Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis.

BACKGROUND: Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Acute fluid collections and pseudocyst formation are the most frequent complications of acute pancreatitis. AIMS: The aims of this study were to evaluate the incidence, risk factors, and clinical course of pancreatic fluid collections and pseudocyst formation following acute pancreatitis. METHODS: A prospective multicenter study was conducted in five participating centers with 302 patients diagnosed with acute pancreatitis from January 2011 to July 2012. RESULTS: The incidence of pancreatic fluid collections and pseudocyst was 42.7 and 6.3 %, respectively. Patients with fluid collections were significantly younger, compared to those without fluid collections (51.5 ± 15.9 vs. 60.4 ± 16.5 years, P = 0.000). The proportion of alcoholic etiology (54.3 %) in patients with fluid collections was significantly higher compared to other etiologies (P = 0.000). C-reactive protein (CRP) (48 h) was significantly higher in patients with fluid collections, compared to patients without fluid collections (39.2 ± 77.4 vs. 15.1 ± 36.2 mg/dL, P = 0.016). LDH (48 h) was significantly higher in patients with pseudocyst formation, compared to patients with complete resolution (1,317.6 ± 706.4 vs. 478.7 ± 190.5 IU/L, P = 0.000). Pancreatic fluid collections showed spontaneous resolution in 69.8 % (90/129) and 84.2 % of the pseudocysts disappeared or decreased in size during follow up. CONCLUSIONS: Age, CRP (48 h), and alcohol etiology are risk factors for pancreatic fluid collections. LDH (48 h) appears to be a risk factor for pseudocyst formation. Most pseudocysts showed a decrease in size or spontaneous resolution with conservative management.

Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients.

BACKGROUND: Although there has been much debate over the fate of the gallbladder (GB) after endoscopic common bile duct (CBD) stone removal, subsequent cholecystectomy is generally recommended in patients with GB stones to prevent further biliary complications. The aims of this study were to assess the natural course of the patients with GB in situ after endoscopic CBD stone removal and to evaluate the necessity of prophylactic cholecystectomy. METHODS: Four hundred sixty-one patients who had undergone CBD stone removal at Yeungnam University Hospital between January 2000 and December 2004 were retrospectively analyzed, and 232 patients were ultimately enrolled in this study. RESULTS: The mean duration of follow-up was 73 (range = 7-126) months in the cholecystectomy group and 66 (6-127) months in the GB in situ group (p = 0.168). Ten patients (14.7 %) in the cholecystectomy group and 31 patients (18.9 %) in the GB in situ group developed recurrent CBD stones (p = 0.295). The highest percentage of recurrent CBD stones in both groups was that for brown stones (80 and 80.6 %). In the GB in situ group, cumulative recurrence rates of CBD stones were not significantly different between patients with GB stones and without GB stones (15.9 vs. 20 %, p = 0.798). However, the incidence of acute cholecystitis was significantly higher in patients with GB stones compared to patients without GB stones (13.6 vs. 2.5 %, p = 0.003). CONCLUSIONS: Prophylactic cholecystectomy seems to be unnecessary in patients without GB stones after endoscopic sphincterotomy. However, in patients with GB stones, elective cholecystectomy or close observation is recommended due to the higher risk of cholecystitis.

Bioelectrical impedance may predict cell viability during ischemia and reperfusion in rat liver.

Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but no method could monitor or predict it real-time during surgery. We measured bioelectrical impedance (BEI) and cell viability to assess the usefulness of BEI during I/R in rat liver. A 70% partial liver ischemia model was used. BEI was measured at various frequencies. Adenosine triphosphate (ATP) content, and palmitic acid oxidation rate were measured, and histological changes were observed in order to quantify liver cell viability. BEI changed significantly during ischemia at low frequency. In the ischemia group, BEI increased gradually during 60 min of ischemia and had a tendency to plateau thereafter. The ATP content decreased below 20% of the baseline level. In the I/R group, BEI recovered to near baseline level. After 24 hr of reperfusion, the ATP contents decreased to below 50% in 30, 60 and 120 min of ischemia and the palmitic acid metabolic rates decreased to 91%, 78%, and 74%, respectively, compared with normal liver. BEI may be a good tool for monitoring I/R during liver surgery. The liver is relatively tolerant to ischemia, however after reperfusion, liver cells may be damaged depending upon the duration of ischemia.