Search

Background/Aims: Non-occlusive mesenteric ischemia (NOMI) has been defined as diffuse intestinal ischemia that often results in intestinal gangrene in the presence of a patent arterial trunk. The prevalence and nature of NOMI in acute pancreatitis was investigated. Methods: A total of 120 consecutive patients with acute pancreatitis managed in the Department of Surgery II, Kumamoto University Medical School, from April 1992 through December 2002, were investigated retrospectively. Among them, 60 patients had the severe form. Results: The overall mortality of acute pancreatitis patients was 8.3% (10/120). The prevalence and mortality of acute pancreatitis associated with NOMI were 6.7% (8/120) and 63% (5/8), respectively, while those of patients with NOMI-associated intestinal gangrene were 4.2% (5/120) and 100% (5/5), respectively. The mortality of patients with severe acute pancreatitis who did not develop NOMI was 10% (5/52). All patients with NOMI-associated intestinal gangrene quickly progressed and subsequently died of multiple organ failure. Plasma creatine phosphokinase (CPK) and lactate levels were elevated significantly in patients with NOMI. Conclusion: Acute pancreatitis associated with NOMI was extremely severe. If the plasma CPK and lactate levels are extremely high, NOMI should be suspected. [ABSTRACT FROM AUTHOR]

Aims: Group II phospholipase A[sub 2] (PLA[sub 2] ) is thought to play an important role in inflammation and tissue injury. It has been suggested that the inflammatory process is important in the setting and progression of myocardial ischemia or reperfusion. We measured plasma PLA[sub 2] as well as inflammatory cytokines in patients in the acute stage of myocardial infarction. Methods and Results: In 48 patients with acute myocardial infarction, blood samples were taken to measure plasma PLA[sub 2] , tumor necrosis factor-alpha (TNF-α) and interleukin-1β (IL-1β) 36–48 h after onset. Serial changes in plasma PLA[sub 2] were also examined in 15 consecutive patients in this group. Plasma PLA[sub 2] levels were significantly higher in complicated patients (Killip’s class ≥ II) than in uncomplicated patients (Killip’s class = I) (35.9 ± 11.9 vs. 5.3 ± 1.1 ng/ml, p < 0.01). Plasma PLA[sub 2] concentrations increased gradually over time during the first 3 days and at 36–48 h after onset were correlated with left-ventricular ejection fraction on admission (r = –0.42, p < 0.01), and with plasma TNF-α (r = 0.39, p < 0.01), but not with IL-1β. Conclusion: Plasma PLA[sub 2] concentrations rose during the acute stage of myocardial infarction, especially in severe cases mainly with heart failure. TNF-α may be associated with PLA[sub 2 ] activity as a potent stimulator in vivo. [ABSTRACT FROM AUTHOR]

Background/Aims: The priming mechanism of macrophages to secrete cytokines in acute pancreatitis is important for remote organ failure following septic complication. The effects of novel carboxamide derivative, IS-741, on neutrophil chemoattractant production by bronchoalveolar macrophages were studied in rats with cerulein-induced pancreatitis complicated by sepsis. Methods: Pancreatitis was induced by four intramuscular injections of cerulein (50 μg/kg at 1-hour intervals). Pancreatitis rats were injected intraperitoneally with 10 mg/kg of lipopolysaccharide (LPS) 6 h following the first cerulein injection as a septic challenge. Pancreatitis rats received a continuous intravenous injection of IS-741 (3 mg/kg/h) 30 min before the septic challenge. Results: Intense mononuclear cell infiltration and lung hemorrhage occurred in untreated pancreatitis rats complicated with sepsis, but hemorrhage was not seen in septic pancreatitis rats receiving a continuous intravenous injection of IS-741 shortly before sepsis induction. The IS-741-treated rats had lower serum concentrations of cytokine-induced neutrophil chemoattractant (CINC), as well as fewer the pulmonary neutrophils and infiltrates immunoreactive for CINC or Mac-1 (CD11b/CD18). Conclusion: The novel carboxamide derivative IS-741 reduced CINC production by bronchoalveolar macrophages and effectively prevented pancreatitis-associated lung injury following the septic challenge. [ABSTRACT FROM AUTHOR]

There are indications of the possible effects of sex hormones on pancreatic carcinoma. Estrogen receptor (ER) has been demonstrated in pancreatic tumors in experimental animals and in humans and it has been suggested that endocrine manipulation may be effective in the treatment of pancreatic carcinoma. However, it is still controversial whether this lethal cancer can potentially benefit from endocrine therapy. One explanation for the conflicting data on the benefit of hormonal manipulation in the treatment of pancreatic carcinoma may stem from the fact that there is no adequate marker to assess estrogen dependency of the pancreatic tumors. In this article, we review our work on tissue plasminogen activator as a prognostic guide to evaluate the efficacy of hormonal therapy in human pancreatic carcinoma, and also suggest that a selected subgroup of patients with this lethal cancer may have a potential clinical benefit from endocrine therapy, especially medroxyprogesterone acetate treatment. [ABSTRACT FROM AUTHOR]