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World Journal of Gastroenterology 2008年第16期14卷 2612-2614页

作者： Qing He Yue-Qin Liu Yuan Liu Yong-Song Guan Department of Oncology Huaxi Hospital Sichuan University Chengdu 610041 Sichuan Province China

acute necrotizing pancreatitis complicated with pancreatic pseudoaneurysm is a rare emergency associated with high mortality that demands immediate treatment to save the patient’s life. We treated a 64-year-old man who presented with a bleeding pseudoaneurysm of the superior mesenteric artery caused by acute pancreatitis, using interventional embolizing therapy. In the present report we show that interventional treatment is an effective therapeutic modality for patients with acute necrotizing pancreatitis complicated with intra-abdominal bleeding.

关键词： acute necrotizing pancreatitis Bleeding Complications Pseudoaneurysm Arterial embolization

acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

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World Journal of Gastroenterology 2010年第23期16卷 2959-2962页

作者： Jeroen I Lenz Jimmy M Jacobs Bart Op de Beeck Ivan A Huyghe Paul A Pelckmans Tom G Moreels Division of Gastroenterology and Hepatology Antwerp University Hospital Division of Radiology Antwerp University Hospital Division of Nuclear Medicine Antwerp University Hospital

We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid *** the acute pancreatitis was treated *** patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic *** the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very *** pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been *** is important to treat the provoking ***,the cause of hypercalcemia should be identif ied *** resection of the parathyroid adenoma is the ultimate therapy.

关键词： acute necrotizing pancreatitis Hypercalcemia Primary hyperparathyroidism Parathyroid adenoma

Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients:A retrospective cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 77-82页

作者： Wen-Jian Mao Jing Zhou Guo-Fu Zhang Fa-Xi Chen Jing-Zhu Zhang Bai-Qiang Li Lu Ke Wei-Qin Li Department of Critical Care Medicine Jinling HospitalNanjing Medical UniversityNanjing 210002China Department of Critical Care Medicine Jinling HospitalMedical School of Nanjing UniversityNanjing 210002China National Institute of Healthcare Data Science Nanjing UniversityNanjing 210010China

Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been ***,whether it affects long-term outcomes is *** study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP ***:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were *** primary outcome was 90-day readmission after *** proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day ***:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did *** who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did *** the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two *** Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission ***:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.

关键词： Anticoagulation Splanchnic venous thrombosis acute necrotizing pancreatitis Readmission Long-term outcomes

Effects of Chai-Qin-Cheng-Qi Decoction on cefotaxime in rats with acute necrotizing pancreatitis

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World Journal of Gastroenterology 2009年第35期15卷 4439-4443页

作者： Li-Hui Deng Da-Kai Xiang Ping Xue Hai-Yan Zhang Lei Huang Qing Xia Department of Integrated TraditionalChinese and Western Medicine West China Hospital SichuanUniversity Chengdu 610041 Sichuan Province China

AIM:To investigate the effect of Chai-Qin-Cheng-Qi Decoction(CQCQD)on cefotaxime(CTX)concentration in pancreas of rats with acute necrotizing pancreatitis (ANP). METHODS:Sixty healthy male Sprague-Dawley rats were divided randomly into an ANP group(ANP model +CTX,n=20),treatment group(ANP model+CTX +CQCQD,n=20)and control group(normal rats+ CTX,n=20).ANP models were induced by retrograde intraductal injection of 3.5%sodium taurocholate (1 mL/kg),and the control group was injected intraductally with normal *** rats were injected introperitoneally with 0.42 g/kg CTX(at 12-h intervals for a continuous 72 h)at 6 h after intraductal injection. Meanwhile,the treatment group received CQCQD (20 mL/kg)intragastrically at 8-h intervals,and the ANP and control group were treated intragastrically with normal *** 15 min after the last CTX injection,blood and pancreas samples were collected for the determination of CTX concentration using validated high-performance liquid chromatography. Pathological changes and wet-to-dry-weight(W/D) ratio of pancreatic tissue were examined. RESULTS:Serum CTX concentrations in three groups were not significantly *** CTXconcentration and penetration ratio were lower in ANP group vs control group(4.4±0.6μg/mL vs 18.6± 1.7μg/mL,P=0.000;5%vs 19%,P=0.000),but significantly higher in treatment group vs ANP group (6.4±1.7μg/mL vs 4.4±0.6μg/mL,P=0.020;7% vs 5%,P=0.048).The histological scores and W/D ratio were significantly decreased in treatment group vs ANP and control group. CONCLUSION:CQCQD might have a promotive effect on CTX concentration in pancreatic tissues of rats with ANP.

关键词： acute necrotizing pancreatitis Cefotaxime Chai Qin Cheng Qi Decoction Drug penetration Traditional Chinese medicine

Effects of chondroitin sulfate on alteration of actin cytoskeleton in rats with acute necrotizing pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 537-543页

作者： He, Zhong-Ye Guo, Ren-Xuan China Med Univ Dept Gen Surg Affiliated Hosp 1 Shenyang 110001 Peoples R China

BACKGROUND: In experimental acute pancreatitis, a large amount of reactive oxygen species are produced, and in turn cytoskeletal changes may be induced in pancreatic tissue. These changes contribute to an imbalance of digestive enzyme segregation, transport, exocytosis and activation, resulting in cell injury. In this study, we assessed the effects of chondroitin sulfate (CS) on attenuation of oxidative damage and protection of F-actin in rats with acute necrotizing pancreatitis (ANP). METHODS: Ninety male Wistar rats were divided randomly into three groups. Group A was infused with 5% sodium taurocholate; group B was treated with CS; and group C served as control. Rats from the three groups were killed at 1, 3 or 8 hours. The levels were measured of malonyl dialdehyde (MDA), total superoxide dismutase (SOD), glutathione synthetase (GSH), serum amylase (SAM) and adenosine triphosphate (ATP). F-actin immunostained with rhodamine-phalloidin was analyzed using a confocal laser scanning system and the content of F-actin protein was determined. RESULTS: The levels of SAM increased in groups A and B, whereas the levels of GSH, SOD and ATP in group A decreased markedly during pancreatitis, and MDA increased significantly. The levels of GSH, SOD and ATP in group B were higher than those in group A, but the level of MDA was lower than in group A. At the same time, ANP resulted in early disruption of the cytoskeleton with dramatic changes and a loss of F-actin. Administration of CS moderated the damage to the actin cytoskeleton. CONCLUSIONS: Retrograde infusion of sodium taurocholate via the pancreatic duct may produce pancreatic necrosis and a marked increase in serum amylase activity, induce a severe depletion of ATP level, prime lipid peroxidation, and damage F-actin. Treatment with CS can ameliorate pancreatic cell conditions, limit cell membrane peroxidation, protect F-actin, and attenuate pancreatitis.

关键词： chondroitin sulfate acute necrotizing pancreatitis reactive oxygen species filament actin

Ligustrazine alleviates gastric mucosal injury in a rat model of acute necrotizing pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2007年第2期6卷 213-218页

作者： Dang, Sheng-Chun Zhang, Jian-Xin Qu, Jian-Guo Wang, Xue-Qing Fan, Xin Jiangsu Univ Dept Gen Surg Affiliated Hosp Zhenjiang 212001 Peoples R China

BACKGROUND: acute necrotizing pancreatitis (ANP) leads to a systemic inflammatory response characterized by widespread leukocyte activation and, as a consequence, distant organ injury. The aim of this study was to explore the relationship between gastric microcirculatory impairment and inflammatory mediators released in rats and to evaluate the therapeutic effect of ligustrazine extracted from Rhizoma ligusticum wallichii on gastric mucosa injury in a rat model of ANP. METHODS: Ninety-six Sprague-Dawley rats were randomly divided into three groups: normal control (group Q; ANP without treatment (group P); and ANP treated with ligustrazine (group T). The ANP model was induced by injection of 50 g/L sodium taurocholate under the pancreatic membrane (4 ml/kg). Group C was given isovolumetric injection of 9 g/L physiological saline by the same route. Group T was injected with ligustrazine (10 ml/kg) via the portal vein. The radioactive biomicrosphere technique was used to measure the blood flow 2 and 12 hours after the induction of ANP. Samples of the pancreas and stomach were taken to assess pathological changes by a validated histology score; meanwhile, the levels of serum interleukin-1 beta (IL-1 beta) were determined. Gastric tissues were also used to measure the level of myeloperoxidase (MPO), which is expressed intracellularly in the azurophilic granules of neutrophils. RESULTS: Blood flow in group P was significantly lower than that in group C (P < 0.01). Pathological changes were significantly aggravated in group P. The gastric MPO activity in group P was significantly higher than that in group C (P < 0.01). The level of serum IL-1 beta in group P increased more significantly than that in group C (P < 0.01). Blood flow of the stomach in group T was significantly higher than that in group P after 2 hours (P < 0.01). The pathological changes were significantly alleviated in group T. The MPO activity of group T was significantly lower than that of group P (P < 0.01

关键词： acute necrotizing pancreatitis microcirculation ligustrazine gastric mucosal injury interleukin-1 beta

acute necrotizing pancreatitis: challenges and interventions-a narrative review

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Journal of Pancreatology 2022年第4期5卷 40-82页

作者： Yan Luo Le Li Rui Kong Yuhang Sui Bei Sun Department of Pancreatic and Biliary Surgery the First Affiliated Hospital of Harbin Medical UniversityHarbinChina Key Laboratory of Hepatosplenic Surgery Ministry of Educationthe First Affiliated Hospital of Harbin Medical UniversityHarbinChina

acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up *** pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor *** CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each ***,many challenges are still remaining during the treatment of *** the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected *** nowadays treatment scenario of ANP,the necessity for open surgery remains to be *** of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.

关键词： acute pancreatitis acute necrotizing pancreatitis step-up approach postoperative residual infection infected pancreatic necrosis

Continuous veno venous hemofiltration in treatment of acute necrotizing pancreatitis

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Chinese Medical Journal 2003年第4期116卷 549-553页

作者：谢红浪季大玺龚德华刘芸徐斌周红刘志红黎磊石李维勤全竹富黎介寿 Research Institute of Nephrology Jinling HospitalSchool of MedicineNanjing University Research Institute of General Surgery Jinling HospitalNanjing University School of Medicine

To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP) Methods Thirteen ANP patients were involved in this study, including 4 females and 9 ma les, averaging 50 6±10 8 years old CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8 9±2 1 CVVH was maintained for at least 72 hours and the AN69 hemofilter (1 2 m 2) was changed every 24 hours The ultrafiltration rate during CVVH was 2993 9±983 0 m l/h, the blood flow rate was 250-300 ml/min, and the substitute fluid was infused in a pre-diluted manner Low molecular weight heparin was used as anticoagulant Results CVVH was well tolerated in all the patients Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed Two patients died of systemic fungal infections and another died o f intracranial fungi infection, resulting in an ICU mortality of 23 1% Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge The APACHE Ⅱ score before CVVH was 15 2±6 5, but decreased significantly to 8 1±5 3, 7 5±4 9 and 8 0±5 2 at the 24th, 48th and 72nd hour after CVVH, respectively (P<0 01) Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later After CVVH had ceased, the serum levels of two cytokines i ncreased to their peaks at the 120th hour and decreased eventually at the 144th hour The sieving coefficient (SC) of IL-1β and TNFα was 0 33±0 11 and 0 16±0 08 Conclusion CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1β and TNFα; CVVH at early stages of SAP may contribute to the impro

关键词： acute necrotizing pancreatitis multiple org an dysfunction syndrome veno venous hemofilration

Dynamic changes of IL-2/IL-10, sFas and expression of Fas in intestinal mucosa in rats with acute necrotizing pancreatitis

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World Journal of Gastroenterology 2008年第14期14卷 2246-2250页

作者： Sheng-Chun Dang Jian-Xin Zhang Jian-Guo Qu Zheng-Fa Mao Xu-Qing Wang Bei Zhu Department of General Surgery The Affiliated Hospital of Jiangsu University Zhenjiang 212001 Jiangsu Province China

AIM:To investigate dynamic changes of serum IL-2, IL-10, IL-2/IL-10 and sFas in rats with acute necrotizing pancreatitis. To explore the expression of Fas in intestinal mucosa of rats with acute necrotizing pancreatitis (ANP). METHODS:A total of 64 Sprague-Dawley (SD) rats were randomly divided into two groups:normal control group (C group), ANP group (P group). An ANP model was induced by injection of 50 g/L sodium taurocholate under the pancreatic membrane. Normal control group received isovolumetric injection of 9 g/L physiological saline solution using the same method. The blood samples of the rats in each group were obtained via superior mesenteric vein to measure levels of IL-2, IL-10, sFas and calculate the value of IL-2/IL-10. The levels of IL-2, IL-10 and sFas were determined by ELISA. The severity of intestinal mucosal injury was evaluated by pathologic score. The expression of Fas in intestinal mucosal tissue was determined by immunohistochemistry staining. RESULTS:Levels of serum IL-2 were significantly higher in P group than those of C group (2.79 ± 0.51 vs 3.53 ± 0.62, 2.93 ± 0.89 vs 4.35 ± 1.11, 4.81 ± 1.23 vs 6.94 ± 1.55 and 3.41 ± 0.72 vs 4.80 ± 1.10, respectively, P 0.05). In sFas assay, there was no significant difference between P group and C group (3.16 ± 0.75 vs 3.31 ± 0.80,

关键词： acute necrotizing pancreatitis Fas Intestinal mucosal injury T helper cell

Changes of gastric and intestinal blood flow, serum phospholipase A_2 and interleukin-1β in rats with acute necrotizing pancreatitis

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World Journal of Gastroenterology 2005年第23期11卷 3578-3581页

作者： Jian-XinZhang Sheng-ChunDang Jian-GuoQu Xue-QingWang Guo-ZuoChen DepartmentofGeneralSurgery TheAffiliatedHospitalofJiangsuUniversityZhenjiang212001JiangsuProvinceChina

AIM:To explore the relationship between gastric and intestinal microcirculatory impairment and inflammatory mediators released in rats with acute necrotizing pancreatitis (ANP). METHODS: A total of 64 rats were randomized into control group and ANP group. ANP model was induced by injection of 5% sodium taurocholate under the pancreatic membrane. Radioactive biomicrosphere technique was used to measure the gastric and intestinal tissue blood flow at 2 and 12 h after the induction of ANP, meanwhile serum phospholipase A2 (PLA2) activities and interleukin-1β levels were determined. Pathologic changes in pancreas, gastric and intestinal mucosae were studied. RESULTS: The gastric blood flow in ANP group (0.62±0.06 and 0.35±0.05) mL/(min·g) was significantly lower than that in control group (0.86±0.11 and 0.85±0.06) mL/(min·g) (P<0.01) at 2 and 12 h after induction of ANP. The intestinal blood flow in ANP group (0.80±0.07 and 0.50±0.06) mlV(min·g) was significantly lower than that in control group (1.56±0.18 and 1.61±0.11) mL/(min·g) (P<0.01). Serum PLA2 activities (94.29±9.96 and 103.71± 14.40) U/L and IL-1β levels (0.78±0.13 and 0.83±0.20)μg/L in ANP group were higher than those in control group (65.27±10.52 and 66.63±9.81) U/L, (0.32±0.06 and 0.33±0.07)μg/L (P<0.01). At 2 and 12 h after introduction of the model, typical pathologic changes were found in ANP. Compared with control group, the gastric and intestinal mucosal pathologic changes were aggravated significantly (P<0.01) at 12 h after induction of ANP. Gastric and intestinal mucosal necrosis, multiple ulcer and hemorrhage occurred. CONCLUSION: Decrease of gastric and intestinal blood flow and increase of inflammatory mediators occur simultaneously early in ANP, both of them are important pathogenic factors for gastric and intestinal mucosal injury in ANP.

关键词： acute necrotizing pancreatitis Interleukin-1 Phospholipase A2 Microcirculation