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

Bone mineral density in patients on home parenteral nutrition: a follow-up study.

Home artificial nutrition

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

Acute pancreatitis in children. An Italian multicentre study

AIM: To evaluate the clinical, morphological and aetiological aspects of acute pancreatitis in children in Italy. PATIENTS: The hospital records of 50 consecutive patients with acute pancreatitis observed in 5 Italian Pediatric Departments were reviewed. RESULTS: A total of 25 males and 25 females (median age 10.5 years, range 2-17) were studied. Of these patients, 48 (96%) had abdominal pain. The pancreatitis was associated with biliary disease in 10 patients (20%); it was due to viral infection in 6 patients (12%), pancreatic duct abnormalities in 4 (8%, familial chronic pancreatitis in 3 (6%), trauma in 5 (10%) and other causes in 5 (10%); the pancreatitis was of unknown origin in 17 patients (34%). Previous attacks of the disease had occurred in 14 patients. A diagnosis of mild pancreatitis was made in 41 patients (82%) and of severe disease in 9 (18%). One patient with severe pancreatitis died from multiorgan failure. Patients with severe pancreatitis had significantly higher serum concentrations of C-reactive protein than patients with mild pancreatitis. Hospital stay was similar for patients with the mild form and those with the severe form of the disease. CONCLUSIONS: In Italian children, acute pancreatitis is of unknown origin in about one-third of the children and is recurrent in 28% of the cases. The disease is severe in 18% of the case

The role of inflammation in patients with intraductal mucinous neoplasm of the pancreas and in those with pancreatic adenocarcinoma

Background: There are very few data regarding inflammation in patients with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Aim: To evaluate the circulating concentrations of placental growth factor (PlGF), transforming growth factor-alpha (TGF-\u3b1), transforming growth factor-beta 1 (TGF-\u3b21), tumour necrosis factor receptor 1 (TNF-R1) and matrix metalloproteinase-2 (MMP-2) in patients with IPMNs and in those with pancreatic adenocarcinomas. Patients and Methods: Sixty-nine patients were enrolled: 23 (33.3%) had IPMNs and 46 (66.7%) had histologically confirmed pancreatic adenocarcinomas. Thirteen healthy subjects were also studied. PlGF, TGF-\u3b1, TGF-\u3b21, TNF-R1 and MMP-2 were determined using commercially available kits. Results: TNF-R1 (p=0.003) was the only protein significantly different among the three groups. Conclusion: Serum TNF-R1 was elevated in patients with IPMNs and in those with pancreatic adenocarcinomas, suggesting a high apoptotic activity in both groups of patients studied

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

Falsely low IgG4 in routine analysis - How not to miss IgG4 disease

Background IgG4 disease can have apparently “normal” levels of IgG4 due to antigen excess conditions. IgG4 measurement therefore appears falsely low. UK NEQAS data and other reports have suggested this problem occurred despite pre-existing antigen excess detection steps. Methods We examined the prevalence and characteristics of prozoning in our laboratory and patient cohorts, to determine the clinical relevance of the problem. Results We establish that the prevalence of raised IgG4 in routine IgG4 analysis is low (<1%) using one of the 2 routine methods in use in the UK. We show that subsequent assay modification appears to have reduced the likelihood of misleading readings. However, the original version of the assay prozoned to low levels (below 0.64g/L) in 41% of high IgG4 samples in our patients. This may explain the previous reports of low sensitivity of raised IgG4 for IgG4RD, and predictive values should be re-evaluated in this disease using modified prozone-resistant protocols. Conclusions All laboratories providing IgG4 measurements should verify that their assays are fit for the clinical quality requirement of detection raised IgG4 levels and must verify the upper limit of their reference ranges and freedom from prozoning

Randomised Italian Sonography for Occiput POSition Trial Ante Vacuum (R.I.S.POS.T.A.)

Objective: To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. Methods: Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. Results: On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. Conclusions: Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright \ua9 2018 ISUOG. Published by John Wiley & Sons Ltd

Evaluation of microalbuminuria in patients with erectile dysfunction

Introduction: The recent sophisticated diagnostic procedures aimed at identifying the exact cause of erectile dysfunction (ED) are often complicated in clinical application, invasive, or highly expensive. Microalbuminuria, a test easy to perform and of low cost, is a marker of extensive endothelial dysfunction, and it has been suggested to be linked to ED. Aim: The aim of this study was to investigate the eventual role of microalbuminuria in differentiating patients with arteriogenic and non arteriogenic ED. Methods: The diagnosis of ED was based on the International Index of Erectile Function 5-questionnaire, and patients were classified as arteriogenic (N = 29) and non-arteriogenic (N = 49) in relation to the results of echo-color-doppler examination of cavernosal arteries in basal conditions and after intracavernous injection of 10 \u3bcg prostaglandin E1. Main Outcome Measures: The microalbuminuria of 78 males without the most common atheriosclerotic risks and with ED was measured. Results: Microalbuminuria, defined as urinary albumin/creatinine ratio, was not significantly (P > 0.05) different between patients of the two groups. Conclusions: Our data show that in ED patients the cavernosal arteries damage, as assessed by dynamic echo-color-doppler, may be independent on or precede extensive endothelial dysfunction, and that microalbuminuria cannot be predictive of penile arteriogenic etiology

Is the pancreas affected in patients with septic shock? A prospective study

Hyperamylasemia can be observed anecdotally during the course of severe sepsis or septic shock. This study aimed to investigate the possibility of pancreatic involvement in patients with septic shock using serum pancreatic enzyme determinations and imaging techniques in 21 consecutive patients with septic shock and 21 healthy subjects as controls. METHODS: The serum activity of pancreatic amylase and lipase was assayed initially in all subjects and 24 and 48 hours after the initial observation in the 21 patients with septic shock. All patients also underwent radiological examination to detect pancreatic abnormalities. RESULTS: The serum activity of pancreatic amylase was significantly higher in the 21 patients with septic shock than in the 21 control subjects during the study period, while the serum activity of lipase was similar to that of the control subjects. Amylase and lipase serum activity did not significantly changed throughout the study period in the 21 patients with septic shock. None of the patients with pancreatic hyperenzymemia had clinical signs or morphological alterations compatible with acute pancreatitis. CONCLUSION: The presence of pancreatic hyperenzymemia in septic shock patients is not a biochemical manifestation of acute pancreatic damage, and the management of these patients should be dependent on the clinical situation and not merely the biochemical result