Management of necrotizing pancreatitis: flexible approach depending on intra-operative assessment of necrosis.

INTRODUCTION: The surgical management of necrotizing pancreatitis (NP) has changed over the years. MATERIAL AND METHODS: Among 144 patients, 12.5% (n = 18) were treated conservatively and 87.5% (n = 126) underwent surgery. The choice of operative method depended on the intra-operative assessment of consistency and on the extent of necrosis. A group of 126 patients underwent necrosectomy, followed by laparostomy with open packing in 80% (n = 101) cases, drainage in 14% (n = 18) and continuous closed lavage in 6% (n = 7). RESULTS: Postoperative complications occurred in 42.8% (n = 54) of the patients who underwent the surgery. Hospital mortality rate over all patients was 18% and 20.6% (n = 26) in the group of patients who underwent the surgery. Mean hospital stay was 61 +/- 36 days. Patients managed conservatively (n = 18) were discharged without surgical intervention. In this group no complications or deaths were observed. CONCLUSION: Using the three different surgical techniques in the management of NP, depending on intra-operative assessment of necrosis, showed promising results. A flexible approach targeted at a single patient and tailored to the clinical course and intra-operative situation should be considered in the treatment of NP.

Detection of cytomegalovirus in infant cerebrospinal fluid by conventional PCR, nested PCR and PCR-Digene.

The possibility of amplification of human cytomegalovirus (HCMV) DNA in cerebrospinal fluid (CSF) for the diagnosis of HCMV central nervous system (CNS) infection in infants was studied. Single-step PCR, nested PCR and PCR-Digene were used to assay CSF specimens from 37 patients. Criteria for patient inclusion in the study were: 1. clinical manifestations suggesting CMV neuroinfection such as seizures, hypertonia, hypotonia, intracranial calcification, microcephaly, chorioretinitis; 2. any of the following symptoms: anaemia, hepetomegaly, prolonged cholestatic jaundice, or hepatitis, splenomegaly, thrombocytopenia, intrauterine hypotrophy; 3. serologic presentation, and/or positive results for CMV infection obtained by single-step PCR and PCR-Digene in urine and/or blood. PCR-Digene results were positive in 6 CSF samples. Four CSF samples were positive by nested PCR and 1 CSF sample by single step PCR. We found that the double PCR was about ten or more times more sensitive than single PCR and the PCR-Digene was only three times more sensitive than nested-PCR. The results were correlated with serology. Thirty-three out of 37 examined patients were seropositive (ELISA IgG); ELISA IgM gave positive results in 9 patients. In control studies, cells infected with other members of the herpes virus family were negative with these methods, which suggest that amplification combined with primers from the IE and the L-region of CMV is specific. In conclusion, nested-PCR seems to be the best method for early diagnosis of CMV infection in CSF due to an absence of false positive results and its high specificity and sensitivity.

[The prognostic meaning of the selection parameters amniotic fluids samples and frequency occurrence respiratory distress newborn]. / Znaczenie prognostyczne wybranych parametrów plynu owodniowego a czestosc wystapienia zaburzen oddechowych u noworodkow.

Prenatal diagnosis of amniotic fluid enables the evaluation of fetal lungs maturity. The aim of the study is to evaluate prognostic significance of measurement of concentration of lamellar body count (LC) in comparison with other laboratory investigations for prenatal fetal lung maturity evaluation. The study was carried out on 60 amniotic fluid collections obtained by amniocentesis of pregnant women, hospitalized in Polish Mother's Health Centre between August 1998-January 2000. Following tests were performed: phosphatydyloglicerol concentration (PG), concentration of lamellar body (CLC), optical density-reading absorbance in wave length 400, 570, 650 nm. Test PG showed 70% specificity and 100% sensitivity, LC 70% specificity; 100% sensitivity. PG and LC showed good correlation for the assessment of fetal lung maturity. The study involved small number of patients pointed out the necessity of continuation quantitative investigation of LC to confirm diagnostics utility for the assessment of fetal lung maturity.

[Prenatal evaluation of fetal lung maturity by determination of phosphatidylglycerol (PG) concentration in amniotic fluid]. / Prenatalna ocena dojrzalosci pluc plodu poprzez oznaczanie stezenia fosfatydyloglicerolu (PG) w plynie owodniowym.

Phosphatidylglycerol (PG) is considered to be the most important phospholipid of lung surfactant, responsible for its biological activity. The aim of the study was to investigate the predictive value of phosphatidylglycerol (PG) concentration in amniotic fluid in prediction of neonatal lung maturity. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested--phosphatidylglycerol (PG) concentration was assayed by immunological test Amnio Stat FLM. In the study value PG < or = 0.2 microgram/ml was found in 110 (49.3%) samples of amniotic fluid, PG = 0.5 microgram/ml in 57 (25.6%) and PG > or = 2.0 micrograms/ml in 56 (25.1%). In our research predictive value of PG in relation to clinical lung maturity of neonates was verified. It turned out that PG concentration in amniotic fluid < or = 0.2 microgram/ml indicates a possibility of RDS occurring in neonates born before 72 hours of performed determination. Concentration PG in amniotic fluid PG > or = 2.0 micrograms/ml corresponds to complete clinical lung maturity of neonates with predictive value 98%.

[Diagnostic significance of index alpha-amylase/glucose in amniotic fluid in prediction of fetal maturity]. / Znaczenie indeksu alpha-amylaza/glukoza w plynie owodniowym w prognozowaniu dojrzalosci plodu.

An increase in alpha-amylase activity with parallel decrease in glucose concentration in amniotic fluid is observed during pregnancy. This interdependence is a theoretical basis for using an alpha-amylase/glucose index in fetal maturity evaluation. The aim of the study was to investigate usefulness of the alpha-amylase/glucose index in amniotic fluid in prenatal fetal maturity diagnosis. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested for glucose concentration and alpha-amylase activity. It was found that the alpha-amylase/glucose < 6.0 index indicates a possibility of RDS occurring in neonates born before 72 hours of performed determination. The alpha-amylase/glucose > or = 6.0 index has high diagnostic value (95.8%) in prenatal prediction of fetal lung maturity.

[Alpha-amylase/glucose index in amniotic fluid as a new method in prenatal assessment of fetal maturity]. / Indeks alpha-amylaza/glukoza w plynie owodniowym jako nowa metoda prenatalnej oceny dojrzalosci plodu.

Prenatal diagnosis of amniotic fluid enables fetal maturity evaluation, particularly that of fetal lungs. The aim of the study is to evaluate the diagnostic value of on alpha-amylase/glucose index in amniotic fluid in comparison to routinely performed tests, used for prenatal fetal lung maturity evaluation, particularly in respect of PG concentration, whose predictive value is almost 100%. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested- in all samples following assays and tests were performed: bubble stability test (BST), optical density, orange cells test, phosphatidylglycerol concentration (PG), glucose concentration, alpha-amylase activity urea and creatinine concentration. The alpha-amylase/glucose index in amniotic fluid is statistically significant with PG concentration. The value of the alpha-amylase/glucose index is < 6.0 when amniotic fluid assay indicates fetal immaturity, but when amniotic fluid assay indicates fetal maturity, its value is 36.0. The evaluation of fetal lung maturity on the basis of the alpha-amylase/glucose index multiply decreases the cost of examinations. Authors make a suggestion to implement this method in all hospital departments of the country.

Essential fatty acid metabolism in infants with cholestasis.

Long-chain polyunsaturated fatty acids are important for the growth and early development of the central nervous system. Cholestatic infants suffer from fat malabsorption and disturbed lipid metabolism and therefore may be at risk of developing polyunsaturated fatty acid depletion. The aims of this study were to determine essential fatty acid status in cholestatic infants and to study the relationship to disease severity, degree of undernutrition, antioxidant status and mode of feeding. Twenty-four-hour dietary records were obtained in 34 cholestatic infants, and measurements were taken of skin fold thicknesses, bilirubin levels, activities of serum alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, prothrombin time, serum concentrations of albumin, bile acids, total lipids, phospholipids, cholesterol, vitamins A and E, the fatty acid composition of plasma phospholipids and plasma lipid peroxides expressed as thiobarbiturate reactive substance (TBARS). Plasma phospholipid fatty acids and TBARS were also determined in 12 age-matched healthy control infants. The cholestatic patients had very low percentage values of phospholipid essential fatty acids, particularly linoleic acid ( 18:2omega-6, median 14.74% vs 20.76% in controls, p < 0.001) and its major metabolite arachidonic acid (20:4omega-6, 6.80 vs 7.87%, p=0.04). The patients' essential fatty acid depletion was reflected by increased levels of the non-essential fatty acids, Mead acid (20:3omega-9, 0.74 vs 0.21%, p < 0.001) and palmitoleic acid (16:1omega-7, 2.20 vs 0.43%, p < 0.001). Polyunsaturated fatty acid profiles did not differ between infants with biliary atresia (n=13) and those with intrahepatic cholestasis (n=21), or between 17 infants with severe malnutrition (all skin folds < 10th percentile) and mild malnutrition (at least two skin folds > 10th percentile). TBARS were significantly higher in cholestatic patients than in controls (2.74 vs 0.85 nmol ml(-1), p < 0.001) and correlated with direct (r=0.41, p=0.02) and total bilirubin. The daily dietary intake of linoleic acid (per 100 kcal) correlated with plasma phospholipid linoleic acid (r=0.38,p=0.037) and total omega-6 fatty acids (r=0.38,p=0.036). Breastfed cholestatic infants (n=6) had higher values of the omega-3 long-chain polyunsaturated fatty acids docosapentanoic acid (22:5omega-3, 0.47 vs 0.28%, p=0.0006) and docosahexanoic acid (22:6omega-3, 2.39 vs 1.73%, p=0.01) than formula-fed infants, while disease severity was similar in the two groups. In conclusion, cholestatic infants are at high risk of essential fatty acid depletion, which appears to be related to fat malabsorption, hepatic essential fatty metabolism, enhanced lipid peroxidation and dietary intake.

[Application of polymerase chain reaction (PCR) for the detection of DNA-HCMV in cerebrospinal fluid of neonates and infants with cytomegalovirus infection]. / Wykorzystanie polimerazowej reakcji lancuchowej (PCR) do wykrywania DNA-HCMV w plynie mózgowo-rdzeniowym noworodków i niemowlat z zakazeniem wirusem cytomegalii.

The goal of the work was to prove the usefulness of PCR for detection of DNA-HCMV in cerebrospinal fluid of the infected newborns and infants and to compare our results with clinical diagnosis. The studied group consisted of 24 newborns and infants with HCMV infection (presence of DNA-HCMV in urine and blood, presence of specific IgM, IgG antibodies in serum, and clinical symptoms). Among 12 children with symptoms from central nervous system, DNA-HCMV was detected in CSF of 11 patients. Additionally DNA-HCMV was found in cerebrospinal fluid of 2 children IgM, IgG anti CMV positive but without CNS symptoms. Extraction of DNA from pellet was the most effective method of DNA preparation from CSF for PCR reaction. Final results were obtained approximately 7-8 hours after taking the samples for examination. Our results suggest that PCR technique as a highly specific method is very helpful for the detection of DNA-HCMV in CSF of children with CNS symptoms of disease.

[Long term observation of children with Giardia intestinalis invasion treated with metronidazole and furazolidone]. / Dlugotrwala obserwacja dzieci z inwazja Giardia intestinalis leczonych metronidazolem i furazolidonem.

The results of a long-term (3-year) follow-up of children infected with G. intestinalis treated with metronidazole and furazolidone are presented. Therapy was effective in 84-95% of cases, depending of the duration or the follow-up. Repetition of therapy with tinidazole was indicated in 5% of children after 6 months and in 15% of children after 1 and 2 years of observation because of persisting symptoms of the infection or recurrence. More frequent the treatment was necessary in children under 3 years of age. Some (14%) children required milk free diet and in a few cases (underlying disease--coeliac) gluten-free diet or a diet free of main allergens.

[Humoral response of the immunologic secretory system of the small intestine in children infected with Giardia intestinalis]. / Humoralna reakcja immunologicznego ukladu wydzielniczego jelita cienkiego u dzieci zarazonych Giardia intestinalis.

Local humoral response of the intestinal mucosa was determined with secretory IgA levels and secretory component activity in enterocytes and duodenal content of 15 children infected with G. intestinalis. The obtained results were compared to those in 5 children with coeliac disease and 12 children with diarrhoea without lambliasis. Secretory IgA was increased in about 50% of children with lambliasis (in the remaining groups in 25% of children) to the values higher than that in the comparative groups. Secretory component activity was relatively high in the intestinal epithelium. Secretory component activity in the duodenal content was high in about 40% of children independently of the examined group. No correlation between the said variables was noted except positive correlation of secretory IgA levels and secretory component activity in the bile.

[Expression of HLA-DR antigen in small intestinal mucosa of children infected with Giardia intestinalis]. / Ekspresja antygenu HLA-DR w sluzówce jelita cienkiego u dzieci zarazonych Giardia intestinalis.

HLA-DR Antigen expression was shown in the small intestinal mucosa sampled by aspiration biopsy in 12 children infected with Giardia intestinalis. The studies were performed by using three immunohistochemical techniques, with the best results achieved by use of fluorescein- stained avidin biotin system. HLA-DR Antigen expression in Giardiasis was slightly enhanced in the enterocytes of the absorption region; an increased number of HLA-DR positive cells was also found in the lamina propria of the small intestine as compared with controls. This phenomenon is recognized in various inflammations of the small intestinal mucosa.