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Time course of serum pancreatic enzymes in hypovolemic shock
85
87 PREVALENCE, CLINICAL CORRELATES AND DIAGNOSTIC ROLE OF ANTI-NEUTROPHIL CYTOPLAShlIC ANTIBODIES (p-ANCA) AND ANTI-SACCRAROMYCES CEREVISL4E ANTIBODIES (ASCA) ASSAYS IN INF LAhIMATORY BOWEL DISEASE (IBD). Vecchi M, Saibeni S, Folli C, Formenti S, de Fraochis R IRCCS Ospedale Policlinico, Uoiversti degli Studi, Milaoo. ITALY B&ground among several antibodies described in IBD, AntiNeutrophil Cytaplasmic Antibodies (pANCA) and Anti-Saccbaromyces Cerevisiae Antibodies (ASCA) appear to he the most helpful in the differential diagnosis between Crohn’s disease (CD) and Ulcerative Colitis (UC). Aims to evaluate the prevalence, sensitivity, specificity and Positive Predictive Value (PPV) of p-ANCA and ASCA determinations and ofthe combined assay in the diagnosis of CD and UC in Italian IBD patients (pts), to analyze the influence of surgery, location and activity of the disease on ASCA expression in CD pts. Methods: 84 CD pts (46 men, mean age ? SD, 38 7 + 12.3 years) and 44 UC pts (25 men, 42.0 i 14 6 years) were consecutively enrolled in the study. 24 out of 84 CD pts (28 6%) and 8 out of 44 UC pts (I 8.2%) had active disease. p-ANCA and ASCA-IgG and -1gA were tested, respectively, by means of an indirect immunofluorescence method (INOVA, Menarini Diagnostics, San Diego, CA) and a commercially available ELISA kit (Medimu, Milan, Italy) Results ASCA-IgG positivity was observed in 38 out of 84 CD pts (45 2%) and in I o”t of 44 UC pts (2.3%) (p
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Conclusions: p-ANCA and ASCA-IgG and -IgA are specific markers of UC and CD The combined determination can be helpful in the differential diagnosis of IBD In CD, ASCA expression is not influenced by location or activity of the disease or by resective surgery
INTERFERON + RIBAVIIUN RE-TREATMENT IN HEMOPHILIC PATIENTS RELAPSERS OR NON-RESPONDERS TO INTERFERON ALONE MG Rumi E Santagostino, R. Soffrcdini, M Rivi, A Gringeri, M Colombo,:M. Mannucci and the Hepatitis Study Group of the Association of Italian Hemophilia Centers Ctr for Liver Disease “A.M. & A Migliavacca”, and “A Bianchi Bono& Thrombosis and Haemostasis Ctr , Dept Intern Med , Univ of Milan, IRCCS Maggiore Hospital, Milan, Italy. Background Six-month IFN+Ribavirin combmation therapy, yielded sustained virologic responses in 35% naive patients, 50% relapsers and a few non-responders to previous interferon therapy Patients with unfavourahle response predictors i.e. genotype I and/or high RNA viremia could benefit from extended (12 months) treatment with lFN+P.ibavirin Arm to assess the tolerability and efficacy of combination therapy in the retreatment of hemophilic patients with chronic hepatitis C and the pretreatment variables that might predict a sustained response Parrents 38 hemophiliacs, relapsers or non-responders to a previous 6.month course of 3MIJitiw IFN alone At baseline the patients had mednn viremia of 3 47 Meq/ml and genotype la in 20, lb in 8, 2h in 2 and 3 in 8 Treutmenr 5MU lMci2b SCfor six months followed by 3 MU for the addmonal six months + ribavirin 100011200 me dailv All eatients were followed for six months atier therapy Tolerabilrfy a hecrea, m haemoglobin levels (mean -2.9g/dI) was observed in all patients during treatment. In 4 (10%) cases therapy was stopped for severe fatigue, anorexia, nausea, dose of ribavirin was reduced for the occurrence of haemolvtic anaemia in 6 (16%) and IFN dose was reduced for thrombocytopen& hypothyroidism and fatigue in 4 (10%) Efficacy. ALT nomnlization was achieved in 21 (55%) patients and the complete response (normal ALT and negative HCV-RNA) in 18 (47%) at the end of therapy At the end of follow-up, 14 (37%) patients maintained the biochemical response. According to the intention-to treat-analysis, the 4 (10%) patients who stopped therapy for side-effects were considered nonresponders. The 14 biochemical sustained responders and the 24 nonresponders+relapsers were similar in term of age, ALT and baseline median value of HCV-RNA Genotype other than I was associated with B higher probability of response (p=O 01) Corzclwrom in hemophilic patients who relapsed or non-responded to treatment with IFN, re-treatment with combination therapy resulted in a high rate of sustained biochemical response The HCV genotype was associated with sustained response to combination therapy Combination therapy was relatively safe, but modifications in the dose and discontmuation were often required
86 TIME COURSE OF SERUM PANCREATIC ENZYMES IN HYPOVOLEMIC SHOCK R. Pezzilli, A.M. Morselli L&ate, G.V. M&i d’Eril. Emergency Dept., Dept. of Internal Medicine and Gastroenterology, Sant’Orsola Hospital, Bologna: Clinical Chemistry, Insubna University, Varese, Italy Background. The pancreas, lie the liver, is vulnerable to prolonged ischemia. However, the data on the involvement of tbe pancreas in shock are lacking. Alms. To evaluate the time cowse of serum pancreatic and hepatic enzymes and of acute phase proteins in patients with hypovolemic shock. Patients md methods. I2 consecutive patients (3 M, 9 F: mean age 19.4 years, range 67-87) with hypovolemic shock were studied within 2 hours Rum the onset of illness. Hypovolemic shock was assessed on the basis of an arterial pressure of less than 80 mmHg and central venous pressure of less than 8 cm HzO. Swan patients died during the hospital stay: 3 on admission, 3 within 4-8 hour from admission and I after 24 hours. In all patients, amylase (upper reference value, URL 220 U/L), lipasc (URL 58 U/L), AST (URL 35 U/L), ALT (URL 33 IJiL), C-reactive protein (CRP) (URL 4.2 mg/dL), serum amyloid A (SAA) (URL 41.5 mg/L), interleukin 6 (IL6) (URL 2 pgimL) and VCAM-I (URL 1693 ngimL) serum concentrahons were determined on admission and 4, 8, and 12 hours thereafter. All patients also underwent ultrasonography and/or computed tomography to detect pancreatic abnormalities. StatWeal analysis. Mann-Whitney and McNemar tests. Results. Serum concenbations of the proteins studied are repolted m the Table Table: Mean (*SD) s-concentrations ofthe proteins assayed. Basal 4h all 12 b Amylasc &J/L) 256f236 346i247 321k279 234tl70 Lip&e (U/L) 24il3 36i2.9 24t21 31M3 AST &J/L) 202r476 469f1088 52zt36 15of264 ALT (U/L) 91f147 1221298 35*43 96f169 CW (mg/dL) 12+10 14i14 1s+12 22*12 396f461 404i425 684zk671 795t-687 s&$2; 4597t5985 567727116 2167i2745 134lztl898 VCAM-1 (ng/mL) 168M575 2008+856 2161f706 26481299 None of the patients developed clinical signs or morphological alterations compatible wtb acute pawmatitis. Fitly-eight percent of the patients had an inctease of serutn amylase concentrations, whereas only 16.7% had an increase of serum lipase levels (F’=O.MZ). Regarding hepatic enzymes, 58.3% of patients had increased serum levels of AST and 50% of ALT. No significant differences m serum concentrations of all proteins studied were found between survivors and non-survivors. Conclusions. In patients with hypavolemic shock, sewn amylase is more frequently elevated than serum lipase. None of the patients showed pancreatic injury at imaging. In VIYO, pancreatic acinar cell injury during hypovolemic shock seems to be less frequent when compared to liver cell injury.
A118
PARENCBYMAL DAMAGE DUE TO ISCHEMIA-REPERFUSION IN PATIENTS UNDERGOING VASCULAR SURGERY C. Di Cnmpli, A. Freyrtc*, G. Angcltti, A. Armuzzl, C. Ptialino, F. Cn~ddueci, KC. Nit&S. Di Cam. G. Gasbarrini. M. D’Addato*. A. Gprbnrrini. ‘Dent. of Intcrn~I Medicine, Catholic Ihivc&y of Rome and Dept. of V&ular Surgery’, University of Bologna, Italy. Background and aim: in patients undergoing vascular surgery that include sonic cross-clamping for almost one hour a free-radicals mediated damage of liver. pancreas and gut may occur. The mechanism underlying this damage is related to the hypotension aa consequent hypoperfuslon of these organs. In this study we aimtoassesswhe&z r a lschemla mcdnted “’mImy may occur in liver, pancreasand gut after a period of complete visceral ischemla. Methods: 10 patients undergoing surgery for tboraco-abdominal aortic aneurism were studied. The mean duration of aortic clamping was 41.3 min, range 15.80 min. Effects of ischemia on liver, pancreas and gut were awessed clinically and biochemically (by serum concentration of amylase, lipase,GPT, hepatic ~oenzyme of alcaline phosphataseand intestinal ionenzyme of lacticodehydrogenase) in basal conditions, atier clamping and after release of the clamp at varying intervals (15 min. 50 min. 24 hs and 48 hs). Results: none of IO patientspresent symptoms or signs of acute pancrcatatis, acute hepatitis or ischemic intestinal damage.Basal enzymes levels were in the normal range for all patients. A&r release of aortic clamp a significant increase war already evident in the mitnl(50 min) determination and reached a peek about24 hs after clamp removing. Then the enzyme levels tended to decrease to basal values, even if remained significantly elevated for 48 ha after releaseof clamp. We also observed a rlgnificant correlation between increase in enzymes levels and aonr clamping time. Cooclwioos: Total suppression of blood flow by aortic clamming may deternone an ischemia-mediatedinjury of liver. pancreas and gut. Thi; d&age is usually subclinical and its degree is strictly related to the duration of &hernia. Further studies on the pathogenic mechanisms underlying this clinical ohservatwn are underway TO T4 T5 Enzyme ibasal value1 (24hs after (48hs after
Table 1.Enzyme levels at baseline,24 and 48 hs after clamping in UVI.
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-_I
87 PREVALENCE, CLINICAL CORRELATES AND DIAGNOSTIC ROLE OF ANTI-NEUTROPHIL CYTOPLAShlIC ANTIBODIES (p-ANCA) AND ANTI-SACCRAROMYCES CEREVISL4E ANTIBODIES (ASCA) ASSAYS IN INF LAhIMATORY BOWEL DISEASE (IBD). Vecchi M, Saibeni S, Folli C, Formenti S, de Fraochis R IRCCS Ospedale Policlinico, Uoiversti degli Studi, Milaoo. ITALY B&ground among several antibodies described in IBD, AntiNeutrophil Cytaplasmic Antibodies (pANCA) and Anti-Saccbaromyces Cerevisiae Antibodies (ASCA) appear to he the most helpful in the differential diagnosis between Crohn’s disease (CD) and Ulcerative Colitis (UC). Aims to evaluate the prevalence, sensitivity, specificity and Positive Predictive Value (PPV) of p-ANCA and ASCA determinations and ofthe combined assay in the diagnosis of CD and UC in Italian IBD patients (pts), to analyze the influence of surgery, location and activity of the disease on ASCA expression in CD pts. Methods: 84 CD pts (46 men, mean age ? SD, 38 7 + 12.3 years) and 44 UC pts (25 men, 42.0 i 14 6 years) were consecutively enrolled in the study. 24 out of 84 CD pts (28 6%) and 8 out of 44 UC pts (I 8.2%) had active disease. p-ANCA and ASCA-IgG and -1gA were tested, respectively, by means of an indirect immunofluorescence method (INOVA, Menarini Diagnostics, San Diego, CA) and a commercially available ELISA kit (Medimu, Milan, Italy) Results ASCA-IgG positivity was observed in 38 out of 84 CD pts (45 2%) and in I o”t of 44 UC pts (2.3%) (p
~~~~
Conclusions: p-ANCA and ASCA-IgG and -IgA are specific markers of UC and CD The combined determination can be helpful in the differential diagnosis of IBD In CD, ASCA expression is not influenced by location or activity of the disease or by resective surgery
INTERFERON + RIBAVIIUN RE-TREATMENT IN HEMOPHILIC PATIENTS RELAPSERS OR NON-RESPONDERS TO INTERFERON ALONE MG Rumi E Santagostino, R. Soffrcdini, M Rivi, A Gringeri, M Colombo,:M. Mannucci and the Hepatitis Study Group of the Association of Italian Hemophilia Centers Ctr for Liver Disease “A.M. & A Migliavacca”, and “A Bianchi Bono& Thrombosis and Haemostasis Ctr , Dept Intern Med , Univ of Milan, IRCCS Maggiore Hospital, Milan, Italy. Background Six-month IFN+Ribavirin combmation therapy, yielded sustained virologic responses in 35% naive patients, 50% relapsers and a few non-responders to previous interferon therapy Patients with unfavourahle response predictors i.e. genotype I and/or high RNA viremia could benefit from extended (12 months) treatment with lFN+P.ibavirin Arm to assess the tolerability and efficacy of combination therapy in the retreatment of hemophilic patients with chronic hepatitis C and the pretreatment variables that might predict a sustained response Parrents 38 hemophiliacs, relapsers or non-responders to a previous 6.month course of 3MIJitiw IFN alone At baseline the patients had mednn viremia of 3 47 Meq/ml and genotype la in 20, lb in 8, 2h in 2 and 3 in 8 Treutmenr 5MU lMci2b SCfor six months followed by 3 MU for the addmonal six months + ribavirin 100011200 me dailv All eatients were followed for six months atier therapy Tolerabilrfy a hecrea, m haemoglobin levels (mean -2.9g/dI) was observed in all patients during treatment. In 4 (10%) cases therapy was stopped for severe fatigue, anorexia, nausea, dose of ribavirin was reduced for the occurrence of haemolvtic anaemia in 6 (16%) and IFN dose was reduced for thrombocytopen& hypothyroidism and fatigue in 4 (10%) Efficacy. ALT nomnlization was achieved in 21 (55%) patients and the complete response (normal ALT and negative HCV-RNA) in 18 (47%) at the end of therapy At the end of follow-up, 14 (37%) patients maintained the biochemical response. According to the intention-to treat-analysis, the 4 (10%) patients who stopped therapy for side-effects were considered nonresponders. The 14 biochemical sustained responders and the 24 nonresponders+relapsers were similar in term of age, ALT and baseline median value of HCV-RNA Genotype other than I was associated with B higher probability of response (p=O 01) Corzclwrom in hemophilic patients who relapsed or non-responded to treatment with IFN, re-treatment with combination therapy resulted in a high rate of sustained biochemical response The HCV genotype was associated with sustained response to combination therapy Combination therapy was relatively safe, but modifications in the dose and discontmuation were often required
86 TIME COURSE OF SERUM PANCREATIC ENZYMES IN HYPOVOLEMIC SHOCK R. Pezzilli, A.M. Morselli L&ate, G.V. M&i d’Eril. Emergency Dept., Dept. of Internal Medicine and Gastroenterology, Sant’Orsola Hospital, Bologna: Clinical Chemistry, Insubna University, Varese, Italy Background. The pancreas, lie the liver, is vulnerable to prolonged ischemia. However, the data on the involvement of tbe pancreas in shock are lacking. Alms. To evaluate the time cowse of serum pancreatic and hepatic enzymes and of acute phase proteins in patients with hypovolemic shock. Patients md methods. I2 consecutive patients (3 M, 9 F: mean age 19.4 years, range 67-87) with hypovolemic shock were studied within 2 hours Rum the onset of illness. Hypovolemic shock was assessed on the basis of an arterial pressure of less than 80 mmHg and central venous pressure of less than 8 cm HzO. Swan patients died during the hospital stay: 3 on admission, 3 within 4-8 hour from admission and I after 24 hours. In all patients, amylase (upper reference value, URL 220 U/L), lipasc (URL 58 U/L), AST (URL 35 U/L), ALT (URL 33 IJiL), C-reactive protein (CRP) (URL 4.2 mg/dL), serum amyloid A (SAA) (URL 41.5 mg/L), interleukin 6 (IL6) (URL 2 pgimL) and VCAM-I (URL 1693 ngimL) serum concentrahons were determined on admission and 4, 8, and 12 hours thereafter. All patients also underwent ultrasonography and/or computed tomography to detect pancreatic abnormalities. StatWeal analysis. Mann-Whitney and McNemar tests. Results. Serum concenbations of the proteins studied are repolted m the Table Table: Mean (*SD) s-concentrations ofthe proteins assayed. Basal 4h all 12 b Amylasc &J/L) 256f236 346i247 321k279 234tl70 Lip&e (U/L) 24il3 36i2.9 24t21 31M3 AST &J/L) 202r476 469f1088 52zt36 15of264 ALT (U/L) 91f147 1221298 35*43 96f169 CW (mg/dL) 12+10 14i14 1s+12 22*12 396f461 404i425 684zk671 795t-687 s&$2; 4597t5985 567727116 2167i2745 134lztl898 VCAM-1 (ng/mL) 168M575 2008+856 2161f706 26481299 None of the patients developed clinical signs or morphological alterations compatible wtb acute pawmatitis. Fitly-eight percent of the patients had an inctease of serutn amylase concentrations, whereas only 16.7% had an increase of serum lipase levels (F’=O.MZ). Regarding hepatic enzymes, 58.3% of patients had increased serum levels of AST and 50% of ALT. No significant differences m serum concentrations of all proteins studied were found between survivors and non-survivors. Conclusions. In patients with hypavolemic shock, sewn amylase is more frequently elevated than serum lipase. None of the patients showed pancreatic injury at imaging. In VIYO, pancreatic acinar cell injury during hypovolemic shock seems to be less frequent when compared to liver cell injury.
A118
PARENCBYMAL DAMAGE DUE TO ISCHEMIA-REPERFUSION IN PATIENTS UNDERGOING VASCULAR SURGERY C. Di Cnmpli, A. Freyrtc*, G. Angcltti, A. Armuzzl, C. Ptialino, F. Cn~ddueci, KC. Nit&S. Di Cam. G. Gasbarrini. M. D’Addato*. A. Gprbnrrini. ‘Dent. of Intcrn~I Medicine, Catholic Ihivc&y of Rome and Dept. of V&ular Surgery’, University of Bologna, Italy. Background and aim: in patients undergoing vascular surgery that include sonic cross-clamping for almost one hour a free-radicals mediated damage of liver. pancreas and gut may occur. The mechanism underlying this damage is related to the hypotension aa consequent hypoperfuslon of these organs. In this study we aimtoassesswhe&z r a lschemla mcdnted “’mImy may occur in liver, pancreasand gut after a period of complete visceral ischemla. Methods: 10 patients undergoing surgery for tboraco-abdominal aortic aneurism were studied. The mean duration of aortic clamping was 41.3 min, range 15.80 min. Effects of ischemia on liver, pancreas and gut were awessed clinically and biochemically (by serum concentration of amylase, lipase,GPT, hepatic ~oenzyme of alcaline phosphataseand intestinal ionenzyme of lacticodehydrogenase) in basal conditions, atier clamping and after release of the clamp at varying intervals (15 min. 50 min. 24 hs and 48 hs). Results: none of IO patientspresent symptoms or signs of acute pancrcatatis, acute hepatitis or ischemic intestinal damage.Basal enzymes levels were in the normal range for all patients. A&r release of aortic clamp a significant increase war already evident in the mitnl(50 min) determination and reached a peek about24 hs after clamp removing. Then the enzyme levels tended to decrease to basal values, even if remained significantly elevated for 48 ha after releaseof clamp. We also observed a rlgnificant correlation between increase in enzymes levels and aonr clamping time. Cooclwioos: Total suppression of blood flow by aortic clamming may deternone an ischemia-mediatedinjury of liver. pancreas and gut. Thi; d&age is usually subclinical and its degree is strictly related to the duration of &hernia. Further studies on the pathogenic mechanisms underlying this clinical ohservatwn are underway TO T4 T5 Enzyme ibasal value1 (24hs after (48hs after
Table 1.Enzyme levels at baseline,24 and 48 hs after clamping in UVI.
-
-
-_I