C-Reactive Protein and Procalcitonin as Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery.

BACKGROUND: The association between postoperative inflammatory markers and risk of complications after pancreaticoduodenectomy (PD) is controversial. We sought to assess the diagnostic value of perioperative C-reactive protein (CRP) and procalcitonin (PCT) levels in the early identification of patients at risk for complications after PD. METHODS: In 2014, 84 patients undergoing elective PD were enrolled in a prospective database. Clinicopathological characteristics, CRP and PCT, as well as short-term outcomes, such as complications and pancreatic fistula, were analyzed. Complications and pancreatic fistula were defined based on the Clavien-Dindo classification and the International Study Group on Pancreatic Fistula (ISGPF) classification, respectively. High CRP and PCT were classified using cut-off values based on ROC curve analysis. RESULTS: The majority (73.8 %) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 postoperative days (POD) were higher among patients who experienced a complication versus those who did not (p < 0.001). Postoperative CRP and PCT levels were also higher among patients who developed a grade B or C pancreatic fistula (p < 0.05). A CRP concentration >84 mg/l on POD 1 (AUC 0.77) and >127 mg/l on POD 3 (AUC 0.79) was associated with the highest risk of overall complications (OR 6.86 and 9.0, respectively; both p < 0.001). Similarly patients with PCT >0.7 mg/dl on POD 1 (AUC 0.67) were at higher risk of developing a postoperative complication (OR 3.33; p = 0.024). On POD 1, a CRP >92 mg/l (AUC 0.72) and a PCT >0.4 mg/dl (AUC 0.70) were associated with the highest risk of pancreatic fistula (OR 5.63 and 5.62, respectively; both p < 0.05). CONCLUSIONS: CRP and PCT concentration were associated with an increased risk of developing complications and clinical relevant pancreatic fistula after PD. Use of these biomarkers may help identify those patients at highest risk for perioperative morbidity and help guide postoperative management of patients undergoing PD.

[Spontaneous acute subdural hematoma]. / Spontaniczny ostry krwiak podtwardówkowy.

A rare case of spontaneous acute subdural haematoma is reported. Causes of non-traumatic subdural haematomas are discussed stressing the necessity of rapid surgical intervention.

[Diagnosis of cerebello-pontine angle tumors]. / Rozpoznawanie guzów kata mostowo-mózdzkowego.

History and results of investigations in 34 patients with cerebello-pontine angle tumours are presented. Tumour was diagnosed in the first, audiological stage of the disease only in 4 patients. In 7 more patients additional symptoms of central nervous system focal disorders occurred. The remaining 23 patients were in the third stage of the disease with symptoms of increased intracranial pressure. The main reason for such a late diagnosis of the tumour was neglecting of the early audiological symptoms of the disease by patients and by general practitioners as well.

[Results of non-operative treatment of primary brain tumors using teleradiotherapy and chemotherapy]. / Wyniki leczenia nieoperacyjnych pierwotnych guzów mózgu teleradioterapia i chemioterapia.

In the years 1979-1984 25 patients with inoperable primary brain tumours were treated. The clinical diagnosis in all cases was glioma, histological examinations were not done. The patients received teleradiotherapy (DG 6000 rads) and simultaneously combined chemotherapy by the Hildebrand schedule (methotrexate, vincristine, CCNU, dexamethasone). In one case severe toxicity was observed. The median survival time was 41 weeks and 10 patients survived over one year.