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Acute panreatitis

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12 papers 0 to 25 followers
Elisabetta Moggia, Rahul Koti, Ajay P Belgaumkar, Federico Fazio, Stephen P Pereira, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES: To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs)...
April 21, 2017: Cochrane Database of Systematic Reviews
Rob Mac Sweeney, Daniel F McAuley
Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided...
November 12, 2016: Lancet
Peter A Banks
A great deal of progress has been made in the last 50 years in the diagnosis and treatment of acute pancreatitis. Many landmark studies have been published and have focused on the classification of acute pancreatitis, markers of severity, important roles of imaging and endoscopy, and improvements in our treatment. This report will review several landmark studies, describe ongoing controversies in management decisions including standards of early fluid resuscitation and appropriate use of enteral feeding, and outline what will be required in the future to improve the care of patients with acute pancreatitis...
May 2016: Pancreas
Olaf J Bakker, Mark C van Baal, Hjalmar C van Santvoort, Marc G Besselink, Jan-Werner Poley, Joos Heisterkamp, Thomas L Bollen, Hein G Gooszen, Casper H van Eijck
OBJECTIVE: Endoscopic transpapillary stenting (ETS) of the pancreatic duct facilitates ductal outflow and may reduce time to pancreatic fistula closure. However, data on the feasibility of ETS in patients with necrotizing pancreatitis are scarce. BACKGROUND: Pancreatic fistulas often occur after intervention in necrotizing pancreatitis and frequently close only after months of conservative treatment. METHODS: From a prospective cohort of patients with acute pancreatitis admitted in 15 hospitals (2004-2007), all patients who underwent ETS or conservative treatment for a pancreatic fistula were identified...
May 2011: Annals of Surgery
Olaf J Bakker, Hjalmar van Santvoort, Marc G H Besselink, Marja A Boermeester, Casper van Eijck, Kees Dejong, Harry van Goor, Sijbrand Hofker, Usama Ahmed Ali, Hein G Gooszen, Thomas L Bollen
OBJECTIVE: In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking. METHODS: A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT...
October 2013: Gut
Peter A Banks, Thomas L Bollen, Christos Dervenis, Hein G Gooszen, Colin D Johnson, Michael G Sarr, Gregory G Tsiotos, Santhi Swaroop Vege
BACKGROUND AND OBJECTIVE: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations...
January 2013: Gut
Mark C van Baal, Marc G Besselink, Olaf J Bakker, Hjalmar C van Santvoort, Alexander F Schaapherder, Vincent B Nieuwenhuijs, Hein G Gooszen, Bert van Ramshorst, Djamila Boerma
OBJECTIVES: To determine the risk of recurrent biliary events in the period after mild biliary pancreatitis but before interval cholecystectomy and to determine the safety of cholecystectomy during the index admission. BACKGROUND: Although current guidelines recommend performing cholecystectomy early after mild biliary pancreatitis, consensus on the definition of early (ie, during index admission or within the first weeks after hospital discharge) is lacking. METHODS: We performed a systematic search in PubMed, Embase, and Cochrane for studies published from January 1992 to July 2010...
May 2012: Annals of Surgery
Robbert A Hollemans, Thomas L Bollen, Sandra van Brunschot, Olaf J Bakker, Usama Ahmed Ali, Harry van Goor, Marja A Boermeester, Hein G Gooszen, Marc G Besselink, Hjalmar C van Santvoort
INTRODUCTION: At least 30% of patients with infected necrotizing pancreatitis are successfully treated with catheter drainage alone. It is currently not possible to predict which patients also need necrosectomy. We evaluated predictive factors for successful catheter drainage. METHODS: This was a post hoc analysis of 130 prospectively included patients undergoing catheter drainage for (suspected) infected necrotizing pancreatitis. Using logistic regression, we evaluated the association between success of catheter drainage (ie, survival without necrosectomy) and 22 factors regarding demographics, disease severity (eg, Acute Physiology And Chronic Health Evaluation II score, organ failure), and morphologic characteristics on computed tomography (eg, percentage of necrosis)...
April 2016: Annals of Surgery
Jessica LaRusch, Jinsei Jung, Ignacio J General, Michele D Lewis, Hyun Woo Park, Randall E Brand, Andres Gelrud, Michelle A Anderson, Peter A Banks, Darwin Conwell, Christopher Lawrence, Joseph Romagnuolo, John Baillie, Samer Alkaade, Gregory Cote, Timothy B Gardner, Stephen T Amann, Adam Slivka, Bimaljit Sandhu, Amy Aloe, Michelle L Kienholz, Dhiraj Yadav, M Michael Barmada, Ivet Bahar, Min Goo Lee, David C Whitcomb
CFTR is a dynamically regulated anion channel. Intracellular WNK1-SPAK activation causes CFTR to change permeability and conductance characteristics from a chloride-preferring to bicarbonate-preferring channel through unknown mechanisms. Two severe CFTR mutations (CFTRsev) cause complete loss of CFTR function and result in cystic fibrosis (CF), a severe genetic disorder affecting sweat glands, nasal sinuses, lungs, pancreas, liver, intestines, and male reproductive system. We hypothesize that those CFTR mutations that disrupt the WNK1-SPAK activation mechanisms cause a selective, bicarbonate defect in channel function (CFTRBD) affecting organs that utilize CFTR for bicarbonate secretion (e...
July 2014: PLoS Genetics
David W da Costa, Stefan A Bouwense, Nicolien J Schepers, Marc G Besselink, Hjalmar C van Santvoort, Sandra van Brunschot, Olaf J Bakker, Thomas L Bollen, Cornelis H Dejong, Harry van Goor, Marja A Boermeester, Marco J Bruno, Casper H van Eijck, Robin Timmer, Bas L Weusten, Esther C Consten, Menno A Brink, B W Marcel Spanier, Ernst Jan Spillenaar Bilgen, Vincent B Nieuwenhuijs, H Sijbrand Hofker, Camiel Rosman, Annet M Voorburg, Koop Bosscha, Peter van Duijvendijk, Jos J Gerritsen, Joos Heisterkamp, Ignace H de Hingh, Ben J Witteman, Philip M Kruyt, Joris J Scheepers, I Quintus Molenaar, Alexander F Schaapherder, Eric R Manusama, Laurens A van der Waaij, Jacco van Unen, Marcel G Dijkgraaf, Bert van Ramshorst, Hein G Gooszen, Djamila Boerma
BACKGROUND: In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission cholecystectomy is poor, and concerns exist about an increased risk of cholecystectomy-related complications with this approach. In this study, we aimed to compare same-admission and interval cholecystectomy, with the hypothesis that same-admission cholecystectomy would reduce the risk of recurrent gallstone-related complications without increasing the difficulty of surgery...
September 26, 2015: Lancet
Olaf J Bakker, Sandra van Brunschot, Hjalmar C van Santvoort, Marc G Besselink, Thomas L Bollen, Marja A Boermeester, Cornelis H Dejong, Harry van Goor, Koop Bosscha, Usama Ahmed Ali, Stefan Bouwense, Wilhelmina M van Grevenstein, Joos Heisterkamp, Alexander P Houdijk, Jeroen M Jansen, Thom M Karsten, Eric R Manusama, Vincent B Nieuwenhuijs, Alexander F Schaapherder, George P van der Schelling, Matthijs P Schwartz, B W Marcel Spanier, Adriaan Tan, Juda Vecht, Bas L Weusten, Ben J Witteman, Louis M Akkermans, Marco J Bruno, Marcel G Dijkgraaf, Bert van Ramshorst, Hein G Gooszen
BACKGROUND: Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis. METHODS: We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter...
November 20, 2014: New England Journal of Medicine
Jose Manuel Ramia, Joan Fabregat, Manuel Pérez-Miranda, Joan Figueras
Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the pancreatic duct and the gastrointestinal tract caused by ductal necrosis after severe acute necrotizing pancreatitis treated medically, by percutaneous drainage, or necrosectomy. There are no clear epidemiological data on the real incidence of DPDS; approximately 10 to 30% of patients with severe acute pancreatitis could develop DPDS. The existing literature is scarce, the terminology is confusing and therapeutic algorithms are not clearly defined...
January 2014: Cirugía Española
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