Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

BACKGROUND Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. CASE REPORT We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. CONCLUSIONS The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated.

Support Systems of Clinical Decisions in the Triage of the Emergency Department Using Artificial Intelligence: The Efficiency to Support Triage.

Purpose: In the Emergency Departments (ED) the current triage systems that are been implemented are based completely on medical education and the perception of each health professional who is in charge. On the other hand, cutting-edge technology, Artificial Intelligence (AI) can be incorporated into healthcare systems, supporting the healthcare professionals' decisions, and augmenting the performance of triage systems. The aim of the study is to investigate the efficiency of AI to support triage in ED. Patients­Methods: The study included 332 patients from whom 23 different variables related to their condition were collected. From the processing of patient data for input variables, it emerged that the average age was 56.4 ± 21.1 years and 50.6% were male. The waiting time had an average of 59.7 ± 56.3 minutes while 3.9% ± 0.1% entered the Intensive Care Unit (ICU). In addition, qualitative variables related to the patient's history and admission clinics were used. As target variables were taken the days of stay in the hospital, which were on average 1.8 ± 5.9, and the Emergency Severity Index (ESI) for which the following distribution applies: ESI: 1, patients: 2; ESI: 2, patients: 18; ESI: 3, patients: 197; ESI: 4, patients: 73; ESI: 5, patients: 42. Results: To create an automatic patient screening classifier, a neural network was developed, which was trained based on the data, so that it could predict each patient's ESI based on input variables.The classifier achieved an overall accuracy (F1 score) of 72.2% even though there was an imbalance in the classes. Conclusions: The creation and implementation of an AI model for the automatic prediction of ESI, highlighted the possibility of systems capable of supporting healthcare professionals in the decision-making process. The accuracy of the classifier has not reached satisfactory levels of certainty, however, the performance of similar models can increase sharply with the collection of more data.

Ectopic pancreatic tissue in stomach: A case report.

Introduction and importance: Ectopic Pancreas (EP) is a rare condition that is mostly found in the Gastrointestinal tract and especially in the stomach. Although the lesion is mainly asymptomatic, non-specific symptoms can be present, making the diagnosis even more challenging. Case presentation: In our case a 52-year-old woman, with heartburn as the only symptom, was undergone successive examinations, indicating a subepithelial lesion in the antrum of the stomach, from which only Magnetic Resonance Imaging (MRI) indicated the presence of ectopic pancreas, while Computed Tomography results considered the mass as Gastrointestinal Stromal Tumor. Wedge gastrectomy was performed in order to extract the lesion and the histopathological examination confirmed the findings of the MRI. The patient fully recovered with no complications. Clinical discussion: In most cases, EP is described in endoscopy as a subepithelial mass with normal mucosa. As EP can mimic other subepithelial masses, even adenocarcinoma, it is of utmost importance not to omit the performance of surgical removal and histopathological examination. Consequently, resection is essential not only for the diagnosis but also for the treatment of the patient. Conclusion: EP is not a usually detected clinical pathology. There is no specific algorithm, which physicians should follow in order to reach the diagnosis without the surgical intervention. For this reason, clinicians should be conscious of the existence of EP in the stomach.