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Intensive therapy of acute pancreatitis

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https://www.readbyqxmd.com/read/28661823/stereotactic-body-radiation-vs-intensity-modulated-radiation-for-unresectable-pancreatic-cancer
#1
Joseph J Park, Carla Hajj, Marsha Reyngold, Weiji Shi, Zhigang Zhang, John J Cuaron, Christopher H Crane, Eileen M O'Reilly, Maeve A Lowery, Kenneth H Yu, Karyn A Goodman, Abraham J Wu
BACKGROUND: Stereotactic body radiation therapy (SBRT) is an emerging treatment option for unresectable pancreatic cancer, and is postulated to be more effective and less toxic than conventionally fractionated intensity modulated radiation therapy (IMRT). MATERIAL AND METHODS: We retrospectively reviewed unresectable stage I-III pancreatic adenocarcinoma treated from 2008 to 2016 at our institution with SBRT (five fractions, 30-33 Gy) or IMRT (25-28 fractions, 45-56 Gy with concurrent chemotherapy)...
June 29, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28630246/ominous-triad-triggered-by-high-dose-glucocorticosteroid-therapy
#2
Sarah Bär, Fritz Daudel, Thomas Zueger
Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis-a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy...
June 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28596690/continuing-episodes-of-pain-in-recurrent-acute-pancreatitis-prospective-follow-up-on-a-standardised-protocol-with-drugs-and-pancreatic-endotherapy
#3
C Ganesh Pai, M Ganesh Kamath, Mamatha V Shetty, Annamma Kurien
AIM: To assess the outcomes of drug therapy (DT) followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis. METHODS: DT comprised of pancreatic enzymes and anti-oxidants failing which, endotherapy (ET; pancreatic sphincterotomy and stent placement) was done. The frequency of pain, its visual analogue score (VAS), quality of life (QoL), serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET...
May 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28482383/-efficacy-of-continuous-blood-purification-in-treatment-of-severe-acute-pancreatitis-in-children
#4
Y Zhu, Y Cui, Y C Zhang, H J Miao, F Wang, R X Chen, Q F Rong
Objective: To explore the therapeutic role of bedside continuous blood purification(CBP) in children with severe acute pancreatitis(SAP). Method: The clinical and laboratory data of 11 children with SAP who were admitted to Pediatric Intensive Care Unit (PICU) of Shanghai Children's Hospital from June 2013 to May 2016 were analyzed, including using pediatric critical illness score (PCIS) and pediatric risk of score mortality (PRISM)-Ⅲ score to assessing the severity of the disease.For those patients with severe organ dysfunction, CBP treatment was used when conventional therapy was not efficient...
May 4, 2017: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/28435316/subanesthetic-ketamine-for-pain-management-in-hospitalized-children-adolescents-and-young-adults-a-single-center-cohort-study
#5
Kathy A Sheehy, Caroline Lippold, Amy L Rice, Raissa Nobrega, Julia C Finkel, Zenaide Mn Quezado
BACKGROUND: Subanesthetic doses of ketamine, an N-methyl-d-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. PURPOSE: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28414683/recurrent-hypertriglyceridemic-pancreatitis-htgp-and-the-use-of-insulin-drip-as-treatment
#6
T Tran, N Lee
INTRODUCTION: Chronic pancreatitis by definition is a recurrent episode of acute pancreatitis and is commonly associated with alcoholism in the US. Another cause of chronic pancreatitis is hypertriglyceridemia (HTGP);, occurring in 1-5 percent of cases. The incidence of HTGP is higher in patients with diabetes and HIV, usually requiring triglyceride levels > 1000 mg/dL. CASE: A 33 year old man with uncontrolled type 1 diabetes and recurrent pancreatitis, first diagnosed 5 years prior, presented as a transfer from an outside hospital for a recurrent episode of HTGP...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28246469/restoration-of-energy-level-in-the-early-phase-of-acute-pediatric-pancreatitis
#7
REVIEW
Dóra Mosztbacher, Nelli Farkas, Margit Solymár, Gabriella Pár, Judit Bajor, Ákos Szűcs, József Czimmer, Katalin Márta, Alexandra Mikó, Zoltán Rumbus, Péter Varjú, Péter Hegyi, Andrea Párniczky
Acute pancreatitis (AP) is a serious inflammatory disease with rising incidence both in the adult and pediatric populations. It has been shown that mitochondrial injury and energy depletion are the earliest intracellular events in the early phase of AP. Moreover, it has been revealed that restoration of intracellular ATP level restores cellular functions and defends the cells from death. We have recently shown in a systematic review and meta-analysis that early enteral feeding is beneficial in adults; however, no reviews are available concerning the effect of early enteral feeding in pediatric AP...
February 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28144728/-acute-pancreatitis-in-intensive-care-medicine-which-risk-score-is-useful
#8
A J Fischer, F Andreottola, P Lenz, P Lebiedz
INTRODUCTION: Acute pancreatitis is a disease with an increasing incidence in the Western countries associated with a high mortality depending on severity of disease. Etiology is often biliary or due to alcoholism. Incidence of etiology varies between regions depending on risk-factor prevalence. Several risk scores are available to estimate mortality. The aim of the study is to identify the risk factors most relevant for patients being treated for severe acute pancreatitis in an ICU of a tertiary medical center...
January 31, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28125855/predictors-and-outcomes-of-acute-pancreatitis-in-critically-ill-patients-presenting-to-the-emergency-department-of-a-tertiary-referral-centre-in-australia
#9
Krishnaswamy Sundararajan, Tom Schoeman, Lara Hughes, Suzanne Edwards, Benjamin Reddi
OBJECTIVE: To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. METHODS: A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. RESULTS: Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0...
April 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28105159/small-bowel-metastasis-from-pancreatic-cancer-in-a-long-term-survival-patient-with-synchronous-advanced-malignant-pleural-mesothelioma-a-case-report-and-literature-review
#10
Morena Fasano, Carminia Maria Della Corte, Giovanni Vicidomini, Valerio Scotti, Pier Francesco Rambaldi, Alfonso Fiorelli, Marina Accardo, Ferdinando De Vita, Mario Santini, Fortunato Ciardiello, Floriana Morgillo
Diffuse malignant pleural mesothelioma (MPM) is an aggressive tumor that originates from the surface of the pleura. Approximately 70% of cases are associated with chronic asbestos exposure. MPM is regarded as an incurable disease, with a median survival of ~2 years following intensive multimodality treatment. Pancreatic cancer is a malignancy also associated with a poor prognosis, with only 2% of patients surviving for 5 years. The majority of patients with pancreatic cancer are diagnosed with an advanced stage of disease and experience a poor response to therapy...
December 2016: Oncology Letters
https://www.readbyqxmd.com/read/27964837/efficacy-of-sitagliptin-for-the-hospital-management-of-general-medicine-and-surgery-patients-with-type-2-diabetes-sita-hospital-a-multicentre-prospective-open-label-non-inferiority-randomised-trial
#11
Francisco J Pasquel, Roma Gianchandani, Daniel J Rubin, Kathleen M Dungan, Isabel Anzola, Patricia C Gomez, Limin Peng, Israel Hodish, Tim Bodnar, David Wesorick, Vijay Balakrishnan, Kwame Osei, Guillermo E Umpierrez
BACKGROUND: The role of incretin-based drugs in the treatment of patients with type 2 diabetes admitted to hospital has not been extensively assessed. In this study, we compared the safety and efficacy of a dipeptidyl peptidase-4 inhibitor (sitagliptin) plus basal insulin with a basal-bolus insulin regimen for the management of patients with type 2 diabetes in general medicine and surgery in hospitals. METHODS: We did a multicentre, prospective, open-label, non-inferiority randomised clinical trial (Sita-Hospital) in five hospitals in the USA, enrolling patients aged 18-80 years with type 2 diabetes and a random blood glucose concentration of 7·8-22·2 mmol/L who were being treated with diet or oral antidiabetic drugs or had a total daily insulin dose of 0·6 units per kg or less, admitted to general medicine and surgery services...
February 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/27881128/effect-of-intensive-insulin-treatment-on-plasma-levels-of-lipoprotein-associated-phospholipase-a2-and-secretory-phospholipase-a2-in-patients-with-newly-diagnosed-type-2-diabetes
#12
Xiu-Hong Lin, Ming-Tong Xu, Jv-Ying Tang, Li-Fang Mai, Xiao-Yi Wang, Meng Ren, Li Yan
BACKGROUND: China has the highest absolute disease burden of diabetes worldwide. For diabetic patients, diabetes-related vascular complications are major causes of morbidity and mortality. The roles of lipoprotein-associated phospholipase A2 (Lp-PLA2) and secretory phospholipase A2 (sPLA2) as inflammatory markers have been recently evaluated in the pathogenesis of both diabetes and atherosclerosis. We aimed to determine the mechanism through which patients with newly diagnosed type 2 diabetes gain long-term vascular benefit from intensive insulin therapy by evaluating the change in Lp-PLA2 and sPLA2 levels after early intensive insulin treatment and its relevance with insulin resistance and pancreatic β-cell function...
November 23, 2016: Lipids in Health and Disease
https://www.readbyqxmd.com/read/27796165/chemotherapy-and-intensity-modulated-radiation-therapy-for-locally-advanced-pancreatic-cancer-achieves-a-high-rate-of-r0-resection
#13
Florence Huguet, Carla Hajj, Corrine B Winston, Weiji Shi, Zhigang Zhang, Abraham J Wu, Eileen M O'Reilly, Diane L Reidy, Peter Allen, Karyn A Goodman
BACKGROUND: To assess local control, survival and conversion to resectability among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (ICT) followed by chemoradiotherapy treatment using intensity-modulated radiation therapy (IMRT). MATERIAL AND METHODS: Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy. RESULTS: With a median follow-up of 20 months, median overall survival (OS) was 23 months...
March 2017: Acta Oncologica
https://www.readbyqxmd.com/read/27675789/interim-acute-toxicity-analysis-and-surgical-outcomes-of-neoadjuvant-gemcitabine-nab-paclitaxel-and-hypofractionated-image-guided-intensity-modulated-radiation-therapy-in-resectable-and-borderline-resectable-pancreatic-cancer-anchor-study
#14
M Palta, B Czito, J Abbruzzese, H Uronis, E A Duffy, D T Blazer, C G Willett
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/27619808/natural-history-after-acute-necrotizing-pancreatitis-a-large-us-tertiary-care-experience
#15
Chandraprakash Umapathy, Amit Raina, Shreyas Saligram, Gong Tang, Georgios I Papachristou, Mordechai Rabinovitz, Jennifer Chennat, Herbert Zeh, Amer H Zureikat, Melissa E Hogg, Kenneth K Lee, Melissa I Saul, David C Whitcomb, Adam Slivka, Dhiraj Yadav
BACKGROUND: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. METHODS: Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. RESULTS: Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis...
November 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27549125/the-clinical-value-of-adipokines-in-predicting-the-severity-and-outcome-of-acute-pancreatitis
#16
MULTICENTER STUDY
Andrius Karpavicius, Zilvinas Dambrauskas, Audrius Gradauskas, Arturas Samuilis, Kristina Zviniene, Juozas Kupcinskas, Gintautas Brimas, Artur Meckovski, Audrius Sileikis, Kestutis Strupas
BACKGROUND: Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP). METHODS: Prospective study was conducted in four clinical centers...
August 22, 2016: BMC Gastroenterology
https://www.readbyqxmd.com/read/27412455/long-term-retrospective-analysis-of-gene-therapy-with-alipogene-tiparvovec-and-its-effect-on-lipoprotein-lipase-deficiency-induced-pancreatitis
#17
Daniel Gaudet, Erik S Stroes, Julie Méthot, Diane Brisson, Karine Tremblay, Sophie J Bernelot Moens, Giorgio Iotti, Irene Rastelletti, Diego Ardigo, Deyanira Corzo, Christian Meyer, Marc Andersen, Philippe Ruszniewski, Mark Deakin, Marco J Bruno
Alipogene tiparvovec (Glybera) is a gene therapy product approved in Europe under the "exceptional circumstances" pathway as a treatment for lipoprotein lipase deficiency (LPLD), a rare genetic disease resulting in chylomicronemia and a concomitantly increased risk of acute and recurrent pancreatitis, with potentially lethal outcome. This retrospective study analyzed the frequency and severity of pancreatitis in 19 patients with LPLD up to 6 years after a single treatment with alipogene tiparvovec. An independent adjudication board of three pancreas experts, blinded to patient identification and to pre- or post-gene therapy period, performed a retrospective review of data extracted from the patients' medical records and categorized LPLD-related acute abdominal pain events requiring hospital visits and/or hospitalizations based on the adapted 2012 Atlanta diagnostic criteria for pancreatitis...
November 2016: Human Gene Therapy
https://www.readbyqxmd.com/read/27359113/a-platform-for-rapid-quantitative-assessment-of-multiple-drug-combinations-simultaneously-in-solid-tumors-in-vivo
#18
Joyoti Dey, William S Kerwin, Marc O Grenley, Joseph R Casalini, Ilona Tretyak, Sally H Ditzler, Derek J Thirstrup, Jason P Frazier, Daniel W Pierce, Michael Carleton, Richard A Klinghoffer
While advances in high-throughput screening have resulted in increased ability to identify synergistic anti-cancer drug combinations, validation of drug synergy in the in vivo setting and prioritization of combinations for clinical development remain low-throughput and resource intensive. Furthermore, there is currently no viable method for prospectively assessing drug synergy directly in human patients in order to potentially tailor therapies. To address these issues we have employed the previously described CIVO platform and developed a quantitative approach for investigating multiple combination hypotheses simultaneously in single living tumors...
2016: PloS One
https://www.readbyqxmd.com/read/27159517/pathology-image-of-the-month-cough-and-shortness-of-breath-in-a-noncompliant-patient-with-hiv-aids
#19
Reggie Thomasson, Tracy Dewenter, Robin R McGoey
A 37- year-old man with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) was admitted to the intensive care unit following a four month history of progressive shortness of breath, productive cough, and flu-like symptoms. His HIV/AIDS was diagnosed at the age of 19 (CD4 count =15; viral load = 294,436 copies/ mL) and was complicated by hemodialysis-dependent, HIV-associated nephropathy, prior Pneumocystis pneumonia and known noncompliance with prescribed antiretroviral therapy. Chest film at admission was interpreted as diffuse bilateral interstitial and airspace opacities with a right sided layering density representative of laminar pleural effusion...
July 2015: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/27138544/pathology-image-of-the-month-cough-and-shortness-of-breath-in-a-noncompliant-patient-with-hiv-aids
#20
Reggie Thomasson Md, Tracy Dewenter Md, Robin R McGoey Md
A 37- year-old man with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) was admitted to the intensive care unit following a four month history of progressive shortness of breath, productive cough, and flu-like symptoms. His HIV/AIDS was diagnosed at the age of 19 (CD4 count =15; viral load = 294,436 copies/ mL) and was complicated by hemodialysis-dependent, HIV-associated nephropathy, prior Pneumocystis pneumonia and known noncompliance with prescribed antiretroviral therapy. Chest film at admission was interpreted as diffuse bilateral interstitial and airspace opacities with a right sided layering density representative of laminar pleural effusion...
July 2015: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
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