review of literature on clinical pancreatology - The Pancreapedia

groups. None <strong>of</strong> the patients in the three groups developed any feature suggestive <strong>of</strong> acutepancreatitis in the postoperative period. These findings indicate that prop<strong>of</strong>ol administrationat recommended doses does not produce dose-related increases in pancreatic enzyme andtriglyceride levels in ASA physical status I and II patients [180].In smokersThe newest conducted investigations showed the significant role <strong>of</strong> tobacco smoking ininducing pathological changes in pancreas. Additionally exposure to heavy metals presentson polluted environment influences on function this organ. However, the mechanism <strong>of</strong>development <strong>of</strong> these changes has not been fully recognised. The aim <strong>of</strong> this study is toprove the influence <strong>of</strong> tobacco smoking on total amylase and termolabile amylase activity inserum <strong>of</strong> smoking and nonsmoking healthy persons and workers at cooper foundry inLegnica occupationally exposed to heavy metals: cadmium, arsenic, lead. Blood has beencollected from 28 healthy persons and 60 founders. The enzyme total activity has beendetermined using the colorimetric method with substrate 1,2-odilauryl-rac-glycero-3-glutaricacid-(6-methylresorufin) ester. The thermolability activity has been determined using thethermolability test. It has been noted significant higher total amylase and thermolabileamylase activity in serum <strong>of</strong> smoking healthy persons and <strong>of</strong> non-smoking and smokingfounders comparison with non-smoking healthy persons. It hasn't been found significantdifferences in total and thermolabile amylase activity in smoking founders and non-smokingfounders. The fact that there are significant differences in serum amylase activity in serum <strong>of</strong>smoking and nonsmoking founders in comparison with nonsmoking healthy persons prove asignificant influence <strong>of</strong> exposure to heavy metals on exocrine function <strong>of</strong> pancreas [181].HyperlipedemiaThe association <strong>of</strong> pregnancy, hypertriglyceridemia, and acute pancreatitis is wellestablished even though gestational hyperlipidemic pancreatitis is an uncommon but seriousdisorder. In women having type I, IV, or V hyperlipoproteinemia (HLP), the superimposition <strong>of</strong>the physiologic hyperlipidemia <strong>of</strong> pregnancy may lead to acute pancreatitis. Type III HLP isan inborn error <strong>of</strong> metabolism characterized by defective apo E, which is a ligand for thereceptor-mediated uptake <strong>of</strong> chylomicron and VLDL remnants by the liver. More than 90percent <strong>of</strong> type III HLP subjects are homozygous carriers <strong>of</strong> apo E2 (Arg158 -> Cys), whichdisplays less than 1 percent binding affinity for the cell surface lipoprotein receptors.However, less than 10 percent <strong>of</strong> apo E2/E2 homozygous subjects have hyperlipidemia.These observations indicate that other genetic environmental factors or concomitantdiseases are necessary for expression <strong>of</strong> the hyperlipidemia in apo E2/E2 subjects. A casedescribed was the first case <strong>of</strong> apo E2/E2 homozygous familial type III HLP-relatedgestational hyperlipidemic pancreatitis. A 39-year-old gravida 3-para woman without knownmedical history except hyperlipidemia for 3 years and regular medication until 6 monthsbefore preparation <strong>of</strong> gestation was referred to our hospital for acute pancreatitis at 14 weeks<strong>of</strong> gestation. On arrival, the lipid pr<strong>of</strong>iles showed hypercholesterolemia (807 mg/dL) andhypertriglyceridemia (3596 mg/dL). During her stay in the hospital, she received totalparenteral nutrition for 14 days and resumed oral intake with low-fat diet smoothly. She wasdischarged at 18 weeks <strong>of</strong> gestation and continued with the low-fat diet with fish oilsupplement (4 g/d) according to the dietitian's instruction. She gave birth to a healthy maleinfant at 39 weeks <strong>of</strong> gestation, and her triglyceride level fell below 1000 mg/dL after delivery.Fish oil is well known to decrease VLDL secretion from the liver and thus lower theproduction <strong>of</strong> intermediate-density lipoproteins and low-density lipoprotein. A dose <strong>of</strong> 3 to 4 gn-3 fatty acids per day decreases serum triglyceride levels by around 30-50 percent inhypertriglyceridemic patients. Thus, fish oil supplement could be an effective therapy forprevention <strong>of</strong> gestational hyperlipidemic pancreatitis [182].In a patient with diabetic ketoacidosis complicated by severe elevation <strong>of</strong> plasma triglyceride