review of literature on clinical pancreatology - The Pancreapedia

concentration and clinical symptoms suggested chylomicronemia syndrome with urgent needfor treatment. After a course <strong>of</strong> several subsequent therapeutic plasmapheresis triglyceridessignificantly decreased. Safety and effectiveness <strong>of</strong> this method was confirmed [223].Intravenous protease inhibitorsSevere acute pancreatitis is poor prognosis. Continuous regional arterial infusion <strong>of</strong> proteaseinhibitors and antibiotics were developed in Japan. It was evaluated whether arterial infusionboth celiac artery and superior mesenteric artery for this disease would reduce mortality.Seventeen patients were treated arterial infusion <strong>of</strong> protease inhibitor and antibiotics via bothceliac artery and superior mesenteric artery. Changes <strong>of</strong> Acute Physiology and ChronicHealth Evaluation II score and mortality were evaluated. Arterial infusion via two routesreduced the mortality rate and improved Acute Physiology and Chronic Health Evaluation IIscore. The overall mortality rate was 12 percent. The mortality rate in patients in those thatwere treated within 3 days after the onset was significantly lower than that in patients inwhom were treated without 3 days after the onset. Arterial infusion via superior mesentericartery might prevent both bacterial translocation and non-occlusive mesenteric ischemia.Continuous arterial infusion both celiac artery and superior mesenteric artery might beeffective for reducing mortality and preventing the development <strong>of</strong> pancreatitis, especiallywhen initiated within 3 days after the onset [224].Dialysis as a treatment for acute pancreatitisThe aim <strong>of</strong> one study was to study the therapeutic effects and the mechanism <strong>of</strong> combination<strong>of</strong> hem<strong>of</strong>iltration (HF) and peritoneal dialysis (PD) in the treatment <strong>of</strong> severe acutepancreatitis (SAP). Fifty-one cases <strong>of</strong> severe acute pancreatitis were randomly divided intothe HF+PD group (treated group, 36 patients) and the non-HF+PD group (control group, 15patients). Both groups were treated by the same traditional methods. The relief time <strong>of</strong>abdominal pain and abdominal distension, computed tomographic scores, acute physiologyand chronic health enquiry II scores, length <strong>of</strong> stay, cost <strong>of</strong> hospitalization, operability, andrecovery rate <strong>of</strong> the 2 groups were compared. The concentration <strong>of</strong> tumor necrosis factoralpha,IL-6, and IL-8 in serum and ascites volumes was determined before and aftertreatment. The mean time <strong>of</strong> abdominal pain relief, amelioration <strong>of</strong> abdominal distension,decrease <strong>of</strong> computed tomographic scores, acute physiology and chronic health enquiry IIscores, the mean length <strong>of</strong> stay, and cost <strong>of</strong> hospitalization <strong>of</strong> the treated group weresignificantly shorter or less than those <strong>of</strong> the control group. The aforementioned inflammatorycytokines, detected at the end <strong>of</strong> 1 day and 2 days after HF+PD treatment, were decreasedsignificantly compared with those observed in pretherapy and the control group. It wasconcluded that inflammatory cytokines, which overproduced in SAP, can be eliminatedeffectively from the blood and the ascites by HF+PD treatment [225].Peritoneal lavageThe evaluation <strong>of</strong> precocious and prolonged lavage and drainage by laparoscopic approachin the treatment <strong>of</strong> severe acute pancreatitis was studied 2006-2008 on a sample consisting<strong>of</strong> 35 subjects with the severe acute pancreatitis that was divided into two lots. One lot wasformed by 16 patients whom were applied the method mentioned ahead and in the B lot, 19patients, treated by conventional and known methods <strong>of</strong> treatment. The method proposed,completed about laparoscopic approach in a third day <strong>of</strong> admission, consists, after settinglesional balance, in lavage <strong>of</strong> peritoneal space and mounting two tubes drainage, onesubhepatic space and the other in Douglas space. Peritoneal lavage discontinuous withphysiological serum was done during 7 days. For an accurate assessment may weredetermined serum and peritoneal concentrations <strong>of</strong> interleukin 6. The duration <strong>of</strong> organicdysfunction was 8 days for A lot subjects and 18 days for B lot subjects. The mortality at A lot