allopurinol and Pancreatic-Diseases

Uric acid deposition in the pancreas is very rare and neither an endoscopic ultrasound (EUS) nor a contrast-enhanced CT image of this condition has ever been published. We describe a case of asymptomatic pancreatic gout that was detected incidentally on CT. Imaging features mimicked pancreatic neoplasm, warranting further evaluation with EUS-guided fine-needle aspiration. Samples revealed debris encrusted with monosodium urate crystals. Follow-up CT showed complete resolution with urate-lowering therapy. We aim to augment current knowledge on the imaging of pancreatic gout and discuss its management.

Topics: Aged; Allopurinol; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Gout; Humans; Incidental Findings; Male; Multimodal Imaging; Pancreatic Diseases; Tomography, X-Ray Computed; Treatment Outcome

Oxidants and their generator, xanthine oxidase (XO), play a major role in the damaging of the structural and functional integrity of the lung. Such damage has been recently demonstrated in the presence of pancreas ischemia-reperfusion (IR). We investigated whether mannitol, a clinically used agent and antioxidant, prevented lung damage after pancreas IR. Rats (n = 48) were anesthetized, after which each pancreas was isolated and perfused (controls), or made ischemic (IR) for 40 min, or made ischemic and treated upon reperfusion with four different doses of mannitol administered in the perfusate (8 replicates/group). Ischemia was followed by in-series 15-min pancreas plus normal isolated lung reperfusion. Isolated lungs were subsequently perfused for 45 min with the 15-min accumulated effluents. Pancreas injury occurred in all IR organs as demonstrated by abnormal reperfusion pressure, the wet-to-dry ratio, amylase and lipase leakage into the circulation, and XO activity and reduced glutathione (GSH) pool in the tissues. Pulmonary plateau pressure increased by 80%, and final PO(2)/FiO(2) decreased by 28% in the IR-untreated paired lungs. Bronchoalveolar lavage volume increased by 50% and 2- to 8-fold increase in their contained XO and GSH were recorded as well. The above indices of injury in lungs perfused with 0.77 mM mannitol were the least detected, compared with negligible efficacy of other (0.55 < 0.22 < 1.1 mM) dosages. Amylase and lipase did not contribute to lung injury. Ex vivo acute pancreatitis induces acute lung injury via oxidants/antioxidants imbalance, which is preventable by mannitol.

Topics: Acute Lung Injury; Amylases; Animals; Antioxidants; Disease Models, Animal; Dose-Response Relationship, Drug; Enzyme Inhibitors; Glutathione; Lipase; Lung; Male; Mannitol; Oxidative Stress; Pancreas; Pancreatic Diseases; Rats; Rats, Wistar; Reperfusion Injury; Time Factors; Xanthine Oxidase

Topics: Allopurinol; Diabetes Mellitus, Type 1; Drug Hypersensitivity; Enzyme Inhibitors; Female; Humans; Hypertension; Middle Aged; Pancreatic Diseases

Topics: Adenosine; Adolescent; Adult; Allopurinol; Amylases; Edema; Female; Glutathione; Humans; Insulin; Magnetic Resonance Imaging; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas Transplantation; Pancreatic Diseases; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Adolescent; Adult; Allopurinol; Edema; Glutathione; Humans; In Vitro Techniques; Insulin; Magnetic Resonance Imaging; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Pancreatic Diseases; Raffinose; Time Factors; Tissue Donors; Water