Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis.

BACKGROUND & AIM: Acute pancreatitis (AP) and chronic pancreatitis (CP) traditionally have been thought to be distinct diseases, but there is evidence that AP can progress to CP. Little is known about the mechanisms of pancreatitis progression. We performed a meta-analysis to quantify the frequency of transition of AP to CP and identify risk factors for progression. METHODS: We searched PubMed, Scopus, and Embase for studies of patients with AP who developed CP, published from 1966 through November 2014. Pooled prevalence and 95% confidence intervals (CIs) were calculated for these outcomes, and sensitivity, subgroup, and meta-regression analyses were conducted. RESULTS: We analyzed 14 studies, which included a total of 8492 patients. The pooled prevalence of recurrent AP was 22% (95% CI, 18%-26%), and the pooled prevalence of CP was 10% (95% CI, 6%-15%). Sensitivity analyses yielded a pooled prevalence of CP of 10% (95% CI, 4%-19%) and 36% (95% CI, 20%-53%) in patients after the first occurrence and recurrent AP, respectively. Subgroup analyses found alcohol use and smoking to be the largest risk factors for the development of CP, with pooled prevalence values of 65% (95% CI, 48%-56%) and 61% (95% CI, 47%-73%), respectively. Meta-regression analysis found that men were more likely than women to transition from AP to CP. CONCLUSIONS: Ten percent of patients with a first episode of AP and 36% of patients with recurrent AP develop CP; the risk is higher among smokers, alcoholics, and men. Prospective clinical studies are needed to study pancreatitis progression.

Diagnosis and localization of parathyroid adenomas using 16-slice SPECT/CT: A clinicopathological correlation.

INTRODUCTION: This study aimed to evaluate a new 16-slice SPECT/CT scanner at Auckland City Hospital for its use in the detection and localization of parathyroid adenomas in patients with primary, secondary and tertiary hyperparathyroidism. The secondary outcome was to compare findings from SPECT/CT with ultrasound and operative findings. METHODS: One hundred patients who underwent a SPECT/CT scan for primary/secondary/tertiary hyperparathyroidism were included in this study. Of these patients, 45 received surgery. SPECT/CT and ultrasound findings were collated for each patient, and of those who received surgery, operative and pathological findings were compared with those on SPECT/CT. RESULTS: The sensitivity of diagnosis and localization was 86.5% (95% CI: 71.2-95.5%). Specificity was 25.0% (95% CI: 3.2-65.1%). Comparison between SPECT/CT and ultrasound findings demonstrated a kappa coefficient of 0.203 (95% CI: -0.036 to 0.442), correlating with fair agreement. These figures are in line with other published series. CONCLUSION: The SPECT/CT scanner (and associated reporters) at Auckland City Hospital demonstrates high sensitivity in the detection and localization of parathyroid adenomas and is an effective first-line investigation in patients with primary/secondary/tertiary hyperparathyroidism.