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1.
Medicine (Baltimore) ; 99(8): e19044, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080079

RESUMO

INTRODUCTION: The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. METHODS AND ANALYSIS: We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals. ETHICS AND DISSEMINATION: The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42019147503.


Assuntos
Dor Abdominal/terapia , Terapia por Acupuntura/métodos , Pancreatite/terapia , Terapia por Acupuntura/efeitos adversos , China/epidemiologia , Defecação/efeitos dos fármacos , Defecação/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Metanálise como Assunto , Pancreatite/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Escala Visual Analógica
2.
BMJ ; 367: l6227, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791953

RESUMO

The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques. Surgery is no longer an early intervention and may not be needed. Instead, interventional radiologic and endoscopic methods seem to be safer with at least as good survival outcomes. Newly developed evidence based quality indicators are available to assess and improve performance. Development and clinical testing of drugs to target the mechanisms of disease are necessary for further advancements.


Assuntos
Gerenciamento Clínico , Pancreatite/diagnóstico , Pancreatite/terapia , Assistência Progressiva ao Paciente/métodos , Doença Aguda , Tratamento Conservador/métodos , Drenagem/métodos , Endoscopia/métodos , Humanos
3.
Zhonghua Wai Ke Za Zhi ; 57(12): 917-920, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826596

RESUMO

Objective: To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis. Methods: Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People's Liberation Army General Hospital from January 2013 to December 2018. Age of the patients was (46±14) years (range: 14-85 years); 249 cases (70.3%) were males. There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis. Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis. Among 313 cases of acute necrotising pancreatitis, 62 cases underwent non-surgical treatment, 251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique. Results: There were 15 cases of colon fistula following acute necrotising pancreatitis, and the incidence rate was 4.2%(15/354). There were 7 males and 8 females, with age of (39±8) years (range: 27 to 50 years). The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134) days. Two cases occurred at the hepatic flexure of the colon, 4 cases at transverse colon, and 9 cases at splenic flexure of colon. Of the 354 patients, 39 cases died and the mortality was 11.0%. Two patients underwent laparotomy, and one of them died. The remaining 13 patients underwent non-surgical treatment and were discharged. Conclusion: Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.


Assuntos
Doenças do Colo/terapia , Fístula Intestinal/terapia , Pancreatite/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/etiologia , Feminino , Humanos , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/terapia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
4.
Methodist Debakey Cardiovasc J ; 15(3): 220-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687102

RESUMO

It is estimated that there are more than 210,000 hospital admissions for acute pancreatitis and more than 56,000 admissions for chronic pancreatitis each year in the United States. Pancreatitis comes with numerous complications that can increase morbidity, mortality, and length of hospital stay. Local and systemic complications include pseudocysts, necrosis, sepsis, multiorgan failure, and vascular complications. Thrombosis of the splanchnic venous system occurs in approximately 2% of patients with pancreatitis, but thrombosis is rarely seen in the arterial system. In this report, we describe a case of thrombosis of the abdominal aorta and superior mesenteric artery in a female patient who presented with acute pancreatitis.


Assuntos
Doenças da Aorta/etiologia , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/etiologia , Pancreatite/complicações , Trombose/etiologia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/tratamento farmacológico , Feminino , Hidratação , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/tratamento farmacológico , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(38): e17284, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568012

RESUMO

BACKGROUND: This study will assess the efficacy and safety of blood purification (BP) for severe pancreatitis (SP) and acute respiratory distress syndrome (ARDS). METHODS: We will search the following electronic databases of Ovid MEDLINE, EMBASE, Web of Science, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANGFANG from inception to the present without language restriction. A systematic review and data synthesis will be carried out of randomized controlled trials of BP for the treatment of patients with SP and ARDS. RevMan 5.3 software will be used for statistical analysis. RESULTS: This systematic review will evaluate the efficacy and safety of BP for the treatment of patients with SP and ARDS. The primary outcome includes respiratory indexes, blood biochemical and inflammatory factors. The secondary outcomes consist of complications, sepsis, abdominal hemorrhage, renal failure, length of hospital stay, and mortality. CONCLUSION: This study will provide up-to-date evidence of BP for the treatment of patients with SP and ARDS. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139467.


Assuntos
Hemofiltração , Pancreatite/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Doença Aguda , Hemofiltração/métodos , Humanos , Pancreatite/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Resultado do Tratamento
8.
Am J Chin Med ; 47(6): 1223-1235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31505937

RESUMO

Western medicine is routinely used in developed nations as well as in Eastern countries, where traditional medicine is frequently used by a selection of patients or family member as a complement to mainstream Western medicine. Chinese medicine plays an important role in the treatment of chronic diseases, especially when Western medicine is not very effective. Many published reports have shown that Chinese medicine could also be successfully used in the management of acute and critical illnesses. Chinese medicine has a holistic view of the human body, and emphasizes individualization based on body balance and mind-body interaction and employs herbal medicines and acupuncture. This review paper gives a brief overview of Chinese medicine theory and therapeutic modality and then addresses the application of Chinese medicine in the treatment of acute and critical medical conditions, including epidemics. Using this ancient therapy as a complementary medicine, the management of serious medical conditions, such as SARS, acute heart diseases, and ischemic cerebral stroke, are presented. In order to promote more widespread application of Chinese medicine, well-designed controlled clinical trials are urgently needed to prove its safety and effectiveness.


Assuntos
Doença Aguda/terapia , Estado Terminal/terapia , Medicina Tradicional Chinesa , Fitoterapia , Terapia por Acupuntura , Artrite Gotosa/terapia , Cardiopatias/terapia , Humanos , Pancreatite/terapia , Pneumonia/terapia , Medicina de Precisão , Síndrome Respiratória Aguda Grave/terapia , Acidente Vascular Cerebral/terapia
9.
World J Gastroenterol ; 25(29): 4019-4042, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31413535

RESUMO

BACKGROUND: Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.AIMSTo study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS: A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms "Post endoscopic retrograde cholangiopancreatography pancreatitis" AND "prevention" through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies. RESULTS: 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results. CONCLUSION: Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.


Assuntos
Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/terapia , Complicações Pós-Operatórias/terapia , Administração Retal , Anti-Inflamatórios/administração & dosagem , Cateterismo/instrumentação , Cateterismo/métodos , Drenagem/instrumentação , Drenagem/métodos , Humanos , Pâncreas/efeitos dos fármacos , Pâncreas/metabolismo , Pâncreas/cirurgia , Pancreatite/etiologia , Inibidores da Fosfodiesterase 5/administração & dosagem , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Medição de Risco , Fatores de Risco , Somatostatina/administração & dosagem , Esfíncter da Ampola Hepatopancreática/efeitos dos fármacos , Esfíncter da Ampola Hepatopancreática/cirurgia , Stents
10.
Ann R Coll Surg Engl ; 101(7): 487-494, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31362520

RESUMO

INTRODUCTION: Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years. METHODS: A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data. RESULTS: A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6-10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, P < 0.0001). CONCLUSIONS: The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.


Assuntos
Cuidados Críticos/métodos , Cálculos Biliares/terapia , Auditoria Médica/estatística & dados numéricos , Pancreatite/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Cuidados Críticos/normas , Inglaterra/epidemiologia , Feminino , Cálculos Biliares/complicações , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/terapia , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
11.
Vet Q ; 39(1): 122-130, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31401946

RESUMO

Background: High mobility group box 1 (HMGB1) is an important mediator of systemic inflammatory response syndrome (SIRS) in humans with severe acute pancreatitis (AP), but there is little information regarding its role in dogs. Aim: To compare the serum concentrations of C-reactive protein (CRP) and HMGB1 in healthy dogs and those with AP with or without SIRS. Methods: The study included 22 dogs with AP and 20 healthy dogs. CRP and HMGB1 were assessed by ELISA. Statistical analyses were conducted by non-parametric tests. Results: Median (interquartile range) serum CRP and HMGB1 concentrations were significantly (P < 0.05) higher in dogs with AP [60.56 (14.50-140.10) µg/mL and 0.35 (0.03-1.12) ng/mL, respectively] than in healthy dogs [2.23 (1.75-5.14) µg/mL and 0.02 (0.01-0.05) ng/mL, respectively]. After the recommended treatments for AP, serum CRP concentration in AP dogs significantly decreased, but that of HMGB1 in AP dogs significantly increased. There was also a significant difference in median serum HMGB1 concentration between AP dogs with and without SIRS. The use of serum HMGB1 concentration of 0.35 ng/mL to distinguish AP dogs with and without SIRS was associated with a sensitivity of 87.5% and a specificity of 71.5%. A positive correlation was identified between HMGB1 and clinical severity of AP. All AP dogs had a positive outcome during hospitalization [6.0 (1.5-6.0) days]. Conclusion: Results indicate that HMGB1 might be a useful biomarker for the progression of AP and may play a role in progression of AP into SIRS in dogs.


Assuntos
Proteína C-Reativa/análise , Doenças do Cão/sangue , Proteína HMGB1/sangue , Pancreatite/veterinária , Animais , Biomarcadores/sangue , Doenças do Cão/terapia , Cães , Feminino , Masculino , Pancreatite/sangue , Pancreatite/terapia , Projetos Piloto
12.
Clin Nephrol ; 92(5): 243-249, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31448719

RESUMO

OBJECTIVE: To study the effects of early continuous veno-venous hemofiltration (CVVH) on organ function and intra-abdominal pressure (IAP) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). MATERIALS AND METHODS: 48 SAP patients with ACS were included in this study. Among them, 37 patients, receiving both conventional treatment and hemofiltration therapy in the ICU, were regarded as the treatment group, and the rest, receiving only conventional treatment, were regarded as the control group. Symptoms, signs, and adverse reactions of both groups were observed and recorded during treatments. Serum and urine amylase, liver and kidney function, C-reactive protein, and intra-abdominal pressure of the patients were detected before and on days 1, 2, 3, 4, 5, and 6 after treatment. RESULTS: 1. Symptoms and signs in the treatment group disappeared quickly, and their hospitalization time was significantly shorter than those of control group (p < 0.05). 2. After treatment, on days 1, 2, 3, 4, 5, and 6, patients' serum and urine amylase levels, C-reactive protein, and intra-abdominal pressure were significantly lower, and liver and kidney function was significantly better than those of the control group (p < 0.05). CONCLUSION: Early hemofiltration in SAP with ACS can effectively reduce intra-abdominal pressure, improve symptoms, accelerate liver and renal function recovery, avoid multiple organ failure and decrease mortality rate.


Assuntos
Hemofiltração , Hipertensão Intra-Abdominal , Pancreatite , Adulto , Idoso , Feminino , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Hipertensão Intra-Abdominal/terapia , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/fisiopatologia , Pancreatite/terapia
14.
Pancreatology ; 19(6): 834-841, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31421974

RESUMO

OBJECTIVES: The aim of this study was to evaluate the long-term outcomes of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for pediatric patients with pancreas divisum (PD) presenting with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). METHODS: Between May 2008 and August 2017, pediatric patients with PD who received endotherapy at Ruijin Hospital were identified and grouped according to clinical presentation, namely ARP and CP. Primary success was defined as patients' improvement in symptoms after index ERCPs, without further intervention or any analgesic. RESULTS: A total of 74 ERCPs were performed in 38 pediatric patients. The frequency of at least 1 genetic mutation identified in patients with ARP and CP was 44.4% and 68.4%, respectively. Patients with CP required more ERCPs than those with ARP (2.4 ±â€¯1.7 vs. 1.1 ±â€¯0.4, P = 0.005). The incidence of post-ERCP complications was 14.9%, including pancreatitis of 13.5% and hemorrhage of 1.4%. During a median follow-up duration of 41 months (range, 12-123 months), the frequency of pancreatitis episodes decreased significantly from 2.31 to 0.45 (P < 0.0001). The 25% recurrence and reintervention rates were estimated at 25 and 48 months, respectively, without significant difference between patients with ARP or CP. There was a nonsignificant trend towards a higher rate of primary success in patients with ARP than those with CP (92.9% vs. 69.6%, P = 0.123). After further endotherapy, 91.3% patients with CP improved clinically. CONCLUSIONS: Therapeutic ERCP is an effective and safe intervention for pediatric patients with symptomatic PD. Patients presenting with CP seem to achieve improvement after additional ERCPs.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Pâncreas/anormalidades , Pancreatite Crônica/terapia , Pancreatite/terapia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Mutação , Pancreatite/genética , Pancreatite Crônica/genética , Complicações Pós-Operatórias/epidemiologia , Recidiva , Resultado do Tratamento
15.
PLoS One ; 14(7): e0219151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291306

RESUMO

BACKGROUND: Infection in acute pancreatitis (AP) is associated with nutritional therapies including naso-gastric (NG), naso-jejunal (NJ), and total parenteral nutrition (TPN). To examine infections among NG, NJ, TPN, and no nutritional support (NNS) in treating patients with AP. METHODS: The investigators completed comprehensive search in the Cochrane library, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov without restriction on language and publication date before January 21, 2019. They also searched the reference lists of relevant studies for randomized controlled trials (RCTs) comparing NG, NJ, TPN, and NNS among patients with AP. Quantitative synthesis was conducted in a contrast-based network meta-analysis. To clarify effects, a network meta-analysis was conducted to calculate the surface under the cumulative ranking curve (SUCRA). Beside of overall infections, the event rates of infected pancreatic necrosis, bacteremia, line infection, pneumonia, urinary tract infection, and other types of infections were measured. RESULTS: The network meta-analysis of 16 RCTs showed that NJ had significantly lower overall infection rates compared with TPN (risk ratio: 0.59; 95% confidence interval: 0.38, 0.90); and NG had a larger effect size and higher rank probability compared with NJ, TPN, and NNS (mean rank = 1.7; SUCRA = 75.8). TPN was the least preferred (mean rank = 3.2; SUCRA = 26.6). CONCLUSIONS: NG and NJ may be preferred therapies for treating patients with AP. Clinicians may consider NG as a first-line treatment for patients with AP (including severe AP) and even in patients receiving prophylactic antibiotics. In addition, we found that NNS should be avoided when treating patients with severe AP.


Assuntos
Doenças Transmissíveis/epidemiologia , Terapia Nutricional/efeitos adversos , Pancreatite/terapia , Humanos , Meta-Análise em Rede , Terapia Nutricional/instrumentação , Nutrição Parenteral Total/efeitos adversos , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
BMC Surg ; 19(1): 77, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277624

RESUMO

BACKGROUND: The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the second most performed bariatric surgical procedure. With the increasing number of patients undergoing bariatric surgery, the number of complications is also growing. Early diagnosis and treatment of the complications is crucial. CASE PRESENTATION: A very unusual complication was met after an uneventful laparoscopic gastric bypass (LGBP) procedure due to an obstructing blood clot in the biliairy limb resulting in an acute pancreatitis and gastric distention, accompanied by an obstructing blood clot in the distal ileum causing small bowel obstruction. A review of the occurrence of these complications and the diagnosis and treatment is presented. CONCLUSION: Post-bariatric acute pancreatitis is uncommon, but could be fatal. Blood clots should be considered as possible causes of small bowel obstruction, ileus or pancreatitis.


Assuntos
Derivação Gástrica/efeitos adversos , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversos , Pancreatite/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/terapia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/terapia , Obesidade Mórbida/cirurgia , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Tomografia Computadorizada por Raios X
17.
Drug Discov Ther ; 13(3): 137-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327789

RESUMO

Existing evidence suggests that protease inhibitors (PIs) used to prevent or treat pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) are ineffective, and their use is not recommended by clinical practice guidelines. However, in Japan, PIs are administered with the aim to prevent or treat post-ERCP pancreatitis. This study aimed to clarify the gap between guideline recommendations and contents of practice. We used the health insurance claims database of Japan Medical Data Center. Among patients who had undergone ERCP, those with acute pancreatitis or post-ERCP pancreatitis recorded in claims as disease names were defined as post-ERCP pancreatitis patients. The study period was divided into three terms according to the date of publication of clinical practice guidelines for acute pancreatitis. Among 2,945 patients who had undergone ERCP, 2,847 were eligible for analysis. Of these, 1,375 (48.3%) patients had claims with pancreatitis recorded as the disease name; PIs were prescribed to 1,238 (90.0%). Rates of prescription of PIs were 72.3% in 2005-07, 70.9% in 2008-09, and 83.6% in 2010-15, showing a significant increase (p < 0.001). In conclusion, PIs are administered in clinical practice in Japan for the purpose of preventing or treating pancreatitis, with an increasing trend in prescription in recent years.


Assuntos
Pancreatite/prevenção & controle , Pancreatite/terapia , Lacunas da Prática Profissional/métodos , Inibidores de Proteases/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica , Medicina Baseada em Evidências , Feminino , Humanos , Revisão da Utilização de Seguros , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prescrições/estatística & dados numéricos , Inibidores de Proteases/uso terapêutico
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 714-718, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315729

RESUMO

OBJECTIVE: To evaluate the clinical efficacy and safety of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP) receiving percutaneous drainage (PCD). METHODS: Clinical data of SAP patients receiving PCD admitted to department of hepatobiliary surgery of the First Affiliated Hospital of Xi'an Jiaotong University from November 11th 2015 to May 13th 2018 were retrospectively analyzed. The patients were divided into CRRT group and control group according to whether or not receiving CRRT. Demographic data, relevant variables before and after PCD, complication and outcome were all compared. RESULTS: A total of 75 patients were included in the study, 30 were treated with application of CRRT and 45 without CRRT. (1) There was no significant difference in gender, age, body mass index (BMI), medical history (smoking, drinking), complications (cardiovascular disease, chronic lung disease, diabetes, chronic renal insufficiency), etiology (gallstone, alcohol abuse, hyperlipidemia and others), or white blood cell count (WBC), C-reactive protein (CRP), serum procalcitonin (PCT), fluid resuscitation, mechanical ventilation, vasoactive agent or intra-abdominal pressure within 48 hours after admission between the two groups. However, acute physiology and chronic health evaluation II (APACHE II) score within 48 hours after admission of CRRT group was significantly higher than that of control group (18.3±4.5 vs. 12.8±6.2, P < 0.05). (2) There was no significant difference in WBC, PCT, APACHE II score or computed tomography severity index (CTSI) before PCD between the two groups. There was no significant difference in the position or times of PCD procedure between the two groups, but the time interval of PCD in the CRRT group was significantly longer than that in the control group (days: 19.4±5.4 vs. 12.8±2.2, P < 0.05). Meanwhile, there was no significant difference in drainage of fluid properties, incidence of abdominal bleeding, infection, gastrointestinal fistula, endoscopic removal of necrotic tissue, laparotomy for removal of necrotic tissue or the time from PCD to endoscopy or laparotomy between two groups. However, the length of intensive care unit (ICU) stay and the length of hospital stay in the CRRT group were significantly longer than those in the control group (days: 23.2±8.5 vs. 15.3±12.1, 51.2±21.2 vs. 31.2±14.0, both P < 0.01). (3) Kaplan-Meier survival analysis showed that there was no significant differences in 1-year or 3-year cumulative survival rates between the two groups (χ21 = 0.097, P1 = 0.755; χ22 = 0.013, P2 = 0.908). CONCLUSIONS: CRRT is safe and feasible in the treatment of SAP patients receiving PCD procedure. It does not increase the risk of bleeding and may delay the time interval of PCD intervention. However, it may prolong the length of ICU stay and the length of hospital stay. It should be worthy of much attention for clinicians.


Assuntos
Drenagem , Pancreatite/terapia , Terapia de Substituição Renal/métodos , APACHE , Doença Aguda , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Pancreatology ; 19(5): 646-652, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31301995

RESUMO

BACKGROUND & AIM: Ascites in patients with acute pancreatitis (AP) is understudied although recent literature hints at its evident role in the final outcome. This study was planned to study the characteristics of ascites in patients of AP and its effect on the disease course and outcome. METHODS: Consecutive patients of AP were studied and patients with or without ascites were evaluated for the baseline parameters and severity assessment. Ascites was quantified and fluid analyzed for its characteristics. Intraabdominal pressure (IAP) was monitored. The various outcome parameters were compared between the two groups of patients with and without ascites. RESULTS: Of the cohort of 213 patients, 82 (38.5%) developed ascites. Ascites group had significantly higher rates of organ failure (p = 0.001), necrosis (p=<0.001) and higher severity assessment scores. The ascites group had significantly longer hospital and ICU stay and higher ventilator days compared to the non-ascites group. Mortality was also higher in the ascites group (34.1% vs 8.45; p = 0.001). Majority of patients with ascites had moderate to gross ascites (75.6%), low serum ascites albumin gradient (87.8%) with low amylase levels (71.9%). Sub-group analysis in ascites group showed that patients with fatal outcome had higher rates of moderate to gross ascites, higher baseline IAP and lower reduction in IAP after 48 h. Moderate to gross ascites and grades of intra-abdominal hypertension (IAH) were significant predictors of mortality (AUC - 0.76). CONCLUSION: AP patients with ascites have a more severe disease with poorer outcome. Higher degrees of ascites and IAH grades are significant predictors of mortality.


Assuntos
Ascite/patologia , Pancreatite/patologia , Doença Aguda , Adulto , Amilases/metabolismo , Líquido Ascítico/química , Líquido Ascítico/patologia , Estudos de Coortes , Feminino , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/mortalidade , Pancreatite/terapia , Paracentese , Valor Preditivo dos Testes , Resultado do Tratamento
20.
J Coll Physicians Surg Pak ; 29(8): 785-787, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358107

RESUMO

The objective of this study was to compare effects of octreotide and continuous hemofiltration versus continuous hemofiltration alone in the treatment of severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). It was an experimental study carried out from April 2016 to April 2018. A total of 86 cases of SAP complicated with ARDS were randomly divided into group A and group B, with 43 cases in each group. Group A was given continuous hemofiltration alone, and group B was given continuous hemofiltration combined with octreotide. The research findings showed that serum tumor necrosis factor (TNF-α), interleukin-1 (IL-1), IL-6, IL-8, diamine oxidase (DAO), endotoxin, D-lactic acid levels and acute physiology and chronic health evaluation (APACHE II) and systemic inflammatory response syndrome (SIRS) scores of group B were lower than those of group A (all p<0.001) after treatment. There was no significant difference in mortality between two groups after 90 days of discharge (p=0.306). Compared with continuous hemofiltration alone, treatment with continuous hemofiltration plus octreotide is higher in efficiency, but did not translate into improved mortality.


Assuntos
Fármacos Gastrointestinais/uso terapêutico , Hemofiltração , Octreotida/uso terapêutico , Pancreatite/complicações , Pancreatite/terapia , Síndrome do Desconforto Respiratório do Adulto/etiologia , APACHE , Adulto , Idoso , Biomarcadores/sangue , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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