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3.
Rev. esp. enferm. dig ; 114(7): 422-424, julio 2022. ilus
Artigo em Inglês | IBECS | ID: ibc-205682

RESUMO

A 69-year-old woman with severe acute necrotizing pancreatitis underwent a CT-scan, which revealed a peripancreatic collection near the pancreatic body/tail, with heterogeneous content and gas inside, suggestive of an infected walled-off-pancreatic-necrosis (WOPN). The patient was proposed to WOPN transgastric endoscopic drainage. Due to persistence of sepsis, endoscopic necrosectomy was deemed necessary. During the fifth session, the endoscopist noted a large pulsatile vessel at the posterior wall of the collection. Given location and morphologic features, it was assumed that vessel was the splenic artery. The procedure was suspended. (AU)


Assuntos
Humanos , Feminino , Idoso , Drenagem/métodos , Endoscopia/métodos , Gastroenterologistas , Resultado do Tratamento , Sonhos , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/cirurgia
4.
Med. clín (Ed. impr.) ; 158(11): 556-563, junio 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-204675

RESUMO

La pancreatitis aguda continúa siendo una de las patologías más relevantes en los servicios de aparato digestivo, destacando la litiasis y el alcohol como las causas principales. Presenta unos criterios diagnósticos bien establecidos y unas indicaciones específicas para la realización de pruebas de imagen, considerando de gran utilidad la ecografía abdominal en el estudio etiológico y la tomografía computarizada abdominal para la estratificación del riesgo y estudio de complicaciones locales. Una fluidoterapia basada en metas, el uso precoz de la nutrición por vía oral y una adecuada analgesia constituyen los pilares básicos del manejo inicial. La antibioterapia está indicada en casos de necrosis infectada o infecciones extrapancreáticas pero no ha demostrado beneficio como profilaxis en pancreatitis aguda necrotizante. En la última década se han desarrollado abordajes mínimamente invasivos que han cambiado radicalmente el tratamiento de las necrosis encapsuladas mejorando la tasa de complicaciones, estancia hospitalaria y calidad de vida de los pacientes. (AU)


Acute pancreatitis is nowadays one of the most common diseases among gastroenterology disorders, being gallstones and alcohol the main etiologies. Diagnostic criteria and indications of different imaging techniques are well defined, so that abdominal ultrasound is useful for etiological diagnosis whereas computarized tomography is better for risk stratification and local complications assessment. Goal directed fludtherapy, early starting of oral feeding and pain management are the mainstay of early treatment in acute pancreatitis. Antibiotics are useful when infected necrosis or extra pancreatic infections are documented or suspected but no as prophylaxis in sterile necrotizing pancreatitis. Minimally invasive approaches have emerged in the last decade for walled off necrosis management, improving complication rates, quality of life and length of hospital stay when compared with open surgery. (AU)


Assuntos
Humanos , Doença Aguda , Necrose , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Qualidade de Vida , Terapêutica
10.
Radiología (Madr., Ed. impr.) ; 62(5): 360-364, sept.-oct. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-199814

RESUMO

OBJETIVO: Determinar si existen diferencias en la concentración de iodo cuantificada con TC de doble energía en el páncreas de pacientes con pancreatitis aguda y pacientes sin signos analíticos ni en imagen de patología pancreática. MATERIAL Y MÉTODOS: Se estudian 27 casos de pancreatitis aguda a los que se realizó una TC con energía dual a las 48-72 horas del inicio de los síntomas, realizada con contraste intravenoso y una sola fase con un retraso de 55 segundos. Se compara con un grupo control de 11 pacientes con una TC realizada con el mismo protocolo, pero sin datos radiológicos de pancreatitis y amilasa y lipasa normales. Mediante posprocesado se obtienen reconstrucciones con mapa de iodo y se realizan tres regiones de interés en cabeza, cuerpo y cola pancreática para obtener los valores de concentración de iodo (mg/ml) y se comparan entre ambos grupos. Se hace un segundo cálculo normalizando la densidad de iodo con la aorta. RESULTADOS:En las pancreatitis, el valor medio de densidad de iodo es 2,5mg/ml. En el grupo de los controles es de 3,65mg/ml (p = 0,02). Hay tres casos con necrosis glandular en los que la densidad de iodo es 1,53mg/ml. CONCLUSIONES: Existen diferencias significativas en la concentración de iodo del páncreas medida en TC con energía dual entre pacientes con pancreatitis aguda en fases iniciales y pacientes sin signos analíticos ni en imagen de patología pancreática


OBJECTIVE: To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS: We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS: The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS: The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease


Assuntos
Humanos , Masculino , Feminino , Pancreatite Necrosante Aguda/diagnóstico por imagem , Radioisótopos do Iodo/administração & dosagem , Tomografia Computadorizada por Raios X/métodos , Estudos de Casos e Controles , Estudos Retrospectivos , Índice de Gravidade de Doença , Pancreatite Necrosante Aguda/classificação
12.
An. sist. sanit. Navar ; 43(1): 103-106, ene.-abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193684

RESUMO

Everolimus es un inhibidor de mTOR, empleado en oncología y como inmunosupresor en el trasplante de órgano sólido. Sus efectos adversos a nivel metabólico son muy frecuentes, especialmente los más severos. Puede ocasionar hiperglucemia, hipercolesterolemia e hipertrigliceridemia, por lo que la monitorización de los parámetros metabólicos en las sucesivas visitas es vital para detectar e iniciar tratamientos que puedan prevenir las complicaciones. Se presenta el caso de una mujer con diagnóstico de tumor neuroendocrino intestinal que desarrolló dos pancreatitis agudas secundarias a hipertrigliceridemia severa por everolimus. Tras inicio de tratamiento con fibratos y omega-3, se normalizó la cifra de triglicéridos sin presentar nuevas complicaciones metabólicas ni digestivas secundarias al fármaco. La recomendación en pacientes con cáncer en tratamiento activo con everolimus es mantener los triglicéridos por debajo de 500 o 300 mg/dL, dependiendo de si la esperanza de vida es inferior o superior a un año, respectivamente


Everolimus is an mTOR inhibitor, approved as a treatment for cancer and as an immunosuppressant agent in solid organ transplantation; it frequently produces toxic metabolic effects, particularly of the most severe kind. Its use can cause hyperglycemia, hypercholesterolemia and hypertriglyceridemia; thus, metabolic values should be monitored regularly to prevent these adverse events. We present the case of a woman with an intestinal neuroendocrine tumor who developed two episodes of acute pancreatitis, secondary to severe hypertriglyceridemia caused by everolimus. After treatment with fibrates and omega-3, triglyceride levels returned to baseline, without developing new metabolic or digestive complications. Targeted levels of triglyceride for cancer patients treated with everolimus, should be below 500 or 300 mg/dL, depending on whether life expectancy is less or longer than one year, respectively


Assuntos
Humanos , Feminino , Adulto , Hipolipemiantes/administração & dosagem , Pancreatite Necrosante Aguda/tratamento farmacológico , Hipertrigliceridemia/induzido quimicamente , Everolimo/administração & dosagem , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/tratamento farmacológico , Imunossupressores/administração & dosagem , Everolimo/efeitos adversos , Tomografia Computadorizada de Emissão , Íleo/diagnóstico por imagem , Proteína Regulatória Associada a mTOR/antagonistas & inibidores
13.
Rev. clín. esp. (Ed. impr.) ; 219(5): 266-274, jun.-jul. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186563

RESUMO

La pancreatitis aguda es una entidad de notable importancia debido a su elevada incidencia y a su no desdeñable morbimortalidad. Se conoce como pancreatitis aguda idiopática aquella en la que no se consigue determinar la causa del cuadro tras un estudio básico inicial. Conocer la etiología subyacente permite plantear un tratamiento dirigido para así disminuir el riesgo de recurrencia. La ecoendoscopia y la colangiografía por resonancia magnética son las pruebas de elección para profundizar en el estudio etiológico. La principal causa es la enfermedad litiásica no diagnosticada en el estudio inicial, cuyo tratamiento de elección es la colecistectomía. Por otra parte, la pancreatitis aguda recurrente se diagnostica tras la existencia de 2 o más episodios de pancreatitis aguda. El objetivo de esta revisión es proporcionar una aproximación actualizada de estas 2 entidades, repasando aspectos de su epidemiología, diagnóstico y alternativas terapéuticas disponibles


Acute pancreatitis is an entity of notable importance due to its high incidence and its non-negligible morbidity and mortality. Idiopathic acute pancreatitis is that in which the cause of the clinical condition cannot be determined after an initial basic study. Understanding the underlying aetiology enables clinicians to propose a targeted treatment to reduce the risk of recurrence. Endoscopic ultrasonography and magnetic resonance cholangiopancreatography are the tests of choice to deepen the aetiological study. The main cause is undiagnosed lithiasic disease in the initial study, whose treatment of choice is cholecystectomy. Moreover, recurrent acute pancreatitis is diagnosed after 2 or more episodes of acute pancreatitis. The objective of this review is to provide an updated approach for these 2 entities, reviewing aspects of their epidemiology, diagnosis and available alternative therapies


Assuntos
Humanos , Pancreatite Necrosante Aguda/terapia , Colangiopancreatografia por Ressonância Magnética/métodos , Endossonografia/métodos , Pancreatite Necrosante Aguda/classificação , Recidiva , Neoplasias Pancreáticas/diagnóstico por imagem , Doenças Autoimunes/epidemiologia , Predisposição Genética para Doença , Pancreatite Alcoólica/diagnóstico por imagem
15.
Rev. esp. enferm. dig ; 111(6): 471-480, jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190083

RESUMO

Background and aim: the incidence of acute pancreatitis is rising across the world, thus further increasing the burden on healthcare services. Approximately 10% of patients with acute pancreatitis will develop infected necrotizing pancreatitis (INP), which is the leading cause of high mortality in the late phase. There is currently no consensus with regard to the use of endoscopic or minimally invasive surgery as the first-line therapy of choice for INP. However, more clinical research with regard to the superiority of an endoscopic approach has been recently published. Therefore, we conducted a systematic review and meta-analysis to determine which of the two treatments leads to a better prognosis. Methods: four databases (Medline, SINOMED, EMBASE and Cochrane Library) were searched for eligible studies from 1980 to 2018, comparing endoscopic and minimally invasive surgery for INP. Results: two randomized controlled trials (RCTs) and seven clinical cohort studies were included. After the analysis of data amenable to polling, significant advantages were found in favor of the endoscopic approach in terms of pancreatic fistulas (OR = 0.10, 95% CI 0.04-0.30, p < 0.001) and the length of hospital stay (weighted mean difference [WMD] = -24.72, 95% CI = -33.87 to -15.57, p < 0.001). No marked differences were found in terms of mortality, multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, recurrence of pseudocysts, and length of stay (LOS) in the Intensive Care Unit (ICU), endocrine insufficiency and exocrine insufficiency. Conclusion: compared with minimally invasive surgery, an endoscopic approach evidently improved short-term outcomes for infected necrotizing pancreatitis, including pancreatic fistula and the length of hospital stay. Furthermore, relevant multicenter RCTs are eager to validate these findings


No disponible


Assuntos
Humanos , Pancreatite Necrosante Aguda/cirurgia , Endoscopia Gastrointestinal/métodos , Pâncreas/microbiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento , Infecções/cirurgia
18.
Gastroenterol. hepatol. (Ed. impr.) ; 41(10): 618-628, dic. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-178233

RESUMO

INTRODUCTION: The aim of this systematic review is to summarize epidemiological data and areas of future acute pancreatitis research in Spain. METHODS: We conduct an independent search in PubMed and Web of Science and analyse articles by Spanish researchers from 2008 to 2018. RESULTS: We identified an overall incidence of 72/100,000 person-years, with biliary pancreatitis as the most common etiology. BISAP was useful but suboptimal for predicting severity and some biomarkers such as Oleic acid chlorohydrin have shown promising results. The modified determinant-based classification can help to classify patients admitted to intensive care units. Ringer's lactate solution is currently the fluid of choice and classic surgery has been surpassed by minimally-invasive approaches. Starting a full-caloric diet is safe when bowel sounds are present. DISCUSSION: There are numerous well-defined research fields in Spain. Future multicentre studies should focus on management, predicting severity and cost-effectiveness


INTRODUCCIÓN: El objetivo de esta revisión sistemática es sintetizar datos epidemiológicos y campos de investigación en pancreatitis aguda en España. MÉTODOS: Realizamos una búsqueda independiente en PubMed y Web of Science, analizando artículos de investigadores españoles desde 2008 hasta 2018. RESULTADOS: La incidencia global fue de 72/100.000 personas/año, siendo la etiología biliar la más común. BISAP resultó útil, aunque subóptimo en predicción de gravedad y ciertos biomarcadores como el ácido oleico clorhídrico han mostrado resultados prometedores. La clasificación basada en determinantes modificada puede ayudar en la clasificación de pacientes ingresados en UCI. La sueroterapia basada en Ringer lactato es actualmente de elección y la cirugía tradicional ha sido sustituida por abordajes mínimamente invasivos. La dieta amplia de inicio, cuando los ruidos intestinales están presentes es segura. DISCUSIÓN: Existen múltiples áreas de investigación bien definidas en España. Futuros estudios multicéntricos deberían centrarse en manejo, predicción de la gravedad y el coste/efectividad


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pancreatite/epidemiologia , Biomarcadores/análise , Índice de Gravidade de Doença , Pancreatite Necrosante Aguda/cirurgia , Pancreatite/diagnóstico , Pancreatite/etiologia , Doença Aguda , Valor Preditivo dos Testes , Espanha/epidemiologia , Hidratação , Dieta
19.
Rev. esp. enferm. dig ; 110(10): 669-671, oct. 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-177824

RESUMO

Several types of thoracic complications can be associated with severe acute pancreatitis. Some are very common, such as pleural effusion, whilst some others are very rare although life threatening, such as enzymatic mediastinitis (EM). Only a few cases of EM (when related to acute pancreatitis) have been described in the literature. Here we describe the case of a 76-year-old female who developed acute respiratory failure and atrial fibrillation during the postoperative period after an open pancreatic necrosectomy, due to an EM episode. The mediastinal collection was drained by thoracotomy, following an improvement of the patient's general condition. This is the first case of EM following surgical management for acute necrotizing pancreatitis. EM is a rare but life threatening complication that usually requires surgery


No disponible


Assuntos
Humanos , Feminino , Idoso , Mediastinite/enzimologia , Pancreatite Necrosante Aguda/cirurgia , Pancreatectomia/efeitos adversos , Necrose/cirurgia , Pancreatite Necrosante Aguda/complicações , Complicações Pós-Operatórias , Drenagem/métodos
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