Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition.

BACKGROUND: Pancreatic diseases involve complex nutritional challenges. Despite this, conflicting evidence exists regarding the clinical relevance of detecting the risk of malnutrition and implementing systematic nutrition support for these patients. Thus, our aims were to investigate whether screening for malnutrition risk and initiating nutrition support are predictive of mortality for hospitalized patients with pancreatic diseases. DESIGN: From 2008 to 2018, 34 prevalence surveys of nutrition were conducted at Haukeland University Hospital (HUH), Norway. Risk of malnutrition was defined by a score of ≥3 in Nutritional Risk Screening 2002 (NRS 2002). Primary outcomes included overall, one-year, and one-month mortality, and were compared according to malnutrition risk and nutrition support for adult patients with ICD-10 codes of K85: acute pancreatitis, K86: other diseases of pancreas, and C25: malignant neoplasm of pancreas. Length of hospital stay (LOS) was included as a secondary outcome. RESULTS: Of the 283 patients investigated, risk of malnutrition was present in 61.5%. Risk of malnutrition was associated with higher overall mortality (Hazard Ratio (HR) = 1.67, 95% confidence interval (CI): 1.2-2.4, P = 0.003) and one-year mortality (HR = 1.89, 95% CI: 1.2-2.9, P = 0.004) compared to patients not at risk. Not receiving nutrition support for at-risk patients was associated with higher overall mortality (HR = 1.60, 95% CI: 1.1-2.4, P = 0.019) and one-year mortality (HR = 1.64, 95% CI: 1.04-2.6, P = 0.034) compared to patients at risk who received nutrition support. Patients at risk of malnutrition had increased LOS (20.5 nights vs 15.2 nights, P = 0.044) compared to patients not at risk of malnutrition. CONCLUSION: This study of hospitalized patients with pancreatic disease suggests that risk of malnutrition may be associated with higher mortality rates, whereas nutrition support may decrease mortality rates. CLINICAL TRIAL REGISTRY: Not registered.

The Use of Complementary and Alternative Medicine is Frequent in Patients With Pancreatic Disorders.

BACKGROUND: Herbal remedies and other complementary and alternative medicine (CAM) are used by 30% of the patients with liver and inflammatory bowel diseases. However, there are no data regarding CAM use in patients with pancreatic disorders, including potential pancreatotoxicity. AIM OF THE STUDY: The aim of the study was to assess the prevalence of CAM use in patients with pancreatic disorders and screen for pancreatotoxicity. MATERIALS AND METHODS: This was a cross-sectional survey of consecutive outpatients seen at a Pancreas Center. Data were collected in a specific questionnaire. Descriptive statistics were used to analyze the prevalence and the patterns of CAM use. Characteristics associated with CAM use were analyzed by appropriate statistics. RESULTS: Of 108 patients (52% male; mean age, 65±13 years), 47 (43.5%) used CAM. The use of CAM was more frequent among patients with previous acute pancreatitis (47%). Reported reasons for the use of CAM were to help standard therapies and for an overall better feeling. About 61% of the patients reported advantages with treatment. As compared with nonusers, CAM users were more often female (55% vs. 42%), with a higher school degree (43% vs. 36%), more frequently performing physical activity (51% vs. 41%), and reporting anxiety (45% vs. 31%). However, none of these differences were statistically significant. Three patients with previous acute pancreatitis reported the use of Serenoa repens that is potentially pancreatotoxic. DISCUSSION: The rate of CAM use in patients with pancreatic disorders is similar to those reported for other digestive diseases. CAM use seems to be more frequent in women with a higher education level and a "healthier lifestyle." Patients might not be aware of the potential pancreatotoxicity of CAM, which should be carefully considered by physicians.

[Concomitant use of intravenous ozone therapy and small doses of direct current in the integrated treatment of patient with sterile pancreatonecrosis].

AIM: To estimate effectiveness of concomitant use of direct current in a small doses and intravenous ozone therapy in the integrated treatment of patients with sterile pancreatonecrosis. PATIENTS AND METHODS: 89 (39 women and 50 men, average age 48,2 +/- 3,6 years) Patient medical records, received a treatment for sterile pancreatonecrosis in surgery departments of Aktobe oblast were analyzed. In the period of 1997-2013, diagnosis of sterile pancreatonecrosis and its complication was found out on the basis of historical study, physical examination, clinical laboratory findings, ultrasound investigation and computerized tomography. All patients passed through complex basic conservative therapy and main group received also intravenous ozone therapy and small doses (20-25mkA) of direct current. RESULTS: Usage of small doses of direct current and intravenous ozone therapy in the integrated treatment of patients with sterile pancreatonecrosis helped on more rapid general well-being mend of patients. CONCLUSIONS: registered drop of transition frequency of sterile pancreatonecrosis into infected forms in 3 times, reduction of patients period of stay at hospital in 1,6 times and mortality rates--in 1,3 times.

[Severe acute liver and pancreas damage in anorexia nervosa].

Anorexia nervosa, a syndrome most commonly affecting young women, is characterized by weight less than 85% of weight that is considered normal for that persons age and height, distorted body image, and fear of becoming obese, and its mortality is up to 9%. We present a case of a 33-year-old woman with a 9-year history of anorexia nervosa. She admitted to our institution with decreased mentality, and her body mass index was 11.5 kg/m2 of the time admission. Initial aminotransferase level was severely elevated, but it was normalized solely with improved nutrition and weight gain. Five and sixteen days after the admission urinary tract infection and elevation of pancreatic enzymes occurred. They were successfully treated with antibiotics and nutritional support. Fifty seven days after the admission, she discharged. We report a case of acute hepatitis and pancreatitis treated with nutritional rehabilitation in a patient with severe anorexia nervosa for the first time in Korea.

Effect of parenteral and enteral nutrition combined with octreotide on pancreatic exocrine secretion of patients with pancreatic fistula.

AIM: To evaluate the effect of parenteral and enteral nutrition combined with octreotide on pancreatic exocrine secretion of the patients with pancreatic fistula. METHODS: Pancreatic juice, drained directly from the pancreatic fistula, was collected, and the volume, protein, amylase, HCO(3)(-), K(+), Na(+) and Cl(-) were determined on d 1, 4 and 7 before and after 7-d treatment with octreotide, respectively. RESULTS: No differences in exocrine pancreatic secretion were observed during the enteral and parenteral nutrition period (t = 2.03, P > 0.05); there were significant decreases in pancreatic juice secretion volume, protein, amylase, HCO(3)(-), K(+), Na(+) and Cl(-) after parenteral and enteral nutrition combined with octreotide compared with octreotide pretreatment (t = 4.14, P < 0.05). CONCLUSION: There is no stimulatory effect on the pancreatic secretion by intrajejunal nutrition and parenteral nutrition. Octreotide is effective on the reduction of pancreatic fistula output.

[Correction of the gastric and duodenal motility by laser puncture in pancreatobiliary diseases]. / Korrektsiia motoriki zheludka i dvenadtsatiperstnoi kishki pri zabolevaniiakh organov pankreatobiliarnoi zony metodom lazeropunktury.

96.7 percent of patients with affections of organs of the pancreatobiliary zone displayed motor function disorders of upper portions of the alimentary canal (AC). A characteristic sign of the pathological process in pancreatobiliary organs is decreased frequency of recordable biopotentials and qualitative changes in electrogastrogrames. Changes in qualitative characteristics of the electrogastrogram are clearly related to increase in the intraduodenal pressure recordable with the aid of the "open catheter" technique. Laseropuncture is an effective supplementary method for correction of motility disorders in the upper portions of AC in those patients presenting with affections of the pancreatobiliary organs.

Complementary and alternative veterinary medicine and gastrointestinal disease.

Gastrointestinal, hepatic, and pancreatic diseases provide a significant challenge to the veterinary practitioner. Specific causes and effective therapies can be elusive and sometimes frustrate both the animal caretaker and the veterinarian. The therapeutic options of a conventional veterinary practice are frequently limited and may come down to a decision of which is worse: the disease or the side effects of the treatment. This article provides information for the veterinary practitioner to consider for expanding his/her options. Acupuncture, herbal remedies, and homeopathy are not newly discovered modalities. They are old practices that are getting a fresh look from Western medicine as we seek new ways to better serve our patients and clients. The goal of this article is to provide the reader with many ideas and sufficient solid information to consider the use of these options. Specific therapies are suggested for numerous gastrointestinal and liver problems. Many of these may be used in conjunction with conventional therapies to aid in the healing process.

Hyperbaric oxygen therapy in the treatment of refractory peripancreatic abscess associated with severe acute pancreatitis.

Five patients with peripancreatic abscesses associated with severe acute pancreatitis were treated by hyperbaric oxygen therapy (HBO). In 3 patients, the course after surgical mobilization of the pancreas and drainage of the pancreas bed was complicated by peripancreatic abscesses. HBO was conducted under a pressure of 2.8 atmospheres for two hours daily. Four of the 5 patients showed a progressive improvement in their condition. In one patient who failed to respond despite seven sessions of HBO, Pseudomonas aeruginosa was isolated from the discharge, and resection of necrotic tissue and drainage were performed. The main effects of HBO were the alleviation of high spiking fever, the improvement of white blood cell count and serum amylase levels, and the reduction of the abscess size. We recognized HBO to be a successful treatment for peripancreatic abscess associated with severe acute pancreatitis and better results were obtained than in cases that did not receive HBO.

Successful diagnosis and treatment of cardiac perforation due to subclavian catheter during total parenteral nutrition.

A case of atrial perforation by a subclavian vein catheter, which was inserted for total parenteral nutrition (TPN) is reported. Acute thoracic symptoms developed 3 days after the infusion was started. The diagnosis was correctly made by demonstrating contrast medium within the pericardial sac. The catheter was withdrawn and the patient recovered satisfactorily. The clinical picture and the differential diagnosis of this complication are discussed.