[The management of acute pancreatitis according to the modern guidelines]. / Managementul pancreatitei acute conform ghidurilor terapeutice actuale.

Severe acute pancreatitis is a critical illness as the organism that produces a significant mortality despite diagnostic and therapeutic acquisitions. While new mechanisms have been identified for production and were crystallized management principles, a number of controversies remain awaiting resolution in the near future. Aim is to establish, based on their experience and literature data, place the current means of diagnosis and treatment in close correlation with the pathophysiological events of acute pancreatitis.

[Interleukin 17--prognostic marker of severe acute pancreatitis]. / Interleukina 17--marker prognostic al pancreatitei acute severe.

OBJECTIVE: The evaluation of the interleukin 17 capacity as precociously predictive marker of the severe forms of acute pancreatitis. MATERIAL AND METHOD: This prospective and diagnosis study took place during 01.01.2006-31.03.2008 on a sample of 83 subjects hospitalized with acute pancreatitis. Among these, 48 have submitted forms mild disease and formed batch A. Subjects with severe acute pancreatitis formed batch B (n=16), to whom it was applied peritoneal lavage extended by laparoscopic method and batch C (n=19), who have used conventional methods of treatment. Were determined serum concentrations of interleukin 17 in the first and tenth days of admission for the subjects of A and C lots and in the first, third and tenth day at then subjects of B lot, they were dosage and levels peritoneal or lavage fluid in the third, sixth and tenth days of admission. At the same time were determined interleukin 6 levels. RESULTS: Interleukin 17 has proved a sensitivity of 97% and a specificity of 94% in early identification forms of severe acute pancreatitis, the correlation coefficient is 0.81. The correlation was good even in combination with organic disfunction (0.66) and the risk of death (0.54). The predictive capacity of sepsis has been reduced (0.44). The dynamics of this cytokines show a significant decrease in concentrations forms mild disease (batch A) and in severe forms treated with peritoneal extended lavage (lot B). In conversely, the subjects treated by conventional methods (lot C) the decrease was not significant between the first and tenth days of admission. A similar dynamic has been recorded after short peritoneal lavage, lasting three days. At large in, the concentrations of interleukin 17 have evolved in parallel with those of interleukin 6. CONCLUSIONS: Interleukin 17 is an important predictive marker of early forms of severe acute pancreatitis. Also, serum concentrations are correlated with the risk of organic disfunction development and the fatal evolution. The dynamics of this cytokine is depending on the therapeutic measures that attenuates the body's inflammatory response.

[Early and prolonged peritoneal lavage with laparoscopy in severe acute pancreatitis]. / Lavajul peritoneal precoce si prelungit prin abord laparoscopic în pancreatita acuta severa.

OBJECTIVE: The evaluation of precocious and prolonged lavage and drainage by laparoscopic approach in the treatment of severe acute pancreatitis. MATERIAL AND METHOD: This therapeutic prospective study was conducted during 01.01.2006-31.03.2008 on a sample consisting of 35 subjects with the severe acute pancreatitis has been divided into two lots. A lot is formed by 16 patients whom were applied the method mentioned ahead and in the B lot--19 patients, treated by conventional and known methods of treatment. The method proposed, completed about laparoscopic approach in a third day of admission, consists, after setting lesional balance, in lavage of peritoneal space and mounting two tubes drainage, one subhepatic space and the other in Douglas space. Post operator for 7 days performed peritoneal lavage discontinuous with physiological serum. For an accurate assessment may were determined serum and peritoneal concentrations of interleukin 6. RESULTS: The duration of organic disfunction was 8 days for A lot subjects and 17,7 days for B lot subjects. The complications occurred and the needs of surgical treatment was net disadvantage at the patients treated conventionally. The mortality at A lot was 12.5% (n=2) and at lot B 36.8% (n=7). The tardive mortality by sepsis was null at subjects with lavage and was 15,8% (n=3) at subjects without lavage. The precocious mortality was 12,5% (n=2) in the A lot and 21% (n=4) in the lot B. The average hospitalization was 25,8 days in subjects with peritoneal lavage and 35,8 days in those treated conservatively, the difference is statistically significant. The method has proved not generating of morbidity and supplementary mortality. Study of the variation of serum and peritoneal concentrations of interleukin 6 shows the modulator effect of the peritoneal lavage early and prolonged of the inflammatory response and offers an argument of the inefficiency of short peritoneal lavage. CONCLUSIONS: The data obtained indicate early and extended peritoneal lavage by laparoscopic method as a useful therapy in the management of severe acute pancreatitis.

[Aneurysm of the splenic artery]. / Anevrism al arterei splenice.

The work is presenting the case of a young patient with splenic aneurysm, a more and more frequent diagnosis in these last years. The peculiarity consist in the biphase and bi-directional evolution, first toward the gastric lumen, with hematemesis and consequently, after about a month, in the peritoneal cavity, with hemoperitoneum. The positive diagnosis and the final surgical solution was obtained after successive procedures, due to the lack of an appropriate technical equipment (angiographic exploration) due to the lack of the medical information at one time (inefficient anamnesis and the lack of the documentation) and finally, due to some elements that disturbed the surgical reasoning.

[Liver gunshot wounds]. / Plagile hepatice prin arme de foc.

The paper presents the 6 cases of liver shot wounds that were in supervision of the general surgery unit, County Hospital of Baia Mare, between the years 1990-1997. The patients were males, most of them being 20 to 30 years old. In 3 situations hunting rifles were involved, all followed by retention of metal foreign body. The wounds were plurivisceral in 5 of the 6 cases, the most frequently wounded was the right liver lobe. All the patients presented serious traumatic shock and haemorrhagic shock. Livertectomy was used in 40% of the cases being imposed by the dilacerant and transfixiant character of the wounds and also by the retention of foreign bodies in parenchime. We registered 2 demises, both in the first postoperatory hours. The paper proposes a few criteria that allow the application of a conservatory treatment:rapid favourable answer at deshocking therapy; hemodynamic stability; minimal hemoperitoneus (echographical and tomographical); absence of associated visceral wounds or, when they exist, of serious physiopathological consequences; access to performant means of imagistics.