BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
Bacterial Infections/diagnosis/*prevention & control ; Humans ; Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy ; Retrospective Studies ; Treatment Outcome

BACKGROUNDPost-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography (ERCP). Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate (GM) on PEP are contradictory. The present study was designed to evaluate the prophylactic effect of ulinastatin and GM on PEP with meta-analyses of randomized controlled trials (RCTs).

METHODSFive electronic databases were searched for RCTs evaluating the preventive effect of ulinastatin and GM on PEP. Summary effects were assessed with the methods recommended by the Cochrane Collaboration.

RESULTSTwelve studies involving 5105 participants were included in our meta-analyses. Administration of ulinastatin decreased the incidence of PEP only at sufficient doses (OR, 0.39; 95%CI, 0.19 to 0.81; P = 0.01). Number needed to treat (NNT) was 6. And administration of ulinastatin also reduced the incidence of post-ERCP hyperamylasemia (PEHA) (OR, 0.40; 95%CI, 0.28 to 0.58; P < 0.000 01). Slow infusion of high-dose GM was effective for PEP prevention (OR, 0.44; 95%CI, 0.25 to 0.79; P = 0.006), and rapid infusion of low-dose GM also showed efficacy for PEP prophylaxis (OR, 0.37; 95%CI, 0.20 to 0.69; P = 0.002). NNT was 7 and 6 respectively. However, administration of GM at low doses and by slow infusions was ineffective (OR, 0.99; 95%CI, 0.64 to 1.55; P = 0.98). Administration of GM had the tendency to reduce PEHA rate, but not to a statistical significance (OR, 0.86; 95%CI, 0.73 to 1.01; P = 0.06). When low-quality studies were excluded, the meta-analysis with two high-quality studies indicated that ulinastatin did not reduce the rate of PEP (OR, 0.63; 95%CI, 0.32 to 1.26; P = 0.19) and PEHA incidence (OR, 0.80; 95%CI, 0.31 to 2.07; P = 0.64). The meta-analysis with six high-quality studies showed that GM administration decreased PEP incidence (OR, 0.52; 95%CI, 0.29 to 0.91; P = 0.02), while was not efficacious for PEHA prevention (OR, 0.88; 95%CI, 0.74 to 1.04; P = 0.12).

CONCLUSIONSUlinastatin and GM may be of value for the prophylaxis of PEP. GM should be administered at high doses and by rapid infusions. And the doses of ulinastatin should be sufficient. However, the conclusions are not overwhelming. More large-sample size and high-quality RCTs are still needed to elucidate whether administrations of the two drugs really have prophylactic effect on PEP.

Cholangiopancreatography, Endoscopic Retrograde ; adverse effects ; Gabexate ; therapeutic use ; Glycoproteins ; therapeutic use ; Humans ; Pancreatitis ; prevention & control

Acute Disease ; Dexamethasone ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Pancreatitis ; complications ; therapy ; Respiratory Distress Syndrome, Adult ; etiology ; prevention & control ; Systemic Inflammatory Response Syndrome ; etiology ; prevention & control

BACKGROUNDEffects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia.

METHODSThis was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions: pre-ERCP somatostatin (0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n = 36), post-ERCP somatostatin (0.5 mg/h for 24 hours, starting 1 hour after ERCP; n = 47), or placebo (saline for 24 hours, starting 1 hour prior to ERCP; n = 41). Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP.

RESULTSThe three groups did not differ in age, gender, medical history, or ERCP procedure (catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type). The rate of PEP was 13.7% (17/124) in the overall study sample and 16.7% (6/36), 10.6% (5/47), and 14.6% (6/41) in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively (P = 0.715). The rate of post-ERCP hyperamylasemia was 19.4% (7/36), 21.3% (10/47), and 46.3% (19/41) in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively (P = 0.011).

CONCLUSIONSHigh-dose, long-term continuous infusion (0.5 mg/h for 24 hours) of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.

Adult ; Aged ; Cholangiopancreatography, Endoscopic Retrograde ; adverse effects ; Female ; Humans ; Hyperamylasemia ; prevention & control ; Male ; Middle Aged ; Pancreatitis ; prevention & control ; Pilot Projects ; Somatostatin ; therapeutic use

OBJECTIVE: To investigate the effects of subcutaneous administration of insulin on insulitis,beta cell apoptosis and diabetes in non-obese diabetic (NOD) mice, and to explore the mechanism of immune tolerance induced by insulin. METHODS: Sixty female NOD mice were randomly divided into insulin group (n=32) and phosphate buffered saline (PBS) group (PBS group, n=28). Insulin was subcutaneously injected with humulin N (60 microL, 6U)+IFA (60 microL) at 4, 12, 20, and 28 weeks respectively, while the PBS group received PBS (60 microL) + IFA (60 microL). Insulitis and beta cell apoptosis of islets were observed at 12 weeks. IL-4 and IFN-gamma in the sera were measured by enzyme linked immunosorbent assay (ELISA). The expression levels of I-Abeta(g7), IL-4, IFN-gamma, IL-1beta, and Fas mRNA of islets were measured by reverse transcription-polymerase chain reaction (RT-PCR) at 12 weeks. RESULTS: The incidences in the insulin group were significantly lower than those in the PBS group (21.4% vs 71.4% at 30 weeks, 28.6% vs 85.7% at 52 weeks, P<0.05). The insulitis scores in the insulin group were lower than those in the PBS group, but there was no statistical significance. Fas expression on islets and apoptotic beta cell rates in the insulin group were lower than those in the PBS group (P<0.05). In the insulin group, serum IL-4 levels were higher, but IFN-gamma levels were lower than those in the PBS group (P<0.05). The levels of I-Abeta g7, IFN-gamma, IL-1beta and Fas mRNA transcription in islets were lower in insulin group, but IL-4 mRNA levels were higher than those in the PBS group (P<0.05). CONCLUSION The specific autoantigen insulin may induce immune tolerance and prevent diabetes in NOD mice, but it can't block the progression of insulitis. Subcutaneous administration of insulin can induce the regulatory T cells, and make Th1 to Th2 cytokine shifts in system and islets, thus preventing the Fas-mediated beta-cell apoptosis and diabetes.
Animals ; Apoptosis ; drug effects ; Diabetes Mellitus, Experimental ; prevention & control ; Diabetes Mellitus, Type 1 ; prevention & control ; Female ; Injections, Subcutaneous ; Insulin ; administration & dosage ; pharmacology ; Islets of Langerhans ; immunology ; pathology ; Mice ; Mice, Inbred NOD ; Pancreatitis ; prevention & control ; Random Allocation

OBJECTIVETo review the recent research progress in pharmacological actions and mechanisms of ginkgolide B. Data sources Information included in this article was identified by searching of PUBMED (1987 - 2006) online resources using the key terms "ginkgolide B", "platelet activating factor", and "pharmacological". Study selection Mainly original milestone articles and critical reviews written by major pioneer investigators of the field were selected.

RESULTSThe key issues related to the pharmacological actions and mechanisms of ginkgolide B were summarized. The ginkgolide B possesses a number of beneficial effects such as anti-inflammatory, anti-allergic, antioxidant, and neuroprotective effects. Meantime, their mechaniams were discussed.

CONCLUSIONSThe Ginkgolide B is the most potent antagonist of platelet activating factor (PAF) and exhibits therapeutic action in a variety of diseases mainly by the PAF receptor.

Acute Disease ; Animals ; Anti-Asthmatic Agents ; pharmacology ; Antineoplastic Agents ; pharmacology ; Ginkgolides ; chemistry ; pharmacology ; Humans ; Lactones ; chemistry ; pharmacology ; Neuroprotective Agents ; pharmacology ; Pancreatitis ; drug therapy ; Reperfusion Injury ; prevention & control

Acute pancreatitis remains the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP), with reported incidence rates that have changed little over several decades. Patient- and procedure-related risk factors for post-ERCP pancreatitis (PEP) are well-defined. Effective measures to prevent PEP have been identified, including improvements in cannulation techniques and pancreatic stenting, as well as pharmacological intervention. Pharmacotherapy has been widely studied in the prevention of PEP, but the effect in averting PEP has been inconclusive. Although pharmacological prophylaxis is appealing, attempts to find an ideal drug are incomplete. Most available data on the efficacy of pharmacological agents for PEP prophylaxis have been obtained from patients at average risk for PEP. However, recently, a randomized prospective controlled trial of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent PEP in high-risk patients was published. The results revealed that rectal indomethacin reduced the incidence of PEP significantly. Thus, rectal administration of diclofenac or indomethacin immediately before or after ERCP is used routinely to prevent PEP. However, additional studies with NSAIDs using large numbers of subjects are necessary to confirm the prophylactic effect of these drugs and to establish whether they act synergistically with other prophylactic interventions, including pancreatic stenting.
Acute Disease ; Administration, Rectal ; Animals ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Humans ; Pancreatitis/etiology/*prevention & control ; Treatment Outcome

OBJECTIVETo observe the effects of Qingyi Granule (QYG) on the changes of total protein expressions in the pancreatic tissue of rats with severe acute pancreatitis (SAP) induced by sodium taurocholate (STC).

METHODSSAP was induced by retrograded injecting 5% STC from the gut-pancreatic duct in 36 Sprague-Dawley (SD)rats. Then they were randomly divided into the SAP group and the QYG treatment group (abbreviated as the QYG group), 18 in each group. After successful modeling, rats in the QYG group were administered with QYG water solution (W: W = 1:1) once with an interval of 12 h (1 mL/100 g), while rats in the SAP group were administered with normal saline. The medication was performed four times. The total proteins were extracted from the pancreatic tissue of all rats to perform two-dimensional electrophoresis, fluorescent staining, and atlas analysis. The protein dots with differential expressions more than four times between each other in 48 h gel pictures were chosen and used for MALDI-TOF/TOF mass chromatographic analysis and biological information analysis.

RESULTSThe 5% STC induced SAP model rats had typical pathological changes in the pancreatic tissue. The proteomics changes of the pancreatic tissue were analyzed by gel image manipulation software. Twenty two disparate points were detected between two groups at 48 h, 5 points of the protein were up-regulated and 17 points were down-regulated of the total after QYG intervention. Nine protein spots expressed differently more than 4 times and stably at 48 h, 7 kinds of proteins have been identified by mass chromatographic analysis and Data Base Retrieval, and they were Serpinb1a 39 kDa protein, Serpinb1a 43 kDa protein, Prdx4 Prx IV, Clps, gamma-actin (Actg1), Eprs and Hadhsc. Those proteins were involved in signal transmit during the process of SAP pancreas--pathological injury analyzed from their functions.

CONCLUSIONSProteomics can well reflect the effects of QYG on differential expression proteins in the pancreatic tissue of rats with SAP. Studying differential expression proteins may provide a new theoretical basis and molecule target for QYG treating SAP.

Animals ; Disease Models, Animal ; Drugs, Chinese Herbal ; therapeutic use ; Pancreas ; metabolism ; Pancreatitis ; chemically induced ; metabolism ; prevention & control ; Proteome ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo analyze the indication and choice of operation technique for duodenum-preserving resection of pancreatic head.

METHODSThe Clinical material of the 22 patients who received duodenum-preserving resection of pancreatic head (DPPHR) from January 2001 to January 2006 was analyzed. Of the 22 cases, 8 cases presented with mucinous cystadenoma, 2 cases with mucinous cystadenocarcinoma, 4 cases with solid-pseudopapillary tumors, 2 cases with pancreatic endocrine tumors, 4 cases with chronic pancreatitis, 1 case with lymph epidermis cyst, 1 case with serous cystadenoma. The indication, choice of operation technique of DPPHR and the prevention and management of the post-operative complications were investigated.

RESULTSNo patient died of the operation. Three cases (13.6%) developed pancreatic fistula after the operation, 1 case (4.5%) developed biliary fistula, 1 case (4.5%) developed abdominal infection and 2 cases of duodenal fistula occurred (9.1%).

CONCLUSIONSDPPHR retains the continuity of stomach, duodenum and biliary ducts. The operation is safe and it reduces wounds and excision scope. This procedure can be used in benign and low malignant lesions in the head and neck of the pancreas.

Adult ; Aged ; Duodenum ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Neoplasms ; surgery ; Pancreatitis ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome

BACKGROUND/AIMS: We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. METHODS: This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. RESULTS: There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection. CONCLUSIONS: Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.
Adult ; Aged ; Aged, 80 and over ; Ampulla of Vater/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/*surgery ; Endoscopy/methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts/surgery ; Pancreatitis/*prevention & control ; Postoperative Complications/*prevention & control ; Retrospective Studies ; Sphincterotomy, Endoscopic/methods ; *Stents