Search

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 2(nd) (P=0.044) and 3(rd) 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.

Amyloid A (SAA) and procalcitonin (PCT) have been reported as useful indicators of inflammation. Our aim was to assess the utility of SAA and PCT in establishing the severity of acute pancreatitis in comparison to C-reactive protein (CRP): Thirty-one patients with acute pancreatitis enrolled within 24 hr from the onset of pain and 31 healthy subjects were studied. Nineteen patients had mild acute pancreatitis, and 12 had severe pancreatitis. Serum SAA, PCT, and CRP were measured in all subjects at admission and, in acute pancreatitis patients, during the following five days. Patients with acute pancreatitis had serum concentrations of SAA, PCT, and CRP significantly higher (P < 0.001) than those of healthy subjects during the entire study period. Using cutoff values ranging from 240 to 250 mg/liter for SAA, from 0.252 to 0.255 ng/ml for PCT, and from 12.8 to 12.9 mg/dl for CRP, the sensitivity (calculated on patients with severe pancreatitis), the specificity (calculated on patients with mild pancreatitis), and the efficiency (calculated as the percentage of correct classifications) were 76.8%, 69.3%, and 72.4% for SAA; 21.7%, 83.2%, and 58.2% for PCT; and 60.9%, 89.1%, and 77.6% for CRP. In conclusion, the sensitivity of SAA is significantly higher than that of PCT and CRP in assessing the severity of pancreatitis, whereas PCT and CRP had a specificity significantly higher than SAA. The accuracy and efficiency were similar for SAA and CRP, and both these markers had an accuracy and efficiency significantly higher than those of PCT.

Aim: To establish whether serum pancreatic enzyme determination is useful in the identification of patients with chronic pancreatitis and in revealing the presence of exocrine pancreatic insufficiency, Patients and Methods: A total of 50 patients with chronic pancreatitis were included in the investigation: 19 were studied during a painful attack of the disease and 31 were observed during clinical remission of the disease and underwent a secretin-caerulein test; 21 of the 31 patients had severe pancreatic insufficiency. Thirty patients with non-pancreatic digestive diseases were also studied. Serum amylase, pancreatic isoamylase, lipase, trypsinogen and elastase- were determined in all patients., Results: Serum levels of the 5 enzymes studied were significantly higher in patients with pancreatic pain than in those studied during a clinical remission of the disease, and in those with non-pancreatic digestive diseases. In patients with chronic pancreatitis studied during clinical remission of the disease serum levels of pancreatic isoamylase and trypsinogen were significantly lower than in those patients with non-pancreatic digestive diseases. Considering only low serum concentrations of the five enzymes studied in diagnosing chronic pancreatitis, trypsinogen showed a sensitivity of 28%, specificity of 100%, a predictive value of a positive test of 100% and a predictive value of a negative test of 96.4%. In the 21 patients with severe pancreatic insufficiency, abnormally low serum concentrations of trypsinogen were found in 12 patients (57%), of lipase and elastase-1 in 6 (29%), of pancreatic isoamylase in 5 (24%), and of amylase in 3 (14%)., Conclusions: Serum pancreatic enzymes can not be considered a useful tool to identify patients with pancreatic insufficiency. However, of the five enzymes studied, serum trypsinogen appears to be a useful marker in the diagnostic work-up of chronic pancreatitis.

Background: Prostate-specific antigen has been considered a specific and sensitive marker of prostate cancer. In recent years, it has been reported that prostate-specific antigen may also be found in pancreatic tissue; however, very little evidence of serum levels of this protein in pancreatic disease has been forthcoming., Aims: To explore the possibility that pancreatic diseases may influence both total and free serum prostate-specific antigen., Patients and Methods: A total of 72 females were studied: 44 patients with acute pancreatitis: 6 with chronic pancreatitis: 12 with pancreatic carcinoma and 10 healthy volunteers. Total and free serum prostate-specific antigen were measured using commercial kits., Results: In patients with acute pancreatitis, total and free serum prostate-specific antigen were detectable in two out of the 44 patients (5%). In patients with chronic pancreatitis, total and free serum prostate-specific antigen were undetectable, whereas 4 out of the 12 patients (33%) with pancreatic carcinoma had detectable serum levels of total and free prostate-specific antigen., Conclusions: Female patients with acute pancreatitis and especially those with pancreatic cancer may have detectable serum levels of total and free prostate-specific antigen. Further studies are necessary to understand why these molecules are elevated in patients with pancreatic diseases, thus affecting the specificity of prostate-specific antigen determination as a prostate tumour marker.

Background: There are no systems for the rapid diagnosis and prognosis of acute pancreatitis in the Emergency Department. Our aim was to evaluate whether the combined use of serum lipase and interleukin-6 or serum lipase and C-reactive protein is able to simultaneously establish both the diagnosis and the prognosis of acute pancreatitis., Methods: Eighty patients with acute abdomen were studied on admission to the Emergency Room. Forty patients had nonpancreatic acute abdomen, and 40 had acute pancreatitis (25 had mild acute pancreatitis and 15 had severe pancreatitis). Forty healthy subjects comparable for sex and age were also studied as controls. Lipase, interleukin-6, and C-reactive protein were determined on serum in all subjects., Results: Using lipase to discriminate between patients with nonpancreatic acute abdomen and patients with acute pancreatitis (cutoff values ranging from 419 to 520 U/L), one patient with acute pancreatitis was not identified correctly. To discriminate between patients with severe acute pancreatitis and those with mild pancreatitis in the remaining 39 patients, interleukin-6 (cutoff value, <3.7 microgram/L) had a sensitivity of 100% (15 of 15) and a specificity of 83% (20 of 24); 75 of 80 (94%) patients were classified correctly. C-reactive protein (cutoff values ranging from 6 to 7 mg/L) showed a lower prognostic efficiency than interleukin-6: sensitivity of 87% (13 of 15) and specificity of 46% (11 of 24). Sixty-four of 80 patients (80%) were classified correctly. The area under the ROC curve for interleukin-6 (0.911 +/- 0.049) was significantly (P = 0.013) greater than that for C-reactive protein (0.685 +/- 0.090)., Conclusion: The combined use of serum lipase and interleukin-6 is useful in simultaneously establishing both the diagnosis and the prognosis of acute pancreatitis.

Over the last few years, remarkable progress has been made in diagnosis, severity assessment and treatment as well as in our understanding of the pathophysiology of acute pancreatitis. New treatment modalities and new specific drugs have been introduced and this has led to practical changes in the daily bedside management of patients with acute pancreatitis. Treatment is essentially medical, both for mild and severe disease, and is aimed at reducing abdominal pain, restoring electrolyte and fluid losses, removing the aetiological factor(s), attenuating inflammation and autodigestive processes, as well as preventing local and systemic complications. Diagnostic and interventional percutaneous or endoscopic procedures are indicated mainly for patients with severe forms of the disease. Surgery is generally indicated for patients with necrosis infection or other local complications not manageable by percutaneous or endoscopic means.

We compared the morphologic findings of the common bile duct by ultrasonography and endoscopic retrograde cholangiopancreatography in patients with biliary acute pancreatitis. Forty-five patients were studied. The diagnosis of acute pancreatitis was based on the presence of characteristic abdominal pain associated with an elevation of serum amylase and lipase concentrations. All patients underwent ultrasonography and subsequently urgent endoscopic retrograde cholangiopancreatography and eventually endoscopic sphincterotomy. Ultrasonography showed gallstones in 33 patients and sludge of the gallbladder in seven patients. In the common bile duct, lithiasis was found in two patients and sludge in 25. Endoscopic retrograde cholangiopancreatography showed choledocolithiasis in eight patients and sludge of the common bile duct in 32. In 27 cases (60%) concordance occurred between ultrasonographic and endoscopic retrograde cholangiopancreatographic detection of lithiasis or sludge of the common bile duct. The average diameter of the common bile duct determined by sonography was significantly smaller (P < 0.001) than that obtained by endoscopic retrograde cholangiopancreatography. The evaluation of this parameter indicated that a good correlation existed between the values obtained with the two techniques (r(s) = 0.765, P < 0.001). Both ultrasonography and endoscopic retrograde cholangiopancreatography can provide reliable measurements of the common bile duct diameter. Ultrasonography is the technique of choice in the initial investigation of patients with biliary acute pancreatitis.

We evaluated the behavior of sera interleukin p70 (IL-12p70) and IL-12p40 in patients with acute pancreatitis. Twenty-three acute pancreatitis patients were studied (12 had severe pancreatitis and 11 had mild pancreatitis). Twenty healthy subjects were studied as controls. Serum concentrations of total IL-12, IL-12p70, IL-12p40, and IL-6 were determined in all subjects on admission to the hospital; in patients with acute pancreatitis, the serum levels of these molecules also were determined for the 5 days after admission. Acute pancreatitis patients had serum concentrations of total IL-12, IL-12p40, and IL-6 significantly higher (p < 0.05) than those of the healthy subjects from the first to the sixth day of the study; serum concentrations of IL-12p70 were significantly higher in acute pancreatitis patients (p < 0.02) than in the healthy subjects on the first of the disease and significantly lower (p < 0.05) on the second, third, and fourth days of illness. Reduction of IL-12p70 in acute pancreatitis patients was not due to a failure of the monocytes because the production of IL-6 was increased. Increased amounts of IL-12p40 in acute pancreatitis patients may be responsible for their increased susceptibility to infection.

Background: To evaluate the efficacy of the peripheral leukocyte count and chest X-rays as an index which could be used in the early assessment of the severity of acute pancreatitis in an Emergency Room., Methods: We prospectively evaluated the peripheral leukocyte count and the findings of chest X-rays in 181 consecutive patients (102 males, 79 females, mean age 61 years, range 16-97) who were admitted to our Emergency Department with acute pancreatitis. One hundred twenty six patients had mild pancreatitis and 55 had severe pancreatitis. The peripheral leukocyte count and the chest X-rays were evaluated in all patients upon admission. The Ranson criteria were also assessed., Results: Using a cut off value of 13,000/mm3, 45% of the patients with severe pancreatitis and 17% of those with mild acute pancreatitis had a peripheral leukocyte count greater than 13,000/mm3. Pleural or pulmonary alterations observed on chest X-ray were found in 66% of patients with severe pancreatitis and in 2% of those with mild acute pancreatitis. A peripheral leukocyte count greater than 13,000/mm3 and/or pleural or pulmonary alterations present on chest X-ray were found in 78% of the patients with severe pancreatitis and in 19% of those with mild pancreatitis. The Ranson criteria greater than or equal to three were found in 45% of the patients with severe acute pancreatitis and in 16% of those with the mild form of the disease. The positive predictive value was 92% for the presence of alterations on the chest X-rays, 64% for the alteration of at least one of the abnormal findings on the chest X-ray and a peripheral leukocyte count greater than 13,000/mm3, 56% for a peripheral leukocyte count greater than 13,000/mm3, and 54% for the presence of Ranson criteria greater than or equal to three. The negative predictive values were similar., Conclusions: The presence of pleural or pulmonary alterations on chest X-rays may be useful in the Emergency Room for the early identification of patients with severe acute pancreatitis.

It has been reported that electrocardiographic abnormalities may be associated with acute pancreatitis. However, the data are lacking or sketchy. The aim of this study was to assess the frequency and type of electrocardiographic abnormalities present in patients with acute pancreatitis. Fifty-six consecutive patients with acute pancreatitis and without previous history of heart disease were studied. Eleven patients had arterial hypertension. Forty-one patients had mild pancreatitis and 15 had the severe form of the disease. On admission, all patients underwent a standard 12-leads electrocardiogram and a serum electrolyte determination. Nineteen healthy subjects were also studied as controls. Twenty-seven patients (48.2%) (10 with severe pancreatitis and 17 with mild pancreatitis) had a normal electrocardiogram. In the remaining 29 patients (51.8%), one patient with severe pancreatitis had atrial extrasystoles and eight had bradycardia (less than 60 beats/minute) (two with severe pancreatitis and six with mild pancreatitis); 14 patients had changes of the T-wave and/or the ST-segment (two with severe pancreatitis and 12 with mild pancreatitis); seven patients showed disturbances of the intraventricular conduction (one with severe pancreatitis and six with mild pancreatitis): four had left anterior hemiblock, two had complete left bundle branch block and one had left anterior hemiblock and incomplete right bundle branch block; one patient with mild pancreatitis had atrioventricular block (first degree). No differences in heart rate, RR interval, PR interval and QT interval were found when patients with acute pancreatitis were compared with healthy subjects, nor when patients with severe pancreatitis were compared with those having the mild form of the disease. Seventeen of the 29 patients with electrocardiographic abnormalities (52.6%) also had serum electrolyte alterations. More than 50% of the patients with acute pancreatitis had electrocardiographic abnormalities and electrolyte alterations were also present in about one-half of these.

Serum amylase and lipase concentrations were determined in 78 patients with chronic liver diseases [26 chronic active hepatitis (CAH) and 52 liver cirrhosis] and in 15 healthy subjects. Pancreatic isoamylase concentrations and macroamylase complexes were assayed in hyperamylasemic sera. Serum amylase levels were abnormally elevated in 27 patients (35%; 22 liver cirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 liver cirrhosis, 1 CAH). In 9 of the 27 hyperamylasemic patients, the hyperamylasemia was of pancreatic type. Macroamylasemic complexes were not detected in hyperamylasemic sera. Patients with liver cirrhosis had serum levels of amylase and lipase significantly higher than both the healthy subjects and the patients with CAH, while no significant differences were found in serum levels of these enzymes in patients with CAH as compared to the healthy subjects. A decreased liver metabolism of serum amylase and lipase in patients with chronic infective liver disease, especially in those having liver cirrhosis, may lead to an accumulation of these enzymes in the blood.

Aims: To establish the incidence of rhabdomyolysis in patients with acute pancreatitis and to determine the effectiveness of myoglobin in assessing the severity of the disease., Methods: Sixty-one patients having acute pancreatitis (33 males, 28 females, mean age 66 years, range 16-97 years) were studied; diagnosis of acute pancreatitis was based on the typical abdominal pain associated with elevated concentrations of serum lipase and further confirmed by imaging techniques. Rhabdomyolysis was defined as a level of serum myoglobin which is two or more times greater than the upper normal test limit. All patients had normal renal function at the time of the study, none had clinical and/or electrocardiographic signs of acute myocardial infarction and none were drug addicts. Forty-five patients had mild acute pancreatitis and 16 had the severe form of the disease. Serum myoglobin was determined using a nephelometric technique., Results: Patients with mild pancreatitis had serum concentrations of myoglobin (median and range; 35.7, 24-713 microg/L) similar to those with severe pancreatitis (26.8, 24-710 microg/L). Twelve of the 61 patients with acute pancreatitis (20%) had serum myoglobin concentrations above the upper normal limit: eight of the 45 patients with mild pancreatitis (17.7%) and four of the 16 patients with severe pancreatitis (25.0%). Four of the 61 patients with acute pancreatitis (7%) had serum myoglobin levels more than twice the upper normal limit: two with mild disease and two with the severe form of pancreatitis., Conclusions: Rhabdomyolysis may occur asymptomatically in patients with acute pancreatitis, especially in those with the severe form of the disease. Serum myoglobin determination is not useful in establishing the severity of acute pancreatitis.

Background: We previously identified serum creatinine values >2 mg/dL (176.8 micromol/L) and pathological chest radiographs due to the presence of pleural effusions or pulmonary densifications as two early prognostic factors of life-threatening acute pancreatitis (AP). The aim of the present study was to validate their prognostic efficacy in combination., Methods: We analyzed as prognostic factors only the data obtained within 24 hours of admission in 539 cases of AP, including 163 patients (30.2%) with acute necrotizing pancreatitis (NP). Eleven patients (2%) presented with infected pancreatic necrosis, and 20 patients (3.7%) died., Results: One hundred and nine cases (20.2%) presented pathological chest radiographs: 32 (5.9%) pulmonary densifications and 77 (14.3%) pleural effusions (18 right, 25 left, 34 bilateral). Fifty-one patients (9.5%) had serum creatinine values >2 mg/dL. Pathological chest radiographs and serum creatinine values >2 mg/dL were significantly associated both with mortality risk (P <0.00001), with a diagnosis of NP (P <0.00001), and with risk of developing infected necrosis (P <0.0001). Considering positivity of either or both tests, the mortality risk sensitivity was 90% (95% confidence interval [CI] 70.7 to 98.3) with a specificity of 76% (CI 72.5 to 79.8), for the NP diagnosis the sensitivity was 60% (CI 52.5 to 67.4) and the specificity 88% (CI 85.0-91.5), whereas for the risk of infected necrosis the sensitivity was 73% (CI 42.2 to 92.6) and specificity 75% (CI 70.1 to 78.4). These data are comparable to those obtained with the Ranson or Glasgow scores at 24 hour in this patient group, with a cut-off > or =3., Conclusions: Serum creatinine and chest radiographs are two indices capable of identifying, within 24 hour of admission, a subgroup of acute pancreatitis patients with a more severe or adverse clinical course.

This study assessed the diagnostic accuracy of fecal elastase 1 in chronic pancreatitis. Fifty-three healthy subjects, 44 patients with chronic pancreatitis (22 severe, 13 moderate, and 9 mild), and 43 patients with nonpancreatic digestive disease were studied. Elastase 1 concentration was determined on a small sample of feces using a commercially available kit. Fecal chymotrypsin was also measured. With a cutoff level of 190 microg/g, all healthy controls except one (98.1%), and the majority of patients with nonpancreatic digestive diseases (40 of 43; 93.0%) had elastase values above this limit. Among the 44 patients with chronic pancreatitis, 34 (77.3%) had pathological values: all 22 (100%) with severe disease, 10 of 13 (76.9%) with moderate disease and 2 of 9 (22.2%) with mild disease. Chymotrypsin values were pathological in 25 of 44 (56.8%) patients with chronic pancreatitis: 17 of 22 (77.2%) with severe pancreatitis, 7 of 13 (53.8%) with moderate pancreatitis, and 1 of 9 (11.1%) with mild disease. The specificity was 95.8% for elastase 1 and 85.4% for chymotrypsin. The difference both in sensitivity and specificity of the two enzymes was statistically significant (P < 0.05). Fecal elastase 1 has a high sensitivity, superior to that of fecal chymotrypsin, in the diagnosis of chronic pancreatitis. For its simplicity and rapidity, it could represent the tubeless test of choice in chronic pancreatitis.

Hypoglycemia is known to produce various EKG changes, including arrhythmias. Although these changes have been rarely documented, their presence may pose diagnostic and therapeutic problems in an emergency situation. We report the case of a 81-year-old man with insulin-dependent diabetes mellitus who showed electrocardiographic features of acute myocardial ischemia during an episode of hypoglycemia; these alterations disappeared after glucose administration.

In the Emergency Department it is mandatory to establish the diagnosis and the prognosis of acute pancreatitis as soon as possible. To evaluate whether the association of serum lipase either with serum beta2-microglobulin or with C-reactive protein allows simultaneously to establish the diagnosis and the prognosis of acute pancreatitis, 96 patients with acute abdomen were studied. Fifty-eight patients had non-pancreatic acute abdomen and the remaining 38 had acute pancreatitis: 23 mild acute pancreatitis, and 15 severe acute pancreatitis. Forty healthy subjects were studied as controls. Lipase, beta2-microglobulin and C-reactive protein were determined in the serum of all subjects, using commercial kits. One patient with acute pancreatitis was not correctly classified when lipase was used to discriminate between patients with non-pancreatic acute abdomen and those with acute pancreatitis. For the discrimination of patients with severe acute pancreatitis from those with the mild form of the disease in the remaining 37 acute pancreatitis patients, beta2-microglobulin had a sensitivity of 53.3 %, specificity of 81.8%, and prognostic accuracy of 70.3 % (27 of the 37 patients correctly classified); 87.5 % of the 96 cases were correctly classified. C-reactive protein showed a lower prognostic accuracy than beta2-microglobulin: sensitivity 86.7%, specificity 45.5%, accuracy 62.2 %; 84.4 % of the cases were correctly classified. Using the polychotomous logistic regression analysis we found the same accuracy in discriminating between patients with acute pancreatitis and those with non-pancreatic acute abdomen (99.0%) but a lower accuracy (54.1%) between patients with severe acute pancreatitis and those with the mild form of the disease. Our study shows that the association of serum lipase with beta2-microglobulin or with C-reactive protein is not useful in simultaneously establishing the diagnosis and prognosis of acute pancreatitis.

Background/aims: To correlate the severity of acute pancreatitis with the etiology, age and sex of the patients., Methodology: 158 consecutive acute pancreatitis patients (92 males, 66 females; mean age 59.7+/-18.1 years; mean+/-SD) who were admitted to our Emergency Department between January 1991 and March 1995 were included in this study. The diagnosis of acute pancreatitis was made on the basis of the characteristic abdominal pain associated with hyperamylasemia and hyperlipasemia and was further confirmed by ultrasonography and/or computed tomography findings., Results: Acute pancreatitis was associated with biliary disease in 112 patients (70.9%), due to alcohol abuse in 26 patients (16.5%), due to other causes in 8 (5.1%), and was of unknown origin in 12 (7.6%). On the basis of the Atlanta criteria, 110 patients (69.6%) were diagnosed as having mild acute pancreatitis and 48 (30.4%) as having the severe form of the disease. The age of the males was significantly lower than that of females; the age of patients with biliary pancreatitis was significantly higher than that of the overall population, whereas the age of patients with acute pancreatitis due to other causes was significantly lower. A significantly higher frequency of acute biliary pancreatitis was found in females (97.0%) as compared to males (52.2%), while alcoholic pancreatitis and pancreatitis due to other causes was present only in males (28.3% and 8.7%, respectively)., Conclusions: An age greater than 55 years, the male sex, pancreatitis of unknown origin and alcoholic pancreatitis were positively associated with the severity of the disease.

To our knowledge, only two cases of pancreatic involvement after tricyclic overdose have so far been described in the literature. We report another case of pancreatic involvement after tricyclic antidepressant overdose. Patient. A 30-year-old female was admitted to our Emergency Room after having ingested 800 mg of amitriptyline in a suicide attempt. On the second day of hospitalization, high serum values of amylase 823 IU/l (normal values < 220 IU/l) and lipase 1054 IU/l (normal value < 270 IU/l) were found. The pancreas appeared normal upon ultrasonography. Serum pancreatic enzymes further increased on the third day of hospitalization, peaked on the fourth day and then progressively decreased. Repeated ultrasonography examination did not show any alteration in the pancreatic gland. The patient was discharged eight days after admission. Fifteen days after the overdose episode, the ultrasonographic examination still did not show any alteration of the pancreatic gland, and serum amylase and lipase were 403 IU/l and 239 IU/l, respectively. In our opinion, serum pancreatic enzymes should be determined in patients with tricyclic overdose in order to detect possible pancreatic involvement.

Background: Data concerning the interleukin 6 pattern in acute biliary pancreatitis are lacking., Aim: To define the best cut-off point of this molecule in differentiating the severe form of acute biliary pancreatitis from the mild form and to evaluate its sensitivity, specificity and diagnostic accuracy in the prognosis of acute biliary pancreatitis in comparison with those of serum C-reactive protein., Patients: Forty-four patients with acute biliary pancreatitis: 27 patients with mild pancreatitis and 17 with the severe form of the disease., Methods: Serum interleukin-6 and C-reactive protein concentrations were assessed in all patients on admission and for the following 5 days., Results: Serum interleukin-6 levels were significantly higher (p < 0.02) in patients with severe acute biliary pancreatitis than in those with the mild form of the disease. No significant difference in serum C-reactive protein levels was found in the first 2 days in patients with mild biliary pancreatitis when compared to those with the severe form of the disease. Using a cut-off point of 2.7 pg/ml for serum interleukin-6 and 11 mg/dl for serum C-reactive protein, the sensitivity of the two molecules in assessing the severity of acute pancreatitis on the first day of the study was 87.5% for interleukin-6 and 6.3% for C-reactive protein, the specificity, 83.3% for interleukin-6 and 91.7% for C-reactive protein, and the accuracy 85.0% for interleukin-6 and 57.5% for C-reactive protein., Conclusions: Serum determination of interleukin-6 in the first 24 hours of the disease is a better marker of the severity of acute biliary pancreatitis than C-reactive protein.

It was recently demonstrated in experimental models that, after pancreatic outflow obstruction, serum amylase levels first increase and then progressively decline regardless of whether the obstruction was maintained or relieved. Furthermore, early decompression of the ductal biliary system may prevent the progression of the disease. This finding prompted us to look for a similar pattern in patients with obstructive acute pancreatitis due to biliary stones. Forty-two patients with biliary acute pancreatitis were prospectively studied. Twenty-one patients underwent urgent endoscopic sphincterotomy (ES), and 21 received conservative medical treatment (CMT). The two groups were comparable for sex, age, onset of pain, and severity. Serum amylase and lipase were determined in all patients on admission and 24 h later. The percentage variation of serum amylase and lipase was calculated considering, for each patient, the concentrations of the two enzymes assayed on admission and 24 h later. On admission, all patients had elevated serum concentrations of amylase (mean +/- SEM: ES, 2,560+/-473 U/L; CMT, 1,783+/-481 U/L) and lipase (ES, 3,037+/-574 U/L; CMT, 3,179+/-724 U/L). The serum amylase variation (mean +/- SEM) was -65.6+/-5.5% in the ES and -47.2.1+/-8.1% in the CMT patients. The serum lipase variation was -59.1+/-7.7 and -33.1+/-18% in the same groups, respectively. These differences were not statistically significant. Acute pancreatitis worsened in one patient in the ES group and in seven in the CMT group; this difference was statistically significant (p < 0.02). The mean length of hospitalization was 8.9 days in the ES group and 19.7 days in the CMT group (p < 0.001). Serum pancreatic enzymes determination is not useful to evaluate the results of the early decompression of biliary duct in human acute pancreatitis. Indeed, early endoscopic sphincterotomy may result in a substantial improvement in the outcome of biliary acute pancreatitis.

We examined the feasibility of the lipase-amylase (L/A) ratio to differentiate alcoholic from nonalcoholic acute pancreatitis in a large prospective series of patients with acute pancreatitis. One hundred fifty-eight consecutive patients with acute pancreatitis were studied. The pancreatitis was of biliary origin in 112 patients, due to alcohol abuse in 26, due to other causes in 8, and of unknown origin in 12. For all patients, serum, amylase, and lipase levels were determined simultaneously, and the L/A ratio was calculated using the amylase and lipase serum levels expressed as multiples of the respective upper normal limit. The ratios in patients with alcoholic acute pancreatitis ranged from 0.3 to 8 and in patients with nonalcoholic acute pancreatitis from 0 to 19.9. A value of 2.2 for the serum L/A ratio was found to be the best cutoff value for differentiating alcoholic from nonalcoholic acute pancreatitis. Using this limit, the sensitivity, specificity, and diagnostic accuracy of the L/A ratio in determining the alcoholic form of acute pancreatitis were 54%, 82%, and 77% respectively. Our study showed that the L/A ratio is not useful in distinguishing alcoholic from nonalcoholic acute pancreatitis.

Background/aim: Ingestion of a meal causes the release of cholecystokinin and neurotensin into the circulation, but little is known about the duration of this release., Methods: Six healthy volunteers were studied. Blood samples for cholecystokinin, neurotensin and gastrin assessment were drawn before and after consumption of a typical Italian lunch. Postprandial samples were obtained every hour for a total of 10 hours. All peptides were measured using previously validated radioimmunoassays., Results: Ingestion of the meal caused a prompt and significant increase in plasma levels of all three peptides. Cholecystokinin remained elevated for about 7 hours and then tended to return towards basal values, whereas the increase of neurotensin persisted for the entire period of the study (10 hours). Gastrin remained elevated for about 5 hours and then declined. The integrated CCK and gastrin responses during the initial postprandial hours were greater than those in the late hours, whereas the integrated neurotensin response during the initial hours was lower than that in the late hours., Conclusions: The results indicate that, after an ordinary meal, cholecystokinin is released into the circulation for about 7 hours, much longer than previously reported (3-4 hours). The release of neurotensin begins soon after the meal and persists even longer, for at least 10 hours. Possible physiological implications of these findings are discussed.

Background: The cut-off point of serum C-reactive protein to differentiate the mild from the severe form of acute pancreatitis is still debated; data concerning the C-reactive protein pattern in assessing the severity of acute biliary pancreatitis are lacking., Aim: To define the best cut-off point in differentiating the severe from the mild form of acute biliary pancreatitis., Patients: Fifty patients with acute biliary pancreatitis: 34 patients with mild pancreatitis and 16 with the severe form of the disease were studied., Methods: Serum C-reactive protein concentrations were assessed in all patients upon admission and for the following 5 days., Results: No significant difference in serum C-reactive protein levels was found in the first 2 days in patients with mild pancreatitis compared to those with the severe form of the disease. Using a cut-off point of 11 mg/dl, the sensitivity of serum C-reactive protein in assessing the severity of acute pancreatitis during the first two days of the study was 9% and 57%, the specificity, 93% and 81%, and the accuracy 71% and 74%, respectively., Conclusions: Serum determination of C-reactive protein in the first 48 hours of the disease is not a reliable marker of the severity of acute biliary pancreatitis.

Background: Few studies have dealt with the effect of i.v. administration of lipids on gallbladder emptying, and the results have been conflicting., Methods: Five healthy volunteers, three women and two men, aged 26 to 54 years, (mean, 29 years) were studied. Gallbladder emptying was assessed by means of real-time ultrasonography., Results: In all subjects, the infusion of a 10% fat emulsion (Intralipid; Kabivitrum, Stockholm) over 3 hours caused a reduction in gallbladder volume. This effect was statistically significant at about 80 minutes of lipid infusion and became progressively more marked as the infusion progressed, reaching a reduction of approximately 30% during the third hour of infusion. A significant relationship (p < .001) was found between the concentration of serum triglycerides and the degree of gallbladder volume decrease. In control studies, infusion of physiologic saline containing glycerol, the excipient of intralipid, caused no significant changes in gallbladder volume., Conclusions: The results indicate that i.v. infusion of lipids is able to stimulate significantly contraction of human gallbladder.

Objectives: Pancreatitis-associated protein (PAP) is a secretory protein that is overexpressed by the pancreas during acute pancreatitis. This study was carried out to assess the clinical value of PAP in acute pancreatitis, particularly its ability to indicate the severity of the disease., Methods: Twenty-one healthy subjects, 58 patients with acute pancreatitis, and 20 patients with nonpancreatic acute abdomen were studied. In addition to serum PAP concentration, serum concentrations of amylase, lipase, and C-reactive protein (CRP) were measured at admission and, in patients with acute pancreatitis, during the following 5 days., Results: On admission, serum PAP concentrations were abnormally high in 46 of the 58 patients with acute pancreatitis (79%); serum amylase, in 57 patients (98%); serum lipase, in all patients (100%); and serum CRP, in 40 patients (69%). During the subsequent days of the study, PAP and CRP tended to increase, whereas amylase and lipase decreased. No significant differences in PAP or amylase and lipase concentrations were found between patients with mild pancreatitis and those with severe pancreatitis during the entire study period, whereas from the third day to the sixth day, CRP concentrations were significantly higher in patients with severe pancreatitis than in those with mild pancreatitis. Among the 20 patients with nonpancreatic acute abdomen, PAP concentrations were abnormally high in 10 (50%), whereas amylase concentrations were abnormally high in five (25%), and lipase concentrations were high in two (10%)., Conclusions: Our results indicate that the clinical value of PAP in acute pancreatitis is quite limited and, in particular, that PAP is not a useful marker for determining the severity of the disease.

Unlabelled: Recently, a new ELISA kit for determination of elastase 1 in faeces has become commercially available. Studies in patients with chronic pancreatitis have indicated that it is a simple and sensitive test of exocrine pancreatic function. The aim of this study was to assess the clinical value of this new test in cystic fibrosis. A total of 72 children were studied: 27 who were healthy, 22 with cystic fibrosis and 23 with non-pancreatic disorders. Oral pancreatic extracts were not discontinued in the children with cystic fibrosis. A small sample of faeces was collected from each subject for elastase 1 concentration and chymotrypsin activity determination. In all of the healthy children and most of those with non-pancreatic disorders (20/23), elastase 1 concentrations were greater than 500 microg/g; in contrast, the vast majority (20/22) of children with cystic fibrosis had very low values (less than 20 microg/g). The differences between children with cystic fibrosis and the other two groups were highly significant (P < 0.001). With a cut-off level of 132 microg/g, the sensitivity and specificity of faecal elastase 1 for the determination of exocrine pancreatic insufficiency were 96% and 100%, respectively. The specificity of faecal chymotrypsin was 96%, but its sensitivity was not calculated since the children with cystic fibrosis continued to take pancreatic extracts during the study., Conclusion: The determination of faecal elastase 1 concentration is a simple and reliable means of assessing exocrine pancreatic function in children with cystic fibrosis. Results are not influenced by non-pancreatic disorders or by enzyme supplementation.

Interleukin 10 (IL-10) recently emerged as an antiinflammatory cytokine that inhibits the secretion of proinflammatory cytokines by monocytes and/or macrophages and the release of free oxygen radicals. It has been reported that treatment with IL-10 decreases the severity of experimental pancreatitis, mainly by inhibiting cellular necrosis. The aim of this study was to evaluate the behavior of serum IL-10 in patients with acute pancreatitis and to explore the possibility of a relationship between this cytokine and severity of the disease. Forty-five patients with acute pancreatitis were studied. Acute pancreatitis was of biliary origin in 30 patients, due to alcohol abuse in 10, due to pancreas divisum in 1, and of unknown origin in the remaining 4. According to the Balthazar criteria, 19 patients had scores of A, B, or C and 25 had scores of D or E. Twelve healthy subjects were also studied as controls. Serum IL-10 was determined in all subjects on admission, and in acute pancreatitis patients also daily for the following four days using a commercial kit. Healthy subjects had no detectable serum levels of IL-10. In acute pancreatitis patients, serum IL-10 levels were increased on the first day of the disease and then progressively decrease in the following days. On the first day of the acute pancreatitis, patients with the mild disease had serum levels of IL-10 significantly higher than those with severe disease, whereas in the following days, no statistically significant difference was observed between the two groups. The elevation of IL-10 on the first day of the illness is more marked in patients with mild acute pancreatitis than in those with the severe form of the disease. The finding of low values of serum IL-10 in severe acute pancreatitis suggests that there may be altered down-regulation of the immune system response in these patients.

Background and Aims: The aim of this study was to evaluate the incidence in the serum of elevated levels of amylase, pancreatic isoamylase, and lipase in acute alcohol intoxication among occasional drinkers and chronic alcoholics, and to assess the diagnostic ability of the three enzymes for acute alcoholic pancreatitis., Patients and Methods: One-hundred and seventeen consecutive subjects with acute alcohol intoxication but no abdominal pain (47 occasional drinkers, 70 chronic alcoholics), and 17 with acute alcoholic pancreatitis were studied. For all subjects serum amylase, pancreatic isoamylase, and lipase were determined using commercially available kits., Results: Among occasional drinkers, serum amylase levels were abnormally high in 6 subjects (13%), whereas serum pancreatic isoamylase and lipase were abnormally high in one, (2%). In chronic alcoholics without abdominal pain serum amylase and lipase were abnormally high in 10 subjects (14%) but serum pancreatic isoamylase in only 7 (10%). In patients with acute alcoholic pancreatitis, serum amylase and pancreatic isoamylase were abnormally high in 16 of the 17 patients (94%), whereas serum lipase was abnormally high in all., Conclusions: Chronic alcohol abuse, but not occasional alcohol intoxication, may cause pancreatic damage. Amylase, pancreatic isoamylase and lipase determinations in the serum are all equally useful in the diagnosis of acute alcoholic pancreatitis.

Serum amylase and lipase were measured in 32 patients with cerebral ischemia, 19 with spontaneous cerebral hemorrhage, 15 with head injury and intracranial bleeding, and 22 with head injury without intracranial bleeding; 20 healthy subjects were also studied as controls. Serum pancreatic isoamylase concentrations were assayed in hyperamylasemic sera. The overall incidence of hyperamylasemia was 14% (12 of 88 patients: 4 with cerebral ischemia, 4 with spontaneous cerebral hemorrhage, 1 with head injury and intracranial bleeding, and 3 with head injury without intracranial bleeding). In 4 of the 12 patients the hyperamylasemia was of pancreatic origin: 1 patient with cerebral ischemia, 1 patient with spontaneous cerebral hemorrhage, 1 patient with head injury and intracranial bleeding, and 1 patient with head injury without intracranial bleeding. The incidence of hyperlipasemia was 7% (6 of the 88 patients: 1 patient with cerebral ischemia, 2 with spontaneous cerebral hemorrhage, and 3 with head injury without intracranial bleeding). We conclude that hyperamylasemia is more frequent than hyperlipasemia in patients with an altered state of consciousness due to head injury or stroke and is usually of non-pancreatic origin. This knowledge may save these patients from invasive and costly examinations.

Purpose: We evaluated the proliferative response of lymphocytes to phytohemagglutinin P (PHA P), concanavalin A (Con A), and pokeweed mitogen (PWM) during the course of acute pancreatitis., Patients and Methods: Sixty consecutive patients with acute pancreatitis were studied within 48 h of the onset of pain, and 16 of them were also studied 1 month after complete recovery. According to the Atlanta criteria, 21 patients had severe disease and 39 had mild disease. Fifteen healthy subjects and 11 patients with nonpancreatic acute abdomen were studied as controls. In 12 patients with acute pancreatitis the lymphocyte proliferation after stimulation with the three mitogens was also assessed in autologous and heterologous plasma., Results: The lymphocyte proliferative response to optimal doses of PHA P, Con A, and PWM was significantly lower (p < 0.001) in acute pancreatitis patients (mean +/- SD; PHA P 74,310 +/- 22,960 cpm; Con A 64,669 +/- 20,188 cpm; PWM 26,714 +/- 6,436 cpm) than in healthy subjects (PHA P 111,316 +/- 12,044 cpm; Con A 96,276 +/- 12,327 cpm; PWM 33,957 +/- 3,601 cpm). Patients with nonpancreatic acute abdomen had a significantly higher lymphocyte proliferative response to PHA P and Con A than acute pancreatitis patients (PHA P p < 0.002; Con A p < 0.01; PHA P 91,116 +/- 22,995 cpm; Con A 77,879 +/- 19,083 cpm). In patients with acute pancreatitis, lymphocyte proliferation stimulated with PHA P and Con A was significantly lower (PHA P p < 0.005; Con A p < 0.001) in those with severe disease (PHA P 63,190 +/- 15,157 cpm; Con A 52,813 +/- 13,324 cpm) than in those with mild disease (PHA P 80,298 +/- 24,340 cpm; Con A 71,052 +/- 20,490 cpm). In the group of 16 patients studied during the initial phase of acute pancreatitis and 1 month after recovery, lymphocyte proliferation significantly improved after remission of the disease but remained impaired compared with that of healthy subjects. No difference was found in the lymphocyte proliferation of the 12 patients with acute pancreatitis assayed in autologous and heterologous plasma., Conclusions: The peripheral lymphocyte proliferative response to mitogen stimulation in patients with acute pancreatitis was decreased during the early phases of the disease.

Objective: To describe two cases of macroamylasemia associated with hyperlipasemia., Methods and Results: The patients were a young male soccer player who had sustained a kick in the groin during a match and a woman with a specific dyspeptic complaints. In both the macroamylasemia had been previously undetected; when admitted with the above complaints, serum pancreatic isoamylase levels, as determined by the inhibitor method, were markedly increased, as were serum lipase levels. In both cases these findings led to the erroneous diagnosis of pancreatitis and consequent multiple diagnostic and therapeutic procedures. The cause of the hyperlipasemia was not clear in either case, although the possibility that it was due to the presence of macrolipase cannot be excluded., Conclusion: The possibility of macroamylasemia associated with hyperlipasemia should be kept in mind to avoid unnecessary diagnostic and therapeutic efforts.

Current data regarding an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer are conflicting. We evaluated the frequency with which these factors were present in 720 patients with newly diagnosed pancreatic cancer and in 720 matched controls. All subjects were interviewed personally and in detail about their clinical history. Cholelithiasis was present in 126 patients with pancreatic cancer (17.5%) and in 95 controls (13.2%), constituting a statistically significant association (odds ratio, 1.39; 95% confidence interval, 1.04-1.86); however, considering only the patients and controls in whom the diagnosis of cholelithiasis was made more than one year before cancer diagnosis or interview, the association was no longer significant (odds ratio, 1.04; 95% confidence interval, 0.75-1.44). Cholecystectomy had been performed in 93 patients with pancreatic cancer (12.9%) and in 71 controls (9.9%). When all subjects were considered, the odds ratio was mildly, although not significantly, increased (odds ratio, 1.35; 95% confidence interval, 0.97-1.87); when only subjects who underwent cholecystectomy one year or more before the cancer diagnosis or interview were considered, the odds ratio fell to unity. Gastrectomy had been performed in 28 patients with pancreatic cancer (3.9%) and in 25 controls (3.5%); analysis revealed no significant association between these two factors (odds ratio, 1.14; 95% confidence interval, 0.64-2.05). In conclusion, our study, one of the largest on this topic, has found no evidence for an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer.

Objectives: To establish the prevalence of pericardial effusion and to evaluate left ventricular function in patients with acute pancreatitis., Methods: Twenty-one consecutive acute pancreatitis patients were studied. In 15 patients, the pancreatitis was of biliary origin and was attributable to other causes in the remaining six; eight patients had severe pancreatitis and 13 a mild disease. Using M-mode and B-mode echocardiography, pericardial effusion and left ventricular function were evaluated in all of the patients within 48 h of pain onset. All patients underwent an electrocardiogram and a standard chest x-ray. In 12 patients, the same parameters were evaluated 1 month after clinical recovery. Twenty healthy subjects, comparable for sex and age, have been studied as controls., Results: Left ventricular function was similar in patients with acute pancreatitis and in healthy subjects; it was also similar both in patients with biliary and nonbiliary pancreatitis as well as in patients with severe pancreatitis and in those with mild disease. In the 12 patients in whom echocardiography was performed on hospital admission and one month after clinical recovery, no changes of left ventricular function were observed. Two patients with a mild form and one with a severe disease had pericardial effusion. One patient had negative T waves at electrocardiogram and an apical asynergy at echocardiography; these alterations disappeared after recovery. Chest x-ray revealed pleural effusion in seven patients with severe pancreatitis, whereas no alterations of cardiac silhouette were found. Acute abdominal fluid collections were also detected in seven of eight patients with severe pancreatitis, by contrast-enhanced computed tomography., Conclusions: The presence of pericardial effusion or left ventricular asynergy may be observed occasionally at echocardiography in acute pancreatitis patients; these findings, in contrast to the presence of pleural and abdominal effusions, seem to be unrelated to the severity of the disease.

The amino acid consumption test (AACT) has been proposed as a simple tubeless test of pancreatic function, but studies of its diagnostic accuracy have produced conflicting results. Eighty-three consecutive patients with clinical suspicion of pancreatic disease underwent pancreatic stimulation for 1 h with an intravenous infusion of cerulein (50 ng/kg/h); the total plasma amino acid concentration was measured at -15, 0, 30, 45, and 60 min of infusion. The maximal percentage decrease in plasma amino acid concentration during cerulein infusion was taken as an index of pancreatic function. In addition, patients had pancreatic function assessed with the pancreolauryl test (PLT). Of the 83 patients studied, 24 were found to have chronic pancreatitis and four pancreatic cancer; the remaining 55 had various nonpancreatic digestive disorders. Pancreatic function, as assessed by the PLT, was impaired in 22 of the 28 patients with pancreatic diseases, and it was normal in all but four patients with nonpancreatic disorders. Cerulein infusion caused a decrease in total plasma amino acid concentration that was generally more pronounced in patients with nonpancreatic diseases (maximal percentage decrease: median, 14%; range, 4-28%) than in those with pancreatic diseases (maximal percentage decrease: median, 9%; range, 0-21%) (p < 0.001). Using a cutoff of a 14% amino acid decrease, the sensitivity of the AACT was 89% and the specificity 53% (diagnostic accuracy, 65%); with a cutoff of 12%, the sensitivity was 75% and the specificity 69% (diagnostic accuracy, 71%). The sensitivity of the PLT was 79% and the specificity 93% (diagnostic accuracy, 88%). The results indicate that the sensitivity of the AACT is relatively high, but they show that the specificity is low, making the test unsuitable for clinical use, at least in its present form.

Chronic pancreatitis is commonly included among the organic causes of dyspepsia, however the frequency and characteristics of this association are ill-defined. One-hundred-fifteen consecutive patients with chronic pancreatitis and 85 healthy subjects were interviewed regarding their clinical history, with particular attention to dyspeptic symptoms. Attacks of prolonged upper abdominal pain, recurring at unpredictable intervals and in most cases without identifiable triggering factors, were the most frequent clinical manifestation (108, 94%). During the attacks, many patients (66, 61%) complained of vomiting, which was generally mild and of brief duration. Between the attacks, very few patients (12, 10%) complained of dyspeptic disturbances, mainly postprandial epigastric fullness and abdominal bloating. These complaints were episodic, usually after abundant meals, in 8, and persistent in the remaining 4. Among these 12 patients, there were no significant differences in the frequency of dyspeptic symptoms in relation to the severity of exocrine pancreatic insufficiency. The frequency of dyspeptic complaints among patients (10%) was significantly lower (p < 0.01) than the frequency of dyspeptic symptoms among the controls (25%). The results of this study indicate that, other than recurrent attacks of abdominal pain, dyspeptic symptoms are uncommon in chronic pancreatitis, and that impairment of digestion of pancreatic origin is not a cause of dyspepsia.

The aim of this study was to compare the sensitivity, specificity, and diagnostic accuracy of serum interleukin-6, interleukin-8, beta 2-microglobulin, and C-reactive protein in the assessment of the severity of acute pancreatitis using commercial kits for their respective assays. Thirty-eight patients with acute pancreatitis (25 men, 13 women, mean age 59 years, range 16-97) were studied; the diagnosis was based on prolonged upper abdominal pain associated with a twofold increase of serum lipase, and it was confirmed by imaging techniques. According to the Atlanta criteria, 15 patients had severe illness and 23 had mild disease. The four serum markers were determined in all patients on admission, as well as daily for the following five days. On the first day of the disease, the sensitivity (calculated on patients with severe pancreatitis), specificity (calculated on patients with mild pancreatitis), and the diagnostic accuracy of these serum markers for establishing the severity of acute pancreatitis were 100%, 86%, and 91% for interleukin-6 (cutoff level 2.7 pg/ml); 100%, 81% and 88% for interleukin-8 (cutoff level 30 pg/ml); 58%, 81%, and 73% for beta 2-microglobulin (cutoff level 2.1 mg/liter); and 8%, 95%, and 64% for C-reactive protein (cutoff level 11 mg/dl). The results of our study indicate that, when assayed during the first 24 hr of disease onset, interleukin-6 and interleukin-8 are better markers than beta 2-microglobulin or C-reactive protein for evaluating the severity of acute pancreatitis.

While cigarette smoking is a well-established risk factor for pancreatic cancer, the role of alcohol, coffee and tea consumption remains controversial. In view of this, and because of the limited information on possible environmental risk factors of pancreatic cancer in Italy, we carried out this study. Five hundred seventy patients with newly diagnosed pancreatic cancer and 570 controls from 14 Italian centers were studied. Using a standardized questionnaire, all were interviewed personally about their smoking habits, as well as habitual alcohol, coffee, and tea consumption throughout their lives prior to clinical onset of the disease. Details were also obtained on exposure to potential occupational carcinogens. A moderate association, statistically significant only in women (odds ratio, 2.18; 95% confidence interval, 1.30-3.68), was found between pancreatic cancer and cigarette smoking, but none was observed with alcohol or tea consumption or with any particular occupational exposure. Consumption of 1 or 2 cups of coffee per day was not associated with increased risk; 3 coffees per day increased the risk, but not significantly (odds ratio, 1.49; 95% confidence interval, 0.97-2.30); with consumption of more than 3 coffees per day the increase in risk was highly significant (odds ratio, 2.53; 95% confidence interval, 1.53-4.18). A statistically significant dose-response relationship (p < 0.001) was observed in each sex. The association between coffee use and pancreatic cancer still held after controlling for potential confounding factors such as cigarette smoking or alcohol use, and when the analysis was restricted to nonsmoking coffee drinkers. The results of this study, one of the largest of its type so far published, suggest that a causal relationship may exist between coffee consumption and pancreatic cancer.

Serum CA 242, CA 19-9 and CEA concentrations were determined in 94 subjects divided into 5 groups: Group 1 consisted of 22 healthy subjects; Group 2 consisted of 40 patients with pancreatic adenocarcinoma; according to Cubilla and Fitzgerald's classification, 11 tumours were Stage I, 4 were Stage II, and 25 were Stage III. Group 3 consisted of 10 chronic pancreatitis patients, group 4 of 10 acute pancreatitis patients, group 5 of 12 patients with nonpancreatic digestive carcinomas. Ten of these 12 patients had distant metastases. The sensitivity of CA 19-9 in the diagnosis of pancreatic cancer was higher than that of CEA and CA 242 (p < 0.05 and p < 0.005, respectively). In Stage I cancer patients the sensitivity of the markers studied was less than 50% (45% for CA 19-9, 18% for CEA, and 9% for CA 242) whereas most of the 25 patients with metastatic tumours of the pancreas had elevated serum levels of all 3 markers. The various combinations of the three markers did not significantly improve the sensitivity in diagnosing pancreatic cancer. No relationship was found between the localization of the tumour and the serum levels of the 3 markers studied. Similarly, no differences were found between patients with cholestasis and those without. The specificity of the 3 markers, evaluated in patients with benign pancreatic diseases, was 100% for CA 242, 90% for CA 199 and 70% for CEA.(ABSTRACT TRUNCATED AT 250 WORDS)

We investigated peripheral lymphocyte subsets in 34 consecutive acute pancreatitis patients (21 males, 13 females; mean age, 57 years; range, 16-85 years) studied within 48 h of pain onset and for 5 consecutive days to understand better the immunological response during the course of the disease. The diagnosis was based on characteristic abdominal pain associated with a twofold increase in serum lipase and confirmed by imaging techniques in all patients. Acute pancreatitis was of biliary origin in 25 patients, due to alcohol abuse in 5, due to pancreas divisum in 1, and of unknown origin in 3. Fifteen patients had severe illness and 19 had mild disease. In all patients, total lymphocyte and lymphocyte subset counts were carried out on admission, as well as on the third and fifth day of hospitalization, using a flow cytometric analysis. Twenty-three patients (13 with severe illness and 10 with mild disease) also had a repeat count 1 month after recovery. Twenty-five healthy subjects and 27 patients with nonpancreatic acute abdomen comparable for sex and age were studied as controls. On the first day of the study, the leukocyte number was significantly higher in patients with acute pancreatitis and in those with nonpancreatic acute abdomen with respect to healthy subjects, whereas the number of total and CD4+, CD8+, CD3+ DR-, and CD3- DR+ lymphocytes was significantly lower in acute pancreatitis patients than in healthy subjects or in patients with nonpancreatic acute abdomen. These subject counts persisted on the third and fifth days of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated serum concentrations of beta 2-Microglobulin (beta 2-MG) has been reported in a variety of chronic diseases and solid tumors. We determined serum beta 2-MG concentrations in 140 subjects divided into five groups: group 1, 34 patients with proven chronic pancreatitis, 8 of whom were studied during a painful relapse; group 2, 40 patients with pancreatic cancer staged according to the Cubilla-Fitzgerald classification; group 3, 40 healthy subjects; group 4, 10 patients with digestive nonpancreatic carcinomas; group 5, 16 patients with benign digestive nonpancreatic diseases. Serum soluble interleukin-2 receptor (sIL-2R) was also determined in all patients with pancreatic diseases as an index of immune system activation. In addition, serum CA 19-9 was assayed in patients of groups 2 and 4, and C-reactive protein (CRP) of groups 1 and 5. Renal function, evaluated by serum creatinine determination, was normal in all subjects studied. Patients with pancreatic cancer and those with chronic pancreatitis had serum concentrations of beta 2-MG significantly higher than those of healthy subjects (p < 0.001 and p < 0.005, respectively). Patients with stage I and stage III pancreatic cancer had similar serum levels of beta 2-MG, and these concentrations were significantly lower than those of patients with stage II tumors (p < 0.002 and p < 0.05, respectively). In chronic pancreatitis patients, those studied during painful relapse of the disease had serum concentrations of beta 2-MG similar to those studied during clinical remission.(ABSTRACT TRUNCATED AT 250 WORDS)

We assessed the ability of serum human pancreatic secretory trypsin inhibitor (hPSTI) to establish the severity of acute pancreatitis and compared it in this respect to that of serum C-reactive protein (CRP). Of 26 patients studied with acute pancreatitis, 16 had mild pancreatitis, and 10, severe disease. Initial studies were performed at onset of the disease in 20 patients, on the second day of illness in two, and on the third day of illness in the remaining four. In all, serum hPSTI and CRP concentrations were determined on admission and daily for the following 5 days using commercial kits; Ranson's score was evaluated within the first 48 h of admission. Sixty-three healthy subjects and 31 patients with nonpancreatic acute abdomen were also studied. Values of 70 ng/ml for serum hPSTI and 10 mg/dl for serum CRP were taken as limits to distinguish severe from mild-to-moderate acute pancreatitis. When assessed within the first 24 h of pain, serum hPSTI correctly classified 71% of the patients with severe acute pancreatitis, whereas serum CRP did so for 29%. In subsequent days, the two markers showed a similar sensitivity in predicting severe acute pancreatitis. Serum hPSTI and CRP were alike in excluding a diagnosis of severe acute pancreatitis. Ranson's score correctly identified 50% of patients with severe illness and 63% of patients with mild pancreatitis. This study indicates that, when assessed within 24 h of pain onset, serum hPSTI is a better predictor of the severity of acute pancreatitis than serum CRP or Ranson's criteria.

Background: Diabetes and pancreatic cancer are known to be associated, but the cause of the association and whether diabetes is a risk factor for pancreatic cancer remain controversial., Methods: A total of 720 patients with pancreatic cancer and 720 control patients from 14 Italian centers were enrolled in the study. All subjects were interviewed personally and in detail about their clinical history. The diagnosis of diabetes was based on criteria recommended by the American Diabetes Association., Results: One hundred sixty-four patients with pancreatic cancer (22.8 percent) and 60 controls (8.3 percent) had diabetes. In the majority of the patients with pancreatic cancer (56.1 percent), diabetes was diagnosed either concomitantly with the cancer (in 40.2 percent), or within two years before the diagnosis of cancer (in 15.9 percent). The association between the two conditions was significant (odds ratio, 3.04; 95 percent confidence interval, 2.21 to 4.17). However, when only patients with diabetes of three or more years' duration were considered, the association was no longer significant (odds ratio, 1.43; 95 percent confidence interval, 0.98 to 2.07). All the patients with pancreatic cancer whose diabetes had been diagnosed before the cancer had non-insulin-dependent diabetes; all but one of the control patients with diabetes had the non-insulin-dependent form of the disease., Conclusions: Diabetes in patients with pancreatic cancer is frequently of recent onset and is presumably caused by the tumor. Diabetes is not a risk factor for pancreatic cancer.

Inflammatory diseases of the pancreas are not uncommon in the elderly; although acute and chronic pancreatitis in this age group are essentially the same diseases as in younger patients, some features are unique to the old patient. Acute pancreatitis in the elderly is more commonly of gallstone etiology; it is also more likely to have an atypical clinical presentation, making recognition more difficult. In acute necrotizing pancreatitis, the elderly patient has an increased risk of complications including multisystem failure; for this reason, such patients should be more carefully monitored and aggressively treated. Chronic pancreatitis with initial onset older than 60 years is rare in the elderly, and generally without apparent cause; much more commonly, it is seen as the advanced stage of a disease started in youth. Diffuse glandular destruction and resulting severe insufficiency are usually present; thus, rather than pain, the most frequent clinical manifestations are steatorrhea and diabetes. These complications should be adequately treated to avoid malnutrition, which may seriously affect the well-being and quality of life in the elderly.