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https://www.readbyqxmd.com/read/29215631/which-patients-with-mild-acute-pancreatitis-require-prolonged-hospitalization
#1
Harkirat Singh, Amir Gougol, Rawad Mounzer, Dhiraj Yadav, Efstratios Koutroumpakis, Adam Slivka, David C Whitcomb, Georgios I Papachristou
OBJECTIVES: In our experience, a subset of mild acute pancreatitis (AP) patients, as defined by the Revised Atlanta Classification, has longer than expected hospitalization. Our aims are to report the prevalence of patients with mild AP who have a prolonged length of stay (LOS), evaluate the etiology, thoroughly phenotype, and finally compare this subset to those with expected LOS. METHODS: Patients admitted with AP from 2003 to 2015 were prospectively enrolled into this cohort study...
December 7, 2017: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/29189393/acute-pancreatitis-in-the-elderly-a-cause-for-increased-concern
#2
Joana R Carvalho, Samuel R Fernandes, Patrícia Santos, Carlos M Moura, Teresa Antunes, José Velosa
BACKGROUND: Acute pancreatitis (AP) is an aggressive and potentially fatal clinical condition. Although all age groups are at risk, the elderly may be a group of special concern. We aimed at evaluating clinical outcomes of patients with elderly-onset AP. MATERIALS AND METHODS: Using a single-center retrospective database, treatment and follow-up records of 550 patients admitted with AP were reviewed. Outcomes included mortality, admission to the ICU, need for interventional procedures, nutritional support, and length of hospital and ICU stay...
November 17, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29150368/the-utility-of-ercp-in-pediatric-pancreatic-trauma
#3
Eric H Rosenfeld, Adam M Vogel, Denise B Klinkner, Mauricio Escobar, Barbara Gaines, Robert Russell, Brendan Campbell, Hale Wills, Anthony Stallion, David Juang, Rajan K Thakkar, Jeffrey Upperman, Mubeen Jafri, Randall Burd, Bindi J Naik-Mathuria
BACKGROUND/PURPOSE: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. METHODS: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests...
October 13, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29148072/ultrastructure-of-endocrine-pancreatic-granules-during-pancreatic-differentiation-in-the-grass-snake-natrix-natrix-l-lepidosauria-serpentes
#4
Magdalena Kowalska, Weronika Rupik
We used transmission electron microscopy to study the pancreatic main endocrine cell types in the embryos of the grass snake Natrix natrix L. with focus on the morphology of their secretory granules. The embryonic endocrine part of the pancreas in the grass snake contains four main types of cells (A, B, D, and PP), which is similar to other vertebrates. The B granules contained a moderately electron-dense crystalline-like core that was polygonal in shape and an electron-dense outer zone. The A granules had a spherical electron-dense eccentrically located core and a moderately electron-dense outer zone...
November 17, 2017: Journal of Morphology
https://www.readbyqxmd.com/read/29145291/early-enteral-nutrition-versus-delayed-enteral-nutrition-in-acute-pancreatitis-a-prisma-compliant-systematic-review-and-meta-analysis
#5
REVIEW
Ping Feng, Chenjian He, Guqing Liao, Yanming Chen
BACKGROUND: Whether early enteral nutrition (EEN) administration is more beneficial than delayed enteral nutrition (DEN) for patients with acute pancreatitis remains controversial. METHODS: This meta-analysis aimed to pool all relevant articles to evaluate the effects of EEN within 48 hours versus DEN beyond 48 hours on the clinical outcomes of patients with acute pancreatitis. We searched PubMed, Scopus, Embase, and Web of Science for all relevant studies and extracted the data concerning basic characteristics, complications, and mortality...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29132523/pancreatitis-and-pancreatic-cancer
#6
REVIEW
Anne Walling, Robert Freelove
Most cases of acute pancreatitis are related to gallstones. More than 80% resolve within a few days. The diagnosis is based on upper abdominal pain, elevated lipase and/or amylase, and transabdominal ultrasound findings. Management requires early aggressive hydration, pain control, nutritional support, and monitoring for progression. Patients who develop hypovolemia, systemic inflammatory response, pancreatic necrosis, and organ failure have high mortality, risk of recurrence, and progression to chronic pancreatitis (CP)...
December 2017: Primary Care
https://www.readbyqxmd.com/read/29100225/acute-pancreatitis-etiology-pathology-diagnosis-and-treatment
#7
Shirin Majidi, Adam Golembioski, Stephen L Wilson, Errington C Thompson
Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis...
November 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/29031861/the-benefits-of-early-oral-nutrition-in-mild-acute-pancreatitis
#8
Kate M Ellery, Soma Kumar, Wallace Crandall, Cheryl Gariepy
OBJECTIVE: To determine whether early patient-directed oral nutrition in children with mild acute pancreatitis decreases the length of hospitalization without increasing complications. STUDY DESIGN: Hospitalized patients aged 2-21 years of age who met the criteria for acute pancreatitis based on the Revised Atlanta Classification were enrolled prospectively and allowed to eat by mouth at their discretion (patient-directed nutrition [PDN]). These patients were compared with a retrospective cohort of children who were allowed to eat based on traditional practices (treatment team-directed nutrition [TTDN])...
October 11, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29019560/pancreatoduodenectomy-brazilian-practice-patterns
#9
Orlando Jorge M Torres, Eduardo de Souza M Fernandes, Rodrigo Rodrigues Vasques, Fabio Luís Waechter, Paulo Cezar G Amaral, Marcelo Bruno de Rezende, Roland Montenegro Costa, André Luís Montagnini
BACKGROUND: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. AIM: To understand the Brazilian practice patterns for pancreatoduodenectomy. METHOD: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy...
July 2017: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
https://www.readbyqxmd.com/read/28912191/high-versus-low-energy-administration-in-the-early-phase-of-acute-pancreatitis-goulash-trial-protocol-of-a-multicentre-randomised-double-blind-clinical-trial
#10
Katalin Márta, Anikó N Szabó, Dániel Pécsi, Péter Varjú, Judit Bajor, Szilárd Gódi, Patrícia Sarlós, Alexandra Mikó, Kata Szemes, Mária Papp, Tamás Tornai, Áron Vincze, Zsolt Márton, Patrícia A Vincze, Erzsébet Lankó, Andrea Szentesi, Tímea Molnár, Roland Hágendorn, Nándor Faluhelyi, István Battyáni, Dezső Kelemen, Róbert Papp, Attila Miseta, Zsófia Verzár, Markus M Lerch, John P Neoptolemos, Miklós Sahin-Tóth, Ole H Petersen, Péter Hegyi
INTRODUCTION: Acute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP...
September 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/28870388/the-optimal-timing-of-enteral-nutrition-and-its-effect-on-the-prognosis-of-acute-pancreatitis-a-propensity-score-matched-cohort-study
#11
Meng Jin, Huimin Zhang, Bo Lu, Yi Li, Dong Wu, Jiaming Qian, Hong Yang
BACKGROUND: Early enteral nutrition (EN) can improve the prognosis of acute pancreatitis (AP), but the optimal initiation time is unknown. In this study, the optimal time of early EN was analyzed to disclose the application of early EN in AP. METHODS: Data of 104 patients with AP were prospectively collected. With secondary infection (infected pancreatic necrosis and extrapancreatic infection) as the primary outcome variable, receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of early EN...
September 1, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28837512/the-management-of-acute-pancreatitis-in-the-pediatric-population-a-clinical-report-from-the-naspghan-pancreas-committee
#12
Maisam Abu-El-Haija, Soma Kumar, J Antonio Quiros, Keshawadhana Balakrishnan, Bradley Barth, Samuel Bitton, John F Eisses, Elsie Jazmin Foglio, Victor Fox, Denease Francis, A Jay Freeman, Tanja Gonska, Amit S Grover, Sohail Z Husain, Rakesh Kumar, Sameer Lapsia, Tom Lin, Quin Y Liu, Asim Maqbool, Zachary M Sellers, Flora Szabo, Aliye Uc, Steven L Werlin, Veronique D Morinville
BACKGROUND: While the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. METHODS: The NASPGHAN Pancreas committee performed a MEDLINE review using several pre-selected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed...
August 23, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28814218/diagnosis-and-management-of-pancreatic-exocrine-insufficiency
#13
Mehrdad Nikfarjam, Jeremy S Wilson, Ross C Smith
In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food...
August 21, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28771447/chronic-pancreatitis
#14
Dennis Yang, Chris E Forsmark
PURPOSE OF REVIEW: Summarize key clinical advances in chronic pancreatitis reported in 2016. RECENT FINDINGS: Early diagnosis of chronic pancreatitis remains elusive. Recent studies suggest that endoscopic ultrasound may be less accurate than previously thought and new MRI techniques may be helpful. Genetic predisposition may independently affect the clinical course of chronic pancreatitis and the risk for pancreatic cancer. Cigarette smoking may have a greater negative impact on chronic pancreatitis than previously thought and moderate alcohol consumption may be protective...
September 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28735575/negotiating-the-complexities-of-exocrine-and-endocrine-dysfunction-in-chronic-pancreatitis
#15
Sinead N Duggan
Chronic pancreatitis is a chronic inflammatory disease of the pancreas characterised by irreversible morphological change and typically causing pain and/or permanent loss of function. This progressive, irreversible disease results in destruction of healthy pancreatic tissue and the development of fibrous scar tissue. Gradual loss of exocrine and endocrine function follows, along with clinical manifestations such as steatorrhoea, abdominal pain and diabetes. Nutrition in chronic pancreatitis has been described as a problem area and, until recently, there was little research on the topic...
July 24, 2017: Proceedings of the Nutrition Society
https://www.readbyqxmd.com/read/28734776/a-preoperative-score-to-predict-early-death-after-pancreatic-cancer-resection
#16
Gianpaolo Balzano, Erica Dugnani, Stefano Crippa, Marina Scavini, Valentina Pasquale, Francesca Aleotti, Daniela Liberati, Alessandra Gandolfi, Giulio Belfiori, Michele Reni, Claudio Doglioni, Giacomo Ruffo, Cristina Marmorale, Massimo Falconi, Lorenzo Piemonti
BACKGROUND: This study aimed to develop and validate a preoperative prognostic model for death within one year post-surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: A derivation cohort study of 296 patients who underwent surgical resection of PDAC was prospectively enrolled in an observational study. Preoperative predictors of one year mortality were used to develop a risk score which was then validated in an external cohort of 182 patients with resectable PDAC...
July 1, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28678307/effect-of-early-enteral-nutrition-en-on-endotoxin-in-serum-and-intestinal-permeability-in-patients-with-severe-acute-pancreatitis
#17
Q-X Shen, G-X Xu, M-H Shen
OBJECTIVE: This work aimed at studying the effect of early enteral nutrition (EN) on serum endotoxin and intestinal permeability in patients with severe acute pancreatitis. PATIENTS AND METHODS: 70 cases of patients with severe acute pancreatitis were cured in our hospital from April 2015 to January 2016. Patients selected were randomly divided into two groups including a group of patients having parenteral nutrition (group PN) and that had enteral nutrition (group EN)...
June 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28674733/micrornas-modulate-core-clock-gene-expression-in-pancreatic-islets-during-early-postnatal-life-in-rats
#18
Cécile Jacovetti, Adriana Rodriguez-Trejo, Claudiane Guay, Jonathan Sobel, Sonia Gattesco, Volodymyr Petrenko, Camille Saini, Charna Dibner, Romano Regazzi
AIMS/HYPOTHESIS: Evidence continues to emerge detailing a fine-tuning of the regulation of metabolic processes and energy homeostasis by cell-autonomous circadian clocks. Pancreatic beta cell functional maturation occurs after birth and implies transcriptional changes triggered by a shift in the nutritional supply that occurs at weaning, enabling the adaptation of insulin secretion. So far, the developmental timing and exact mechanisms involved in the initiation of the circadian clock in the growing pancreatic islets have never been addressed...
October 2017: Diabetologia
https://www.readbyqxmd.com/read/28656511/hyperinsulinemic-hypoglycemia-clinical-molecular-and-therapeutical-novelties
#19
Arianna Maiorana, Carlo Dionisi-Vici
Hyperinsulinemic hypoglycemia (HI) is the most common cause of hypoglycemia in children. Impairment of cellular pathways involved in insulin secretion from pancreatic β-cells, broadly classified as channelopathies and metabolopathies, have been discovered in the past two decades. The increasing use of NGS target panels, combined with clinical, biochemical and imaging findings allows differentiating the diagnostic management of children with focal forms, surgically curable, from those with diffuse forms, more conservatively treated with pharmacological and nutritional interventions...
July 2017: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/28576773/distinct-roles-for-the-mtor-pathway-in-postnatal-morphogenesis-maturation-and-function-of-pancreatic-islets
#20
Katie L Sinagoga, William J Stone, Jacqueline V Schiesser, Jamie I Schweitzer, Leesa Sampson, Yi Zheng, James M Wells
While much is known about the molecular pathways that regulate embryonic development and adult homeostasis of the endocrine pancreas, little is known about what regulates early postnatal development and maturation of islets. Given that birth marks the first exposure to enteral nutrition, we investigated how nutrient-regulated signaling pathways influence postnatal islet development in mice. We performed loss-of-function studies of mechanistic target of rapamycin (mTOR), a highly conserved kinase within a nutrient-sensing pathway known to regulate cellular growth, morphogenesis and metabolism...
July 1, 2017: Development
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