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Measurement of insulin resistance by HOMA-IR index in patients with acute pancreatitis
Abstracts / Pancreatology 12 (2012) 502–597
560
1 Clinical Biochemistry Department, INFIBIOC, School of Pharmacy and Biochemistry, University of Buenos Aires, Argentina 2 “Programa de Estudios Pancreáticos” Hospital de Clínicas-UBA, Argentina 3 Universidad Pontificia Católica Argentina (UCA), Hofstra North Shore – LIJ School of Medicine, Division of Cytopathology North Shore-LIJ, NY, USA
Conclusion: Most patients with acute pancreatitis develop insulin resistance, which may be the potential target for new therapeutic regimen, aiming at the prevention of pancreatic endocrine insufficiency.
Introduction: The pancreas is a mixed gland; the exocrine portion produces and secretes enzymes involved in the digestion of nutrients in the diet. The diagnosis is based on a clinical study, imaging and laboratory. Serum pancreolauryl test (PLs) indirectly measures the activity of a specific pancreatic cholesterol esterase. The aim purpose of appealing to this noninvasive test is to put evidence an unsuspected exocrine pancreatic insufficiency (EPI) or, if already diagnosed to establish its improvement or otherwise its deterioration as a result of the therapeutic approach. Aim: Determinate PLs values in EPI and control patients, and establish differences between them. Materials and methods: We studied 35 adult patients, classified by clinical features and imaging techniques in two groups: Control (n¼14, age: 5014, without gastrointestinal disorders) and EPI (n¼21, age: 5112, with: primary biliary cirrhosis-n¼1, fatty pancreas-n¼1, chronic pancreatitis-n¼5, pancreatic head resection-n¼1, and gastrointestinal disturbsn¼13) PLs: Together with a breakfast rich in fat, Fluorescein Dilaureate was administered. By venous puncture, serum samples were extracted at different times: Basal and post breakfast at: 60,120,150,180,210 and 240 minutes. At all times the free fluorescein was read spectrofotometrically at 492nm.The maximum of absorption was considered for the calculation. The cutoff value used was 4.5 mg/L. Results: In patients with EPI the PLs was lower than the control (7,52,0 vs 2,81,3 respectively; P<0.0001) Conclusion: The PLs is an economic, noninvasive and feasible test to perform in the biochemical laboratory. This study allows us to find patients who consult for diverse gastrointestinal problems, subclinical exocrine pancreatic insufficiency, which is solved by administering supplements enzymatic or therapeutic approach.
Exocrine and endocrine pancreatic insufficiency after acute necrotizing pancreatitis
P-196.
P-197.
T. Lubenets, A. Dronov, I. Kovalska, M. Zemskova. Department of General Surgery N 1 of the National Medical University named after A.A. Bogomolets, Kyiv, Ukraine Introduction: Acute necrotizing pancreatitis is a disease that can lead to the development of exocrine and endocrine pancreatic insufficiency in recovery period. Aim of the study: To examine the incidence of exocrine and endocrine pancreatic insufficiency after acute necrotizing pancreatitis. Patients and methods: 85 patients with acute necrotizing pancreatitis were involved in the study. Exocrine function was evaluated by determination of fecal elastase-1, endocrine function - by determining of glycated hemoglobin and glucose tolerance test. The survey was conducted every six months. Results: Exocrine insufficiency developed in 36 (42.35%) patients; moderate - in 20, severe - in 16 patients. The exocrine insufficiency developed during the first year of the follow up and then remained constant. Endocrine insufficiency occurred in 23 (27.05%) patients: 3 patients during the first year, 8 - in the second year and 12 during the third year after acute necrotizing pancreatitis. Of these, impaired glucose tolerance was found in 35.4% of patients, with pancreatogenic diabetes in 64.6% of patients. Disorders of glucose metabolism have evolved only in patients with exocrine insufficiency, the coefficient of association exocrine and endocrine insufficiency was 0.79 + / - 0.085. Spearman coefficient correlations between the exocrine and endocrine insufficiency was r ¼ -0,673, p ¼ 0,0001. Conclusion: Acute necrotizing pancreatitis in the study group led to the formation of exocrine insufficiency in 42.35% of the patients and endocrine pancreatic insufficiency in 27.05% of the patients; impaired glucose metabolism developed only in patients with formed exocrine pancreatic insufficiency.
Measurement of insulin resistance by HOMA-IR index in patients with acute pancreatitis Bartosz Lesniowski 1, Katarzyna Winter 1, Anna Kumor 2, Ewa Małecka-Panas 1. 1
Department of Digestive Tract Diseases, Medical University of Lodz, Poland 2 Department of Laboratory Diagnostics, Medical University of Lodz, Poland
P-198. Results of standard and extended pancreaticoduodenectomies for pancreatic ductal adenocarcinoma Z.A. Kovalenko, O.V. Melekhina, V.A. Vishnevsky, T.V. Shevchenko, V.I. Egorov. Vishnevsky Institute of Surgery, Moscow, Russia
Background: Insulin resistance (IR) contributes to type 2 diabetes mellitus, non-alcoholic steatohepatitis, metabolic syndrome, arteriosclerosis, obesity, and polycystic ovary syndrome. It has been suggested that acute pancreatitis level may lead to IR, which may represent a new potential therapeutic target. Material and methods: The study group comprised 35 patients with alcoholic AP (median age 4926.7 years; 26 men and 7 women). In all cases AP was classified as B according to Balthazar's CT score and as mild according to Ranson's criteria. The serum level of insulin and glucose were measured on the first day of hospitalization. Insulin resistance was measured with HOMA-IR index. Median patients' BMI was 245. Patients with diabetes mellitus, impaired glucose tolerance (IGT), or renal malfunction were excluded. Results: The median plasma glucose level was 122 53 mg/dl. The median insulin level was 8,36 5,2 microIU/L. In almost all patent with AP : 32 (92%) - the HOMA – IR index was increased : median 1.50 0.5, range: 1.0 to 3.0.No correlation has been found between HOMA-IR and BMI, HOMA –IR and age or HOMA-IR and sex.
Background: Extended pancreatoduodenectomy (PD) for pancreatic adenocarcinoma has been assessed by some retrospective and 4 randomized controlled trials. However, the protocols used and the results found were different. Aim: Assessment of the results of standard (SPD) and extended (EPD) pancreaticoduodenectomies (PDs). Methods: A prospective trial of 30 standard (SPD) and 30 extended (EPD) consecutive PDs for PDA performed from 2004 to 2008. Results: The mean number of excised lymph nodes was significantly higher for EPD (28 vs. 14) (p<0.01). Comparison of mortality (6.6% vs 6,6%), the mean operating time (5.05h for SPD vs. 6.4h for EPD), general morbidity (59% vs. 52%), reoperation (8.3% vs. 13.3%), pancreatic fistula (18.3% vs. 3.3% for EPD), bile leakage rates (11.6% vs. 4%) and blood loss (7.1dl vs. 8.3 dl) have shown a significant difference only in operating time. 30% of EPDs were followed by diarrhea and lymphorrhea. The three- and 5year overall survival rate (OSR) after SPD was 0, and 25% and 17% -for EPD with median survival (MS) of 11 and 12 months. For stage 2b MS was 9
560
1 Clinical Biochemistry Department, INFIBIOC, School of Pharmacy and Biochemistry, University of Buenos Aires, Argentina 2 “Programa de Estudios Pancreáticos” Hospital de Clínicas-UBA, Argentina 3 Universidad Pontificia Católica Argentina (UCA), Hofstra North Shore – LIJ School of Medicine, Division of Cytopathology North Shore-LIJ, NY, USA
Conclusion: Most patients with acute pancreatitis develop insulin resistance, which may be the potential target for new therapeutic regimen, aiming at the prevention of pancreatic endocrine insufficiency.
Introduction: The pancreas is a mixed gland; the exocrine portion produces and secretes enzymes involved in the digestion of nutrients in the diet. The diagnosis is based on a clinical study, imaging and laboratory. Serum pancreolauryl test (PLs) indirectly measures the activity of a specific pancreatic cholesterol esterase. The aim purpose of appealing to this noninvasive test is to put evidence an unsuspected exocrine pancreatic insufficiency (EPI) or, if already diagnosed to establish its improvement or otherwise its deterioration as a result of the therapeutic approach. Aim: Determinate PLs values in EPI and control patients, and establish differences between them. Materials and methods: We studied 35 adult patients, classified by clinical features and imaging techniques in two groups: Control (n¼14, age: 5014, without gastrointestinal disorders) and EPI (n¼21, age: 5112, with: primary biliary cirrhosis-n¼1, fatty pancreas-n¼1, chronic pancreatitis-n¼5, pancreatic head resection-n¼1, and gastrointestinal disturbsn¼13) PLs: Together with a breakfast rich in fat, Fluorescein Dilaureate was administered. By venous puncture, serum samples were extracted at different times: Basal and post breakfast at: 60,120,150,180,210 and 240 minutes. At all times the free fluorescein was read spectrofotometrically at 492nm.The maximum of absorption was considered for the calculation. The cutoff value used was 4.5 mg/L. Results: In patients with EPI the PLs was lower than the control (7,52,0 vs 2,81,3 respectively; P<0.0001) Conclusion: The PLs is an economic, noninvasive and feasible test to perform in the biochemical laboratory. This study allows us to find patients who consult for diverse gastrointestinal problems, subclinical exocrine pancreatic insufficiency, which is solved by administering supplements enzymatic or therapeutic approach.
Exocrine and endocrine pancreatic insufficiency after acute necrotizing pancreatitis
P-196.
P-197.
T. Lubenets, A. Dronov, I. Kovalska, M. Zemskova. Department of General Surgery N 1 of the National Medical University named after A.A. Bogomolets, Kyiv, Ukraine Introduction: Acute necrotizing pancreatitis is a disease that can lead to the development of exocrine and endocrine pancreatic insufficiency in recovery period. Aim of the study: To examine the incidence of exocrine and endocrine pancreatic insufficiency after acute necrotizing pancreatitis. Patients and methods: 85 patients with acute necrotizing pancreatitis were involved in the study. Exocrine function was evaluated by determination of fecal elastase-1, endocrine function - by determining of glycated hemoglobin and glucose tolerance test. The survey was conducted every six months. Results: Exocrine insufficiency developed in 36 (42.35%) patients; moderate - in 20, severe - in 16 patients. The exocrine insufficiency developed during the first year of the follow up and then remained constant. Endocrine insufficiency occurred in 23 (27.05%) patients: 3 patients during the first year, 8 - in the second year and 12 during the third year after acute necrotizing pancreatitis. Of these, impaired glucose tolerance was found in 35.4% of patients, with pancreatogenic diabetes in 64.6% of patients. Disorders of glucose metabolism have evolved only in patients with exocrine insufficiency, the coefficient of association exocrine and endocrine insufficiency was 0.79 + / - 0.085. Spearman coefficient correlations between the exocrine and endocrine insufficiency was r ¼ -0,673, p ¼ 0,0001. Conclusion: Acute necrotizing pancreatitis in the study group led to the formation of exocrine insufficiency in 42.35% of the patients and endocrine pancreatic insufficiency in 27.05% of the patients; impaired glucose metabolism developed only in patients with formed exocrine pancreatic insufficiency.
Measurement of insulin resistance by HOMA-IR index in patients with acute pancreatitis Bartosz Lesniowski 1, Katarzyna Winter 1, Anna Kumor 2, Ewa Małecka-Panas 1. 1
Department of Digestive Tract Diseases, Medical University of Lodz, Poland 2 Department of Laboratory Diagnostics, Medical University of Lodz, Poland
P-198. Results of standard and extended pancreaticoduodenectomies for pancreatic ductal adenocarcinoma Z.A. Kovalenko, O.V. Melekhina, V.A. Vishnevsky, T.V. Shevchenko, V.I. Egorov. Vishnevsky Institute of Surgery, Moscow, Russia
Background: Insulin resistance (IR) contributes to type 2 diabetes mellitus, non-alcoholic steatohepatitis, metabolic syndrome, arteriosclerosis, obesity, and polycystic ovary syndrome. It has been suggested that acute pancreatitis level may lead to IR, which may represent a new potential therapeutic target. Material and methods: The study group comprised 35 patients with alcoholic AP (median age 4926.7 years; 26 men and 7 women). In all cases AP was classified as B according to Balthazar's CT score and as mild according to Ranson's criteria. The serum level of insulin and glucose were measured on the first day of hospitalization. Insulin resistance was measured with HOMA-IR index. Median patients' BMI was 245. Patients with diabetes mellitus, impaired glucose tolerance (IGT), or renal malfunction were excluded. Results: The median plasma glucose level was 122 53 mg/dl. The median insulin level was 8,36 5,2 microIU/L. In almost all patent with AP : 32 (92%) - the HOMA – IR index was increased : median 1.50 0.5, range: 1.0 to 3.0.No correlation has been found between HOMA-IR and BMI, HOMA –IR and age or HOMA-IR and sex.
Background: Extended pancreatoduodenectomy (PD) for pancreatic adenocarcinoma has been assessed by some retrospective and 4 randomized controlled trials. However, the protocols used and the results found were different. Aim: Assessment of the results of standard (SPD) and extended (EPD) pancreaticoduodenectomies (PDs). Methods: A prospective trial of 30 standard (SPD) and 30 extended (EPD) consecutive PDs for PDA performed from 2004 to 2008. Results: The mean number of excised lymph nodes was significantly higher for EPD (28 vs. 14) (p<0.01). Comparison of mortality (6.6% vs 6,6%), the mean operating time (5.05h for SPD vs. 6.4h for EPD), general morbidity (59% vs. 52%), reoperation (8.3% vs. 13.3%), pancreatic fistula (18.3% vs. 3.3% for EPD), bile leakage rates (11.6% vs. 4%) and blood loss (7.1dl vs. 8.3 dl) have shown a significant difference only in operating time. 30% of EPDs were followed by diarrhea and lymphorrhea. The three- and 5year overall survival rate (OSR) after SPD was 0, and 25% and 17% -for EPD with median survival (MS) of 11 and 12 months. For stage 2b MS was 9