review of literature on clinical pancreatology - The Pancreapedia

hemodynamic instability [189].Acute pancreatitis in childrenEpidemiologyStudies show an increased incidence <strong>of</strong> adult acute pancreatitis in recent decades. Aretrospective <strong>review</strong> <strong>of</strong> computerized databases at the Children's Hospital <strong>of</strong> Pittsburgh from1993 to 2004 was performed. The incidence <strong>of</strong> acute pancreatitis was compared with ordersfor amylase and lipase testings and with the catchment population. Over the study period,there were a total <strong>of</strong> 1021 discharge diagnoses <strong>of</strong> acute pancreatitis (731 first diagnoses).The diagnosis <strong>of</strong> acute pancreatitis increased from a low <strong>of</strong> 28 total cases (21 firstdiagnoses) in 1993 to a high <strong>of</strong> 141 total cases (109 first diagnoses) in 2004. The catchmentpopulation decreased from 882,000 to 826,500. The estimated incidences <strong>of</strong> first acutepancreatitis admission were 2.4 to 13.2 per 100,000 children. Linear regression analysissuggests that increased testing for amylase and lipase could account for 94 percent <strong>of</strong> thechange in all acute pancreatitis admissions. It was concluded that the increased incidence <strong>of</strong>AP at the Children's Hospital <strong>of</strong> Pittsburgh from 1993 to 2004 may have been primarily drivenby increased testing for the disease [190].Acute pancreatitis in pediatric acute lymphoblastic leukemiaAcute pancreatitis is a complication in children with acute lymphoblastic leukemia (ALL)receiving chemotherapy and has <strong>of</strong>ten been reported associated with L-asparaginase (L-asp)therapy. To determine the incidence, risk factors, clinical data, outcome, and mortality <strong>of</strong>acute pancreatitis in children with ALL a retrospective cohort study was conducted by<strong>review</strong>ing the data <strong>of</strong> total 192 pediatric ALL patients from one hospital from 2000 to 2006 toassess incidence, clinical data, outcome, and mortality <strong>of</strong> AP. Then, a nested case-controlstudy was conducted to identify potential risk factors for AP by recruiting all patients withacute pancreatitis as cases (n=16), and randomly selected patients without acute pancreatitisto serve as controls up to approximately four controls per case with the total <strong>of</strong> 68 controls.The total incidence <strong>of</strong> acute pancreatitis in children with ALL and L-asp-associated acutepancreatitis was 8.3 percent and 7.3 percent, respectively. In patients with L-asp-associateddisease, pancreatitis developed after the median 6 doses (range: 1 to 20 doses) <strong>of</strong> L-asptherapy and the median interval from the last dose <strong>of</strong> L-asp to the onset <strong>of</strong> acute pancreatitiswas 4 days (range: 1 to 13 days). The mortality rate <strong>of</strong> the pancreatitis group wassignificantly higher than the patients without acute pancreatitis (44 % vs 19 %). Mortality wasassociated with concurrent systemic infection and complications <strong>of</strong> underlying diseases.Multivariate analysis identified using a high-risk chemotherapy regimen was the only riskfactor for acute pancreatitis [191].Specific injuriesPulmonary injuryOne <strong>of</strong> the most common complications <strong>of</strong> acute pancreatitis is acute lung injury, duringwhich intercellular adhesion molecule-1 (ICAM-1) plays an important role by participating inleukocyte adhesion and activation as well as by inducing the "cascade effect" <strong>of</strong> inflammatorymediators, pulmonary microcirculation dysfunction and even acute respiratory distresssyndrome, multiple organ failure or death. Although it is generally believed that themodulatory mechanism <strong>of</strong> ICAM-1 during this process is associated with the activation <strong>of</strong>nuclear transcription factor kappa B which is mediated by IL-1, IL-6, IL-18 and oxygen free