scholarly journals PROCALCITONIN IN EARLY PREDICTION OF ACUTE SEVERE PANCREATITIS

2020 ◽  
Vol 73 (7) ◽  
pp. 1370-1372
Author(s):  
Volodymyr V. Kasian ◽  
Volodymyr D. Sheiko ◽  
Tetiana V. Mamontova ◽  
Liudmyla E. Vesnina ◽  
Oksana A. Shlykova
Keyword(s):  
Acute Pancreatitis ◽  
Early Period ◽  
Infectious Complications ◽  
Pancreatic Tissue ◽  
Screening Methods ◽  
Oral Antibiotic ◽  
Septic Complications ◽  
Key Words Acute Pancreatitis ◽  
Surgical Department ◽  
Significant Difference

The aim of the study was to analyze the prognostic potential of procalcitonin in acute pancreatitis complicated by ascites-peritonitis. Materials and methods: The study analyzed the results of a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites-peritonitis, including 13 patients who were treated in the surgical department of KP “Poltava Regional Clinical Hospital. MV Sklifosovsky POR “, and 5 patients of other emergency hospitals in Poltava, in the period from 2017 to 2019. In addition to standard screening methods, these patients were additionally tested for procalcitonin to predict an adverse course in the early period. Results: To assess the relationship between the presence of elevated procalcitonin levels at the time of hospitalization of 0.5 ng / ml and above and unsatisfactory treatment results, differences were assessed using an accurate Fisher test. When comparing differences in the development of infectious complications in the dynamics of the disease in patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospitalization, a significant difference was found (p <0.05). Conclusions: In our opinion, the use of procalcitonin as a predictor of infectious complications in the dynamics of the disease will determine the category of patients in whom reducing the risk of flora translocation through the use of early oral antibiotic prophylaxis and parenteral drugs tropic to pancreatic tissue may reduce the incidence of purulent complications. In another category of patients, antibacterial therapy is not advisable due to the low risk of purulent-septic complications. KEY WORDS: acute pancreatitis, procalcitonin, ascites-peritonitis, severity of the condition

scholarly journals PREDICTING INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS COMPLICATED BY ASCITIS AND PERITONITIS

2020 ◽  
Vol 20 (3) ◽  
pp. 114-118
Author(s):  
V.V. Kasian
Keyword(s):  
Acute Pancreatitis ◽  
Early Stage ◽  
Statistical Significance ◽  
Early Period ◽  
Infectious Complications ◽  
Study Group ◽  
Oral Antibiotic ◽  
Septic Complications ◽  
Surgical Department ◽  
Significant Difference

Ascites and peritonitis are fairly common complications of acute pancreatitis in the early stage of the disease. At the beginning of acute severe pancreatitis, in most cases, death occurs as a result of multiple organ failure, and starting from the second week, infectious complications can play a more serious and adverse role. However, the diagnosis of infected pancreatitis is difficult as the clinical picture does not differ from the inflammatory reaction caused by pancreatitis itself. Although the peak of infectious complications is observed mainly from the second to the fourth week since the onset of the disease, the timing of infection in pancreatic necrosis is variable and unpredictable. The aim of the study was to analyze the prognostic potential of procalcitonin in predicting the development of infectious complications in the dynamic course of acute pancreatitis complicated by ascites and peritonitis. We analyzed the findings obtained from a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites and peritonitis, including 13 patients who were treated at the surgical department of M. Sklifosovskiy Poltava Regional Clinical Hospital, and 5 patients at other emergency care settings in Poltava for 2017 – 2019. In addition to standards examination methods, procalcitonin was assessed as a biomarker to predict the adverse course of the disease in the early period. Statistical analysis of the findings was performed by the program "STATISTICA 10.0" (StatSoft, Inc., USA); methods of descriptive statistics to calculate qualitative indicators as frequencies and their percentages in the study groups were applied. The statistical significance of differences was determined by a nonparametric method between the indicators of independent groups using Fisher's exact test. Differences at p <0.05 were considered statistically significant. Infectious complications in the dynamics of the disease occurred in 39% of patients in the study group. 86% of them demonstrated an increased procalcitonin concentration at admission to the hospital. A significant difference was found (p = 0.005) when comparing differences in the occurrence of infectious complications in the dynamics of the disease in the patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospital admission. We can suggest that measuring procalcitonin to predict the occurrence of infectious complications in the dynamics of the disease will allow us to detect patients in who reduced risk of flora translocation by parenteral drugs being tropic to pancreatic tissue and early oral antibiotic prophylaxis may lessen the incidence of septic complications.

scholarly journals Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

2010 ◽  
Vol 25 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Josiel Paiva Vieira ◽  
Gutemberg Fernandes de Araújo ◽  
José Raimundo Araújo de Azevedo ◽  
Alberto Goldenberg ◽  
Marcelo Moura Linhares
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Average Length ◽  
Infectious Complications ◽  
Pancreatic Tissue ◽  
Septic Complications ◽  
Disease Etiology ◽  
The Difference ◽  
Length Of Hospitalization

PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.

scholarly journals The Role of Perfusion Computed Tomography as a Predictor of Pancreatic Necrosis in Acute Pancreatitis

2021 ◽  
pp. 11-21
Author(s):  
N. V. Klimova ◽  
V. V. Darvin ◽  
I. V. Bazhukhina ◽  
A. A. Gaus
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Contrast Enhancement ◽  
Pancreatic Necrosis ◽  
Pancreatic Tissue ◽  
Intravenous Contrast ◽  
Surgical Department ◽  
Perfusion Computed Tomography ◽  
Initial Symptoms ◽  
Surgical Tactics

The presented article analyzes the data obtained as a result of the applied imaging methods of the study of 38 patients admitted to the surgical department of the Surgut Regional Clinical Hospital with suspicion of acute pancreatitis. The main criterion for inclusion in the study was the period from the onset of the initial symptoms of the disease, which did not exceed three days. In the hospital, all patients underwent perfusion computed tomography (PCT) in the first 3 days and subsequently, in accordance with national recommendations, multislice computed tomography (MSCT) with bolus intravenous contrast enhancement for 3–5 days. In 31,5 % of cases (12 out of 38 patients), a violation of the perfusion characteristics of the pancreatic parenchyma corresponding to ischemic tissue damage was diagnosed. MSCT with bolus intravenous contrast enhancement confirmed the presence of a formed zone of necrosis of the pancreatic tissue in 21 % of patients. In 10,5 % of cases, progression of ischemic damage to the pancreatic tissue was not revealed by MSCT, which was confirmed by further observation of this group of patients. Based on the study, conclusions were drawn about the ability of perfusion CT to serve as an effective predictor of pancreatic necrosis, which makes it possible to choose the optimal surgical tactics at the early stages of treatment of such patients.

scholarly journals DIFFERENTIAL DIAGNOSIS OF STERILE AND I NFECTED PANCREONECROSIS

2021 ◽  
pp. 31-35
Author(s):  
V. V. Boyko ◽  
V. M. Lykhman ◽  
A. O. Merkulov ◽  
D. O. Myroshnychenko ◽  
S. V. Tkach ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Differential Diagnosis ◽  
Pancreatic Necrosis ◽  
Clinical Laboratory ◽  
Practical Importance ◽  
Modern Medicine ◽  
Infectious Complications ◽  
Infected Pancreatic Necrosis ◽  
Septic Complications ◽  
Great Practical Importance

Summary. Introduction. The search for objective methods for diagnosing the form and severity of acute pancreatitis, accurate prediction and timely prevention of infectious complications in this surgical pathology is of great practical importance for modern medicine. Materials and methods. According to clinical, morphological and bacteriological data, groups of patients were selected. The first group included 33 patients with sterile pancreatic necrosis (SP), the second group consisted of 29 patients with infected pancreatic necrosis (IP). Results and discussion. The program of differential diagnosis of sterile and infected pancreatic necrosis with calculation of the index of differential diagnosis (IDD) for each clinical-laboratory and instrumental indicator used in this system is developed. The development and evaluation of diagnostic possibilities of the method of verification of purulent-septic complications of acute pancreatitis and the transition of a sterile form of pancreatic necrosis to an infected one was carried out. Conclusions. The use of the developed method of diagnosis of sterile and infected pancreatic necrosis with the calculation of the index of differential diagnosis allowed in 93% of cases to distinguish sterile pancreatic necrosis from infected and timely determine the scope and tactics of treatment.

scholarly journals BANDS NEUTROPHILS LEVELS CHARACTERIZATION AND THEIR DYNAMICS AT TREATMENT OF ACUTE ALIMENTARY PANCREATITIS PATIENTS

2019 ◽  
Vol 43 (4) ◽  
pp. 16-20
Author(s):  
Y. V. Avdosiev ◽  
K. M. Pankiv ◽  
S. D. Khimich ◽  
I. V. Belozоrov ◽  
O. M. Kudrevych ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Inflammatory Process ◽  
Primary Treatment ◽  
Repeated Measurements ◽  
Surgical Department ◽  
Course Materials ◽  
Significant Difference ◽  
Severity Of The Disease ◽  
Process Damage ◽  
Degree Of Severity

Abstract Purpose of the study. To evaluate changes of bands nuclear neutrophils level and their dynamics parameters during treatment in patients with acute alimentary pancreatitis based on repeated measurements and taking into account the severity of the course. Materials and methods. Seventy patients with acute alimentary pancreatitis were examined, who treated in Surgical Department of Vinnitsa Regional M. I. Pirogov Clinical Hospital. Average age was 45,4 ± 13,87 years. Severe pancreatitis was found in 34 (48,57%) people, in 25 (35,72%) – moderate, 11 (15,71%) persons had mild forms. The severity of the disease was assessed using the Atlanta classification (2012). To achieve aim of study the repeated measurements of the stabs neutrophils levels were performed for all patients. Statistical analysis was performed using STATISTICA 13. Results. The significant difference between the stabs neutrophils values identified in patients with acute alimentary pancreatitis was proved, taking into account the severity of the course, both during the primary measured (p = 0,04), during treatment (p = 0,004), and after its completion (p < 0,00001). The significant increase of stabs neutrophils level associated with increasing severity of acute pancreatitis, as in the primary treatment of patients (τ = 0,23, p = 0,005), with determination during treatment (τ = 0,31, p = 0,0001) and after its termination (τ = 0,49, p ≤ 0,00001) was determined. When comparing the indexes of stabs neutrophils determined by repeated measurements, a rapid and continuous decrease of their values was found, as a whole in the group – by 3,76 times, and in the groups with a mild course of the inflammatory process – 6,75 times, the average degree of severity – in 5,11 times and severe forms – 3,05 times. Conclusions. High informativeness of evaluation stabs neutrophils level and their dynamic during repeated measurements in patients with acute alimentary pancreatitis taking into account the severity of the course has been proved. Keywords: acute alimentary pancreatitis, stabs neutrophils level, inflammatory process, damage to the pancreas, acute pancreatitis of alimentary genesis.

scholarly journals PECULIARITIES OF THE COURSE OF ACUTE SEVERE PANCREATITIS COMPLICATED WITH ASCITES AND PERITONITIS

2019 ◽  
Vol 19 (2) ◽  
pp. 23-25
Author(s):  
V.V. Kasian
Keyword(s):  
Acute Pancreatitis ◽  
Multiorgan Failure ◽  
Abdominal Cavity ◽  
Early Period ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Acute Severe Pancreatitis ◽  
Surgical Department ◽  
Severe Pancreatitis ◽  
Operative Drainage

Acute pancreatitis is one of the most common diseases of the digestive system that often requires urgent admission to the hospital. Ascites and peritonitis in acute severe pancreatitis is a rather common complication of the early period of the disease. The evacuation of fluid rich in potentially toxic mediators from the abdominal cavity is advocated in a number of reports as an efficient measure to alleviate the burden of disease for patients in emergency condition. The purpose of the work was to analyze the effect of enzymatic ascites and peritonitis and drainage interventions performed on the course of acute pancreatitis. The study was based on the analysis of 44 case histories of inpatients with acute pancreatitis complicated with ascites and peritonitis who took the course of treatment at the surgical department of the M.V. Sklifosovsky Poltava Regional Clinical Hospital for 2013 – 2017. The patients were divided into two groups: the first group included individuals who were performed on surgical interventions for enzymatic ascites and peritonitis in the early period of the disease; the second group included he patients who only had a comprehensive conservative treatment according to the protocols for the treatment of acute pancreatitis. The obtained results confirm that resolving enzymatic ascites enables to avoid mortality in the early period of the disease associated with the increase of organ and multiorgan failure in patients with severe and extremely severe course of acute pancreatitis, and in some cases contributes to regression of the disease. Once the damage is in progression, to some extent it can provoke a more severe course of post-operative drainage due to the number of factors as a surgical trauma, or drainage as an entrance gate for infection.

scholarly journals CHARACTER AND FREQUENCY OF COMPLICATIONS IN PATIENTS WITH POLYTRAUMA AND CHRONIC ALCOHOL INTOXICATION

2021 ◽  
pp. 60-64
Author(s):  
A. V. Omelchenko-Seliukova ◽  
S. S. Dubivska ◽  
Y. V. Volkova
Keyword(s):  
Alcohol Intoxication ◽  
Fatal Outcome ◽  
Craniocerebral Trauma ◽  
Early Period ◽  
Fat Embolism ◽  
Infectious Complications ◽  
Chronic Alcohol ◽  
Septic Complications ◽  
Chronic Alcohol Intoxication ◽  
History Of

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI). Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia. Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%). Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.

scholarly journals The case of the multistage treatment of acute pancreatitis using a variety of minimally invasive techniques

2020 ◽  
Vol 39 (3) ◽  
pp. 40-49
Author(s):  
Sergey Y. Ivanusa ◽  
Maksim Lazutkin ◽  
Dmitriy Shershen ◽  
Anton Chebotar
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Infectious Complications ◽  
Minimally Invasive Techniques ◽  
Septic Complications ◽  
Results Of Treatment ◽  
Invasive Techniques ◽  
Surgical Injury

Treatment of acute pancreatitis and infectious complications is a complex multidisciplinary task. The use of traditional surgical procedures for the rehabilitation of foci of pancreatogenic infection often aggravates the course of the disease, leads to the development of postoperative complications, does not improve the results of treatment. On the contrary, the use of minimally invasive techniques avoids additional surgical injury. The case of stage treatment of acute pancreatitis and its purulent-septic complications with the use of minimally invasive technologies is presented to the readers.

scholarly journals Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Ling Ding ◽  
Cong He ◽  
Xueyang Li ◽  
Xin Huang ◽  
Yupeng Lei ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Infectious Complications ◽  
Controlled Study ◽  
Control Group ◽  
Abdominal Pressure ◽  
Faecal Microbiota ◽  
Faecal Microbiota Transplantation ◽  
Significant Difference ◽  
Rate Of Decline ◽  
And Control

Aims: We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP).Methods: In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant (n = 30) or normal saline (n = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat.Results: We enrolled 60 participants and randomly assigned them to the FMT (n = 30) or control (n = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (−0.6, 0.5) vs. 0.2 (−0.2, 0.6); P = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference (P = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [−0.3 (−3.7, 0.8) vs. 0.4 (−1.1, 0.9); P = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively (P = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (−3.6, 0.9) vs. 0.8 (−1.7, 1.0); P = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT.Conclusion: FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).

scholarly journals Effect of Endotoxemia in Suckling Rats on Pancreatic Integrity and Exocrine Function in Adults: A Review Report

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Jolanta Jaworek ◽  
Barbara Tudek ◽  
Paweł Kowalczyk ◽  
Michalina Kot ◽  
Joanna Szklarczyk ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Experimental Studies ◽  
Early Period ◽  
Pancreatic Tissue ◽  
Exocrine Function ◽  
Heat Shock Protein 60 ◽  
Adult Rats ◽  
Pancreatic Acini ◽  
Suckling Rats ◽  
The Impact

Background. Endotoxin (LPS), the component of Gram-negative bacteria, is responsible for sepsis and neonatal mortality, but low concentrations of LPS produced tissue protection in experimental studies. The effects of LPS applied to the suckling rats on the pancreas of adult animals have not been previously explored. We present the impact of neonatal endotoxemia on the pancreatic exocrine function and on the acute pancreatitis which has been investigated in the adult animals. Endotoxemia was induced in suckling rats by intraperitoneal application of LPS from Escherichia coli or Salmonella typhi. In the adult rats, pretreated in the early period of life with LPS, histological manifestations of acute pancreatitis have been reduced. Pancreatic weight and plasma lipase activity were decreased, and SOD concentration was reversed and accompanied by a significant reduction of lipid peroxidation products (MDA + 4 HNE) in the pancreatic tissue. In the pancreatic acini, the significant increases in protein signals for toll-like receptor 4 and for heat shock protein 60 were found. Signal for the CCK1 receptor was reduced and pancreatic secretory responses to caerulein were diminished, whereas basal enzyme secretion was unaffected. These pioneer studies have shown that exposition of suckling rats to endotoxin has an impact on the pancreas in the adult organism.

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