scholarly journals Ūminio nekrozinio pankreatito gydymo patirtis

2006 ◽  
Vol 4 (2) ◽  
pp. 0-0
Author(s):  
Audrius Šileikis ◽  
Virgilijus Beiša ◽  
Blažiejus Jucevičius ◽  
Saulius Jurevičius ◽  
Albinas Lamošiūnas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
University Hospital ◽  
Medical Documentation ◽  
Optimal Time ◽  
Second Phase ◽  
Key Words Acute Pancreatitis ◽  
Clinical Phase ◽  
Abdominal Complication ◽  
Degree Of Severity

Audrius Šileikis, Virgilijus Beiša, Blažiejus Jucevičius, Saulius Jurevičius, Albinas Lamošiūnas, Kęstutis StrupasVilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Ūminis pankreatitas – tai liga, pasižyminti sunkiai prognozuojama klinikine eiga ir dideliu mirštamumu. Šio straipsnio tikslas – pateikti mūsų sukauptą gydymo patirtį ir ją palyginti su literatūros duomenimis. Ligoniai ir metodai Retrospektyviuoju metodu išnagrinėta 126 ligonių, 2002–2005 m. gydytų nuo nekrozinio pankreatito, medicininė dokumentacija. Ūminis pankreatitas buvo diagnozuojamas remiantis klinika, instrumentiniais tyrimais ir amilazės kiekio padidėjimu kraujyje. Sunkumo laipsniui nustatyti naudotasi Atlantos klinikine klasifikacija. Kasos nekrozei patvirtinti būdavo atliekama kasos KT su intraveniniu kontrastavimu. Ligoniai operuoti tais atvejais, kai būdavo įrodyta kasos nekrozinio audinio infekcija, atsirasdavo intraabdominalinė komplikacija arba toliau gydomo konservatyviai ilgiau nei tris savaites ligonio būklė negerėdavo. Operuojant ligonius būdavo atliekamos nekrektomijos, paskui taikytas atviras ar uždaras plovimo būdas. Rezultatai Pagrindinė ūminio pankreatito priežastis – alkoholis (48%). Daugumai gydytų ligonių kasos nekrozė neviršijo 30% kasos dydžio (69%). Dauguma ligonių išoperuota (57,14%). Pagrindinė indikacija operuoti – kasos nekrozinių audinių infekcija (51,4%). Lyginant kasos nekrozės infekcijos dažnį su kasos nekrozės dydžiu nustatyta, kad kuo didesnis nekrozės plotas, tuo dažnesnė infekcija. Palyginus operacijų būdus konstatuota, kad ligoniams po nekrektomijos ir vėliau taikyto uždaro plovimo žarninių fistulių buvo mažiau ir trumpesnė pooperacinio gydymo trukmė. Mirė 15 ligonių (12%), iš jų 7 ligoniai – pirmosios klinikinės fazės metu ir 8 ligoniai – antrosios. Išvados Norint išvengti sunkaus ūminio pankreatito sukeliamų komplikacijų, dėl kurių gali ištikti mirtis, būtina laiku diagnozuoti ir tinkamai gydyti ligą. Nustatant ūminio pankreatito sunkumo laipsnį, būtina vadovautis Atlantos klinikiniais kriterijais. Diagnozavus kasos nekrozę, rekomenduojama infekcijos profilaktikai skirti antibiotikų. Optimalus operacinio gydymo laikas – trečia ar ketvirta savaitė nuo ligos pradžios. Pageidautina, kad ligoniai, sergantys sunkiu ūminiu pankreatitu, būtų gydomi tretinio lygio centruose, kuriuose būtų užtikrinta jų stebėsena ir adekvati komplikacijų korekcija. Reikšminiai žodžiai: ūminis pankreatitas, kasos nekrozė, infekcija, chirurginis gydymas Experience in treating acute necrotic pancreatitis Audrius Šileikis, Virgilijus Beiša, Blažiejus Jucevičius, Saulius Jurevičius, Albinas Lamošiūnas, Kęstutis StrupasCenter of Abdominal Surgery, Vilnius University Hospital "Santariškių klinikos",Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective Acute pancreatitis is a disease which is notable for its complicated forecast of the clinical course and for its high degree of mortality. Thus, the goal of the present article is to reveal the accumulated experience in its treatment and to compare it with the data presented in the literature. Patients and methods The medical documentation of 126 patients who underwent treatment against necrotics pancreatitis within the years 2002–2005 have been investigated by the retrospective method. Acute pancreatitis was diagnosed referring to the clinic, instrumental investigation and an increase of the quantity of amylase in the blood. The Atlanta clinical classification was applied seeking to ascertain the degree of severity. CT of the pancreas together with intravenous contrasting was employed to prove pancreatic necrosis. The patients were operated on, if infection of pancreatic necrosis was proved, if the intra-abdominal complication occurred or if the patient’s condition did not improve while continuing the conservative treatment for longer than three weeks. Debridment was done while operating on the patients; afterwards the open and closed packing was carried out. Results Alcohol is the main cause of acute pancreatitis (48%). Pancreatic necrosis in most of the patients that had undergone treatment (69%) did not exceed 30% of the size of the pancreas. Most of the patients were operated on (57.14%). Infection of pancreatic necrosis served as the main indication for the operation (51.4%). The frequency of infection of pancreatic necrosis directly depended on the size of the necrosis. As regards the methods of operation, it was ascertained that there were less intestinal fistulas and duration of the post-operational treatment was shorter among the patients who had undergone the debridment followed by closed packing. Fifteen patients died (12%), of them seven died in the course of the first clinical phase and eight patients in the second phase. Conclusions To avoid the complications caused by serious acute pancreatitis, which may be mortal, the timely diagnostics and the proper tactics of treatment are obligatory. While ascertaining the degree of severity of acute pancreatitis it is necessary to refer to the criteria adapted by the Atlanta Congress. Upon diagnosing pancreatic necrosis, it is advisable to prescribe antibiotics to prevent infection. The most optimal time for operational treatment is the 3rd or the 4th week after the onset of the disease. Patients ill with severe acute pancreatitis should be treated in the high-level centers in which their monitoring and an adequate correction of the complications will be assured. Key words: acute pancreatitis, pancreatic necrosis, infection, antibiotic prophylaxis

Pancreatitis in the Critical Care Setting

2017 ◽  
Author(s):  
Lisa M. Kodadek ◽  
Pamela A. Lipsett
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Classification System ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
The United States ◽  
Complex Spectrum ◽  
Early Management ◽  
Key Words Acute Pancreatitis

Pancreatitis is a complex spectrum of disease including chronic pancreatitis, acute pancreatitis, and manifestations of severe acute pancreatitis such as sterile and infected necrotizing pancreatitis. Acute pancreatitis is the leading cause of hospitalization for gastrointestinal disorders in the United States. Pancreatitis is a dynamic condition, and severity may change and evolve during the course of the disease. Although most patients with acute pancreatitis have mild disease, 10 to 15% will run a fulminant course, leading to severe acute pancreatitis, pancreatic necrosis, and multisystem organ injury. The mortality for severe acute pancreatitis is 15 to 30%; however, the overall mortality for all patients with acute pancreatitis is less than 5%. Early management of acute pancreatitis includes fluid resuscitation, pain control, and enteral nutrition. There are no specific directed therapies proven to be effective for the early treatment of acute necrotizing pancreatitis; therapy is entirely supportive. Chronic pancreatitis is a challenging disease often marked by chronic pain. Surgical intervention may help improve quality of life and relieve pain in selected patients. International consensus guidelines provide definitions and classifications to aid clinicians with diagnosis and management of pancreatitis. This review covers advances related to pancreatitis, including literature pertaining to the step-up approach for necrotizing pancreatitis first published in 2010, discussion of the revised Atlanta Classification System for severity of acute pancreatitis published in 2013, review of the current spectrum of microbial pathogens implicated in infected necrotizing pancreatitis, and the international draft consensus proposal for a new mechanistic definition for chronic pancreatitis published in 2016. Key words: acute pancreatitis, antibiotic prophylaxis, Atlanta Classification System, biliary pancreatitis, chronic pancreatitis, necrosectomy, pancreatic necrosis, pancreatitis, step-up approach, video-assisted retroperitoneal drainage (VARD)

scholarly journals MINIMALLY INVASIVE SURGERY IN THE COMPLEX TREATMENT OF ACUTE PANCREATITIS

2019 ◽  
Vol 20 (1) ◽  
pp. 46-52
Author(s):  
E. E. Topuzov ◽  
V. K. Balashov ◽  
E. G. Topuzov ◽  
B. G. Tsatinyan
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Medical Documentation ◽  
Minimally Invasive Techniques ◽  
Complex Treatment ◽  
Medicinal Treatment ◽  
Invasive Techniques ◽  
Minimally Invasive Methods

For the purpose of justification for the use of various minimally invasive interventions in the treatment of patients with moderate to severe acute pancreatitis, the authors retrospectively analyzed the data of medical documentation for the period from 2009 to 2017, shows the results of surgical and medicinal treatment, the structure of mortality and complications depending on the choice of surgical manual for patients with acute pancreatitis. The possibilities of minimally invasive methods of surgical treatment in comparison with traditional operations are presented. It is shown that the use of minimally invasive techniques in the treatment of pancreatic necrosis significantly reduces the level of mortality associated with complications of infected pancreatonecrosis, and also reduces the level of postoperative complications.

Pancreatitis

2017 ◽  
Author(s):  
Lisa M. Kodadek ◽  
Pamela A. Lipsett
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Classification System ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
The United States ◽  
Complex Spectrum ◽  
Early Management ◽  
Key Words Acute Pancreatitis

Pancreatitis is a complex spectrum of disease including chronic pancreatitis, acute pancreatitis, and manifestations of severe acute pancreatitis such as sterile and infected necrotizing pancreatitis. Acute pancreatitis is the leading cause of hospitalization for gastrointestinal disorders in the United States. Pancreatitis is a dynamic condition, and severity may change and evolve during the course of the disease. Although most patients with acute pancreatitis have mild disease, 10 to 15% will run a fulminant course, leading to severe acute pancreatitis, pancreatic necrosis, and multisystem organ injury. The mortality for severe acute pancreatitis is 15 to 30%; however, the overall mortality for all patients with acute pancreatitis is less than 5%. Early management of acute pancreatitis includes fluid resuscitation, pain control, and enteral nutrition. There are no specific directed therapies proven to be effective for the early treatment of acute necrotizing pancreatitis; therapy is entirely supportive. Chronic pancreatitis is a challenging disease often marked by chronic pain. Surgical intervention may help improve quality of life and relieve pain in selected patients. International consensus guidelines provide definitions and classifications to aid clinicians with diagnosis and management of pancreatitis. This review covers advances related to pancreatitis, including literature pertaining to the step-up approach for necrotizing pancreatitis first published in 2010, discussion of the revised Atlanta Classification System for severity of acute pancreatitis published in 2013, review of the current spectrum of microbial pathogens implicated in infected necrotizing pancreatitis, and the international draft consensus proposal for a new mechanistic definition for chronic pancreatitis published in 2016. Key words: acute pancreatitis, antibiotic prophylaxis, Atlanta Classification System, biliary pancreatitis, chronic pancreatitis, necrosectomy, pancreatic necrosis, pancreatitis, step-up approach, video-assisted retroperitoneal drainage (VARD)

scholarly journals Ūminio pankreatito etiopatogenezė

2006 ◽  
Vol 4 (2) ◽  
pp. 0-0
Author(s):  
Audrius Šileikis
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Surgery ◽  
Key Words ◽  
The Other ◽  
University Hospital ◽  
Key Words Acute Pancreatitis ◽  
Scientific Investigations ◽  
Vilnius University

Audrius ŠileikisVilniaus universiteto ligoninės Santariškių klinikųPilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Ūminis pankreatitas – tai liga, kurios metu pažeidžiama ne tik kasa, bet ir kiti organai, o sutrikus jų veiklai žmogus gali mirti. Todėl žinant ligos priežastis ir jos raidos mechanizmą galima išvengti mirtinų komplikacijų. Per pastaruosius du dešimtmečius atlikta nemažai mokslinių tyrinėjimų, leidusių geriau pažinti procesus, vykstančius sergant ūminiu pankreatitu. Jie ir pateikti šiame straipsnyje. Reikšminiai žodžiai: ūminis pankreatitas, citokinai Etiopathogenesis of acute pancreatitis Audrius ŠileikisCenter of Abdominal Surgery,Vilnius University Hospital "Santariškių klinikos",Vilnius, Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Acute pancreatitis is a disease which damages not only the pancreas, but also the other organs, through the functional derangement of which a person may die. Thus, the knowledge of the causes of the disease and the mechanism of the development of the illness itself may help to avoid the threatening inevitable complications. A number of scientific investigations, which contributed to understanding the processes going on in the course of acute pancreatitis have been carried out within the recent twenty years; they are discussed in the paper. Key words: acute pancreatitis, cytokine

scholarly journals 648 The Use of Antibiotics in Acute Pancreatitis - A Re-Audit of Current Practice

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Rai ◽  
S Kudchadkar ◽  
A Munasinghe
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Current Practice ◽  
University Hospital ◽  
First Line ◽  
Nice Guidelines ◽  
Severe Pancreatitis ◽  
Intravenous Antibiotics ◽  
Number Of Patients ◽  
Male Preponderance

Abstract Introduction The NICE guidelines do not advocate the use of prophylactic antibiotics in the management of acute pancreatitis. In severe pancreatitis with necrosis, local antimicrobial guidelines state that it ‘maybe reasonable to use antibiotics with good spectrum anaerobic cover’ and suggest the use of Amoxycillin, Metronidazole and Gentamicin as first line, and Meropenem as second line if needed. Previous audit showed 74% of patients receiving antibiotics without clear indication. Method A retrospective re-audit of the use of antibiotics in patients admitted with a clinical or radiological diagnosis of acute pancreatitis was undertaken in a single-centre University Hospital between July and October 2020. Results 78 patients were admitted during this period, with a mean age of 52years (range 6-89 years), and male preponderance. All patients were conservatively managed with intravenous fluids, analgesics and antiemetics. 31(40%) received intravenous antibiotics, of whom, 14 (45%) had no clearly documented indication for their use. The remaining 17 had pancreatic necrosis (4), cholangitis/cholecystitis (4), infected pseudocyst (2), UTI (2), fever spike (1), positive blood cultures (1) and pancreaticoduodenal fistula (1). Metronidazole was the most commonly used antibiotic (58%), followed by Amoxicillin (38.7%), Co-amoxiclav (35.4%), Gentamicin (22.5%) and Meropenem (22.5%). Conclusions In line with the recommendations made from previous audit and improved awareness, there was a significant improvement in the number of patients receiving antibiotics without indications from 74% to 45%. We hereby stress the importance of the use of appropriate clinical judgement in decision-making and avoiding the unwarranted use of antibiotics in acute pancreatitis.

scholarly journals A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Benoît Misset ◽  
Eric Hoste ◽  
Anne-Françoise Donneau ◽  
David Grimaldi ◽  
Geert Meyfroidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neutralizing Antibodies ◽  
Ethical Issues ◽  
High Titer ◽  
Passive Immunization ◽  
University Hospital ◽  
Optimal Time ◽  
Relative Reduction ◽  
Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

scholarly journals Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy

2021 ◽  
Vol 43 (03) ◽  
pp. 220-224
Author(s):  
Julia Cristina Coronado Arroyo ◽  
Marcio José Concepción Zavaleta ◽  
Eilhart Jorge García Villasante ◽  
Mikaela Kcomt Lam ◽  
Luis Alberto Concepción Urteaga ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Clinical Course ◽  
Necrotizing Pancreatitis ◽  
Rare Condition ◽  
Severe Hypertriglyceridemia ◽  
Fetal Complications ◽  
Acute Necrotizing ◽  
History Of ◽  
Important Objective

AbstractAcute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause. We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.

Portosplenomesenteric Venous Thrombosis in Patients With Acute Pancreatitis Is Associated With Pancreatic Necrosis and Usually Has a Benign Course

2014 ◽  
Vol 12 (5) ◽  
pp. 854-862 ◽  
Author(s):  
Jeffrey Easler ◽  
Venkata Muddana ◽  
Alessandro Furlan ◽  
Anil Dasyam ◽  
Kishore Vipperla ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Venous Thrombosis ◽  
Pancreatic Necrosis ◽  
Benign Course

scholarly journals HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

2021 ◽  
Vol 19 ◽  
pp. 205873922110005
Author(s):  
Bei Lu ◽  
Yang Cai ◽  
Junjie Yin ◽  
Jingrui Wang ◽  
Zhong Jia ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Acute Pancreatitis ◽  
Nervous System ◽  
Herpes Simplex ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Percutaneous Catheter Drainage ◽  
Central Nervous System Complication ◽  
Simplex Virus

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

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