, Mina Kang, Young Min Hur, Young Ju Kim, Sunwha Park Ectopic pregnancy (EP) refers to blastocyst implantation outside the uterine endometrium. EP is major cause of maternal morbidity and mortality. Treatment options include surgery, medical therapy with methotrexate, or expectant management. Methotrexate is the primary regimen used in cases of early, unruptured ectopic pregnancies. Most side effects of methotrexate are minor, including nausea, vomiting, abdominal discomfort, and photosensitive skin reaction. Serious side effects, including bone marrow suppression, and pulmonary fibrosis, are invariably observed when methotrexate is administered in high doses with frequent dosing intervals, in chemotherapeutic protocols for malignancy. These side effects are uncommon with the doses used to treat ectopic pregnancies. Since cases of methotrexate-induced pancreatitis are rare, we report a case of pancreatitis in a patient with EP treated with methotrexate and expect to consider pancreatitis as a side effect of methotrexate in a patient with upper abdominal pain undergoing methotrexate chemotherapy.
Citations
, Min Young Lee, You Won Choi, Hae Young Choi, Ji Yeon Byun Pancreatic panniculitis is a rare skin complication in which subcutaneous fat necrosis occurs in association with pancreatic disorders, most commonly acute or chronic pancreatitis. Erythematous subcutaneous nodules develop on the legs and spontaneously ulcerate or exude an oily substance. A 32-year-old Korean female patient presented with a 2-week-history of tender nodules with erythematous crusts on her left shin. She had a history of alcoholic liver cirrhosis and, 5 weeks earlier, had been diagnosed with acute pancreatitis. The histopathologic findings from a skin biopsy were consistent with lobular panniculitis, without signs of vasculitis, and diffuse fat necrosis. Basophilic calcium deposits were present in the dermis and subcutaneous fat. These findings were suggestive of pancreatic panniculitis. The skin lesion had a chronic course corresponding to repeated exacerbations of the patient’s pancreatitis. Thus, in the differential diagnosis of subcutaneous nodules, clinicians should consider pancreatic panniculitis as a cutaneous manifestation of pancreatic disease.
, Jung Hoon Song, Kyung Pyo Cho, Jae Sung Lee, Yong Moon Woo, Beom Jin Jeong, Young Jun Cho, Yun Ju Han Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.
Citations
, Sun Hee Rho This study aimed to provide an actualized classification system for acute pancreatitis (AP) by applying new principle and investigated the benefits of new classification.
Medical records and computed tomography (CT) images of 235 consecutive patients with AP admitted to the Ewha Womans University Mokdong Hospital between 2005 and 2010 were reviewed. The patients of severe pancreatitis who has necrosis were only 68 cases, these are too small for comparing to mild form. So we analyzed mild form of pancreatitis preferentially into two groups; group A, without morbidity and without organ failure (145 patients, mild acute pancreatitis, MAP); group B, with morbidity and without organ failure (22 patients, aggressive mild acute pancreatitis, AMAP). Clinical characteristics, laboratory findings, duration of hospitalization, need for the intensive care unit (ICU), organ failure, needs of intervention, another severity indexes and death were evaluated.
AMAP (group B) was higher proportion of need for the ICU care and of organ failure than MAP after age-adjusting (P<0.01). Also AMAP had higher incidence of associated malignancy, pseudocysts, and increasing fasting sugar level.
The AMAP is a different type of MAP. We need new category of different grade of mild form pancreatitis, because AMAP showed different clinical course. New classification of mild acute pancreatitis is relatively effective, and has clinically significant value.
, Suk Joon Park, Sang Su Im, Mi Kyung Sung, Byeong Ho Lee, Jang Wook Lee, Jin Hee Park Hyperlipidemia can be a cause of acute pancreatitis. For example, dyslipidemia classified Fredrickson/WHO classification type I, V can induce acute pancreatitis spontaneously. Secondary hyperlipidemia (DM, alcohol, estrogen, etc.) also can induce acute pancreatitis. High serum amylase level and triglyceride level are hall markers of diagnosis. But lactescent serum interferes with accurate laboratory analysis of amylase. Serum amylase was normal or low in 50% of cases. Clinical course and treatment are similar with other causes of acute pancreatitis. Lipoprotein electrophoresis helps classify dyslipidemia by Fredrickson/WHO classification. In some cases, to prevent hyperlipidemic pancreatitis, serum triglyceride should be lower than 500 mg/dl. We report two cases of acute pancreatitis caused by dyslipidemia.
, Sun Young Yi Endoscopic Retrograde Cholangiopancreatogrphy (ERCP) and endoscopic sphincterotomy are useful for both diagnosis and treatment of patients with acute gallstone pancreatitis. In this study, we assessed the feasibility of emergency ERCP in patients with all gallstone pancreatitis.
We retrospectively reviewed the medical records of 66 patients, who underwent ERCP with a diagnosis of acute gallstone pancreatitis between July 1994 and December 2002. Obstructive jaundice from gallstones is excluded, because it is a distinct indication of emergency ERCP. Patients were divided into the group A (emergency ERCP group : ERCP was performed within 72 hours after hospitalization, mean 37.0±16.4 hours, range 6-70 hours) and group B (elective ERCP group ; ERCP, over 72 hours after hospitalization, mean 124.0±49.3 hours, range 76-288 hours). Comparisons of the clinical characteristics and incidence of complications were made between these two groups.
There was no significant difference for biochemical measurements, severity of pancreatitis, complications of pancreatitis, characteristics of ampulla, and length of hospital stay between the two groups, Group A had more cases (40.9%) with macroscopic stones on ERCP than group B (24.2%).
Although ERCP was a very useful modality for the diagnosis and treatment of patients having acute gallstone pancreatitis, an emergency ERCP would not be necessary unless there is definite obstructive jaundice.
, Sun Young Yi, In Jeong Cho, Hye Sung Won, Yoon Hee Jun, Seung Hyun Yoo Pancreatitis is the most common and serious complication of ERCP. On the basis of several reports, corticosteroid, octreotide, or calcium channel blocker might be effective in this regard. The aim of this study was to determine whether the phamacologic agents(steroid, variable amount of octreotide, and verapamil) prevent post-ERCP pancreatitis.
A total of 80 patients were randomized. All patients received intravenously gabexate mesilate(Foy®) before endoscopy. Group 1 has been dose of octreotide (0.2mg blous and 6mg intravenous infusion) in group 3, and verapamil in group 4. Clinical outcomes and risk factors were analysed in each groups. We checked cytokines (IL-1, TNF-α) in group 3 and 4 compared with control and alcohol induced pacreatitis.
The overall frequency of hyperamylasemia and pancreatitis were 35% (28/80) and 13.7% (11/80), respectively. There was no difference among 4 groups with the incidence and severity of pancreatitis. The groups were similar with regard to demographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. There was no risk factors of ERCP-pancreatitis in all groups. In the cytokine data, TNF-α was markedly decreased on right after ERCP in patients with hyperamyasemia and pancreatitis.
Prophylactic administered corticosteroid, octredtid, or verpamil would not be helpful for prevention in post-ERCP pancreatitis. Also IL-1 and TNF-α may not be useful markers in prediction of ERCP-pancretitis. But TNF-α would be useful marker as mild form ERCP-pancreatitis and alcoholic pancreatitis.
, Kyung Eun Lee Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. On the basis of several reports, corticostroid or octreotide might be effective in this regard. The aim of this study was to determine whether the pharmacologic agents(stroid and octreotide) prevent post-ERCP pancreatitis.
Patients received an intravenous infusion of hydrcortisone(100mg) and octreotide (0.2mg bolus) in treated group Tmmediately before endoscopy. A total of 140 patients(73men and 67 women, with an average age of 61.5 yr) who were scheduled to undergo diagnostic or therapeutic ERCP. Nine patients were excluded from the final evaluation for incomplete records. The remaining 131 patients, 61 in the treated group and 70 in the control group, were analyzed.
The overall frequency of hyperamylasmia and pancreatitis were 33.6%(44/131) and 7.6%(10/131), respectively. The all pancreatitis were mild. There was no difference between the groups with the incidence and severity of pancreatitis. The procedure-induced pancreatitis occured in 5 of 61(8.2%) patients treated with hydrocortisone and octreotide and 5 of 70(7.2%) patients in the control group(p=ns). the groups were similar with regard to desmographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. The only risk factor of ERCP-pancreatitis is the visualization of pancreatic duct in both groups.
Prophylactic administered corticosteroid and octreotide did not prevent of post-ERCP pancreatitis. Pancreatic injury may be only related to maneuver of pancreatic duct.
First
Prev
