Blood Urea Nitrogen as a Predictor of Severe Acute Pancreatitis Based on the Revised Atlanta Criteria: Timing of Measurement and Cutoff Points.

Background and Aims. This study evaluated the prognostic accuracy of BUN for severe acute pancreatitis (SAP) and in-hospital mortality (IHM) in terms of the best timing for BUN measurement and the optimal BUN cutoff points. Methods. BUN determinants at the time of admission and 24 hrs after hospital admission were recorded and analyzed statistically. The ability of BUN in predicting the SAP and the occurrence of IHM were assessed using the area under the receiver-operating characteristic (ROC) curve. Results. For SAP, AUC of BUN at admission and 24 hrs after hospital admission was 0.75 and 0.80, respectively. For IHM in acute pancreatitis, it was 0.86 at admission and 0.84 after 24 hrs of hospital admission, respectively. The optimal cutoff point of BUN 24 hrs after hospital admission for SAP and at admission for IHM was 8.3 mmol/L and 13.3 mmol/L, respectively. Conclusion. BUN determination after 24 hrs of hospital admission has high accuracy for prediction of SAP while BUN at initial admission has high accuracy for prediction of IHM.

A retrospective analysis of postoperative recurrence of septated chronic subdural haematoma: endoscopic surgery versus burr hole craniotomy.

OBJECTIVE: To identify the factors associated with Septated chronic subdural haematoma (sCSDH) recurrence and to compare the advantages and disadvantages of burr hole craniotomy (BHC) and endoscopic surgery (ES) with respect to preventing sCSDH recurrence. METHODS: A total of 76 consecutive patients with sCSDH underwent BHC or ES in our institution. Their clinical data were retrospectively analysed to identify the factors associated with sCSDH recurrence and to evaluate the effectiveness of BHC and ES with respect to preventing sCSDH recurrence. RESULTS: There were no significant differences in gender, age, Markwalder grade, side of haematoma, preoperative mid-line shifts, intervals, clinical features or medical histories between the two groups. Bilateral sCSDH was the only factor that significantly influenced the sCSDH recurrence rate (RR) (p = 0.001). Male gender, age ≥ 60 years, poor Markwalder grade, preoperative mid-line shifts ≤10 mm, postoperative mid-line shifts >10 mm, neovessels, intervals ≤20 days and medical histories tended to be associated with sCSDH recurrence. The RRs in the BHC and ES groups were 13.7 and 8.7%, respectively. ES eliminated more factors associated with recurrence than BHC; however, ES required more surgery time (p < 0.001) and more medical consumption (p < 0.001) than BHC. CONCLUSIONS: Bilateral sCSDH exerted the most significant influence on the sCSDH RR. There was no difference between ES and BHC with respect to decreasing the sCSDH RR. However, BHC is a more efficient procedure than ES, as it required less surgery time and less medical consumption than ES.

Endoscopic surgery to chronic subdural hematoma with neovessel septation: technical notes and literature review.

OBJECTIVE AND IMPORTANCE: We report Septated Chronic Subdural Hematoma (sCSDH) cases with the neovessel in the hematoma cavity, and evaluate surgical effect of the neuroendoscope-assisted neovessel coagulation for these sCSDH patients. CLINICAL PRESENTATION: Four patients suffered from sCSDH with different clinical symptoms. Magnetic resonance imaging (MRI) was applied to differentiate the neovessel from the bridge vein and septa fibra. Endoscopic surgeries were performed after their admission. TECHNIQUE: Through the small bone window, we used suction to clean the surgical field so that the neovessels can be exposed, which is thought to be the one of recurrence factors for the sCSDH, then we coagulated and cut them under the neuroendoscope. Case examples are described here to illustrate the technique. CONCLUSION: This report illustrates that the neovessel is one of recurrence factors of sCSDH and has special characteristics showed on MRI. Through this technique with the guidance of MRI the recurrence rate of sCSDH can be reduced.