review of literature on clinical pancreatology - The Pancreapedia

concentrations, treatment with low-level intravenous unfractionated heparin led to promptreduction in plasma triglyceride concentration and may have prevented the development <strong>of</strong>hypertriglyceridemia-associated acute pancreatitis. One article <strong>review</strong>ed the rationale for thistreatment and surveys prior publications using heparin in this and similar settings [183].d-DimerStudies on the clinical value <strong>of</strong> parameters <strong>of</strong> hemostasis in predicting pancreatitisassociatedcomplications are still scarce. The aim <strong>of</strong> one prospective study was to identifythe useful hemostatic markers for accurate determination <strong>of</strong> the subsequent development <strong>of</strong>organ failure during the very early course <strong>of</strong> acute pancreatitis. In 91 consecutive primarilyadmitted patients with acute pancreatitis, prothrombin time, activated partial thromboplastintime, fibrinogen, antithrombin III, protein C, plasminogen activator inhibitor 1, d-dimer, andplasminogen were measured in plasma within the first 24 hours <strong>of</strong> admission and 24 hoursthereafter. Two study groups comprising 24 patients with organ failure and 67 patientswithout organ failure were compared. Levels <strong>of</strong> prothrombin time, fibrinogen, and d-dimer onadmission were significantly different between the organ failure and non-organ failuregroups, and all these parameters plus antithrombin III were significantly different 24 hourslater. d-Dimer in predicting the development <strong>of</strong> organ failure had a sensitivity, specificity, andpositive and negative predictive values <strong>of</strong> 90, 89, 75, and 96 percent, respectively [184].CTA prospective study aimed at evaluating dynamic computed tomography (CT) as aprognostic indicator <strong>of</strong> local complications in patients with pancreatic necrosis. It wasanalyzed the relationship between the anatomic pattern <strong>of</strong> pancreatic necrosis at dynamicCT (pancreatic necrosis, peripancreatic necrosis, and transparenchymal necrosis) and thedevelopment <strong>of</strong> local complications (infected pancreatic necrosis and pseudocyst). Onehundred thirty-eight patients were included in the study. Nine patients were excluded, and 86required surgery. Average time from the onset <strong>of</strong> symptoms to dynamic CT was 8.3 days.Multivariate analysis identified prognostic factors for local complications:- extent <strong>of</strong> pancreatic necrosis (odds ratio, 7)- presence <strong>of</strong> peripancreatic necrosis (odds ratio 37)- transparenchymal necrosis with upstream viable (enhancing) pancreas (odds ratio36)- no peripancreatic necrosis (odds ratio 0.016)It was concluded that dynamic CT prognostic factors useful to predict local complications inpatients with pancreatic necrosis were the extent <strong>of</strong> pancreatic necrosis, presence <strong>of</strong>peripancreatic necrosis, and the finding <strong>of</strong> transparenchymal necrosis with upstream viable(enhancing) pancreas [185].MRDiffusion-weighted imaging (DWI) is a new magnetic resonance imaging (MRI) techniquethat evaluates the random motion <strong>of</strong> water molecules in biological tissues. The clinical utility<strong>of</strong> DWI has been established for acute stroke and brain tumors. Recent technicaladvancements in MRI have enabled DWI for the body and several studies have revealed theefficacy <strong>of</strong> DWI for detecting various diseases. One study documented the efficacy <strong>of</strong> DWIfor the evaluation <strong>of</strong> acute pancreatitis. MRI was performed with sequences including T1-weighted, T2-weighted, diffusion-weighted imaging, MR cholangiopancreatography (MRCP)and computed tomography (CT) examinations on 11 patients with mild acute pancreatitis.MRI examinations were performed using 1.5-T imager. Two experienced radiologists