Long-Standing Pancreatic Hyperenzymemia: Is It a Nonpathological Condition?

Chronic nonpathological pancreatic hyperenzymemia is characterized by a chronic, abnormal increase in the serum concentrations of the pancreatic enzymes including amylase, pancreatic isoamylase, lipase and trypsin. The diagnostic work-up that the physicians should recommend to subjects with hyperenzymemia to definitively assess this syndrome is still an open question. A 72-year-old female was admitted to our Pancreas Unit in December 2008 for the presence of long-standing pancreatic hyperenzymemia of 42 years duration. On admission, serum amylase activity was 160 IU/l (reference range 8–78 IU/l), serum pancreatic isoamylase activity was 91 IU/l (reference range 13–53 IU/l) and serum lipase activity was 127 IU/l (reference range 8–78 IU/l). Other laboratory examinations revealed normal blood tests except for total serum cholesterol, HDL cholesterol and serum triglycerides that was slight elevated. Abdominal ultrasonography demonstrated no alteration of the pancreatic gland. A magnetic resonance cholangiopancreatography was carried out according to our diagnostic work-up of patients with unexplained pancreatic hyperenzymemia. This examination revealed two small cystic lesions: one of 6 mm in diameter in the head of the pancreas and the other one of 9 mm in diameter in the body of the pancreatic gland. The duct of Wirsung was normal and the two cystic lesions were diagnosed as branch-type intrapapillary mucinous tumors of the pancreas. All patients with pancreatic hyperenzymemia should be strictly followed in high volume centers for pancreatic disease in order to early diagnose the possible appearance of morphological pancreatic alterations

Clinical Usefulness of the Serum Carboxypeptidase B Activation Peptide in Acute Pancreatitis

Objective To assess the sensitivity and specificity of the serum carboxypeptidase B activation peptide in diagnosing and determining the severity of acute pancreatitis. Patients Twenty consecutive patients with acute pancreatitis were studied on admission to the Emergency Room: 11 patients had mild pancreatitis, and 9 patients, severe pancreatitis. Twenty consecutive patients with non-pancreatic acute abdomen and 20 healthy subjects were also studied. Main outcome measures Serum carboxypeptidase B activation peptide was determined using radioimmunoassay. Results Nineteen of the 20 patients with acute pancreatitis (95.0%) had serum carboxypeptidase B activation peptide concentrations above the upper reference limit, whereas 1 of the 20 patients with non-pancreatic acute abdomen (5.0%) and none of the healthy subjects had serum levels of this protein above the upper reference limit. The serum carboxypeptidase B activation peptide concentrations of patients with severe acute pancreatitis were significantly higher than those of patients with mild acute pancreatitis on the 2nd (P=0.044) and 3rd days (P=0.028) of the study. The overall sensitivity and specificity of carboxypeptidase B activation peptide in assessing the severity of acute pancreatitis were 84.6% and 59.4%, respectively. Conclusions Serum carboxypeptidase B activation peptide may be used simultaneously both to diagnosis and assess the severity of acute pancreatitis on admission to the Emergency Room.Image: Box and whisker plots of serum CAPAP, amylase, lipase and C-reactive protein

Quality of Life After Pancreaticoduodenectomy Using Different Reconstruction Techniques: A Follow-up Multicenter Study

Context The only available data on quality of life (QoL) in different types of reconstruction techniques for pancreatic head resection (PHR) come from randomized studies and these studies compare only two approaches such as pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). We have no available QoL data on unselected patients as happens in routine clinical practice; in fact, surgeons tend to prefer one technique over the various other possibilities. Objective To evaluate the QoL in a 2-year follow-up study in consecutive subjects who underwent PHR with different reconstruction techniques (PJ layer end-to-side PJ (LEPJ) or duct-to-mucosa PJ (DMPJ)) with or without trans-anastomotic pancreatic duct stenting (TASPJ)] or PG. Patients One-hundred and 97 consecutive patients enrolled in three Italian surgical centres were studied: 164 (83.2%) had malignant and 33 (16.8%) had benign disease. Methods The EORTC QLQ-C30 questionnaire was administered at 5 different times for evaluation: before surgery and 6, 12, 18 and 24 months after discharge. Results PJ was performed in 189 patients (95.9%) (LEPJ in 124 (65.6%), DMPJ in 65 (34.4%)); 18 out of the 65 DMPJ patients (27.7%) had a TASPJ. A PG was carried out in 8 patients (4.1%) only. In the follow-up evaluation, the QoL significantly improved using the various surgical approaches; improvement over time was not significantly different between the PJ and the PG patients as well as between DMPJ and LEPJ, or between those with and without TASPJ. Conclusions In clinical practice surgeons should use a reconstruction technique in which they are experts; this is supported by the fact that the different surgical reconstruction techniques are equally effective in improving the QoL after PHR

Computed Tomography Evaluation of Normal Canine Abdominal Lymph Nodes: Retrospective Study of Size and Morphology According to Body Weight and Age in 45 Dogs

The morphological characteristics of the largest lymphatic vessels and lymph nodes of the body have been described through ultrasonography, although food and gas in the gastrointestinal tract can often have negative effects on the response of small abdominal structures. The aim of the study was to describe the size of normal abdominal lymph nodes (ALs) in dogs affected by disease, not including lymphadenomegaly or lymphadenopathy, and divided according to body weight and age. The ALs studied included the jejunal, medial iliac, portal, gastric, splenic, and pancreaticoduodenal lymph nodes. Statistical correlation considering body weight and age as continuous variables showed that all measurements of the ALs increased according to body weight changes (p p p < 0.05). Other characteristics (shape, attenuation, and enhancement) are subsequently reported. The resulting data can be used to categorize CT measurements of normal ALs displayed based on the body weight and age of the subjects. This study aimed to propose a new parameter of normalcy that may serve as a reference for the evaluation of infectious or neoplastic events

Glucose Intolerance in a Large Cohort of Mediterranean Women With Polycystic Ovary Syndrome

The aim of this study was to investigate the phenotypic parameters and associated factors characterizing the development of glucose intolerance in polycystic ovary syndrome (PCOS). Among the 121 PCOS female subjects from the Mediterranean region, 15.7 and 2.5% displayed impaired glucose tolerance and type 2 diabetes, respectively. These subjects were included in a single group of overweight or obese subjects presenting with glucose intolerance (GI) states. PCOS women with normal glucose tolerance (81.8%) were subdivided into two groups: those who were overweight or obese and those of normal weight. Metabolic and hormonal characteristics of the GI group included significantly higher fasting and glucose-stimulated insulin levels, more severe insulin resistance, hyperandrogenemia, and significantly higher cortisol and androstenedione responses to 1–24 ACTH stimulation. One important finding was that lower birth weight and earlier age of menarche were associated with GI in PCOS women. Frequency of hirsutism, oligomenorrhea, acne, and acanthosis nigricans did not characterize women with GI. Our findings indicate that PCOS patients with GI represent a subgroup with specific clinical and hormonal characteristics. Our observations may have an important impact in preventative and therapeutic strategies

Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers

BACKGROUND: A few studies have assessed the short-term effects of low-dose nicotine e-cigarettes, while data about nicotine-free e-cigarettes (NF e-cigarettes) are scanty. Concerns have been expressed about the use of NF e-cigarettes, because of the high concentrations of propylene glycol and other compounds in the e-cigarette vapor. METHODS: This laboratory-based study was aimed to compare the effects of ad libitum use of a NF e-cigarette or and a traditional cigarette for 5 min in healthy adult smokers (n\u2009=\u200910) and non-smokers (n\u2009=\u200910). The main outcome measures were pulmonary function tests, fraction of exhaled nitric oxide (FeNO) and fractional concentration of carbon monoxide (FeCO) in exhaled breath. RESULTS: The traditional cigarette induced statistically significant increases in FeCO in both smokers and non-smokers, while no significant changes were observed in FeNO. In non-smokers, the traditional cigarette induced a significant decrease from baseline in FEF75 (81 %\u2009\ub1\u200935 % vs 70.2 %\u2009\ub1\u200928.2 %, P\u2009=\u20090.013), while in smokers significant decreases were observed in FEF25 (101.3 %\u2009\ub1\u200916.4 % vs 93.5 %\u2009\ub1\u200931.7 %, P\u2009=\u20090.037), FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 98.3 %\u2009\ub1\u200910 %, P\u2009=\u20090.037) and PEF (109.5 %\u2009\ub1\u200914.6 % vs 99.2 %\u2009\ub1\u200917.5 %, P\u2009=\u20090.009). In contrast, the only statistically significant effects induced by the NF e-cigarette in smokers were reductions in FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 99.5\u2009\ub1\u20097.6 %, P\u2009=\u20090.041) and FEF25 (103.4 %\u2009\ub1\u200916.4 % vs 94.2 %\u2009\ub1\u200916.2 %, P\u2009=\u20090.014). DISCUSSION: The present study demonstrated that the specific brand of NF e-cigarette utilized did not induce any majoracute effects. In contrast, several studies have shown that both traditional cigarettes and nicotine-containing e-cigarettes have acute effects on lung function. Our study expands on previous observations on the effects of NF e-cigarettes, but also for the first time describes the changes induced by smoking one traditional cigarette in a group of never smokers. CONCLUSIONS: The short-term use of the specific brand of NF e-cigarette assessed in this study had no immediate adverse effects on non-smokers and only small effects on FEV1 and FEF25 in smokers. The long-term health effects of NF e-cigarette use are unknown but worthy of further investigations. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02102191

Gioie e dolori del pubblicare in modo alternativo : l'esperienza di JOP - Journal of the Pancreas

Reporto about publishing in an alternative way, using the example of JOP, the Journal of Pancreas

Medical Therapy for Advanced Pancreatic Cancer: Work in Progress

Drug resistance of pancreatic cancer cells is a wellknown phenomenon that occurs mainly as a result of active survival mechanisms sometimes associated with the non efficacious delivery of drugs due to the fibrosis which is the major constituent of pancreatic ductal adenocarcinoma [1, 2, 3]. Furthermore, it is well known that organ functions - normally at a pH of approximately 7.4 - are strongly affected by the disruption of pH homeostasis; this is due to the fact that the organs contain a large number of enzymes with pH sensitive catalytic activity. In contrast, the extracellular pH decreases to below 6.5 in the central regions of solid tumors because of the accumulation of lactate, and this phenomenon is due to poor vascularization [4, 5] associated with an increase in tumor specific aerobic glycolysis combined with impaired mitochondrial oxidative phosphorylation [6]. The diminished pH within the tumor is an additional cause of chemotherapy resistance for pancreatic tumors. Finally, other local pancreatic substances may participate in the spread of the tumors. For example, the local renin angiotensin system (RAS) promotes angiogenesis and proliferation via vascular endothelial growth factor expression or epidermal growth factor receptor expression [7, 8]. The synergistic inhibition of tumor growth has been demonstrated in experimental animals by combining the administration of gemcitabine and losartan which are able to cause vascular endothelial growth factor suppression [9] and induce apoptosis of pancreatic cancer cells by the inhibition of RAS [10, 11]. Therefore, it is necessary to develop alternative strategies and novel therapeutics for the effective treatment of advanced pancreatic cancer - which constitutes the major part of the currently diagnosed pancreatic ductal carcinomas [12] - and three papers recently published on these topics are of particular interest