The Most Common Pancreatic Diseases

Akutni i kronični pankreatitis te karcinom gušterače tri su najčešće bolesti gušterače. U ovome preglednom članku prikazani su najvažniji epidemiološki, patofi ziološki i etiopatogenetski, ali i klinički, dijagnostički i terapijski elementi navedenih bolesti. U posljednjih desetak godina u pankreatologiji je učinjen velik napredak, a neka od novih otkrića omogućila su da se pristup bolesniku s bolešću gušterače promijeni u svakodnevnoj kliničkoj praksi. Cilj je ovog članka ponuditi ponajprije liječnicima opće medicine informacije koje se odnose na suvremen pristup bolestima gušterače.Acute pancreatitis, chronic pancreatitis and pancreatic cancer are three most frequent pancreatic diseases. This overview provides the most important epidemiologic, pathophysiologic and etiopathogenetic, as well as clinical, diagnostic and therapeutic elements of these diseases. Important advances have been made in pancreatology in the last decade, and some of them have changed the approach to the patient with pancreatic disease in clinical practice. The aim of this paper is to provide practicing doctors with information regarding the current diagnostic and therapeutic approach to pancreatic diseases

Obesity and Acute Pancreatitis

Evidence accumulated for the past two decades leads to the conclusion that obesity enhances the development of acute pancreatitis and worsens its clinical course. Is this true? We will try to give an answer to this issue by presenting the scientific data accumulated thus far. “Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.“ (World Health Organization, 2000) The main problem with obesity is determining the best (and easiest) way to measure it. According to the definition, one should calculate the total amount of body fat a person has and deduct the “normal” amount of fat from it. Several methods have been developed, each with its strengths and weaknesses. (Kamel et al, 2000 ; Browning et al, 2011) Body mass index or BMI is the basic method used to determine obesity. It is a measure obtained by dividing the patient’s weight (in kilograms) with the square of his/her height (in meters) ; obesity is defined as BMI > 30 kg/m2. The method is based on the presumption that a person’s excess weight predominantly consists of fat. The advantage of this method is its application simplicity, namely the lack of complicated procedures needed to determine it as well as the fact that it has been globally accepted. The disadvantages are the consequences of the above mentioned presumption namely that a person’s excess weight predominantly consists of fat as well as the lack of body composition in the equation: a person who gains weight due to a component other than fat will have a falsely increased BMI, e.g. athletes have muscle hypertrophy ; patients with ascites (liver cirrhosis) and peripheral edema (renal failure, heart failure) accumulate water, etc. Other methods used to determine obesity measure the amount of subcutaneous fat tissue. These methods are based on the fact that the amount of subcutaneous fat tissue correlates well with the amount of excess fat tissue. The methods include the measurement of skin fold thickness, waist diameter and waist-to-hip ratio. As is the case for BMI, these methods are simple, requiring only a meter or a simple measuring instrument and the results are easily interpreted. The limiting factor for these methods is the presence of edema in the investigated areas (liver cirrhosis, heart and kidney diseases). The method that is not affected by the presence of excess water is dual-energy X-ray absorptiometry (DEXA). It is used to measure body composition based on the difference in the absorption of X-rays in different types of tissues (bone, fat, muscle, water). Compared to Acute Pancreatitis 36 other methods, DEXA is rather expensive, requires radiological equipment and a radiology specialist to interpret the results ; also, it uses radiation (X-rays), which makes it potentially harmful for the patients. After two decades of tedious work in finding the best method for estimating the amount of body fat in acute pancreatitis, scientists offer no clear answers. Although some data suggest that waist diameter and waist-to-hip ratio have the best correlation with the occurrence of complications in acute pancreatitis, BMI is still widely used as the standard procedure. The following sections offer a detailed insight into the best methods for estimating the amount of body fat in acute pancreatitis

Research of haplotypes HLA-B27 in patients with spondyloarthropathies in Croatian population

U ovom radu analizirali smo alele 5 mikrosatelita HLA (D6S248, D6S2674, D6S2811, STR_MICA i D6S273) među HLA-B27 pozitivnim nesrodnim osobama (N=94), bolesnicima s psorijatičnim artritisom (PsA) (N=22) i bolesnicima s juvenilnim spondiloartropatijama (jSpA) (N=29). U sve testirane skupine najučestaliji aleli bili su: D6S248-291pb, D6S2674-131pb, D6S2811-98pb i STR_MICA-A4, dok je na lokusu D6S273 najčešći alel među bolesnicima s jSpA i kontroli bio alel D6S273-4, a meĊu bolesnicima s PsA alel D6S273-5. Analizom bolesnika s PsA utvrdili smo da je alel D6S273-3 podložan za bolest, dok aleli D6S2811-126pb, D6S273-4, kao i haplotipska veza HLA-B*27/D6S273-4 pokazuju zaštitnu ulogu za razvoj bolesti. Među bolesnicima s jSpA otkrivena je smanjena učestalost alela D6S2674-131pb i dviju haplotipskih veza HLA-B*27/D6S2674-131 i HLA-B*27/D6S2811-98 što govori u prilog njihovoj zaštitnoj ulozi za razvoj bolesti, dok je za alel STR_MICA-A9 i haplotipsku vezu HLA-B*27/D6S248-291 utvrđena statistički značajno povišena učestalost što upućuje na zaključak da su podložni za razvoj jSpA.In this study we analyzed the alleles of 5 HLA microsatellites (D6S248, D6S2674, D6S2811, STR_MICA and D6S273) among HLA-B27 positive, healthy individuals (N=94), patients with psoriatic arthritis (PsA) (N=22) and patients with juvenile spondyloarthropaties (jSpA) (N=29). The most common alleles in all tested groups were: D6S248-291pb, D6S2674-131pb, D6S2811-98pb and STR_MICA-A4 alleles, while at the D6S273 locus, the most common allele among patients with jSpA and controls was D6S273-4 allele and among patients with PsA D6S273-5 allele. The analysis of patients with PsA determined that D6S273-3 allele is associated with an increased risk for the disease, while D6S2811-126pb and D6S273-4 alleles, as well as HLA-B*27/D6S273-4 haplotypic association show a protective role for the development of the disease. A decreased frequency of D6S2674-131pb allele and HLA-B*27/D6S2674-131 and HLA-B*27/D6S2811-98 haplotypic associations was discovered among patients with jSpA which implies their protective role for the development of the disease. On the other hand, a statistically significant increase in frequency was determined for STR_MICA-A9 allele and the HLA-B*27/D6S248-291 haplotypic association which leads to the conclusion that they are involved in the development of jSpA

Research of haplotypes HLA-B27 in patients with spondyloarthropathies in Croatian population

U ovom radu analizirali smo alele 5 mikrosatelita HLA (D6S248, D6S2674, D6S2811, STR_MICA i D6S273) među HLA-B27 pozitivnim nesrodnim osobama (N=94), bolesnicima s psorijatičnim artritisom (PsA) (N=22) i bolesnicima s juvenilnim spondiloartropatijama (jSpA) (N=29). U sve testirane skupine najučestaliji aleli bili su: D6S248-291pb, D6S2674-131pb, D6S2811-98pb i STR_MICA-A4, dok je na lokusu D6S273 najčešći alel među bolesnicima s jSpA i kontroli bio alel D6S273-4, a meĊu bolesnicima s PsA alel D6S273-5. Analizom bolesnika s PsA utvrdili smo da je alel D6S273-3 podložan za bolest, dok aleli D6S2811-126pb, D6S273-4, kao i haplotipska veza HLA-B*27/D6S273-4 pokazuju zaštitnu ulogu za razvoj bolesti. Među bolesnicima s jSpA otkrivena je smanjena učestalost alela D6S2674-131pb i dviju haplotipskih veza HLA-B*27/D6S2674-131 i HLA-B*27/D6S2811-98 što govori u prilog njihovoj zaštitnoj ulozi za razvoj bolesti, dok je za alel STR_MICA-A9 i haplotipsku vezu HLA-B*27/D6S248-291 utvrđena statistički značajno povišena učestalost što upućuje na zaključak da su podložni za razvoj jSpA.In this study we analyzed the alleles of 5 HLA microsatellites (D6S248, D6S2674, D6S2811, STR_MICA and D6S273) among HLA-B27 positive, healthy individuals (N=94), patients with psoriatic arthritis (PsA) (N=22) and patients with juvenile spondyloarthropaties (jSpA) (N=29). The most common alleles in all tested groups were: D6S248-291pb, D6S2674-131pb, D6S2811-98pb and STR_MICA-A4 alleles, while at the D6S273 locus, the most common allele among patients with jSpA and controls was D6S273-4 allele and among patients with PsA D6S273-5 allele. The analysis of patients with PsA determined that D6S273-3 allele is associated with an increased risk for the disease, while D6S2811-126pb and D6S273-4 alleles, as well as HLA-B*27/D6S273-4 haplotypic association show a protective role for the development of the disease. A decreased frequency of D6S2674-131pb allele and HLA-B*27/D6S2674-131 and HLA-B*27/D6S2811-98 haplotypic associations was discovered among patients with jSpA which implies their protective role for the development of the disease. On the other hand, a statistically significant increase in frequency was determined for STR_MICA-A9 allele and the HLA-B*27/D6S248-291 haplotypic association which leads to the conclusion that they are involved in the development of jSpA

Therapeutic approach to acute pancreatitis

Sažetak. Akutni pankreatitis obuhvaća raspon od klinički blage do teške, fulminantne bolesti. Nakon što se dijagnoza bolesti potvrdi, terapijski pristup ovisi o ranoj procjeni težine bolesti koja se temelji na kliničkim i laboratorijskim parametrima. Namjera je ovog pregleda opisati nove mogućnosti u terapiji akutnog pankreatitisa koje utječu na smanjenje morbiditeta i mortaliteta. U članku se analizira uloga početne terapije, monitoringa, nutricijske potpore, specifične terapije i antibiotske profilakse kod oboljelih od akutnog pankreatitisa. Opisuje se i pristup bolesnicima s ranim i kasnim komplikacijama bolesti koji može biti konzervativan, endoskopski i kirurški te iznose preporuke za najprikladnije postupke kod takvih bolesnika.Summary. Acute pancreatitis varies from mild to severe fulminant disease. Once the diagnosis of acute pancreatitis is established, the treatment is dependent on the early assessment of disease severity based on objective clinical and laboratory parameters. The purpose of this review is to describe the new developments in the treatment of acute pancreatitis which have an impact in the lowering of the morbidity and mortality. The roles of initial treatment and monitoring, nutritional support, specific therapy and antibiotic prophylaxis are analysed. The therapeutic approach to patients with early and late complications of acute pancreatitis could be medical, endoscopic or surgical and recommendations for relevant management are given