ABSTRACT
OBJECTIVE: Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. PARTICIPANTS: Spanish and international intensive medicine physicians, radiologists, surgeons, gastroenterologists, emergency care physicians and other physicians involved in the treatment of acute pancreatitis. LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION: The GRADE method has been used for drawing them up. DRAWING UP THE RECOMMENDATIONS: The selection of the committee members was performed by means of a public announcement. The bibliography has been revised from 2004 to the present day and 16 blocks of questions on acute pancreatitis in a ICU have been drawn up. Firstly, all the questions according to groups have been drawn up in order to prepare one document. This document has been debated and agreed upon by computer at the SEMICYUC Congress and lastly at the Consensus Conference which was held with the sole objective of drawing up these recommendations. CONCLUSIONS: Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.
Subject(s)
Critical Care/standards , Pancreatitis/diagnosis , Pancreatitis/therapy , Acute Disease , Hemodiafiltration , Humans , Pancreatitis/classification , Pancreatitis/surgeryABSTRACT
La colonografía por TC fue aceptada por la American Cancer Society en el 2008 como técnica de cribado para el cáncer colorrectal. Este hecho debe considerarse un gran paso en el reconocimiento de la técnica, que aun siendo relativamente nueva está cambiando ya algunos algoritmos diagnósticos. En esta actualización sobre colonografía por TC se describen los parámetros de calidad que hacen a una colonografía por TC diagnóstica y se revisan las innovaciones técnicas y de preparación colónica. Se apunta, aunque brevemente, un recordatorio de la semiología, y se discute, para finalizar, el estado actual de sus indicaciones, incidiendo en las controversias actuales (AU)
In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique (AU)
Subject(s)
Humans , Male , Female , Radiology/education , Radiology , Radiology Department, Hospital , Colonography, Computed Tomographic/methods , Colonography, Computed Tomographic , Colorectal Neoplasms , Tomography, X-Ray Computed/trends , Colon/pathology , ColonABSTRACT
In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.
Subject(s)
Colonic Diseases/diagnostic imaging , Colonography, Computed Tomographic , Colonography, Computed Tomographic/methods , Colonography, Computed Tomographic/standards , Humans , SoftwareABSTRACT
INTRODUCTION: Parastomal hernia (PH) is a common complication of end colostomy, found in over 50% of patients. Abdominal computerized tomography (CT) may help diagnosis. The prevalence of PH may be higher than previously reported. We present a new CT classification for use in clinical practice. METHOD: A cross-sectional, descriptive observational study was carried out, assessing the clinical and radiological prevalence of PH in 75 patients with an end colostomy operated on since 1997. Clinical examinations were performed by a single surgeon. Abdominal CTs were assessed by a single radiologist. RESULTS: PH was observed clinically in 33 (44%) of 75 patients and 27 (82%) were symptomatic. Using the classification 0 (Normal), I (Hernial sac containing stoma loop), II (Sac containing omentum), III (Sac containing a loop other than stoma), radiological PH was observed in 35 (47%) patients. Clinical/radiological concordance (Kappa index = 0.4) increased proportionally with sac size. All type-III PHs (n = 9) were symptomatic. The combined prevalence of PH detected by one or other method was 60.8%. CONCLUSION: Clinical and radiological prevalence of PH is high. As there is no gold standard for PH detection, we recommend a combination of the two methods. A new classification for use in clinical practice is proposed.
Subject(s)
Colostomy/adverse effects , Hernia, Ventral/diagnosis , Aged , Cohort Studies , Cross-Sectional Studies , Female , Hernia, Ventral/epidemiology , Hernia, Ventral/etiology , Humans , Male , Prevalence , Tomography, X-Ray ComputedABSTRACT
Primary malignant melanoma of the common bile duct is rare. Only seven cases have been described in the literature. Diagnosis is based on failure to find another primary site, histological examination with electron microscopy, and immunohistochemical tests. We describe a new case of primary malignant melanoma of the biliary tract and present a review of previous reports.
Subject(s)
Common Bile Duct Neoplasms/pathology , Melanoma/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carboplatin/administration & dosage , Cholangiopancreatography, Magnetic Resonance , Common Bile Duct Neoplasms/diagnostic imaging , Dacarbazine/administration & dosage , Fatal Outcome , Gallbladder Neoplasms/secondary , Humans , Interferon alpha-2 , Interferon-alpha/administration & dosage , Lymphatic Metastasis , Male , Melanoma/diagnostic imaging , Melanoma/secondary , Microscopy, Electron , Middle Aged , Palliative Care , Recombinant Proteins , Splenic Neoplasms/secondary , Stomach Neoplasms/secondary , UltrasonographyABSTRACT
El melanoma maligno primario del colédoco es una entidad rara. Sólo se han descrito 7 casos en la bibliografía. El diagnóstico se basa en ausencia de otra localización que pudiera considerarse primaria, en el examen de microscopia electrónica y en el estudio inmunohistoquímico. Describimos un nuevo caso de melanoma maligno primario del conducto biliar y presentamos una revisión de los casos previamente publicados
Primary malignant melanoma of the common bile duct is rare. Only seven cases have been described in the literature. Diagnosis is based on failure to find another primary site, histological examination with electron microscopy, and immunohistochemical tests. We describe a new case of primary malignant melanoma of the biliary tract and present a review of previous reports
