review of literature on clinical pancreatology - The Pancreapedia

necrosis or a severe course, and lower lethality. Other measures <strong>of</strong> severity remainedunchanged. The decrease in severity was particularly marked in patients with alcohol-relatedpancreatitis who are apparently seeking hospital treatment earlier than used to be the case.It was concluded that in contrast to other European countries (Denmark, United Kingdom,The Netherlands, and Sweden), this study showed no change over time in the frequency oretiology <strong>of</strong> acute pancreatitis. There were, however, signs <strong>of</strong> a decrease in disease severity,and this aspect merits further investigation [150].IndiaA prospective analysis <strong>of</strong> the epidemiology and outcome <strong>of</strong> patients admitted with acutepancreatitis to a tertiary health care centre in Goa, India, was carried out during the timeperiod <strong>of</strong> 2003 to 2005. The patients studied were those who were admitted to the GoaMedical College with a diagnosis <strong>of</strong> acute pancreatitis based on a serum amylase <strong>of</strong> greaterthan 180 Somogyii units with appropriate clinical and radiographic evidence. The selectioncriteria were fulfilled by 282 patients. Acute pancreatitis accounted for 2.3 percent <strong>of</strong> alladmissions and 4.9 percent <strong>of</strong> all deaths in the department <strong>of</strong> surgery. The disease was seento affect males more commonly (96 %), alcohol, being the predominant (92 %) aetiologicalfactor. The median age for occurrence <strong>of</strong> the disease was 40 years. Severe acutepancreatitis was encountered in 33 percent <strong>of</strong> cases with a mortality rate <strong>of</strong> 12 percent.Mortality was higher in patients older than 50 years. The widespread availability and use <strong>of</strong>locally made cheaper varieties <strong>of</strong> alcohol in the geographical location explains the trendtowards alcoholic pancreatitis and younger age groups being affected by the disease [151].Etiologic factors and factors <strong>of</strong> importance for development <strong>of</strong> pancreatitisCytokinesTNFTo determine whether increases in soluble tumor necrosis factor receptors (sTNFRs) areassociated with the levels <strong>of</strong> cytokines and proteinases in patients undergoing major surgery.Eleven patients who underwent esophagectomy for squamous cell carcinoma <strong>of</strong> the thoracicesophagus were studied. The circulating blood concentrations <strong>of</strong> interleukin-6 (IL-6), IL-8,sTNF-R55, sTNF-R75, elastase/al-proteinase inhibitor complex (elastase) and matrixmetalloproteinase-9 (MMP-9) were measured by ELISA or EIA before surgery, just aftersurgery, and on postoperative days (POD) 1 and 3. The levels <strong>of</strong> serum IL-6, plasma IL-8,plasma elastase and plasma MMP-9 increased significantly after surgery, peaking just aftersurgery or on POD 1 and then declining. In contrast, the serum levels <strong>of</strong> sTNFRs increasedapproximately 2-fold just after surgery compared with the preoperative values and thenremained elevated. The IL-6 level correlated with the levels <strong>of</strong> sTNF-R55 and sTNF-R75after surgery. These results suggest that increases <strong>of</strong> IL-6, serine proteinases and MMPsmay be involved in the upregulation <strong>of</strong> sTNFRs in patients undergoing major surgery [152].Interleukin 17The evaluation <strong>of</strong> the interleukin 17 capacity as precociously predictive marker <strong>of</strong> the severeforms <strong>of</strong> acute pancreatitis was done in a prospective and diagnosis study that took placeduring 2006-2008 on a sample <strong>of</strong> 83 subjects hospitalized with acute pancreatitis. Amongthese, 48 have submitted forms mild disease and formed batch A. Subjects with severeacute pancreatitis formed batch B (n=16), to whom it was applied peritoneal lavage extendedby laparoscopic method and batch C (n=19), who have used conventional methods <strong>of</strong>treatment, had their serum concentrations <strong>of</strong> interleukin 17 determined in the first and tenthdays <strong>of</strong> admission for the subjects <strong>of</strong> A and C lots and in the first, third and tenth day at thensubjects <strong>of</strong> B lot. Interleukin 17 has proved a sensitivity <strong>of</strong> 97 percent and a specificity <strong>of</strong> 94