = 0. 040). Furthermore, serum triglyceride levels were significantly higher in survived cases ((46 ± 16) mmol/L) than those who died ((37 ± 15) mmol/L) (t = 2. 386, P = 0. 010) . Both serum triglyceride and cholesterol levels were reduced significantly in control group (t = 3. 484, P = 0. 00; t = 4. 086, P = 0. 000, but the degrees of reduction were significantly lower than that of the treatment group. When comparing Uyghur patients to Han patients, Uyghur cases had higher serum triglyceride (t = 2. 083, P = 0. 039), and cholesterol levels (t = 2. 535, P = 0. 012, and their age was significantly younger than that of Hans (t = 3. 373, P = 0. 010 .

CONCLUSIONSs Uyghur patients with hyperlipidemia acute pancreatitis tend to have higher serum triglyceride and cholesterol levels, and age at disease onset is younger. Plasmapheresis is a more effective treatment option for patients with hyperlipidemia acute pancreatitis. Treatment outcome is related to APACHE II score, serum triglyceride levels, and time frame between admission and plasmapheresis treatment.

APACHE ; Acute Disease ; Asian Continental Ancestry Group ; Humans ; Hyperlipidemias ; complications ; therapy ; Length of Stay ; Pancreatitis ; complications ; therapy ; Plasmapheresis ; Time-to-Treatment ; Treatment Outcome ; Triglycerides ; blood

OBJECTIVETo investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae (Danshen) in the treatment of severe acute pancreatitis (SAP)- or obstructive jaundice (OJ)-induced heart injury.

METHODSA total of 288 rats were used for SAP- (n=108) and OJ-associated (n=180) experiments. The rats were randomly divided into sham-operated, model control, and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation, SAP rats in each group were subdivided into 3, 6 and 12 h subgroups (n=12), whereas OJ rats were subdivided into 7, 14, 21, and 28 d subgroups (n=15). At the corresponding time points after operation, the mortality rates of the rats, the contents of endotoxin and phospholipase A2 (PLA2) in blood, and pathological changes of the hearts were investigated.

RESULTSThe numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group, but not significantly (P>0.05). The contents of endotoxin (at 6 and 12 h in SAP rats and on 7, 14, 21, and 28 d in OJ rats, respectively) and PLA2 (at 6 and 12 h in SAP rats and on 28 d in OJ rats, respectively) in the treated group were significantly lower than those in the model control group (P<0.01 and P<0.001, respectively). Besides, myocardial pathological injuries were mitigated in SAP and OJ rats.

CONCLUSIONIn this study, we found that Salvia miltiorrhizae improved myocardial pathological changes, reduced the content of PLA2 in blood, and decreased the mortality rates of SAP and OJ rats, exerting protective effects on the hearts of the rats.

Animals ; Endotoxins ; blood ; Heart Injuries ; blood ; drug therapy ; etiology ; pathology ; Jaundice, Obstructive ; blood ; complications ; drug therapy ; Male ; Microscopy, Electron ; Pancreatitis ; blood ; complications ; drug therapy ; Phospholipases A2 ; metabolism ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Salvia ; chemistry ; Survival Rate