• Advances in pediatric surgery
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• v.2 no.1
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• pp.17-25
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• 1996

Acute pancreatitis(AP) in children is not common but can be associated with severe morbidity rates and its diagnosis is often delayed. Thus, reported mortality rates range from 0 to 78%. We have treated 26 patients with AP from 5 to 17 years of age over the past 17 years. We are intended to assess the relevance of the prognostic criteria used to assess severity of adult AP and to review the etiology, clilical presentation, diagnosis, and management of AP in children. The authors retrospectively reviewed 26 children with AP managed in Kyung Hee University Hospital from 1978 to 1995. Among 26 patients with AP, male were 12, and female were 14. And the mean age of patients was 11.8 years. In 9(34.6%), no definitive cause was identified. Common causes of AP were trauma(23.1%) and biliary tract disease(23.1%). Other etiologies were viral infection(15.4%) and post ERCP(3.8%). The presenting features were abdominal pain(92.3%), vomiting(61.5%), fever(19.2%), submandibular pain(11.5%), and abdominal mass(7.6%). Back pain was rare(3.8%). Abdominal ultrasonographic findings were abnormal in 10 of 16 patients(62.5%) and abdominal CT findings were abnormal for 9 of 9 patients(100%). Seventeen patients(65.3%) were managed conservatively, and nine patients(34.6%) required surgical treatment. There was no mortality. To evaluate the severity of disease, we used the Imrie prognostic criteria used to assess the severity in adult AP. The number of positive criteria was correlated to the duration of hospitalization(r2=0.91) but statistically insignificant(p>0.05). But, the number of positive criteria was correlated to the operative incidence(r2=0.93) and statistically significant(p<0.05). The common causes of AP in children were unknown origin(34.6%), trauma(23.1%), and biliary tract disease(23.1%). Ultrasonography and computed tomography were useful imaging tools of AP in children. The Imrie criteria used to evaluate the severity in adult AP were suspected to be valuable to assess the severity of AP in children.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.356-365
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• 2020

Purpose: There have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP. Methods: We conducted a retrospective chart review of patients between ages of 0-18 years, who were admitted with AP at 2 institutions between 2013-2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS. Results: Ninety-two patients were included in the study. The mean age was 12 years (range, 7.6-17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49). Conclusion: Elevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.5
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• pp.644-649
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• 2013

In this study, we aimed to investigate the effect of GamiChungYi-tang(GCY-t) on caerulein-induced acute pancreatitis (AP). It is performed by detecting oxidative stress markers and observing histopathological examination. Thirty adult male rats(Sprague-Dawley) were divided into six groups as follows: normal (NOR,n=5), caerulein-induced (CON,n=5), caerulein+Cefotaxime Sodium(CT,n=5), caerulein+GCY-t (130 mg/kg, CHA,n=5), caerulein+GCY-t (260 mg/kg, CHB,n=5) and caerulein+GCY-t (520 mg/kg, CHC,n=5) groups. Pancreatic tissues of rats from all groups were removed for apoptosis and light, and electron microscopic examination. Blood of rats from all groups were collected for oxidative stress markers inspection and pathological examination. Pancreatic oxidative stress markers were evaluated by the measurements of leukocyte, serum amylase and platelet activating factor (PAF), Interleukin-6 (IL-6) levels were determined spectrophotometrically. CON group has a significant increase (p<0.05) in amylase compared with NOR, but CT and CHA, CHB, CHC groups reduced the levels of these enzyme. The levels of Platelet activating factor (PAF) were increased in CON compared with NOR, but decreased in CT and CHA, CHB, CHC groups compared with CON. Interleukin-6 (IL-6) levels were increased significantly in CON compared with NOR, but reduced in CT and CHA, CHB, CHC groups. In the observations of Optical microscopy and electron microscopy, The experimental groups showed the significant decreases in pancreatic tissue inflammation, edema, vacuolization, necrosis compared to the control group. After all, GCY-t is potentially capable of limiting pancreatic damage produced during AP by restoring the fine structure of acinar cells and tissue.

• The Journal of Internal Korean Medicine
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• v.34 no.3
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• pp.298-311
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• 2013

Objectives : In this study, we aimed to investigate the effect of Eunhoebanchong-san (EBS) on caerulein-induced acute pancreatitis (AP) by detecting oxidative stress markers and performing histopathological examination. Methods : Thirty adult male Sprague-Dawley rats were divided into five groups as follows: normal (NOR), caerulein-induced (CON), caerulein+EBS (130 mg/kg, EA), caerulein+EBS (260 mg/kg, EB) and caerulein+EBS (520 mg/kg, EC) groups. Pancreatic tissues of rats from all groups were removed for apoptosis, and light, and electron microscopic examination. Blood of rats from all groups was obtained for oxidative stress markers and pathological examination. Pancreatic oxidative stress markers were evaluated by the measurements of serum amylase, and interleukin-6 (IL-6) levels were determined spectrophotometrically. Results : The ratio of pancreas/body weight increased significantly in the CON compared with the NOR, but decreased significantly in the EA, the EB, the EC groups compared with the CON. Caerulein administration resulted in a significant increase in amylase, but EBS reduced the levels of these enzymes. Interleukin-6 (IL-6) levels increased significantly in CON compared with NOR, but reduced in EA, EB, and EC group at 24 hrs. In the observations of optical microscopy and electron microscopy, the experimental groups showed significant decreases in pancreatic tissue inflammation, edema, vacuolization, necrosis compared to the control group. Altogether, this indicates EBS is potentially capable of limiting pancreatic damage produced during AP by restoring the fine structure of acinar cells and tissue. Conclusions : We concluded that EBS may have beneficial effects in the treatment of caerulein-induced AP.

• Korean Journal of Veterinary Research
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• v.59 no.1
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• pp.9-15
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• 2019

In canine acute pancreatitis (AP), inappropriate release and activation of zymogen proteases within the pancreas results in the consumption of serum antiproteases. The aim of this study was to examine whether the serum concentrations of ${\alpha}_2$-macroglobulin (A2MG), ${\alpha}_1$-antitrypsin (A1AT), and C-reactive protein (CRP) differ between dogs with AP and healthy dogs. Twenty healthy dogs and 20 dogs with AP were included in this study. Concentrations of A2MG, A1AT, and CRP were measured in the sera of healthy dogs and dogs diagnosed with AP. Serum A2MG and A1AT concentrations were significantly lower in dogs with AP than in healthy dogs, whereas the serum CRP concentration was significantly higher. In addition, the concentrations of A2MG and A1AT were significantly higher in AP survivors than in AP non-survivors, while the CRP concentration was significantly lower. However, in both AP survivors and non-survivors, the CRP concentrations showed a negative correlation with A2MG concentrations but not with A1AT. These findings indicate that serum antiproteases and CRP concentrations might be associated with the mortality rate of AP in dogs.

• Journal of Korean Medicine Rehabilitation
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• v.15 no.1
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• pp.99-108
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• 2005

Objectives : Patrinia scabiosaefolia (PS) has long been as a remedy for treating infectious diseases in Korea. In the present experiments, the author examined the effects of PS on the cholecystokinin-octapeptide (CCK)-induced pancreatitis (AP) in rats. Methods : Male Wister rats weighing 200 to 250 g were divided into two group. Normal untreated group, in treatment with PS group; PS was administered orally, followed by $75{\mu}g/kg$ CCK subcutaneously three times, after 1, 3 and 5 h. This whole procedure was repeated for 5 days. In treatment with saline group, the protocol was the same as in treatment group with PS. The author determined the pancreatic weight/body weight ratio, the levels of pancreatic heat shock proteins(HSP)60, HSP72 and the secretion of pro-inflammatory cytokines. Results and Conclusion : PS was significantly decreased the pancreatic weight/body weight ratio in CCK-induced AP. PS increased HSP60 and HSP72 compared with CCK-induced AP. Additionally, the secretion of tumor necrosis factor(TNF)-${\alpha}$, interleukin(IL)-$1{\beta}$ and IL-6 the levels of amylase and lipase were lower than that of saline. These results suggest that PS may has a inhibitory effect against CCK-induced AP.

• The Korea Journal of Herbology
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• v.34 no.1
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• pp.75-80
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• 2019

Objectives : Dictamni Radicis Cortex (DRC) has been used as an important traditional medicine for inflammation and fungal diseases. However, the protective effect of DRC water extract on acute pancreatitis (AP) has not been deeply reported. Therefore, we aimed to evaluate the protective effects of DRC water extract on cerulein-induced AP. Methods : AP was induced via intraperitoneal injection of supramaximal concentrations of stable cholecystokinin analogue cerulein ($50{\mu}g/kg$) every hour for 6 times. DRC water extract (0.05, 0.1, or 0.2 g/kg) or saline was administrated intraperitoneally 1 h before to the first injection of cerulein. The mice were sacrificed at 6 h after the final cerulein injection. Pancreas was rapidly removed for histochemical examination and myeloperoxidase (MPO) assay. In addition, polymerase chain reaction (PCR) was performed to examine mRNA levels of proinflammatory cytokines such as Interleukin $(IL)-1{\beta}$, IL-6 and Tumor necrosis factor $(TNF)-{\alpha}$. Results : Administration of DRC water extract significantly inhibited the pancreatic weight to body weight ratio, pancreas histological damages and increase of pancreatic MPO activity during cerulein-induced AP. In addition, increased pancreatic mRNA levels of $IL-1{\beta}$, IL-6 but not $TNF-{\alpha}$ were significantly inhibited by treatment of DRC water extract against cerulein-induced AP. Conclusions : In conclusion, we have revealed that pre-treatment of DRC water extract reduces the severity of cerulein-induced AP. Accordingly, our results could give a clinical basis that DRC could be used as a drug or agent to prevent AP.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.1
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• pp.105-109
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• 2020

The incidence of acute pancreatitis (AP) has increased in the pediatric population over the past few decades and it stands to follow that the complications of severe AP, including symptomatic pancreatic fluid collections (PFCs) will increase as well. In adults, the therapeutic options for this situation have undergone a dramatic evolution from mainly surgical approaches to less invasive endoscopic approaches, mainly endoscopic ultrasound-guided transmural drainage (EUS-TD) followed be direct endoscopic necrosectomy if needed. This has proven safe and effective in adults; however, this approach has not been well studied or reported in pediatric populations. Here we demonstrate that EUS-TD seems to offer a safe, efficacious and minimally invasive approach to the management of large PFCs in pediatric patients by reviewing two representative cases at our institution.

• The Journal of Internal Korean Medicine
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• v.31 no.3
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• pp.500-512
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• 2010

Objectives : This study was designed to investigate the effects of SuJeom-san(SJS) extract in rats with caerulein-induced acute pancreatitis (AP). Methods : We examined changes of pancreatic weight, histological, immunohistochemical and gene expression of cyclooxygenase (COX-2). Thirty-six adult male Sprague-Dawley rats were divided into six groups as follow: normal(Nor), caerulein-induced (Con), caerulein + cefotaxime sodium(CT), caerulein + SJS 3 mg/kg(SJSA), caerulein + SJS 6 mg/kg(SJSB) and caerulein + SJS 12 mg/kg(SJSC) groups. Pancreatic tissues of rats from all groups were removed for histological observation and light, and electron microscopic examination. Platelet activating factor(PAF) and Interleukin-6(IL-6) levels were determined spectrophotometrically. Results : The ratio of pancreas/body weight was significantly(p<0.05) increased in the Con compared with Nor, but significantly(p<0.05) decreased in SJSA, SJSB, SJSC and CT groups compared with Con. Caerulein administration significantly increased(p<0.05) the levels of amylase, but SJSA, SJSB, SJSC and CT significantly(p<0.05) reduced the levels of these enzymes. The levels of platelet activating factor(PAF) increased in Con compared with Nor, but decreased in SJSA, SJSB, SJSC and CT groups compared with Con. Interleukin-6(IL-6) levels increased significantly in all groups compared to Nor at 6 hrs, but significantly(p<0.05) reduced in SJSA, SJSB, SJSC and CT groups compared with Con at 24 hrs. The levels of tumor necrosis factor(TNF)-${\alpha}$ levels increased in all groups compared to Nor at 6 hrs, but significantly(p<0.05) reduced in SJSA, SJSB, SJSC and CT groups compared with Con at 24 hrs. The COX-2 positive materials were observed in the pancreas of the Con, but these positive materials were decreased in the SJS extract treatment group. Conclusion : SJS is potentially capable of limiting pancreatic damage during AP by restoring the fine structure of acinar cells and tissue; therefore, we conclude that SJS may have beneficial effects in the treatment of caerulein-induced AP.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.58-65
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• 2010

Purpose: Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features. Methods: A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007. Results: Twenty males and 21 females (mean age, 8.7${\pm}$4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3${\pm}$553.2 and 766.2${\pm}$723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure. Conclusion: The etiologies of AP in children are varied. Most children have a single episode and a self-limited course. However, AP of childhood still carries significant morbidity and mortality. Early diagnosis, appropriate treatment according to disease severity, and management of complications are important.