Surgical treatment of acute biliary pancreatitis

The analysis of surgical treatment of 126 patients with acute biliary pancreatitis is made. The authors follow an active surgical policy in patients with justified risk of surgery. The operation is carried out in two stages: 1st-radical elimination of pathologic changes of extrahepatic bile ducts, restoration of the passage through the large duodenal papilla (LDP), and 2nd stage is the operation on the pancreas. The indications and contraindications for transduodenal intervention in acute biliary pancreatitis have been determined. The authors think it necessary in destructive forms of acute pancreatitis accompanied by extensive fermentative damage of parapancreatic and retroperitoneal cellular tissue to remove it thoroughly and to drain it widely. The reoperation should be performed not earlier that 12-21 days after the initial operation. Postoperative lethality was 8.7%.     

Value of endoscopy in the treatment of chronic pancreatitis]

Endoscopic treatment in patients with chronic pancreatitis involves several features: sphincterotomy of the wirsung, dilatation, insertion of a prosthesis, cystoenterostomy, cystowirsungostomy. Extracorporal lithotrity is often associated. Endoscopic treatment appears to give satisfactory short-term results in cases with pain, pseudocyst or pancreatic fistula. Morbidity is low. The optimum duration of endoscopic drainage via the prosthesis is still a question of debate and the long-term efficacy remains to be demonstrated. Endoscopic treatment is indicated in patients with a definitive or temporary surgical risk or may be indicated for all symptomatic patients. In this case, endoscopic treatment would be used as a therapeutic test. Stenosis of the main bile duct is not at present a good indication for endoscopic treatment as this stenosis is resistant to balloon dilatation and prosthesis calibration.     

Role of surgery in the treatment of severe acute necrotic pancreatitis

Between May 1975 and December 1991, a total of 208 patients were operated upon for severe acute necrotic pancreatitis. The decision whether to operate on patients with clinical and biologic aggravation despite particularly sustained intensive care was taken after evaluation of ultrasound and CT scan images. Combining pancreatic body resections and necrotic tissue excision with laparostomy and staged lavage drainage reduced global mortality rate from 49.2 to 16.4 p. cent. The criteria used for determining the indication for surgical intervention, and the technical and tactical operative procedures applied allowing this improvement, are described and discussed.     

Analysis of the surgical treatment results in patients with acute pancreatitis

The results of treatment of 248 patients with an acute pancreatitis (AP) are analyzed. Conservative therapy was effective in 178 of them. Mortality was 0.3%. Surgical intervention was done in 64 patients, including 25 with AP, of them 2 (8%) have died; 27--with destructive AP, after cholecystectomy, drainage of bursa omentalis and abdominal cavity 15 (55.5%) died. Pancreatic resection, necrotomy, programmed relaparotomy with permanent necrotomy of pancreas and retroperitoneal cellular tissue were conducted in 17 patients, 3 (17.6%) died.     

Interventional radiology in the acute pediatric abdomen

This article addresses the most common types of interventional procedures performed in the pediatric abdomen. Nonvascular interventions are stressed because they are more common than vascular interventions.     

重症急性胰腺炎保守治疗的护理体会

目的:总结重症急性胰腺炎的护理方法,提高临床治疗效果.方法:回顾分析我们收治的48例重症急性胰腺炎患者的临床护理资料.结果:经过精心护理和治疗,48例患者均获得临床痊愈.结论:观察患者的生命体征和病情变化是重症急性胰腺炎护理的重点,同时要有效预防并发症的发生.     

Computer assisted diagnosis of the acute abdomen

Computer assisted diagnosis (CAD) has been claimed to improve the accuracy of assessment of the acute abdomen. Alternative techniques that may improve decision making are briefly reviewed and CAD is examined critically. The structured collection of complete clinical data with performance feedback, results in improvements comparable to CAD. Computer systems are costly and when installed are used selectively and variably by clinicians. Their place in surgical practice remains to be established.     

The surgical treatment of pancreatic pseudocysts following acute pancreatitis

The tactics and results of the operative treatment of pancreatic cysts, complicating severe destructive pancreatitis in a series of thirteen patients, are discussed. The following operative methods are made use of: marsupialization (1), Yurash (10), cystojejunoanastomosis with Braunova (2). The character and scope of surgical intervention are determined intraoperatively, depending on the anatomical situation faced. In pancreatic cysts operated according to Yurash (cystogastroanastomosis), an original drainage method with two probes introduced nasally is used--one wider into the anastomosis, and a narrower one into the duodenum for feeding. The probes are retained for periods ranging from 9 to 35 days. No relapse of the cysts operated by different methods are registered, with the exception of a female patient undergoing marsupialization. In one case operated according to Yurash where no preoperative preparation is done the outcome is fatal, with the patient dying of hemorrhage on the third postoperative day. All patients are operated within 3 months after the formation of cysts. The preoperative preparation includes Kontrikal, Petphtoruracil, atropine, heparin and antibiotic; in some patients the listed drugs are introduced intraarterially into truncus celiacus. A number of inferences are reached and recommendations made: 1. Waiting for the generally accepted 3-month term is unnecessary. 2. In cysts involving the head of the pancreas, tightly adherent to the posterior wall of the stomach, the method of Yurash with the modification suggested for probing should be given preference. 3. In cysts of the body region and tail cystojejunoanastomosis with Braunova is practicable. 4. Proceeding with the preoperative medication in the postoperative period is advisable.     

Beneficial effects of pentoxifylline treatment of experimental acute pancreatitis in rats

BACKGROUND: Apolipoprotein E (apo E) is a protein associated with plasma lipoproteins. Apo E polymorphism has been related to significant modifications of lipoprotein profile, as well as to the incidence of different pathologies including cardiovascular disease, Alzheimer's disease, and vascular dementia. Furthermore, it was proposed that apo E polymorphism might be involved in the aging selection process. OBJECTIVE: The purposes of the present study were the following: (1) to evaluate apo E polymorphism in 'successful' and 'unsuccessful' aging, defined as the absence or presence of disability and severe chronic diseases (mainly cardiovascular disease and dementia), respectively; (2) to evaluate the impact of apo E polymorphism on plasma lipids in very old individuals free of or affected by disability. METHODS: 253 Italian subjects including 100 free-living healthy octo- and nonagenarians, 62 disabled octo- and nonagenarians, and 91 healthy adult controls, all matched for origin were studied. Apo E phenotypes were determined by PhastSystem (Pharmacia). Lipoprotein parameters (total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, lipoprotein (a), and apoprotein A-I and B) were measured by standardized methods. ADL were evaluated by the Katz index. RESULTS: The frequency of sigma2, sigma3, and sigma4 alleles was 0.062, 0.887, and 0.051 respectively in the entire sample; no differences in alleles distribution were found between the three groups. When the subjects were divided according to the E type (E2 type: E2/E2 and E2/E3; E3 type: E3/E3; E4 type: E3/E4 and E4/E4), no differences in lipoprotein parameters emerged, but a trend toward higher total and LDL-cholesterol from the E2 to the E4 type was observed. The sigma4 allele had a raising effect, while sigma2 had a lowering effect on total cholesterol levels, but these effects were much less profound in the disabled octo- and nonagenarians. CONCLUSIONS: We conclude that (1) the frequency of the sigma4 allele is very low in this sample of subjects from central Italy; (2) no differences emerged in sigma4 distribution between healthy and disabled octo- and nonagenarians, and adult controls; the very low frequency of sigma4 allele might contribute to this finding; (3) our data do not support the hypothesis of a possible association between apo E polymorphism and longevity or disability in this population.     

Severe acute pancreatitis: pathophysiologic mechanisms underlying pancreatic necrosis and remote organ damage

In a non-selected population comprising 15,241 women, an evaluation was performed of the ultrasonic measurement of the biparietal diameter compared with a reliable last menstrual period as the basis for estimation of the day of delivery. In women with a reliable menstrual history and spontaneous onset of labor, the ultrasound estimate was the significantly better predictor of the day of delivery in 52% of cases, and the last menstrual period estimate was the better predictor in 46% of cases. The percentages of women who delivered within 7 days of the predicted day were 61 and 56% for the ultrasound and the last menstrual period estimations, respectively. There was a significantly narrower distribution of births according to the ultrasound estimate (p < 0.001). The proportion of estimated postterm births was 4% using the ultrasound method and 10% using the last menstrual period method (p < 0.001). Even when the difference between the methods in predicting the day of delivery was less than 7 days, the ultrasound method was better than the last menstrual period method. It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure.     

Ultrasound in the management of acute pancreatitis

Thirty-eight patients have been examined by ultrasound when symptoms or sign suggested the development of a pseudocyst following an attack of proven acute pancreatitis. Pseudocyst was diagnosed in 23 of the 38 cases. Five patients had multilocular cysts, four of which were shown to be communicating. Laparotomy was carried out on 14 of the 23 patients and surgical drainage was performed in 12 cases. The remaining nine cases were monitored and showed steady regression. Small cysts arising in the head of pancreas may give rise to recurrent or persistent pancreatitis and may be demonstrated pre-operatively by ultrasound but not readily by other means. A further 12 patients showed an area of irregular absorption of ultrasound interpreted as an inflammatory mass. Monitoring of these cases showed progressive resolution without cyst formation. Three of these cases subsequently required laparotomy-one developed an abscess and one necrosis of the body and tail of pancreas while a third developed severe pancreatic fibrosis of the area identified by ultrasound. The ability to distinguish between pseudocysts and inflammatory masses and to demonstrate communication between multiple cysts is of considerable value in pre-operative diagnosis.     

Changes in blood enzyme activity and tumor necrosis factor level in the treatment of experimental pancreatitis with pentoxifylline

It was established in an acute experiment on rats of Wistar line while an acute pancreatitis simulation using the pancreatic tissue freezing that the level of a tumor necrosis factor (TNF) in a blood serum was maximal in 4 hours from the cold action onset, the activity of amylase and trypsin was heightened and trypsin activity inhibitor (TAI) had lowered. Intraperitoneal application of pentoxifylline in 100 mg/kg dose twice daily have promoted the significant lowering of TNF contents, the amylase and trypsin activity as well, and the TAI concentration increase.     

Therapy of acute necrotizing pancreatitis. Results of a current survey]

In order to ascertain the current clinical concepts in treating acute necrotizing pancreatitis (ANP), an inquiry was made covering 28 anesthesiologic, medical and surgical departments. Problems of particular concern were antibiotics, indication for mandatory ventilation, estimation of ERCP and needle biopsy, methods of treating intestinal stasis, criteria for surgical intervention, estimation of hemofiltration and estimation of mortality and hospital stay in survivors. Twenty-three affiliations participated in the study. Opinions varied significantly concerning antibiotic treatment, value of ERCP and needle biopsy, treatment of intestinal stasis and estimation of clinical course and outcome. Most participants were in agreement regarding the management of mechanical ventilation, nutritional support and surgical intervention. Eleven participants did not prefer a special medical discipline for the treatment of ANP but stressed the importance of efficient teamwork.     

Therapy of acute pancreatitis

Therapy in patients with acute pancreatitis (AP) is primarily conservative and follows the rules of generally accepted principles. A very important basis in the treatment of AP is the interdisciplinary approach to this disease which demands teamwork between clinicians, intensive care specialists and surgeons. Patients with a necrotising course should be hospitalised on the ICU and should receive maximum intensive care measures and antibiotics. Indications for surgical interventions in severe AP are infected pancreatic necrosis and non-response to intensive care therapy.     

Therapy of acute pancreatitis

The mortality rate in acute pancreatitis (AP) is significantly lower in patients hospitalized directly at the intensive care unit than in patients admitted to hospital in 2 weeks after the assessment of diagnosis, prophylactic administration of low-molecular protease inhibitor reduces the occurrence of post ERCP pancreatitis a well a coincident complications. Despite rational considerations concerning the significance of pryphylactic administration of antibodies (ATB) in severe AP, there still not enough convincing data which could be recommended a standard therapy. One of the concepts of causal therapy of AP. Suggest that inhibition of exocrine pancreatic enzymatic secretion reduces autodigestion of the gland (setting the gland at rest). The reports on success of secretin-inhibiting substances a glucagon, calcitonin, atropine and somatostatin require confirmation in randomized or accurately defined comparable groups. The initial studies on the therapeutic significance of lexipanphate-antagonist of platelet activating factor (PAF) in acute pancreatitis is promising. A long-term lavage had reduced the mortality.