To clarify the characteristics of gallstone-associated severe acute pancreatitis (GSAP), 26 patients with GSAP were compared with 66 patients with alcohol-associated severe acute pancreatitis (ASAP) in our department. Age, percentage of female, and APACHE II score on admission were significantly higher in GSAP than in ASAP. The rate of necrotizing pancreatitis was significantly lower in GASP than in ASAP. Among blood biochemical parameters on admission, ALT, amylase, and BUN were significantly different between GSAP and ASAP. The proportion of patients with serum ALT above 160IU/l was significantly higher in the GSAP than ASAP group. Introduction of special therapy including EST/ENBD reduced the mortality rate associated with GSAP. In GSAP, predictable factors of prognosis were BUN, Cr, LDH, and Ca. Predictable factors of infection were LDH and BUN and that of organ dysfunction was LDH. However, these factors were not specific for GSAP. The mortality rate and incidences of infection and organ dysfunction were significantly higher in patients with LDH of more than 1,000IU/l than those with lower LDH. Our results suggest that ALT is useful for identification of GSAP and that LDH is useful for prediction of the clinical course in GSAP.

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We studied the effects of MMP inhibitor on pancreatic tissue damage in a rat pancreatic ischemia/reperfusion model. First, we compared the serum pancreatic enzyme level and histological findings after reperfusion of 3, 6, and 10 hrs following 3-hr pancreatic ischemia. The serum pancreatic enzyme reached peak levels at 6-hr reperfusion. Histologic changes worsened with longer reperfusion time (worst at 10 hrs) and included infiltration of inflammatory cells, degeneration of cell nuclei, and cellular necrosis. Administration of MMP inhibitor in a 3-hrs ischemia/10-hrs reperfusion model did not inhibit serum amylase, compared with the control group, although it reduced serum lipase level. Histologically, tissue damage was mitigated in the group administered MMP inhibitor. Thus, administration of MMP inhibitor can reduce the extent of damage associated with pancreatic ischemia/reperfusion injury.

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The aim of the present study was to clarify a usefulness of the POSSUM surgical scoring system for pancreaticoduodenectomy (PD). From May 1996 to April 2004, 141 patients underwent PD. Operative deaths were seen in 6 patients (4.3%), and postoperative complications in 43 cases (30.5%). The subjects were divided into two groups by the presence or absence of postoperative complications. Thirteen preoperative factors and 4 operative factors, and the POSSUM parameters were compared between these two groups. In terms of the preoperative factors and operative factors, there was no significant difference between the complicated group and the non-complicated group. Of the POSSUM parameters analyzed, the physiological score, operative score, predicted mortality rate and predicted morbidity rate differed significantly between the two groups. The POSSUM scoring system is useful for risk assessment of individuals scheduled to undergo PD.

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We assessed the release of colony-stimulating factor (CSF) from cultured human pancreatic periacinar myofibroblasts (PMFs). CSF release and mRNA expression were determined by ELISA and Northern blotting, respectively. Un-stimulated PMFs secreted a small amount of granulocyte (G) -and granulocyte/macrophage (GM) -CSF, and a considerable amount of macrophage (M) -CSF. Interleukin (IL) -1β and tumor necrosis factor (TNF) -α induced a marked increase of G- and GM-CSF release, and weakly but significantly enhanced M-CSF release. The combination of IL-1β plus TNF-α induced a synergistic increase in G- and GM-CSF release. Adenovirus-mediated transfer of a stable form of IκBα markedly inhibited the effects of IL-1β and TNF-α. Our results indicate that human PMFs have the machinery for CSF biosynthesis. CSFs derived from PMFs may play an important role in the pathophysiology of acute and/or chronic pancreatitis.

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We analyzed long-term outcome of acute pancreatitis (311 severe and 403 moderate cases, at 13-18 years after onset) from the data of national survey by the Intractable Diseases of the Pancreas, Japanese Ministry of Health, Labor and Welfare. The proportion of patients who continued to drink was 30.4%. Recurrence of acute pancreatitis was noted in 20.3%, and was high (20.3%) in alcoholic pancreatitis and low (7.4%) in gallstone pancreatitis. Recurrence rates of acute pancreatitis in the persistent drinkers and in patients with transition to chronic pancreatitis were high (57.7% and 74.5%, respectively). The transition to chronic pancreatitis was noted in 14.8%, and was high (26.0%) in alcoholic pancreatitis and low (1.7%) in gallstone pancreatitis. The transition rates to chronic pancreatitis in the persistent drinkers and in patients with more than twice recurrence of acute pancreatitis were high (40.9% and 61.4%, respectively). Complication with diabetes mellitus was noted in 13.0%, and the rate was high (20.6%) in alcoholic pancreatitis. The percentage of patients who developed diabetes mellitus among the persistent drinkers was high (37.2%). The mortality rate by malignancy was 6.0%. Our results indicate poor long-term outcome in alcoholic acute pancreatitis and persistent drinkers.

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A 73-year-old woman was admitted to our hospital for close examination of a pancreatic tumor detected on abdominal computed tomography (CT). Abdominal ultrasonography detected a hypoechoic mass in the head of the pancreas. Contrast CT revealed a low-density mass with ring enhancement, which appeared hypointense on T 1-weighted images and hyperintense on T 2 weighted-images. Angiography showed a hypervasculized tumor. The patient was diagnosed as a serous cystadenoma, and pylorus-preserving pancreaticoduodenectomy was performed. The tumor was composed of numerous cuboidal cells, which were reactive for NSE immunohistochemically. These clinicopathologic findings were consistent with cystic non-functioning islet cell tumor. Our case emphasizes the difficulty in preoperative differentiation between cystic islet cell tumor and honeycomb type of serous cystadenoma by radiography.

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The patient was a 72-years-old woman with a chief complaint of back pain. Abdominal contrast computed tomography showed a cystic mass measuring 11×10×7 cm, with ring-enhancement in the body and tail of pancreas. MRI detected multi-lobular, hyperintense mass on the T2-weighted image. Angiography revealed a hypervasculized tumor. We diagnosed this patient as serous cystadenoma of the pancreas. Gastrointestinal endoscopy and endscopic ultrasonography (EUS) detected a gastric tumor in which invasion was thought to be limited to the submucosa in middle body of the stomach. Spleen-reserved distal pancreatectomy and total gastrecotmy was performed. Retrospective analysis of previous reports identified 13% in a series of 69 patients with serous cystic tumor of the pancreas to be associated with malignancy of other organs. Considered together with our cases, it is important to conduct a thorough systemic examination during long-term follow-up after resection.

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A 41-year-old man was admitted to a local hospital because of epigastralgia after alcohol intake. He was diagnosed as acute pancreatitis based on elevated serum pancreatic enzyme. Serum triglyceride was found to be markedly increased (3,700 mg/dl). After transfer to our hospital, the diagnosis of severe acute pancreatitis was confirmed, and the cause was considered alcohol-induced hypertriglyceridemia. We immediately started continuous regional arterial infusion of gabexate mesilate. On the third day of hospitalization, he also required of systemic infusion of sivelestat sodium, CPAP, and CHDF due to the development of ARDS and renal failure. The intensive treatment resulted in a rapid recovery from respiratory failure and systemic inflammatory state.

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