[Acute necrotizing pancreatitis: traditional laparotomy vs. minimally invasive procedures]. / Akutní nekrotizující pankreatitida: klasické laparotomie vs. miniinvazivní postupy.

INTRODUCTION: Treatment of necrotizing pancreatitis continues to evolve. The standard therapeutic method for infected pancreatic necrosis and its subsequent septic complications is open surgical drainage. The advances in radiological imaging and interventional radiology have enabled the development of minimally invasive procedures, i.e. percutaneous drainage (PCD) under CT/USG control, endoscopic transgastric necrosectomy (ENE), laparoscopic transperitoneal necrosectomy (LNE) and retroperitoneal access to pancreatic necrosis (RENE). METHODS: Patients with acute pancreatitis treated from 2002 to 2013 (n=932) were included in the study. In patients with a severe form of the disease, results obtained in two groups of patients were compared: the first group was treated by classic laparotomy (group A), the second one was treated by means of minimally invasive procedures (group B). Statistical analysis employed the chi-square test. RESULTS: During the mentioned period, 677 (72.6%) patients with a mild form and 255 (27.4%) with a severe form of the disease were treated. The male/female ratio was 1.4:1. In the group of patients suffering from a severe form of acute pancreatitis, 171 patients were treated conservatively, mortality rate being at 16.4% (28/171). Surgery was indicated in a total of 84 patients, mortality rate reaching 26.2% (22/84). Fifty-two of the patients underwent laparotomy (group A), minimally invasive procedures were used in a total of 32 patients (group B). Overall mortality in group A was 30.8% (16/52) vs. 18.8% (6/32) in group B, p = 0.224. The average length of hospitalization was longer in group A (65.4 days; median 52.4 vs. 49 days; median 36.5 in group B). PCD was the most frequent procedure performed in 19 patients; 5 of them died due to ongoing sepsis and multiorgan failure and 2 of them underwent revisional laparotomy. RENE was performed in 8 patients; lumbotomy was used in 5 of them. ENE was performed on 2 patients, 1 of them died, and LNE was used once. A less invasive procedure, the linea alba fasciotomy, was performed in 2 patients with intra-abdominal hypertension. CONCLUSION: Open surgical drainage represents the standard treatment for infected pancreatic necrosis. Minimally invasive procedures are suitable alternatives especially in critically ill patients providing lower morbidity and mortality rates.

Pharmacokinetics and tolerance of 7-methoxytacrine following the single dose administration in healthy volunteers.

7-methoxy-tetrahydroaminoacridine (7-MEOTA) is a new reversible cholinesterase inhibitor. Forty-eight young male volunteers divided into six dosage groups were included into a single-dose pharmacokinetic study with either oral (p.o.) or intramuscular (i.m.) administration. The dose of 7-MEOTA was 2, 4 or 8 mg/kg body weight p.o. or 0.5, 1 or 2 mg/kg body weight i.m. in the respective six dosage groups. The plasma levels data were fitted to an open one-compartmental model. The compound showed cholinomimetic adverse effects in 2 subjects with the blood levels exceeding 1,500 micrograms/l. The red blood cells levels paralleled those in plasma and were 2.5 times higher. The tmax was 4 hours and 1 h, t1/2 8.7 +/- 3.9 hours and 6.5 +/- 5.8 hours in case of p.o. and i.m. administration, respectively. The apparent clearance (D/AUC) was 5 times higher following p.o. administration, reflecting the differences in bioavailability.

[Use of electroshock for vital indications]. / Pouzití elektrosoku ve vitální indikaci.

Electroshock therapy still remains a very controversial problem in the treatment of mental disorders. It is very effective in a narrow range of indications and has not many absolute contraindications. Epilepsy is one of the relative contraindications of electroshock therapy. The authors submit the case-history of an epileptic patient in a severe catatonic state with incipient metabolic breakdown, where electroshock therapy was followed by a rapid effect without any neurological complications. The contraindications of electroshock are rather relative than absolute and it is up to the doctor to consider whether the assumed therapeutic effect will outweigh possible complications.