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Pravastatin:A potential cause for acute pancreatitis

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World Journal of Gastroenterology 2006年第43期12卷 7055-7057页

作者： Constantine Tsigrelis cs pitchumoni Department of Internal Medicine Sain Peter's University Hospital Robert Wood Johnson Medica School New Brunswick NJ United States Division of Gastroenterology Hepatology and Clinical Nutrition Department of Internal Medicine Saint Peter's University Hospital Robert Wood Johnson Medical School New Brunswick NJ United States

Acute pancreatitis （AP） secondary to drugs is uncommon, with an incidence ranging from 0.3% to 2.0% of AP cases. Drug-induced AP due to statins is rare, and only 12 cases have thus far been reported. In this case report, we report a case of a 50-year-old female on pravastatin therapy for 3 d prior to developing symptoms of AP. The common etiological factors for AP were all excluded. The patient was admitted to the intensive care unit secondary to respiratory distress, though she subsequently improved and was discharged 14 d after admission. Although the incidence of drug-induced AP is low, clinicians should have a high index of suspicion for it in patients with AP due to an unknown etiology. Clinicians should be aware of the association of statins with AR If a patient taking a statin develops abdominal pain, clinicians should consider the diagnosis of AP and conduct the appropriate laboratory and diagnostic evaluation if indicated.

关键词： Drug-induced pancreatitis Acute pancreatitis Statins Pravastatin.

Pathophysiology of pulmonary complications of acute pancreatitis

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World Journal of Gastroenterology 2006年第44期12卷 7087-7096页

作者： George W Browne cs pitchumoni Saint Peter’s University Hospital Robert Wood Johnson Medical School New Brunswick NJ 08903 United States Robert Wood Johnson School of Medicine Saint Peter’s University Hospital New Brunswick NJ 08903 United States

Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia, acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids, chemoattractants such as tumor necrsosis factor （TNF）- alpha, interleukin （IL）-1, IL-6, IL-8, fMet-leu-phe （a bacterial wall product）, nitric oxide, substance P, and macrophage inhlbitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

关键词： Acute pancreatitis Cytokines Acute respiratory distress syndrome Complications of pancreatitis Pleural effusion Interleukins

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

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World Journal of Gastroenterology 2008年第5期14卷 709-712页

作者： Xiangbing Wang cs pitchumoni Khushbu Chandrarana Neha Shah Division of Endocrinology & Metabolism Robert Wood Johnson University Hospital-UMDNJ New Brunswick NJ 08903-0019 United States Division of Gastroenterology St Peter's University Hospital New Brunswick NJ 08901 United States Department of Medicine St Peter's University Hospital New Brunswick NJ 08901 United States

AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms. METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance. RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）. CONCLUSION： The prevalen

关键词： Diabetes Neuropathy Gastroesophageal reflex disease Symptom Heart burn

Vitamin B12 deficiency and gastric histopathology in older patients

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World Journal of Gastroenterology 2005年第45期11卷 7078-7083页

作者： KR Dholakia TS Dharmarajan D Yadav S Oiseth EP Norkus cs pitchumoni Department of Medicine University Hospital of New York Medical College ValhallaNYUnited States Department of Pathology Department of Medical Research

AIM: To compare upper gastric endoscopic and histopathologic findings in older adults in the presence and absence of B12 ***: A prospective analysis of upper gastric endoscopic and gastric histopathologic findings from 30 newly identified B12-deficient patients (11 males,19 females) and 16 controls with normal B12 status (6males, 10 females) was performed. For all subjects, the indication for upper endoscopy and gastric biopsy were unrelated to B12 status. A single pathologist, blinded to B12 status, processed and interpreted the biopsy samples. Endoscopic and histopathologic findings were correlated with age, gender, hematocrit (Hct), MCV and B12 ***: The B12-deficient group had significantly lower mean serum B12 levels compared to the controls (P＜0.00005) while their mean Hct, MCV and serum albumin levels were similar. Iron deficiency (ferritinbased) was present in 21% of B12-deficient patients and intrinsic factor antibodies were present in29% (5/17) of B12-deficient patients. The endoscopic findings revealed significantly different rates of gastritis and atrophy between the B12-deficient and control groups (P= 0.017).B12-deficient patients had significantly less superficial gastritis (62% vs 94%) and significantly more atrophic gastritis (28% vs 0%) as compared to the controls (P= 0.039). Intestinal metaplasia was similar in both groups. Helicobacter pyloriinfection rates were similar in the B12-deficient patients and controls (40% vs31%).CONCLUSION: Significantly different endoscopic findings and types of gastritis could often be observed in the presence and absence of B12 deficiency. Atrophy,based on endoscopy, and atrophic gastritis, based on histopathology, suggest the presence of B12 *** histopathology is not influenced by the age,gender, Hct or MCV of the patients.

关键词： Vitamin B12 deficiency Gastrichistopathology Older adults

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急性胰腺炎的全身性并发症

国外医学（内科学分册） 1989年第8期16卷 364-366,348页

作者： pitchumoni cs 严庆惠

本文详尽介绍了急性胰腺炎的全身并发症,包括低血钙、高脂血症、糖代谢紊乱、凝血异常、关节炎以及骨和皮肤损害、普尔夏氏血管性视网膜病、胰性脑病,还有肾脏、呼吸系和心血管方面的并发症。

关键词：胰腺炎并发症

Acute pancreatitis in pregnancy

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World Journal of Gastroenterology 2009年第45期15卷 5641-5646页

作者： Capecomorin S pitchumoni Balaji Yegneswaran Drexel University College of Medicine and Robert Wood Johnson Medical School New BrunswickNJ 08901 United States Department of Gastroenterology Saint Peter's University Hospital New BrunswickNJ 08901 United States Drexel University College of Medicine Saint Peter's University Hospital New BrunswickNJ 08901 United States

Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts and multiple organ dysfunction syndromes. Pregnancy related hematological and biochemical alterations infl uence the interpretation of diagnostic tests and assessment of severity of AP. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the non-pregnant population. The recent advances in clinical gastroenterology have improved the early diagnosis and effective management of biliary pancreatitis. Diagnostic studies such as endoscopic ultrasound, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography and therapeutic modalities that include endoscopic sphincterotomy, biliary stenting, common bile duct stone extraction and laparoscopic cholecystectomy are major milestones in gastroenterology. When properly managed AP in pregnancy does not carry a dismal prognosis as in the past.

关键词： Acute pancreatitis Pregnancy Pancreatitis in pregnancy

Pathogenesis and managenent of pain in chronic pancreatitis

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World Journal of Gastroenterology 2000年第4期6卷 490-496页

作者： C. S. pitchumoni Professor of Medicine/Community and Preventive Medicine New York Medical College Director of Medicine and Chief of GastroenterologyOur Lady of Mercy Medical CenterBronxNew York 10466

INTRODUCTIONOf the three cardinal manifestations of chronic pancreatitis-pain,diabetes mellitus and steatorrhea,it is pain thatbrings the patient to the physician and is the most difficultto *** intractabale pain that... 详细信息

关键词： pancreatitis/therapy pain/therapy pain intractable/therapy lithotripsy alcoholics anonymous parenteral nutrition total antioxidants analgesics enzyme inhibitors somatostatin sphincterotomy endoscopic

Improved Outcomes Following Hepatocellular Carcinoma(HCC)Diagnosis in Patients Screened for HCC in a Large Academic Liver Center versus Patients Identified in the Community

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 31-34页

作者： Nneoma Okoronkwo Yucai Wang Capecomorin pitchumoni Baburao Koneru Nikolaos Pyrsopoulos Department of Medicine Rutgers New Jersey Medical SchoolNew JerseyUSA Division of Gastroenterology Hepatology and Clinical NutritionSaint Peters University HospitalNew JerseyUSA Department of Surgery Rutgers New Jersey Medical SchoolNew JerseyUSA Division of Gastroenterology and Hepatology Rutgers New Jersey Medical SchoolNew JerseyUSA

Background and Aims:Hepatocellularcarcinoma(HCC)isthe sixth most commonly occurring cancer *** and adherence to HCC surveillance guidelines has been associated with earlier *** sought to evaluate characteristics and outcomes following HCC diagnosis in patients screened for HCC in a large academic liver center versus patients diagnosed and referred from the ***:We reviewed the records of patients diagnosed with HCC in the liver center of an academic institution from January 1999 till December *** were classified into two groups:patients followed in our hepatology clinic and patients with HCC recently referred to our *** analysis was performed using chi-squared test and multivariate analysis was performed using SPSS ***:The records of 410 patients were reviewed,and included 77.3%of patients referred from the community and 22.7%of patients followed in our *** the clinic group,75.6%were identified with one nodule at initial diagnosis,compared to 65.6%in the referral *** in the referral group were more likely to present with tumors≥5 cm at diagnosis,with 28.7%compared to 5.4%in the clinic group(P<0.0001).Patients referred from the community were also less likely to undergo transplant,with 32.2%as compared to 48.4%of the clinic group(P<0.004).Conclusion:Patients with chronic liver disease managed in an academic liver center present in the early stage of HCC diagnosis and are more likely to meet the Milan criteria and undergo *** referral to a specialized transplant center,if feasible,where a multidisciplinary approach is utilized might be essential in the management of chronic liver disease.

关键词： Hepatocellular carcinoma Liver transplant Tumor

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急性胰腺炎的全身并发症

国外医学（消化系疾病分册） 1989年第2期9卷 93-96页

作者： pitchumoni S C 朱詠才

急性胰腺炎(AP)可累及多系统,有些涉及肺、心、肝、肾的并发症可在早期出现,但并不引起这些器官任何结构的变化。一般认为只有低血钙、高血糖和高甘油三脂血症是AP的代谢并发症,但要了解内环境的全面紊乱必须对重要器官的功能紊乱进行... 详细信息

急性胰腺炎(AP)可累及多系统,有些涉及肺、心、肝、肾的并发症可在早期出现,但并不引起这些器官任何结构的变化。一般认为只有低血钙、高血糖和高甘油三脂血症是AP的代谢并发症,但要了解内环境的全面紊乱必须对重要器官的功能紊乱进行更广泛的探讨。

关键词：胰腺炎并发症低血钙