Takotsubo Cardiomyopathy Triggered by Acute Pancreatitis: A Case Report

Takotsubo cardiomyopathy is a heart condition that is widely known to be caused by stress. It presents with symptoms that are similar to a myocardial infarction even though the coronary arteries are clear. This case report details the clinical characteristics, diagnostic assessment, and management plan of a 55-year-old male patient with a past medical history of alcoholism who arrived at the emergency department with the typical symptoms of acute pancreatitis. The case demonstrates the progression of Takotsubo cardiomyopathy, which was triggered by acute pancreatitis in the context of alcoholism, and underlines the significance of early detection and management to enhance the patient’s outcomes.

Acute renal dysfunction in patients with alcoholic hepatitis

Acute renal dysfunction is common in patients with alco-holic hepatitis(AH).Its presence leads to higher mortality in these patients.Despite advances in medical care,the outcome has changed little over the past decades.Studies using Pentoxifylline and molecular adsorbent recirculation system have shown encouraging data in small studies.Further larger well designed studies are needed to assess these modalities of treatment for the treatment of AH.

“Pseudotumoral” hepatic pattern in acute alcoholic hepatitis:A case report

In acute alcoholic hepatitis (AAH), a "pseudotumoral" appearance of the liver parenchyma on computed tomography (CT) scan has been reported. The main findings are hypervascularized areas closely similar to those observed in large hepatocellular carcinomas. We report a case of a patient affected by AAH with an unusual appearance of these "pseudotumoral" areas on CT scan, close resembling a metastatic cancer rather than a primary hepatocellular carcinoma. In fact, in contrast with previous reports, the picture was characterized by the presence of many inhomogeneous, hypoattenuated areas highlighted during both pre- and post-contrast phases. Moreover, we report the first description of "pseudotumoral" lesions on ultrasound scan. This patient was successfully treated with corticosteroids, even if many controversies still exist regarding their efficacy in this setting.

Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis

AIM To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting shortterm mortality among patients with alcoholic hepatitis.METHODS We retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA), CLIF Consortium Organ Failure score(CLIF-C OFs), Maddrey'sdiscriminant function(DF), age, bilirubin, international normalized ratio and creatinine score(ABIC), Glasgow Alcoholic Hepatitis Score(GAHS), model for end-stage liver disease(MELD), and MELD-Na.RESULTS Of 264 patients, 32(12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86(0.81-0.90), 0.89(0.84-0.92), 0.79(0.74-0.84), 0.78(0.72-0.83), 0.81(0.76-0.86), 0.83(0.78-0.88), and 0.83(0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d mortality.CONCLUSION CLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.

Study on Protection Mechanism of Viscum coloratum (Kom.) Nakai f. lutescens kitag Fruit Polysaccharides on Mice with Acute Alcoholic Liver Injury

This study was conducted to investigate the protective mechanism of V. coloratum fruit polysaccharides（ VCFP） on mice with acute alcoholic liver injury. Acute liver injury model was built by one-time alcohol gavage. The mice were randomly divided into VCFP-treated groups（ low-,medium-,and highdose）,alcohol model group and normal control group at the same time. VCFP-treated groups were administrated polysaccharide intragastrically continuously for4 weeks; and the alcohol model group and normal control group were administrated intragastrically the same amount of normal saline. The general situation and liver tissue morphological structure changes were observed. The results showed that the levels of ALT,AST,TC,TG,MDA contents,and CAT and GSH-Px activity of mice in the model group increased significantly（ P 〈 0. 01）,while the activity of SOD and weight and liver index decreased significantly（ P 〈 0. 01） compared with the normal control group. After 4 weeks of gavage,VCFP could significantly improve weight,liver index and SOD activity,and significantly reduce ALT,AST,TC and TG levels,MDA content and CAT and GSH-Px activity. These results suggest that VCFP can improve antioxidant enzyme activity,remove oxygen free radical and reduce membrane lipid peroxidation reaction,thereby protecting liver cells.

Madelung’s disease with alcoholic liver disease and acute kidney injury: A case report

BACKGROUND Madelung’s disease(MD)is a rare disorder of lipid metabolism,characterized by the growth of unencapsulated masses of adipose tissue symmetrically deposited around the neck,shoulders,or other sites around the body.Its pathological mechanism is not yet known.One of the most common comorbidities in MD patients is liver disease,especially chronic alcoholic liver disease(CALD);however,no reports exist of acute kidney injury(AKI)with MD.CASE SUMMARY We report a 60-year-old man who presented with complaint of edema in the lower limbs that had persisted for 3 d.Physical examination showed subcutaneous masses around the neck,and history-taking revealed the masses to have been present for 2 years and long-term heavy drinking.Considering the clinical symptoms,along with various laboratory test results and imaging characteristics,a diagnosis was made of MD with acute exacerbation of CALD and AKI.The patient was treated with liver function protection and traditional Chinese medicine,without surgical intervention.He was advised to quit drinking.After 10 d,the edema had subsided,renal function indicators returned to normal,liver function significantly improved,and size of subcutaneous masses remained stable.CONCLUSION In MD,concomitant liver or kidney complications are possible and monitoring of liver and kidney functions can be beneficial.

In vitro and in vivo models of acute alcohol exposure

Alcohol abuse is a global problem due to the financial burden on society and the healthcare system. While the harmful health effects of chronic alcohol abuse are well established, more recent data suggest that acute alcohol consumption also affects human wellbeing. Thus, there is a need for research models in order to fully understand the effect of acute alcohol abuse on different body systems and organs. The present manuscript summarizes the interdisciplinary advantages and disadvantages of currently available human and non-human models of acute alcohol abuse, and identifi es their suitability for biomedical research.

Changes of learning and memory ability associated with neuronal nitric oxide synthase in brain tissues of rats with acute alcoholism

BACKGROUD： Ethanol can influence neural development and the ability of leaming and memory, but its mechanism of the neural toxicity is not clear till now. Endogenous nitric oxide （NO） as a gaseous messenger is proved to play an important role in the formation of synaptic plasticity, transference of neuronal information and the neural development, but excessive nitro oxide can result in neurotoxicity. OBJECTIVE ： To observe the effects of acute alcoholism on the learning and memory ability and the content of neuronal nitric oxide synthase （nNOS） in brain tissue of rats. DESIGN ： A randomized controlled animal experiment. SETTING ： Department of Physiology, Xinxiang Medical College MATERIALS： Eighteen male clean-degree SD rats of 18-22 weeks were raised adaptively for 2 days, and then randomly divided into control group （n = 8） and experimental group （n = 10）. The nNOS immunohistochemical reagent was provided by Beijing Zhongshan Golden Bridge Biotechnology Co.,Ltd. Y-maze was produced by Suixi Zhenghua Apparatus Plant. METHODS ： The experiment was carded out in the laboratory of the Department of Physiology, Xinxiang Medical College from June to October in 2005. ① Rats in the experimental group were intraperitoneally injected with ethanol （2.5 g/kg） which was dissolved in normal saline （20%）. The loss of righting reflex and ataxia within 5 minutes indicated the successful model. Whereas rats in the control group were given saline of the same volume. ② Examinations of learning and memory ability： The Y-maze tests for learning and memory ability were performed at 6 hours after the models establishment. The rats were put into the Y-maze separately. The test was performed in a quiet and dark room. There was a lamp at the end of each of three pathways in Y-maze and the base of maze had electric net. All the lamps of the three pathways were turned on for 3 minutes and then turned off. One lamp was turned on randomly, and the other two delayed automatically. In 5 seconds after alternation, pulsating electric current presented in the base of unsafe area to stimulate rat＇s feet to run to the safe area. The lighting lasted for 15 seconds as one test. Running from unsafe area to safe area at one time in 10 seconds was justified as successful. Such test was repeated for 10 times for each rat and the successful frequency was recorded. The qualified standard of maze test was that the rat ardved in the safe area g times during 10 experiments. The number of trainings for the qualified standard was used to represent the result of spatial learning. ③ Determination of the content of nNOS in brain tissue： After the Y-maze test, the rats were anaesthetized, and blood was let from the incision on right auricle, transcardially perfused via the left ventricle with about 200 mL saline, then fixed by perfusion of 40 g/L paraformaldehyde. Hippocampal CA1 region, corpus striatum and cerebellum were taken to prepare serial freezing coronal sections. The nNOS contents in the brain regions were determined with the immunohistochemical methods to reflect the changes of nitdc oxide in brain tissue. MAIN OUTCOME MEASURES ： The changes of learning and memory ability and the changes of the nNOS contents in the brain tissue of rats with acute alcoholism were observed. RESULTS ： One rat in the experimental group was excluded due to its slow reaction to electdc stimulation in the Y-maze test, and the other 17 rats were involved in the analysis of results. ① The training times to reach qualifying standards of Y-maze in the expedmental group was more than that in the control group [（34.33 ±13.04）, （27.50±8.79） times, P〈 0.05]. ② Forms and numbers of nNOS positive neurons in brain tissue： It could be observed under light microscope that in the hippocampal CA1 region, there were fewer nNOS positive neurons, which were lightly stained, and the processes were not clear enough; But the numbers of the positive neurons which were deeply stained as huffy were obviously increased in the experimental group, the cell body and cyloplasm of process were evenly stained, but the nucleus was not stained. The nNOS positive neurons in corpus stdatum had similar forms and size in the experimental group and control group. The form of the nNOS positive neurons in cerebellum were similar between the two groups. The numbers of nNOS positive neurons in hippocampal CA1 region and corpus striatum in the expedmental group [（18.22±7.47）, （11.38±5.00） cells/high power field] were obviously higher than those in the control group [（10.15±4.24）, （6.15±3.69） cells/high power field. The number of nNOS positive neurons in cerebellum had no significant difference between the two groups [（49.56±18.84）, （44.43±15.42） cells/high power field, P〉 0.05]. CONCLUSION ： Acute alcoholism may impair learning and memory ability, and nitric oxide may be involved in mediating the neurotoxic role of ethanol.

Hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic:A single-centre study

BACKGROUND The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019(COVID-19)pandemic.These were partially lifted on 15 June and further eased on 4 July.Changes in social behaviour,including increased alcohol consumption were described at the time.However,there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions,specifically alcoholrelated acute pancreatitis(AP).This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown.AIM To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United Kingdom.METHODS All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this study.Patient demographics,their initial presentation with AP,any recurrent admissions,disease severity and length of stay,were evaluated using ANOVA andχ^(2)and Kruskal–Wallis tests.RESULTS One hundred and thirty-six patients were included in the study.The highest total number of AP admissions was seen in March–September 2019 and the highest single-month period was in March–May 2020.Admissions for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years,for example,2016(P<0.05).Furthermore,the rate of admissions decreased by 38.89%between March–May 2020 and June–September 2020(P<0.05),coinciding with the easing of lockdown restrictions.This significant decrease was not observed in the previous year groups during those same time periods.Admissions for recurrent AP were highest in 2019.The median length of hospital stay did not differ between patients from each of the year groups.CONCLUSION An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced;a fall in figures was noted when restrictions were eased.

The Protective Effect of Jiujiuguiyi, a Medicine and Food Homologous Formula, on Acute Alcohol Poisoning Mice

急性酒精中毒已成为当代中国的第三大社会问题,而目前市面上的主流解酒产品主要是单一机制,通过提高与酒精代谢有关的酶活性来加速酒精代谢。因此,我们研发了一款可以同时做到保肝、减缓中枢异常兴奋、改善肌肉松弛的新型解酒配方——九酒归一。方法:给予0.12ml/10g50%乙醇灌胃,建立小鼠急性酒精中毒模型。连续20天给予九酒归一灌胃。接着,将小鼠随机分成8组,每组8只,分别为对照组(CON)、模型组(M)、海王金樽阳性对照组(HWJZ)、实验组(AL,AH,BL,BH,AB)。检测各组小鼠的步态、转棒爬行时间、肝脏和血清中的AST、ALT、SOD活性、血清中的MDA活性、肝脏中的ADH、ALDH、GSH-PX活性以及肝脏切片。结果:与模型组相比,九酒归一使肝脏和血清中的AST、ALT活性、血清中的MDA活性明显降低,同时使肝脏中的ADH、ALDH以及肝脏和血清中的SOD活性明显升高,显示肝脏代谢酒精能力增强、肝损伤降低。HE染色同样证明了九酒归一可以减少干细胞损伤,并且先药后酒组效果更好。而且,九酒归一明显延长了急性酒精中毒小鼠的转棒爬行时间,改善了急性酒精中毒小鼠的步态。结论:本研究证明,九酒归一可以有效保肝、减缓中枢异常兴奋、改善肌肉松弛。其作用机制主要是调节酒精代谢酶和抗氧化酶活性.

Triglyceride levels and apolipoprotein E polymorphism in patients with acute pancreatitis

BACKGROUND:Hypertriglyceridemia is an unusual cause of acute pancreatitis and sometimes considered to be an epiphenomenon.This study aimed to investigate the clinical and analytical features and the APOE genotypes in patients with acute pancreatitis and severe hypertriglyceridemia.METHODS:We undertook a one-year,prospective study of patients with acute pancreatitis whose first laboratory analysis on admission to the emergency department included measurement of serum triglycerides.The APOE genotype was determined and the patients answered an established questionnaire within the first 24 hours concerning their alcohol consumption,the presence of co-morbidities and any medications being taken.The patients’ progression,etiological diagnosis,hospital stay and clinical and radiological severity were all recorded.RESULTS:Hypertriglyceridemia was responsible for 7 of 133 cases of pancreatitis (5%);the remaining cases were of biliary (53%),idiopathic (26%),alcoholic (11%) or other (5%) origin.Compared with these remaining cases,the patients with hypertriglyceridemia were significantly younger,had more relapses,and more often had diabetes mellitus.They usually consumed alcohol or consumed it excessively on the days before admission.Also,the ε4 allele of the APOE gene was more common in this group (P<0.05).CONCLUSION:One of 20 episodes of acute pancreatitis is caused by hypertriglyceridemia and it is linked to genetic (ε4 allele) and comorbid factors such as diabetes and,especially,alcohol consumption.

Definition,epidemiology and magnitude of alcoholic hepatitis

Alcoholic liver disease(ALD) is a major cause of alcoholrelated morbidity and mortality.Its presentation ranges from fatty liver to alcoholic hepatitis(AH),cirrhosis,and hepatocellular carcinoma.Although the amount and pattern of alcohol consumption is a well recognized predisposing factor for the development of serious liver pathology,environmental factors and the host's genetic makeup may also play significant roles that have not yet been entirely explored.Continuing alcohol consumption is a major factor that influences the survival of patients with AH.The presence of cirrhosis at presentation or its development on follow up is a major factor determining the outcome in the long run.This chapter deals with the epidemiology and magnitude of ALD in general and AH in particular.

Alcoholic pancreatitis:New insights into the pathogenesisand treatment

Acute pancreatitis is a necro-inflammatory disease of the exocrine pancreas that is characterized by inappropriate activation of zymogens, infiltration of the pancreas by inflammatory cells, and destruction of the pancreatic exocrine cells. Acute pancreatitis can progress to a severe life-threatening disease. Currently there is no pharmacotherapy to prevent or treat acute pancreatitis. One of the more common factors associated with acute pancreatitis is alcohol abuse. Although commonly associated with pancreatitis alcohol alone is unable to cause pancreatitis. Instead, it appears that alcohol and its metabolic by-products predispose the pancreas to damage from agents that normally do not cause pancreatitis, or to more severe disease from agents that normally cause mild pancreatic damage. Over the last 10 to 20 years, a tremendous amount of work has defined a number of alcohol-mediated biochemical changes in pancreatic cells. Among these changes are: Sustained levels of intracellular calcium, activation of the mitochondrial permeability transition pore, endoplasmic reticulum stress, impairment in autophagy, alteration in the activity of transcriptional activators, and colocalization of lysosomal and pancreatic digestive enzymes. Elucidation of these changes has led to a deeper understanding of the mechanisms by which ethanol predisposes acinar cells to damage. This greater understanding has revealed a number of promising targets for therapeutic intervention. It is hoped that further investigation of these targets will lead to the development of pharmacotherapy that is effective in treating and preventing the progression of acute pancreatitis.

Liver transplantation for alcoholic liver disease

Alcoholic liver disease(ALD) is the second commonest indication for liver transplantation after viral hepatitis in the United States and Europe.Controversies surround the indications and allocation of scarce and expensive resource for this so called self inflicted disease.Controversies stem from the apprehension that alcoholic recipients are likely to relapse and cause damage to the graft.There is a need to select those candidates with lower risk for relapse with the available predictive factors and scores.Substance abuse specialist and psychiatrists are mandatory in the pre-transplant evaluation and in the post-transplant follow-up.There is conflicting evidence to support a fixed period of pretransplant abstinence,although most units do follow this.Alcoholic hepatitis(AH) continues to be a contraindication for transplantation,however there is a need for further research in this f ield as a subset of patients with AH who do not respond to medical treatment,have high early mortality and could benefit from transplantation.One year,3-year,and 5-year survival post-transplant is similar for both ALD and non-ALD recipients.The incidence of post-transplant rejection and retransplantation is also similar to other recipients.ALD with viral hepatitis especially hepatitis C virus leads to a more aggressive liver disease with early presentation for transplantation.ALD patients are more prone to develop de-novo malignancy;this is attributed to the long term effect of alcohol,tobacco combined with immunosuppression.Post-transplant surveillance is important to detect early relapse to alcoholism,presence of de-novo malignancy and treat the same adequately.

Fatty acids of erythrocyte membrane in acute pancreatitis patients

AIM:To evaluate changes in the fatty acid composition of erythrocyte membrane phospholipids during severe and mild acute pancreatitis(AP)of alcoholic and nonalcoholic etiology.METHODS:All consecutive patients with a diagnosis of AP and onset of the disease within the last 72 h admitted to the Hospital of Lithuanian University of Health Sciences between June and December 2007 were included.According to the Acute Physiology and ChronicHealth Evaluation(APACHEⅡ)scale,the patients were subdivided into the mild(APACHEⅡscore<7,n=22)and severe(APACHEⅡscore≥7,n=17)AP groups.Healthy individuals(n=26)were enrolled as controls.Blood samples were collected from patients on admission to the hospital.Fatty acids(FAs)were extracted from erythrocyte phospholipids and expressed as percentages of the total FAs present in the chromatogram.The concentrations of superoxide dismutase and glutathione peroxidase were measured in erythrocytes.RESULTS:We found an increase in the percentages of saturated and monounsaturated FAs,a decrease in the percentages of total polyunsaturated FAs(PUFAs)and n-3 PUFAs in erythrocyte membrane phospholipids of AP patients compared with healthy controls.Palmitic(C16:0),palmitoleic(C16:1n7cis),arachidonic(C20:4n6),docosahexaenoic(DHA,C22:6n3),and docosapentaenoic(DPA,C22:5n3)acids were the major contributing factors.A decrease in the peroxidation and unsaturation indexes in AP patients as well as the severe and mild AP groups as compared with controls was observed.The concentrations of antioxidant enzymes in the mild AP group were lower than in the control group.In severe AP of nonalcoholic etiology,the percentages of arachidic(C20:0)and arachidonic(C20:4n6)acids were decreased as compared with the control group.The patients with mild AP of nonalcoholic etiology had the increased percentages of total saturated FAs and gama linoleic acid(C18:3n6)and the decreased percentages of elaidic(C18:1n9t),eicosapentaenoic acid(EPA,C20:5n3),DPA(C22:5n3),DHA(C22:6n3)as well as total and n-3 PUFAs in erythrocyte membrane phospholipids.CONCLUSION:The composition of FAs in erythrocyte membranes is altered during AP.These changes are likely to be associated with alcohol consumption,inflammatory processes,and oxidative stress.

Prospective evaluation of the cause of acute pancreatitis,with special attention to medicines

AIM: To investigate the cause of acute pancreatitis(AP) by conducting a thorough investigation of drugs and their possible etiological role.METHODS: We investigated the cause of AP in a large retrospective cohort of 613 adult patients admitted with AP at the Akershus University Hospital, Norway, from 2000 until 2009, who were evaluated with standard ward investigations. This group was compared with a prospectively evaluated group(n = 57) admitted from January 2010 until September 2010 who investigated more extensively using medical history and radiological assessment.RESULTS: The groups were comparable with regards to gender, age, comorbidity and severity. The most common etiology was bile stones and alcohol, occurring in 60% in both groups. The prospective group was examined more thoroughly with regards to the use of alcohol and medicines. An increased number of radiological investigations during hospital stay and at follow-up were also performed. A more extensive use of radiological evaluation did not increase the detection frequency of bile stones. In the prospective group, more than half of the patients had two or more possible causes of pancreatitis, being mostly a combination of bile stones and drugs. No possible cause was found in only 3.5% of these patients, compared with 29.7% in the retrospective group.CONCLUSION: A detailed medical history and extensive radiological evaluation may determine a possible etiology in almost all cases of AP. Many patients have several possible risk factors, and uncertainty remains in establishing the definitive etiology.

Exocrine pancreatic function during the early recovery phase of acute pancreatitis

BACKGROUND:Exocrine pancreatic dysfunction has been reported in humans in the convalescent period after acute pancreatitis,but the data are scarce and conflicting.This study aimed to prospectively assess the exocrine pancreatic function in patients with acute pancreatitis at the time of their refeeding. METHODS:Fecal elastase-1 was determined on the day of refeeding in all consecutive acute pancreatitis patients with their first episode of the disease.They were 75 patients including 60(80.0%)patients with mild acute pancreatitis and 15(20.0%)patients with severe acute pancreatitis. Etiologically 61 patients(81.3%)had biliary disease,1(1.3%) had alcoholic disease and 3(4.0%)had hypertriglyceridemia. No causes of acute pancreatitis were found in the remaining 10 patients(13.3%).The mean(±SD)refeeding time after the attack of acute panereatitis was 11.2±10.2 days. RESULTS:Pathological values of FE-1 were found in 9 of the 75 patients(12.0%):7(9.3%)patients with mild pancreatitis and 2(2.7%)patients with severe pancreatitis(P=1.000). The frequency of the pathological values of fecal elastase-1 was significantly different from that of various etiologies of the disease(P=0.030).It was significantly lower in patients with biliary pancreatitis(9.8%;P=0.035)than in one patient with alcoholic pancreatitis(P=0.126),one patient with hypertriglyceridemia-induced pancreatitis(33.3%; P=0.708),and one patient with idiopathic pancreatitis (10.0%;P=0.227).Pathological fecal elastase-1 was not significantly related to sex,age or day of refeeding.CONCLUSION:Exocrine pancreatic function should be routinely assessed in patients with acute pancreatitis at the time of refeeding in order to supplement their diet with pancreatic extracts.

Extracorporeal liver support in severe alcoholic hepatitis

The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.

Is acute recurrent pancreatitis a chronic disease?

Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis transmembrane con-ductance regulator (CFTR) gene mutation, hereditary and obstructive pancreatitis seem an acute disease that progress to chronic pancreatitis, likely as a consequence of the activation and proliferation of pancreatic stellate cells that produce and activate collagen and therefore fibrosis. From the diagnostic point of view, in patients with acute recurrent pancreatitis Endoscopic ultrasound (EUS) seems the more reliable technique for an accurate evaluation and follow-up of some ductal and parenchymal abnormalities suspected for early chronic pancreatitis.

Is alcoholic pancreatitis associated with enteroviral infection?

AIM: To investigate whether enteroviral infection might trigger acute pancreatitis in patients made susceptible due to high alcohol consumption. METHODS: Patients with alcohol-induced acute pan-creatitis were analyzed for signs of simultaneous or preceding enteroviral infection. We studied the serum samples of 40 patients hospitalized for alcohol-induced acute pancreatitis and 40 controls recruited from an alcohol detoxification center. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect enterovirus RNA and diagnose acute viremia. Immuno-globulin G (IgG), immunoglobulin A (IgA) and immuno-globulin M (IgM) enteroviral antibodies were measured using enzyme immunoassay to detect subacute andprevious infections. The samples were considered posi-tive when the antibody titers were≥15 IU. Further-more, using RT-PCR, we studied pancreatic biopsy sam-ples obtained during surgery from nine patients with chronic pancreatitis, one patient with acute pancreatitis and ten control patients with pancreatic carcinoma for evidence of persisting enteroviral RNA in the pancreatic tissue. RESULTS: No enterovirus RNA indicating acute viremia was detected by RT-PCR in the serum samples of any patient or control. A high incidence of positive antibody titers was observed in both study groups: IgM antibod-ies had positive titers in 5/40 (13%) vs 4/40 (10%), P=0.723; IgG in 15/40 (38%) vs 19/40 (48%), P=0.366; and IgA in 25/40 (63%) vs 33/40 (83%), P=0.045, patients and controls, respectively. Ten (25%) patients had severe pancreatitis and two (5%) required treatment in intensive care. The median length of hos-pitalization was 7 d (range: 3-47 d). The severity of acute pancreatitis or the length of hospitalization was not associated with enteroviral IgM, IgG or IgA anti-bodies. Five pancreatic biopsy samples tested positive with RT-PCR, three (8%) in the control group and two (5%) in the patient group (P=0.64). CONCLUSION: The rate of enteroviral infection is not increased in patients with alcohol-induced acute pan-creatitis when compared to alcoholics with similar high alcohol use.