[Is the prophylactic antibiotic therapy with Imipenem effective for patients with pancreatic necrosis?]. / Es la antibióticoterapia profiláctica con Imipenem efectiva en los pacientes con necrosis pancreática?

OBJECTIVE: to evaluate the capacity of Imipenem as a prophylactic treatment for decreasing the number of infected necrosis and surgeries, as well as for diminishing septic complications and the mortality rate among patients with severe acute necrotizing pancreatitis. MATERIAL AND METHODS: from May 2005 to December 2007 a prospective randomized study was conducted in order to evaluate the efficacy of a prophylactic antibiotic therapy in patients with pancreatic necrosis. During this time period 58 patients entered the study protocol. Patients were divided in two groups; the first one underwent antibiotic therapy with Imipenem while the second group received no prophylactic treatment at all. All patients received early enteral nutrition. RESULTS: both studied groups had comparable age, gender ratio, and C.R.P and necrosis percentages. When comparing general morbidity in both groups no difference was found between the group receiving a prophylactic antibiotic and the group that did not receive it (58% vs. 56%). Moreover, when the septic complications were evaluated, it was confirmed that these were more frequent among the group of patients receiving Imipenem (29%), in comparison to the group that did not received antibiotics (15%). 12.5% of the patients that received Imipenem developed pancreatic necrosis infection, while said infection only appeared in 6% of the patients in the group that did not receive antibiotic prophylaxis; nevertheless, none of the comparisons reached statistical significance. The number of patients who required surgery was similar in both groups. When comparing the hospital stay, it was observed that this was longer among the patients receiving prophylactic therapy. No patient died during the study. CONCLUSION: The present study finds no benefits in the use of antibiotic therapy with Imipenem regarding the risk of developing pancreatic necrosis infection and septic complications, and neither when trying to reduce the number of surgeries among patients with severe acute pancreatitis with necrosis.

[Sodium valproate as a cause of acute pancreatitis: a case report]. / Valproato de sodio como causa de pancreatitis aguda: Reporte de un caso.

Valproic acid (VPA) is a commonly used medication approved by the U.S. FDA for the treatment of epilepsy, migraines and bipolar disorders. Adverse effects associated with VPA are typically benign, but there are more serious effects that are less frequent. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect and acute pancreatitis. Even though acute pancreatitis is an adverse effect of very low frequency, it is very important due to the high mortality rate of patients with acute pancreatitis as a consequence of the use of valproic acid. In medical literature, by 2005, 80 cases of acute pancreatitis caused by valproic acid were reported, 33 of these cases were patients under the age of 18. This is a description of the clinical case of a 16 year old patient with necrotic pancreatitis caused by VPA, who was treated at the Acute Pancreatitis Unit of Edgardo Rebagliati Martins National Hospital.

Valproato de sodio como causa de pancreatitis aguda: reporte de un caso / Sodium valproate AS a cause of acute pncreatitis: a case report

El ácido Valproico (VPA) es un medicamento de uso común aprobado para su uso por la F.D.A. en los Estados Unidos para tratar la epilepsia, migraña y desórdenes bipolares. Los efectos menos frecuentes que son más serios. Estos efectos incluyen a la hepatotoxidad, teratogenicidad, posible ovarios poliquísticos con potencial efecto estéril y la pancreatitis aguda. Si bien la pancreatitis aguda es un efecto adverso muy poco frecuente tiene mucha importancia por la altísima tasa de mortalidad que presentan los pacientes que sufren de pancreatitis como consecuencia del uso del ácido valproico. En la literatura hasta el año 2005, existen reportados 80 casos de pancreatitis aguda por ácido valproico de los cuales, 33 fueron en pacientes menores de 18 años. Aquí se describe el caso clínico de un paciente de 16 años que presento pancreatitis con necrosis por VPA y fue manejado en la Unidad de Pancreatitis Aguda del Hospital Nacional Edgardo Rebagliati Martins.

Valproic acid (VPA) is a commonly used medication approved by the U.S. FDA for the treatment of epilepsy, migraines and bipolar disorders. Adverse effects associated with VPA are typically benign, but there are more serious effects that are less frequent. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect and acute pancreatitis. Even though acute pancreatitis is an adverse effect of very low frequency, it is very important due to the high mortality rate of patients with acute pancreatitis as a consequence of the use of valproic acid.In medical literature, by 2005, 80 cases of acute pancreatitis caused by valproic acid were reported, 33 of these cases were patients under the age of 18.This is a description of the clinical case of a 16 year old patient with necrotic pancreatitis caused by VPA, who was treated at the Acute Pancreatitis Unit of Edgardo Rebagliati Martins National Hospital).