scholarly journals Confocal laser endomicroscopy reveals alterations in duodenal permeability in patients with acute pancreatitis

2019 ◽  
Vol 47 (3) ◽  
pp. 1279-1287
Author(s):  
Lingjia Sun ◽  
Min Yue ◽  
Yining Dai ◽  
Chaohui Yu ◽  
Chunxiao Chen
Keyword(s):  
Acute Pancreatitis ◽  
Large Scale ◽  
Duodenal Bulb ◽  
Severity Index ◽  
Duodenal Mucosa ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Mucosal Permeability ◽  
Reactive Protein ◽  
Severity Index Score

Objective Intestinal permeability increases during the course of acute pancreatitis (AP). We assessed duodenal permeability alterations in patients with AP by confocal laser endomicroscopy (CLE). Methods Thirty patients with AP underwent CLE evaluation of the antral and duodenal mucosa. Images were graded based on the appearance of capillaries and the degree of fluorescein leakage. Results Patients with AP had increased duodenal mucosal permeability that could be detected by CLE. The mucosal permeability progressively increased in the gastric antrum, duodenal bulb, and descending duodenum. The CLE parameters in the antrum and duodenal bulb were not significantly different between patients with mild and severe AP. The CLE grades in the descending duodenum were higher in patients with severe than mild AP. The C-reactive protein level in AP was positively correlated with the permeability in the duodenal bulb and descending duodenum, while the computed tomography severity index score was positively correlated with the mucosal permeability in the duodenal bulb and descending duodenum. Conclusion CLE revealed increased duodenal permeability in patients with AP. Higher permeability in the descending duodenum was observed in severe than mild AP. Further large-scale studies are needed to confirm the relationship between altered duodenal permeability and the severity of AP.

Probe-based confocal laser endomicroscopy of the duodenal mucosa with fluorescein dispersion

2014 ◽  
Vol 26 (4) ◽  
pp. 604-604 ◽  
Author(s):  
Kouichi Nonaka ◽  
Ken Ohata ◽  
Yousuke Nakai
Keyword(s):  
Duodenal Mucosa ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser

scholarly journals Diagnostic utility of probe-based confocal laser endomicroscopy in superficial non-ampullary duodenal epithelial tumors

2019 ◽  
Vol 07 (11) ◽  
pp. E1515-E1521
Author(s):  
Tomomitsu Tahara ◽  
Noriyuki Horiguchi ◽  
Tsuyoshi Terada ◽  
Hyuga Yamada ◽  
Dai Yoshida ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Duodenal Mucosa ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Observational Trial ◽  
Histological Features ◽  
Epithelial Tumors ◽  
Neoplastic Lesions ◽  
Columnar Cells

Abstract Background and study aims Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADETs) has not been established. Probe-based confocal laser endomicroscopy (pCLE: Cellvizio) provides real-time endomicroscopic analysis. We developed and validated a new pCLE classification of SNADET based on abnormal findings. Patients and methods pCLE scanning of 20 SNADET lesions including 16 adenomas and four carcinomas was retrospectively evaluated to explore abnormal pCLE findings in relation to histological features. Diagnostic yield of pCLE findings was prospectively evaluated in an additional 20 SNADET lesions including 16 adenomas and four carcinomas. Results In a retrospective study, we identified four abnormal pCLE findings of SNADETs: (1) dark epithelium, (2) columnar cells irregularly extending to the lumen, (3) distorted crypt structure, and (4) fluorescein leakage. Dark epithelium distinguished neoplastic lesions (adenomas and carcinomas) from non-neoplastic duodenal mucosa with a sensitivity of 90 % and a specificity of 100 %. Distorted crypt structure distinguished carcinomas from adenomas and non-neoplastic duodenal mucosa with a sensitivity of 100% and a specificity of 94 %. In the prospective study, the sensitivity and the specificity of the dark epithelium for the diagnosis of neoplastic lesions (adenomas + carcinomas) was 75% and 100 %. Sensitivity and the specificity of the distorted crypt structure for discrimination of carcinoma from adenoma were 100 % and 94 %, respectively. Conclusions The pCLE findings correlated with the histopathology of the SNADETs. Dark epithelium and distorted crypt structure were informative pCLE findings to predict presence of neoplasia and cancer in the SNADET, respectively.UMIN-CTR UMIN000013857 TRIAL REGISTRATION: Single-Center, prospective observational trial UMIN000013857 at upload.umin.ac.jp

scholarly journals A retrospective review of serious infections in febrile infants 0–90 days old

2021 ◽  
pp. 201010582110260
Author(s):  
Zi Xean Khoo ◽  
Cherie Chua ◽  
Zhi Min Yap ◽  
Janine Cynthia Koh ◽  
Sarah Xin Chong ◽  
...  
Keyword(s):  
Clinical Problem ◽  
Severity Index ◽  
Tertiary Hospital ◽  
Reactive Protein ◽  
Serious Infection ◽  
Paediatric Unit ◽  
Serious Infections ◽  
Severity Index Score ◽  
Invasive Bacterial Infection ◽  
Male Sex

Background: Fever without source in infants is a common clinical problem that accounts for many ambulatory care visits and hospitalisations. Currently, there is no reliable method of identifying those at risk of serious infection (SI). Objective: The goal of this study was to determine the incidence and identify the predictors of SI in febrile infants who presented to the emergency department (ED). Methods: This was a single-centre retrospective cohort study of children presenting to a Singapore tertiary hospital paediatric unit between 1 July 2018 and 31 December 2018. Children were included if they were aged 0–90 days and presented to the ED with a fever. SI was defined as urinary tract infection (UTI), sepsis, bacteraemia, meningitis (viral and bacterial), enterocolitis, osteomyelitis, abscess or pneumonia. Results: Of the 659 infants, 161 (24.4%) were diagnosed with SI. Meningitis (49.7%) was the most common SI, followed by UTI (45.3%), enterocolitis (5.6%), sepsis (3.1%) and bacteraemia (2.5%). Factors significantly associated with SI were aged 29–60 days, male sex, Severity Index Score (SIS) <10, absolute neutrophil counts >10×109/L, C-reactive protein (CRP) >20 mg/L and procalcitonin >0.5 ng/mL. Multivariate analysis entering all these items retained only male sex, SIS <10 and CRP >20. Conclusion: Among hospitalised infants aged 0–90 days, the incidence of SI was 24.4%, and invasive bacterial infection was 0.6%. Meningitis was the most common SI followed by UTI. SIS and CRP can be used to predict SI in infants <90 days old.

scholarly journals Correlation of Modified Computed Tomography Severity Index with Biochemical Markers in Acute Pancreatitis

2021 ◽  
Vol 1 (2) ◽  
pp. 6-12
Author(s):  
Joshi BR ◽  
Kumar S ◽  
Khanal UP
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Multislice Computed Tomography ◽  
Serum Amylase ◽  
Scoring Systems ◽  
Severity Index ◽  
Serum Levels ◽  
Index Score ◽  
Severity Index Score ◽  
Progression Of Disease

Introduction Multislice computed tomography examinations performed 3 to 4 days after the onset of symptoms is the imaging procedure of choice in acute pancreatitis, which is mainly done for evaluating the complications. Due to radiation exposure and cost, alternative scoring systems like Ranson’s score and Glasgow’s score were devised but were cumbersome. The serum amylase and lipase were found to increase with progression of disease. The objective of this study was to evaluate the association of acute pancreatitis by modified CT scoring system with the serum levels of amylase and lipase. Material and Methods In hundred patients presenting with acute pancreatitis, the severity of pancreatitis was recorded using the modified CT severity index. The serum amylase and lipase levels were recorded and correlated with modified CT severity index score. Results Among 100 patients studied, 46%, 40% and 14% had mild, moderate and severe grades of pancreatitis respectively by modified CTSI score. No significant correlation was found between the levels of serum amylase (r = -0.104, p = 0.301) and lipase (r = -0.177, p = 0.079) with the modified CT severity index in patients with acute pancreatitis. Conclusion The serum level of amylase and lipase had non-significant correlation with the modified CT severity index score and thus did not indicate severity of pancreatitis.

scholarly journals Assessment of BISAP Scoring System and C-Reactive Protein Analysis in Predicting Severity of Acute Pancreatitis

2021 ◽  
Vol 10 (35) ◽  
pp. 2985-2988
Author(s):  
Aditya Vasant Ghunage ◽  
Kiran Shrikant Kher
Keyword(s):  
Acute Pancreatitis ◽  
Sensitivity And Specificity ◽  
Necrotizing Pancreatitis ◽  
Scoring Systems ◽  
Cost Effective ◽  
Severity Index ◽  
C Reactive Protein ◽  
Key Words Acute Pancreatitis ◽  
Reactive Protein

BACKGROUND Acute pancreatitis (AP) is a dormant deadly illness. The range of seriousness of the ailment goes from mellow self-restricting disease to an exceptionally lethal severe necrotizing pancreatitis. The disease has such a variable course that it may manifest as a simple pain in the abdomen to severe haemorrhagic pancreatitis with septicaemic shock, multi-organ dysfunction syndrome and ultimately leading to death. A cost-effective better prognosticative index is needed for the assessment of the severity of AP. Here in this study, we wanted to assess the role of BISAP scoring systems and CRP for analysis and comparing their values to determine the severity of AP and the prognosis of the disease. METHODS A prospective observational study was done on 83 patients diagnosed with AP after fulfilment of inclusion criteria. Patients were subjected to severity index, bedside index for severity in acute pancreatitis (BISAP) score and CRP calculation and statistical analysis was done with SPSS software. RESULTS In our study, AP was more prevalent in males 87.95 % than females 12.05 %. AP was found to be more common in cases ≤ 40 years of age, however, the mean age of presentation was 38.14 ± 12.59 years. We calculated the sensitivity and specificity of the BISAP score and C-reactive protein (CRP) by co-relating it with CT severity index as gold standard according to which the sensitivity was found to be 64 % and specificity was found to be 85 % for BISAP. The sensitivity and specificity of CRP was 64 % and 85 % respectively. CONCLUSIONS BISAP is an easy way to anticipate the severity of AP within 24 hours. It also helps to prognosticate AP. CRP can also be used to aid BISAP in the assessment of severe acute pancreatitis (SAP). KEY WORDS Acute Pancreatitis, BISAP, CRP.

scholarly journals P-P05 Acute Pancreatitis during COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in Western Health and Social Care Trust

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Bakhat Yawar ◽  
Ahmed Marzouk ◽  
Heba Ali ◽  
Zahid Bahli ◽  
Mohammad Abousamra ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Large Scale ◽  
Severity Index ◽  
Target Population ◽  
Treatment Modalities ◽  
Organ Support ◽  
Common Disease ◽  
Gallstone Pancreatitis ◽  
Icu Admission ◽  
Health And Social Care

Abstract Background Acute pancreatitis is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. COVID-19 pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, primary aim was to ascertain incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30 day mortality, outcomes and management of acute pancreatitis patients from Altnagelvin Area Hospital from 1st March, 2020 till 30th August, 2020. Methods A retrospective observational review of all patients admitted under General Surgical team from March 2020 till September 2020 was performed. Information regarding demographics, severity of acute pancreatitis (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on RedCap tool used by COVID-PAN study. The results were compared to outcomes results of COVID-PAN study for COVID-19 negative patients in that study as we had only one patient who was positive for COVID-19 at time of concomitant pancreatitis diagnosis. Results Forty four (44) patients were admitted with acute pancreatitis. Only one patient (2.3%) was diagnosed with COVID-19 at time of pancreatitis. Aetiology of pancreatitis was found comparable to aetiology reported by large scale studies (2). Mortality was 7% (3 patients). Five patients (11%) needed ICU admission due to organ dysfunction. Three patients (7%) developed ARDS.  Conclusions The overall incidence of COVID-19 in pancreatitis in our population of study was low. Therefore, results were compared to patients who were COVID-19 negative in COVID-PAN study. Patients with acute pancreatitis in our target population were mostly elderly, about one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As has been observed in other centres globally, urgent for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy.

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