PANCREAS ALERTS
Dig Dis Sci 2001; 46(7):1444-57
Iron, zinc, and copper concentration in serum, various organs, and hair of dogs with experimentally induced exocrine pancreatic insufficiency.
Adamama-Moraitou K, Rallis T, Papasteriadis A, Roubies N, Kaldrimidou H.
Department of Internal Medicine, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece.
The concentration of iron, zinc and copper in serum, pancreas, liver, duodenum, kidneys, myocardium, brain, and hair was studied in dogs with experimentally induced exocrine pancreatic insufficiency.
Exocrine pancreatic insufficiency was provoked surgically in eight healthy, 8-month-old mongrel dogs (group I). An equal number of dogs of the same breed and age were used as controls (group II).
One month postoperatively, the dogs in group I showed symptoms of exocrine pancreatic insufficiency, confirmed by the serum Trypsin-like immunoreactivity test, and on autopsy, by histological examination of the pancreas. At the end of the experiment (20 weeks duration) the dogs in both groups were sacrificed. The values of serum iron, percentage transferrin saturation and iron concentration in the pancreas, duodenum, and kidneys in group I dogs were significantly higher than those in the control animals. The concentrations of zinc in the serum, pancreas and myocardium, and of copper in the serum, pancreas, duodenum myocardium, and hair in group I dogs were significantly lower than those in the control animals.
Histological examination of various organs of group I dogs revealed severe atrophy and fibrosis of the pancreas, fatty infiltration of the liver, destruction and reduction in height of the villi of the duodenal epithelium and diffuse infiltration of the duodenal lamina propria with lymphocytes and plasmocytes.
Gastrointest Endosc 2001; 54(3):325-30.
Detection of choledocholithiasis by EUS in acute pancreatitis: A prospective evaluation in 100 consecutive patients.
Liu CL, Lo CM, Chan JK, Poon RT, Lam CM, Fan ST, Wong J.
Departments of Surgery and Diagnostic Radiology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
ERCP is the standard for detection of choledocholithiasis in patients with acute biliary pancreatitis, and, if performed early, ERCP decreases morbidity. However, there are procedure-related complications.
The aim of the present prospective study was to evaluate the ability of EUS to detect choledocholithiasis in patients presenting with acute pancreatitis.
In this study, EUS, and immediately thereafter ERCP, were performed by separate blinded examiners on 100 consecutive patients who presented with acute pancreatitis within 24 hours of admission. The diagnostic accuracy of EUS in identifying gallstones was compared with that of transcutaneous US. The diagnostic accuracy of EUS in detecting choledocholithiasis was then compared with that of US and ERCP based on the results of endoscopic instrumentation of the bile duct after sphincterotomy.
EUS was significantly more sensitive than US in detecting gallstones (100% vs. 84%, P<0.005). The sensitivities of ERCP and EUS for choledocholithiasis were both 97%, and the overall accuracies were 96% and 98%, respectively, with no significant differences. EUS detected the absence of choledocholithiasis in 65 of 66 patients (specificity = 98%). Endosonographic examination was successful in all patients, whereas ERCP was unsuccessful in 5 patients.
Post-endoscopic sphincterotomy bleeding developed in 4 patients; there was no significant EUS-related morbidity.
EUS is as accurate as ERCP in detecting choledocholithiasis and it can be used to select patients with acute pancreatitis who require therapeutic ERCP, thus avoiding diagnostic ERCP and its associated potential for complications in the majority of patients.
J Am Coll Surg 2001; 193(2):146-152.
Serial computed tomography is rarely necessary in patients with acute pancreatitis: a prospective study in 102 patients.
Munoz-Bongrand N, Panis Y, Soyer P, Riche F, Laisne MJ, Boudiaf M, Valleur P.
Department of Digestive Surgery, Lariboisiere Hospital, Paris, France.
CT has proven to be helpful in patients with acute pancreatitis for differentiating between mild and severe forms. Follow-up of acute pancreatitis with CT has been advocated but rarely studied.
The aim of this study was to determine if late CT performed at day 7 might be helpful in establishing the prognosis or the type of complications, and to select a subgroup of patients where CT could be beneficial.
Contrast-enhanced CT was performed upon admission and 7 days after admission in 102 patients admitted for acute pancreatitis. The extent of the pancreatic inflammation was classified according to the Balthazar grade, and intrapancreatic necrosis on these examinations was prospectively assessed and compared with clinical and biologic data and with patient outcomes.
Among 102 patients, complications developed in 23% of the patients. Complications developed in only 8% of patients with Ranson score less than 2, making routine early CT unnecessary. For the patients with Ranson score less than 2 and Balthazar grades A and B at day 1 CT, late CT seemed to be useless. Complications were suspected as a result of clinical and biologic tests before day 7 in 92% of patients with complications suggesting that CT should be utilized only in cases of clinical or biologic deterioration. Late CT was correlated with a complicated course in patients with Balthazar grades D and E or intrapancreatic necrosis greater than 50%. Late CT was predictive of complications in cases of intrapancreatic necrosis which increased after the first examination.
In conclusion, this study showed that, in acute pancreatitis, there is little justification for systematic early CT, especially in patients with Ranson score less than 2, and that late CT does not need to be performed routinely, but only in cases of clinical or biologic worsening.
Br J Surg 2001; 88(8):1077-83.
Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and periampullary region.
Taylor AM, Roberts SA, Manson JM.
Department of Clinical Radiology, Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK.
Computed tomography is currently the most widely available staging investigation for pancreatic tumours. However, the accuracy of CT for determining tumour resectability is variable and can be poor. Laparoscopic ultrasonography (LUS) is potentially a more accurate method for disease staging.
The authors reported their experience with LUS for staging carcinoma of the pancreatic head and periampullary region.
Fifty-one patients with potentially resectable pancreatic tumours defined at CT underwent further investigation with LUS. Twenty-seven patients subsequently had an open laparotomy. The evaluations of tumour resectability at CT and LUS were compared with the operative findings.
At LUS, 24 patients were considered to have resectable tumours, 21 non-resectable tumours and six patients were shown to have no pancreatic tumour mass. Twenty-two patients deemed to have a resectable tumour at LUS underwent surgery. Twenty patients were confirmed to have resectable disease and two patients had non-resectable disease. An additional five patients underwent surgery. In all five, the ultrasonographic diagnosis was confirmed at surgery (four patients with non-resectable disease and no pancreatic tumour in one patient). LUS prevented unnecessary extensive surgery in 53% of patients. For the 22 patients who underwent surgery for potentially resectable disease, the positive predictive value of LUS for defining tumour resectability was 91%.
Based on the authors' experience, LUS is an accurate additional investigative tool for defining tumour resectability and directing management in patients with potentially resectable carcinomas of the pancreatic head or the periampullary region.