scholarly journals Clinical Pattern and Management of Acute Pancreatitis – Our Experience

2014 ◽  
Vol 31 (3) ◽  
pp. 122-127
Author(s):  
MM Hasan ◽  
SZ Laila ◽  
MH Mamun
Keyword(s):  
Acute Pancreatitis ◽  
Gall Stone ◽  
Multiple Organ ◽  
High Serum ◽  
Military Hospital ◽  
Average Hospital ◽  
Systemic Involvement ◽  
Standard Management ◽  
Management Protocol ◽  
Upper Abdomen

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. It is a life threatening disease that has many causes, few effective treatments, numerous serious complications, and an often unpredictable course. The objectives of this study are to develop our knowledge about presentation and diagnosis of acute pancreatitis, to assess the patient with acute pancreatitis accurately and to develop a standard management protocol. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to December 2010. A total 25 patients of Acute Pancreatitis were studied retrospectively, evaluated and managed.Results: In this study 25 patients 19 (76%) were male (male : female = 3.17:1), age range 08 to 55 years, Mean age – 38.92 years. Maximum number of the patients fall into fourth and fifth decades. All patients presented with abdominal pain, specially in upper abdomen. Laboratory test revealed leucocytosis and high serum and urinary amylase, positive findings in Ultrasonogram and CT scan found in all patients. Gall stone was the leading cause 14 (56%). 20 (80%) patient developed some form of complications. 24 patients were treated conservatively. Average hospital stay was 15.52 days. Serious regional and systemic involvement in Acute Pancreatitis causes multiple organ or system failure. Conclusion: Early diagnosis and effective treatment can significantly reduce the morality and morbidity. DOI: http://dx.doi.org/10.3329/jbcps.v31i3.20977 J Bangladesh Coll Phys Surg 2013; 31: 122-127

Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

2019 ◽  
Vol 8 (2) ◽  
pp. 17-29
Author(s):  
Mohammad Monir Hossain ◽  
S M Shakwat Hossain ◽  
Delowar Hossain
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Military Hospital ◽  
Fatty Tissue ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Management Protocol ◽  
Life Threatening

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent. Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed. Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment. Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity. CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

VALUE OF COMBINATION OF HAP SCORE AND BISAP SCORE IN PREDICTING SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

2019 ◽  
pp. 96-100
Author(s):  
Thi Ngoc Suong Le ◽  
Pham Chi Tran ◽  
Van Huy Tran
Keyword(s):  
Acute Pancreatitis ◽  
Positive Predictive Value ◽  
Roc Curve ◽  
Predictive Value ◽  
Prognostic Value ◽  
Acute Inflammation ◽  
Clinical Symptoms ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Central Hospital

Acute pancreatitis (AP) is an acute inflammation of the pancreas, usually occurs suddenly with a variety of clinical symptoms, complications of multiple organ failure and high mortality rates. Objectives: To determine the value of combination of HAP score and BISAP score in predicting the severity of acute pancreatitis of the Atlanta 2012 Classification. Patients and Methods: 75 patients of acute pancreatitis hospitalized at Hue Central Hospital between March 2017 and July 2018; HAP and BISHAP score is calculated within the first 24 hours. The severity of AP was classified by the revised Atlanta criteria 2012. Results: When combining the HAP and BISAP scores in predicting the severity of acute pancreatitis, the area under the ROC curve was 0,923 with sensitivity value was 66.7%, specificity value was 97.1%; positive predictive value was 66.7%, negative predictive value was 97.1%. Conclusion: The combination of HAP and BISAP scores increased the sensitivity, predictive value, and prognostic value in predicting the severity of acute pancreatitis of the revised Atlanta 2012 classification in compare to each single scores. Key words: HAPscore, BiSAP score, acute pancreatitis, predicting severity

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

Multiple organ dysfunction associated with severe acute pancreatitis (SAP)

2001 ◽  
Vol 120 (5) ◽  
pp. A644-A645
Author(s):  
Kimmo I. Halonen ◽  
Ville Pettila ◽  
Ari K. Leppaniemi ◽  
Esko A. Kemppainen ◽  
Pauli A. Puolakkainen ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Dysfunction ◽  
Severe Acute Pancreatitis ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction

scholarly journals Clinical and therapeutic correlations in patients with slight acute pancreatitis

2015 ◽  
Vol 28 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Clewis Henri MUNHOZ-FILHO ◽  
Fernando BATIGÁLIA ◽  
Hamilton Luiz Xavier FUNES
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Vital Signs ◽  
Positive Association ◽  
Multiple Organ ◽  
Glutamic Oxaloacetic Transaminase ◽  
Serum Glutamic Oxaloacetic Transaminase ◽  
Early Return ◽  
Lower Spectrum ◽  
Mild Acute Pancreatitis

BACKGROUND: Acute pancreatitis is an inflammatory disease of the pancreas due to enzymatic autodigestion which can cause necrosis or multiple organ failure; its pathophysiology is not fully known yet. AIM: To evaluate the correlation between clinical and therapeutic data in patients with mild acute pancreatitis. METHODS: A retrospective study in 55 medical records of patients admitted with acute mild pancreatitis was realized to analyze the association between age, leukocytosis, serum glutamic-oxaloacetic transaminase and lactate dehydrogenase, glucose, antibiotics, time admission and Ranson´s scores. RESULTS: There was a positive association between less intensive care (strict hydration, analgesia and monitoring of vital signs), early antibiotic therapy (monotherapy), early return to diet after 48 hours and laboratory control of the serum amylase and lipase (high in the first week and decreasing after 10 days, without any prognostic value). CONCLUSIONS: Changes in the management of patients with mild acute pancreatitis, such as enteral nutrition, rational use of lower spectrum antibiotics and intensive care, have contributed significantly to the reduction of hospitalization time and mortality.

scholarly journals Fatal Septic Shock in a Patient with Hemophagocytic Lymphohistiocytosis Associated with an Infectious Mononucleosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Giorgio Berlot ◽  
Ariella Tomasini ◽  
Lorenzo Zandonà ◽  
Eugenio Leonardo ◽  
Rossana Bussani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Infectious Mononucleosis ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Multiple Organ ◽  
Aggressive Lymphoma ◽  
Systemic Involvement ◽  
Barr Virus ◽  
Epstein Barr ◽  
Clinical Pictures

The authors describe the case of a young woman who developed a clinical pictures resembling a septic shock-related multiple organ dysfunction syndrome a couple of months after having been diagnosed suffering from a hemophagocytic lymphohistiocytosis associated with an infectious mononucleosis. Despite the aggressive treatment, which included antibiotics, vasopressors, IV immunoglobulins, and the use of an extracorporeal device aimed to remove mediators released both during sepsis and the cytokine storm determined by the hemophagocytic lymphohistiocytosis, the patient died. At the autopsy, an extremely uncommon aggressive lymphoma of Epstein-Barr virus-positive T-lymphocytes with systemic involvement was discovered.

scholarly journals Ubiquitin-Specific Protease 25 Aggravates Acute Pancreatitis and Acute Pancreatitis-Related Multiple Organ Injury by Destroying Tight Junctions Through Activation of The STAT3 Pathway

2022 ◽  
Vol 9 ◽  
Author(s):  
Zhengru Liu ◽  
Mingming Qi ◽  
Shan Tian ◽  
Qian Yang ◽  
Jian Liu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Tight Junctions ◽  
Multiple Organ ◽  
Organ Injury ◽  
Pancreatic Acinar Cells ◽  
Stat3 Pathway ◽  
Specific Protease ◽  
Ubiquitin Specific Protease ◽  
Multiple Organ Injury

Ubiquitin-specific protease 25 (USP25) plays an important role in inflammation and immunity. However, the role of USP25 in acute pancreatitis (AP) is still unclear. To evaluate the role of USP25 in AP, we conducted research on clinical AP patients, USP25wild-type(WT)/USP25 knockout (USP25−/−) mice, and pancreatic acinar cells. Our results showed that serum USP25 concentration was higher in AP patients than in healthy controls and was positively correlated with disease severity. AP patients’ serum USP25 levels after treatment were significantly lower than that at the onset of AP. Moreover, USP25 expression was upregulated in cerulein-induced AP in mice, while USP25 deficiency attenuates AP and AP-related multiple organ injury. In vivo and in vitro studies showed that USP25 exacerbates AP by promoting the release of pro-inflammatory factors and destroying tight junctions of the pancreas. We showed that USP25 aggravates AP and AP-related multiple organ injury by activating the signal transducer and activator of transcription 3 (STAT3) pathway. Targeting the action of USP25 may present a potential therapeutic option for treating AP.

scholarly journals Clinical Profile and Outcome of COVID-19 in Children at a Tertiary Hospital, Dhaka

2021 ◽  
Vol 39 (3) ◽  
pp. 154-159
Author(s):  
Mahbuba Sultana ◽  
Sayla Chowdhury ◽  
Abdullah Al Amin
Keyword(s):  
Prospective Observational Study ◽  
Laboratory Finding ◽  
Armed Forces ◽  
Paediatric Population ◽  
Tertiary Hospital ◽  
High Serum ◽  
Clinical Profile ◽  
Military Hospital ◽  
Laboratory Findings ◽  
Structured Questionnaire

Background: Since the first detection on 8th March 2020 in Bangladesh, the number of cases is rising alarmingly. The paediatric population is also getting infected in Bangladesh. So far there is no study of COVID in children in this country. Aim: This study reports on clinical profile, laboratory findings and outcomes of COVID-19 children admitted to Combined Military Hospital (CMH), Dhaka. Materials and Methods: In this prospective observational study, RT-PCR confirmed fifty COVID-19 patients aged below twelve years were included. Relevant investigations were done in the Armed Forces Institute of Pathology (AFIP). Data were collected from patients and/or their attendants by a structured questionnaire. Results: Mean age was 59.96±43.24 months, 48% were male and 52% were female. Predominant symptoms were fever (44%), cough (26%), anosmia (26%) and diarrhea (12%). There was neutropenia in 66% and lymphocytosis in 84% of cases. Mean neutrophil and lymphocyte counts were 38±13% and 52.5±13%, respectively. Significantly raised CRP observed in 14% and high serum procalcitonin was in10% of cases. Serum LDH, D-Dimer and ferritin were raised in 80%,34% and 6% of affected children, respectively. The majority (98%) of the children were improved and discharged from the hospital. One child died in this cohort. Conclusion: Fever and cough were the predominant symptoms of COVID-19 affected children in this study. Lymphocytosis and neutropenia were two important laboratory finding. Death in COVID-19 is also not uncommon. J Bangladesh Coll Phys Surg 2021; 39(3): 154-159

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