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Lee SY, Park SH, Do MY, Lee DK, Jang SI, Cho JH. Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis. Sci Rep 2024; 14:13663. [PMID: 38871990 DOI: 10.1038/s41598-024-64644-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
Acute biliary pancreatitis (ABP) with cholangitis requires endoscopic retrograde cholangiopancreatography (ERCP) within 24 h to resolve ductal obstruction. However, this recommendation is based on the timing of emergency room (ER) visits. We wanted to determine the optimal timing of ERCP for ABP based on the timing of symptom onset, not the timing of the ER visit. We retrospectively reviewed 162 patients with ABP with cholangitis who underwent urgent ERCP (within 24 h of ER admission). Area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to determine differences in complication rates according to time from symptom onset. A difference in ERCP-related adverse events (AEs) was identified, and Youden's J statistic was used to determine a cutoff time from symptom onset (18 h). We compared mortality and complications based on this cutoff. Based on time to symptom onset, significantly higher rates of aspiration pneumonia (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.15-13.92, P = 0.021) and post-ERCP hypotension (OR 11.9, 95% CI 1.39-101.33, P = 0.005) were observed in the ≤ 18-h group than in the > 18-h group. The study found that patients who underwent ERCP within 18 h of symptom onset is associated with an increased risk of ERCP-related AEs.
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Affiliation(s)
- See Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Park
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Min Young Do
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ill Jang
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Duhancioglu G, Arif-Tiwari H, Natali S, Reynolds C, Lalwani N, Fulcher A. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol (NY) 2024; 49:722-737. [PMID: 38044336 DOI: 10.1007/s00261-023-04107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
Abstract
Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.
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Affiliation(s)
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
| | - Stefano Natali
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Conner Reynolds
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Neeraj Lalwani
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
| | - Ann Fulcher
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
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Liu Y, Dai S, Qin S, Zhou J, Wang Z, Yin G. The pathogenic mutations of APOA5 in Chinese patients with hyperlipidemic acute pancreatitis. Lipids Health Dis 2024; 23:44. [PMID: 38331899 PMCID: PMC10851583 DOI: 10.1186/s12944-024-02011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND AIMS To study the role of gene mutations in the development of severe hypertriglyceridemia (HTG) in patients with hyperlipidemic acute pancreatitis (HLAP), especially different apolipoprotein A5 (APOA5) mutations. METHODS Whole-exome sequencing was performed on 163 patients with HLAP and 30 patients with biliary acute pancreatitis (BAP). The pathogenicity of mutations was then assessed by combining clinical information, predictions of bioinformatics programs, information from multiple gene databases, and residue location and conservation. The pathogenic mutations of APOA5 were visualized using the software. RESULTS 1. Compared with BAP patients, pathogenic mutations of APOA5 were frequent in HLAP patients; among them, the heterozygous mutation of p.G185C was the most common. 2. All six pathogenic mutations of APOA5 identified in this study (p.S35N, p.D167V, p.G185C, p.K188I, p.R223C, and p.H182fs) were positively correlated with severe HTG; they were all in the important domains of apolipoprotein A-V (apoA-V). Residue 223 is strictly conserved in multiple mammals and is located in the lipoprotein lipase (LPL)-binding domain (Pro215-Phe261). When Arg 223 is mutated to Cys 223, the positive charge of this residue is reduced, which is potentially destructive to the binding function of apoA-V to LPL. 3. Four new APOA5 mutations were identified, namely c.563A > T, c.667C > T, c.788G > A, and c.544_545 insGGTGC. CONCLUSIONS The pathogenic mutations of APOA5 were specific to the patients with HLAP and severe HTG in China, and identifying such mutations had clinical significance in elucidating the etiology and subsequent treatment.
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Affiliation(s)
- Yuxin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Si Dai
- Department of Gastroenterology, Songtao Miao Autonomous County People's Hospital, Tongren, 554199, Guizhou Province, China
| | - Shuqi Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Jing Zhou
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Zhendan Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Guojian Yin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China.
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Zhang Q, Fu Z, Li S, Ding X, Zhang W, Ma R, Zhai Q. Clinical characteristics of three distinct types of pancreatitis with overlapping etiologies: A ten-year retrospective cohort study. Pancreatology 2023; 23:949-956. [PMID: 37968184 DOI: 10.1016/j.pan.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Hypertriglyceridemia (HTG) is frequently observed in non-HTG-induced acute pancreatitis (AP), such as in the early stage of acute biliary pancreatitis (ABP). There is overlap in the etiologies of ABP, HTG-AP, and biliary-hypertriglyceridemia acute pancreatitis (BHAP), which may be perplexing for clinicians. METHODS We retrospectively analyzed 394 AP patients. The patients were divided into three groups based on etiology. We analyzed the differences among the three groups of patients in terms of general information, laboratory parameters, and prognosis. RESULTS The mean age of patients in the ABP group was significantly higher than that in the HTG-AP and BHAP groups (p < 0.001). Females made up a greater percentage of the ABP group, whereas males made up the majority in the HTG-AP and BHAP groups. The ABP group had the highest PCT, AMS, LPS, ALT, AST, GGT, TBIL, DBIL, APACHE II, and BISAP scores. TG and BMI were highest in the HTG-AP group. AST and GGT levels were substantially greater in BHAP patients than those in HTG-AP. The BHAP group had the greatest incidence of organ failure, systemic complications, and local complications. CONCLUSION ABP usually develops in people aged 50-59 years. HTG-AP primarily affects people aged 30-39 years. However, the peak incidence age of BHAP falls between the two aforementioned age groups (40-49 years). We also found that patients with BHAP seem to be in an intermediate state in terms of some biochemical markers and demographic characteristics. Furthermore, BHAP may have the worst clinical outcomes compared with HTG-AP and ABP.
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Affiliation(s)
- Qiwei Zhang
- Hepatobiliary and Pancreatic Surgery Dept, Banan Hospital of Chongqing Medical University, Chongqing, 401320, PR China.
| | - Zhan Fu
- Hepatobiliary and Pancreatic Surgery Dept, Banan Hospital of Chongqing Medical University, Chongqing, 401320, PR China.
| | - Shengwei Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Xiong Ding
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Wenfeng Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Rong Ma
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
| | - Qilong Zhai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
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Cho NY, Chervu NL, Sakowitz S, Verma A, Kronen E, Orellana M, de Virgilio C, Benharash P. Effect of surgical timing on outcomes after cholecystectomy for mild gallstone pancreatitis. Surgery 2023; 174:660-665. [PMID: 37355408 DOI: 10.1016/j.surg.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/05/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Retrospective and single-center studies have demonstrated that early cholecystectomy is associated with shorter length of stay in patients with mild gallstone pancreatitis. However, these studies are not powered to detect differences in adverse events. Using a nationally representative cohort, we evaluated the association of timing for cholecystectomy with clinical outcomes and resource use in patients with gallstone pancreatitis. METHODS All adult hospitalizations for gallstone pancreatitis were tabulated from the 2016-2019 Nationwide Readmissions Database. Using International Classification of Disease, 10th Revision codes, patient comorbidities and operative characteristics were determined. Patients with end-organ dysfunction or cholangitis were excluded to isolate those with only mild gallstone pancreatitis. Major adverse events were defined as a composite of 30-day mortality and perioperative (cardiovascular, respiratory, neurologic, infectious, and thromboembolic) complications. Timing of laparoscopic cholecystectomy was divided into Early (within 2 days of admission) and Late (>2 days after admission) cohorts. Multivariable logistic and linear regression were then used to evaluate the association of cholecystectomy timing with major adverse events and secondary outcomes of interest, including postoperative hospital duration of stay, costs, non-home discharge, and readmission rate within 30 days of discharge. RESULTS Of an estimated 129,451 admissions for acute gallstone pancreatitis, 25.6% comprised the Early cohort. Compared to patients in the Early cohort, Late cohort patients were older (56 [40-69] vs 53 [37-66] years, P < .001), more likely male (36.6 vs 32.8%, P < .001), and more frequently underwent preoperative endoscopic retrograde cholangiopancreatography (22.2 vs 10.9%, P < .001). In addition, the Late cohort had higher unadjusted rates of major adverse events and index hospitalization costs, compared to Early. After risk adjustment, late cholecystectomy was associated with higher odds of major adverse events (adjusted odds ratio 1.40, 95% confidence interval 1.29-1.51) and overall adjusted hospitalization costs by $2,700 (95% confidence interval 2,400-2,800). In addition, compared to the Early group, those in the Late cohort had increased odds of 30-day readmission (adjusted odds ratio 1.12, 95% confidence interval 1.03-1.23) and non-home discharge (adjusted odds ratio 1.42, 95% confidence interval 1.31-1.55). CONCLUSION Cholecystectomy >2 days after admission for mild gallstone pancreatitis was independently associated with increased major adverse events, costs, 30-day readmissions, and non-home discharge. Given the significant clinical and financial consequences, reduced timing to surgery should be prioritized in the overall management of this patient population.
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Affiliation(s)
- Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/NamYong_Cho
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/SaraSakowitz
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/arjun_ver
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Manuel Orellana
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/ManuOrellanaMD
| | - Christian de Virgilio
- Department of Surgery, UCLA-Harbor Medical Center, Los Angeles, CA. https://twitter.com/drdevirgilio
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis: a meta-analysis. Wideochir Inne Tech Maloinwazyjne 2022; 17:561-578. [PMID: 36818515 PMCID: PMC9909766 DOI: 10.5114/wiitm.2022.119902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Acute biliary pancreatitis (ABP) is a type of acute abdomen caused by biliary tract diseases that trigger outflow obstruction, hypertension of the pancreatic duct, and subsequent pancreatic autodigestion. Aim To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of ABP. Material and methods A comprehensive literature search was performed on four databases (PubMed/WOS/CNKI/Wanfang) to select randomized controlled trials on ERCP for ABP published between 2010 and 2022. Relevant data were then extracted from the eligible studies. Subsequently, meta-analysis and sensitivity analysis were performed using Stata 16.0 statistical software. Publication bias was determined using funnel plots created by the Begg method. Results A total of 1639 patients with ABP were included, of whom 823 were in the observation (ERCP or ERCP + endoscopic sphincterotomy) group and 816 in the control (conservative treatment) group. The observation group demonstrated a higher response rate, lower incidence of complications, and superior postoperative abdominal pain relief time, time to intestinal exhaust, serum amylase recovery time and hospital stay than the control group (p < 0.05). In addition, biochemical parameters and inflammatory factor levels (Tbil/WBC/CRP/TNF-α) were significantly better after treatment in the observation group than in the control group (p < 0.05). Conclusions Collectively, ERCP in the treatment of ABP was associated with relief of abdominal pain, accelerated intestinal exhaust and serum amylase recovery, and effective improvements in serum biochemical parameters and inflammatory factor levels.
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Wu H, Ma K, Liao B, Ji T, Zhang S, Cao T. Comparative Analysis of Early Clinical Features and Complications of Different Types of Acute Pancreatitis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3771610. [PMID: 35795856 PMCID: PMC9252761 DOI: 10.1155/2022/3771610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
Background Acute pancreatitis (AP) is a common surgical acute abdomen. Different kinds of pancreatitis may have different pathophysiological characteristics each other. The objective of this research was to investigate the early clinical features and complications of different types of acute pancreatitis. Methods 787 AP patients admitted in the Huadu District People's Hospital of Guangzhou during January 2009 and December 2019 were analyzed retrospectively. Among 787 AP patients, 520 (66.1%) were biliary AP (group I), 69 (8.7%) were alcoholic AP (group II), and 198 (25.2%) were hypertriglyceridemic AP (group III). According to the local and systemic complications and mortality in the early stage, we compared and analyzed the clinical characteristics and prognosis of different types of pancreatitis. Results Mild acute pancreatitis accounted for the highest proportion (79.4%) in group I, while moderately severe acute pancreatitis in group II (36.2%) and severe acute pancreatitis in group III (62.6%). In terms of severity score of the pancreatitis, the average scores of BISAP, Ranson, APACHE-II, and MCTSI of the patients in group III were the highest (p < 0.01). The incidence of acute peripancreatic fluid collection and infectious pancreatic necrosis was the highest in group III. The incidences of acute necrotic collection, pancreatic pseudocyst, and walled-off necrosis in group III were significantly higher than those in the other two groups (p < 0.01). The incidences of systemic inflammatory response syndrome, sepsis, multiple organ failure, intra-abdominal hypertension, and mortality were highest in group III. Conclusions There is an upward trend of the incidence rate of hypertriglyceridemic AP in recent years; it has been gradually developed into the second type of acute pancreatitis which is second only to the acute biliary pancreatitis. It is worthy to pay more and more attentions to it due to the feature of its younger onset, high incidence of complications, and high mortality.
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Affiliation(s)
- Hongsheng Wu
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Keqiang Ma
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Biling Liao
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Tengfei Ji
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Shengmin Zhang
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Tiansheng Cao
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
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Overlooked but Serious Gallbladder Disease during Extracorporeal Membrane Oxygenation: A Retrospective Analysis. J Clin Med 2022; 11:jcm11082199. [PMID: 35456290 PMCID: PMC9031104 DOI: 10.3390/jcm11082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: To date, there have been no reports assessing the incidence, risk factors, and clinical outcomes of GB disease in patients receiving ECMO for cardiorespiratory failure. Methods: The medical records of adults (aged > 18 years) who underwent ECMO between May 2010 and October 2019 were retrospectively reviewed. We investigated the prevalence and related factors of GB disease during ECMO therapy, compared clinical outcomes between patients with and without GB disease, and performed propensity-matched analysis. Results: In total, 446 patients were included, and symptomatic GB disease was found in 62 patients (13.9%, 76.2/1000 ECMO days). Complicated GB disease occurred in 42 patients (9.4%, 89.4/1000 ECMO days) and presented as acute cholecystitis, acute cholangitis, and biliary pancreatitis in 33 (7.4%), 7 (1.6%), and 5 (1.1%) patients, respectively. In multivariate Cox regression analysis, longer ECMO support (>2 weeks) (hazard ratio (HR), 2.95; 95% confidence interval (CI), 1.69−5.15) and elevated plasma hemoglobin (Hb, >50 mg/dL) (HR. 2.12; 95% CI, 1.18−3.78) were significantly associated with the development of GB disease. In the propensity-matched cohort, the intensive care unit (ICU) and hospital survival rates were significantly lower for patients with GB disease than for those without GB disease (ICU survival rate, 64.5% vs. 84.7%; hospital survival rate, 59.7% vs. 81.5%). Conclusion: The incidence of GB disease was higher in patients who received ECMO than in the general ICU patients. Furthermore, elevated plasma Hb and prolonged ECMO therapy were significant factors for the development of GB disease during ECMO therapy.
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Enespa, Chandra P, Singh DP. Sources, purification, immobilization and industrial applications of microbial lipases: An overview. Crit Rev Food Sci Nutr 2022; 63:6653-6686. [PMID: 35179093 DOI: 10.1080/10408398.2022.2038076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Microbial lipase is looking for better attention with the fast growth of enzyme proficiency and other benefits like easy, cost-effective, and reliable manufacturing. Immobilized enzymes can be used repetitively and are incapable to catalyze the reactions in the system continuously. Hydrophobic supports are utilized to immobilize enzymes when the ionic strength is low. This approach allows for the immobilization, purification, stability, and hyperactivation of lipases in a single step. The diffusion of the substrate is more advantageous on hydrophobic supports than on hydrophilic supports in the carrier. These approaches are critical to the immobilization performance of the enzyme. For enzyme immobilization, synthesis provides a higher pH value as well as greater heat stability. Using a mixture of immobilization methods, the binding force between enzymes and the support rises, reducing enzyme leakage. Lipase adsorption produces interfacial activation when it is immobilized on hydrophobic support. As a result, in the immobilization process, this procedure is primarily used for a variety of industrial applications. Microbial sources, immobilization techniques, and industrial applications in the fields of food, flavor, detergent, paper and pulp, pharmaceuticals, biodiesel, derivatives of esters and amino groups, agrochemicals, biosensor applications, cosmetics, perfumery, and bioremediation are all discussed in this review.
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Affiliation(s)
- Enespa
- School for Agriculture, Sri Mahesh Prasad Post Graduate College, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Prem Chandra
- Food Microbiology & Toxicology Laboratory, Department of Microbiology, School for Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central) University, Lucknow, Uttar Pradesh, India
| | - Devendra Pratap Singh
- Department of Environmental Science, School for Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central) University, Lucknow, Uttar Pradesh, India
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Gurakar M, Jalaly NY, Faghih M, Boortalary T, Azadi JR, Khashab MA, Fan C, Kalloo AN, Zaheer A, Singh VK, Afghani E. Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis. Scand J Gastroenterol 2022; 57:91-98. [PMID: 34663162 PMCID: PMC9278560 DOI: 10.1080/00365521.2021.1984573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the present study is to assess the impact of smoking dose and duration on the distribution of risk factor(s) in patients with RAP and CP, and the impact of genetic testing on the distribution of risk factor(s) in patients with idiopathic RAP and CP. METHODS All adult patients with RAP and CP referred to a multidisciplinary pancreatitis clinic between 2010 and 2017 were evaluated. Risk factors included alcohol and smoking, hypertriglyceridemia, biliary, and other etiologies. Genetic testing was only pursued in patients with idiopathic RAP or CP. RESULTS Among the 1770 patients evaluated, 167 had RAP and 303 had CP. After genetic testing and smoking, the most common risk factors for RAP and CP were pathogenic variant(s) (23%) and the combination of alcohol and smoking (23%), respectively. Genetic testing and smoking assessment decreased the proportion of patients with alcoholic RAP from 17% to 5%, alcoholic CP from 33% to 10%, idiopathic RAP from 49% to 12%, and idiopathic CP from 54% to 14%. Pathogenic CFTR variants were the most common variant in patients with RAP (51%) and CP (43%). Among the 68 patients with pancreas divisum, other risk factor(s) were identified in 72%. CONCLUSION Genetic testing and a detailed assessment of smoking dose and duration reduce the proportion of patients with alcoholic and idiopathic pancreatitis. Other risk factor(s) for pancreatitis are found in the majority of patients with pancreas divisum further questioning its role as an independent risk factor.1. What is the current knowledge?Approximately 30% of patients with pancreatitis have no clear risk factor(s) and are categorized as having an idiopathic etiology.Pathogenic variant(s) as well as smoking dose and duration are well-established risk factors for recurrent acute and chronic pancreatitis but are not widely recognized or incorporated into clinical practice.2. What is new here?Genetic testing and a detailed assessment of smoking dose and duration reduced the proportion of patients with alcoholic and idiopathic acute recurrent and chronic pancreatitis.Approximately three-fourths of patients with pancreas divisum have a risk factor for pancreatitis.
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Affiliation(s)
- Merve Gurakar
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Mahya Faghih
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Tina Boortalary
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad R. Azadi
- Division of Abdominal Imaging, Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Christopher Fan
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anthony N. Kalloo
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Atif Zaheer
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Division of Abdominal Imaging, Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vikesh K. Singh
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elham Afghani
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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11
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Tod P, Farkas N, Németh D, Szénási G, Vincze Á, Hágendorn R, Czakó L, Illés D, Izbéki F, Dunás-Varga V, Papp M, Hamvas J, Varga M, Gombos K, Nagy T, Márton Z, Faluhelyi N, Török I, Ince AT, Galeev S, Hegyi PJ, Szentesi A, Párniczky A, Szakács Z, Hegyi P, Hamar P. Initial Renal Function (eGFR) Is a Prognostic Marker of Severe Acute Pancreatitis: A Cohort-Analysis of 1,224 Prospectively Collected Cases. Front Med (Lausanne) 2021; 8:671917. [PMID: 34485326 PMCID: PMC8416275 DOI: 10.3389/fmed.2021.671917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Acute pancreatitis (AP) is a life-threatening disease. We aimed to explore the prognostic relevance of renal function based on estimated glomerular filtration rate (eGFR). Methods: A prospective registry of AP patients was established by the Hungarian Pancreatic Study Group. Data of 1,224 consecutive patients were collected between 2012 and 2017. Patients were divided into 3 groups according to their eGFR measured within 24 h of hospitalization: normal renal function: >90 mL/min, mild to moderate renal functional impairment: 30–90 mL/min and severe renal dysfunction: <30 mL/min. Associations of eGFR with outcome (survival, length of hospitalization, AP severity, blood glucose), inflammatory markers (erythrocyte sedimentation rate, white blood cell count), anemia and organ failure (heart, kidney, liver) were analyzed. Results: Death, longer hospitalization and severe AP, but not the cause of AP, were significantly associated with lower eGFR. The inflammatory markers (CRP, WBC count) but not anemia (Hb, Htk) were closely associated with severe renal dysfunction. Renal function was associated with heart and renal failure but not with other complications of AP such as respiratory failure, local pancreatic complications, diabetes or peptic ulcer. eGFR was not associated with liver damage (ALAT, γ-GT) or liver function (serum bilirubin) although biliary complications, alcohol and metabolic syndrome were the most common etiologies of AP. Conclusions: Our study suggests a useful prognostic value of initial eGFR in AP patients. Even mild eGFR reduction predicted mortality, severity of AP and the length of hospitalization. Thus, precise evaluation of renal function should be considered for assessing AP severity and outcome.
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Affiliation(s)
- Pál Tod
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Gábor Szénási
- School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Roland Hágendorn
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Illés
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Veronika Dunás-Varga
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Katalin Gombos
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Márton
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nándor Faluhelyi
- Department of Radiology, Medical School, University of Pécs, Pécs, Hungary
| | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureṣ, Romania
| | - Ali Tüzün Ince
- School of Medicine, Hospital of Bezmialem Vakif University, Istanbul, Turkey
| | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | - Péter Jenő Hegyi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Department of Medicine, Centre for Translational Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Zsolt Szakács
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Department of Medicine, Centre for Translational Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Medical School, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Medical School, Semmelweis University, Budapest, Hungary
| | - Péter Hamar
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
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12
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Isbell KD, Wei S, Dodwad SJM, Avritscher EB, Mueck KM, Bernardi K, Hatton GE, Liang MK, Ko TC, Kao LS. Impact of Early Cholecystectomy on the Cost of Treating Mild Gallstone Pancreatitis: Gallstone PANC Trial. J Am Coll Surg 2021; 233:517-525.e1. [PMID: 34325019 DOI: 10.1016/j.jamcollsurg.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Gallstone Pancreatitis: Admission vs Normal Cholecystectomy (Gallstone PANC) Trial demonstrated that cholecystectomy within 24 hours of admission (early) compared with after clinical resolution (control) for mild gallstone pancreatitis, significantly reduced 30-day length-of-stay (LOS) without increasing major postoperative complications. We assessed whether early cholecystectomy decreased 90-day healthcare use and costs. STUDY DESIGN A secondary economic evaluation of the Gallstone PANC Trial was performed from the healthcare system perspective. Costs for index admissions and all gallstone pancreatitis-related care 90 days post-discharge were obtained from the hospital accounting system and inflated to 2020 USD. Negative binomial regression models and generalized linear models with log-link and gamma distribution, adjusting for randomization strata, were used. Bayesian analysis with neutral prior was used to estimate the probability of cost reduction with early cholecystectomy. RESULTS Of 98 randomized patients, 97 were included in the analyses. Baseline characteristics were similar in early (n = 49) and control (n = 48) groups. Early cholecystectomy resulted in a mean absolute difference in LOS of -0.96 days (95% CI, -1.91 to 0.00, p = 0.05). Ninety-day mean total costs were $14,974 (early) vs $16,190 (control) (cost ratio [CR], 0.92; 95% CI, 0.73-1.15, p = 0.47), with a mean absolute difference of $1,216 less (95% CI, -$4,782 to $2,349, p = 0.50) per patient in the early group. On Bayesian analysis, there was an 81% posterior probability that early cholecystectomy reduced 90-day total costs. CONCLUSION In this single-center trial, early cholecystectomy for mild gallstone pancreatitis reduced 90-day LOS and had an 81% probability of reducing 90-day healthcare system costs.
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Affiliation(s)
- Kayla D Isbell
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Shuyan Wei
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Shah-Jahan M Dodwad
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Elenir Bc Avritscher
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Krislynn M Mueck
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Karla Bernardi
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Gabrielle E Hatton
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice
| | - Mike K Liang
- University of Houston, HCA Healthcare Kingwood, Kingwood, TX
| | | | - Lillian S Kao
- Department of Surgery; Center for Surgical Trials and Evidence-based Practice; Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.
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13
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Gijbels E, Pieters A, De Muynck K, Vinken M, Devisscher L. Rodent models of cholestatic liver disease: A practical guide for translational research. Liver Int 2021; 41:656-682. [PMID: 33486884 PMCID: PMC8048655 DOI: 10.1111/liv.14800] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Cholestatic liver disease denotes any situation associated with impaired bile flow concomitant with a noxious bile acid accumulation in the liver and/or systemic circulation. Cholestatic liver disease can be subdivided into different types according to its clinical phenotype, such as biliary atresia, drug-induced cholestasis, gallstone liver disease, intrahepatic cholestasis of pregnancy, primary biliary cholangitis and primary sclerosing cholangitis. Considerable effort has been devoted to elucidating underlying mechanisms of cholestatic liver injuries and explore novel therapeutic and diagnostic strategies using animal models. Animal models employed according to their appropriate applicability domain herein play a crucial role. This review provides an overview of currently available in vivo animal models, fit-for-purpose in modelling different types of cholestatic liver diseases. Moreover, a practical guide and workflow is provided which can be used for translational research purposes, including all advantages and disadvantages of currently available in vivo animal models.
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Affiliation(s)
- Eva Gijbels
- Department of In Vitro Toxicology and Dermato‐CosmetologyVrije Universiteit BrusselBrusselsBelgium,Gut‐Liver Immunopharmacology Unit, Basic and Applied Medical SciencesLiver Research Center GhentFaculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Alanah Pieters
- Department of In Vitro Toxicology and Dermato‐CosmetologyVrije Universiteit BrusselBrusselsBelgium
| | - Kevin De Muynck
- Gut‐Liver Immunopharmacology Unit, Basic and Applied Medical SciencesLiver Research Center GhentFaculty of Medicine and Health SciencesGhent UniversityGhentBelgium,Hepatology Research UnitInternal Medicine and PaediatricsLiver Research Center GhentFaculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Mathieu Vinken
- Department of In Vitro Toxicology and Dermato‐CosmetologyVrije Universiteit BrusselBrusselsBelgium
| | - Lindsey Devisscher
- Gut‐Liver Immunopharmacology Unit, Basic and Applied Medical SciencesLiver Research Center GhentFaculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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14
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Hegab YH, Hassan AO, Metwalli AEM, Awad JR, Orban YA. Adherence to the evidence-based guidelines in the management of acute biliary pancreatitis: A case series. Int J Surg Case Rep 2020; 77:906-914. [PMID: 33395922 PMCID: PMC7749290 DOI: 10.1016/j.ijscr.2020.11.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9-73.4 cases / 100,000 people and the total mortality rate is 4-8%, increasing to 33% in patients with infected necrosis. This study aims to assess the outcome of providing standardized evidence-based care to patients with acute biliary pancreatitis. METHODS Thirty patients diagnosed with acute biliary pancreatitis, were enrolled in this study and managed according to the Japanese guidelines, 2015 with a complementary scope on other recent guidelines. RESULTS Out of 30 patients in the study, 60% were females. Twenty-five cases were presented in the early phase of the disease while the rest presented in the late phase. Gallstones were the commonest cause (80%). The complications encountered were a systemic complication in one case, organ failure in three cases, and the local complications in the form of fluid collections in (43.3%) of cases.Out of 30 patients, 6 patients had an intervention. The main approach was minimally invasive techniques (4 cases), Open approach was performed in 2 cases. The total mortality rate was 10%. Most mild cases were discharged within one week from admission. Cases readmitted with recurrent attacks of acute pancreatitis were 3 cases, one male and 2 females. CONCLUSION By applying guidelines in the management of acute biliary pancreatitis, we can reduce disease-related morbidity and mortality. Besides, we can reduce the costs of medical services with the proper investment of healthcare resources.
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Affiliation(s)
| | - Ahmed Osama Hassan
- Department of Pediatric Surgery, Faculty of Medicine, Zagazig University, Egypt.
| | | | - Joseph Ri Awad
- Department of Surgery, Faculty of Medicine, Zagazig University, Egypt.
| | - Yasser A Orban
- Department of Surgery, Faculty of Medicine, Zagazig University, Egypt.
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15
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Mickevičius A, Valantinas J, Stanaitis J, Jucaitis T, Mašalaitė L. Changes in the Velocity of Blood in the Portal Vein in Mild Acute Pancreatitis-A Preliminary Clinical Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E211. [PMID: 31130704 PMCID: PMC6571583 DOI: 10.3390/medicina55050211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Portal vein thrombosis is associated with a decrease in the main blood velocity in this vessel. While most studies examine etiological factors of portal vein thrombosis after its occurrence, we aimed to evaluate portal vessels and assess whether mild acute pancreatitis affects blood flow in the portal vein and increases the risk of thrombosis. Materials and methods: This prospective single centered follow-up study enrolled 66 adult participants. Fifty of them were diagnosed with mild acute pancreatitis based on the Revised Atlanta classification, and 16 healthy participants formed the control group. All participants were examined three times. The first examination was carried out at the beginning of the disease and the next two at three-month intervals. Blood samples were taken and color Doppler ultrasound performed the first time, whereas ultrasound alone was performed during the second and third visits. Mean and maximal blood velocities and resistivity index in the main portal vein and its left and right branches were evaluated. Results: Mean velocity of the blood flow in the main portal vein and its right and left branches was not significantly different from healthy individuals during the acute pancreatitis phase: 23.1 ± 8.5 cm/s vs. 24.5 ± 8.2 cm/s (p = 0.827); 16.4 ± 7.9 cm/s vs. 16.4 ± 8.1 cm/s (p = 1.000); and 8 ± 3.4 cm/s vs. 7.4 ± 2.5 cm/s (p = 0.826), respectively. The same was observed when comparing the maximal blood flow velocity: 67.9 ± 29 cm/s vs. 67.5 ± 21 cm/s (p > 0.05); 45.4 ± 27 cm/s vs. 44 ± 23.8 cm/s (p = 0.853); and 22.2 ± 9.8 cm/s vs. 20 ± 7.3 cm/s (p = 0.926), respectively. Changes in venous blood velocities were not significant during the follow-up period in separate study groups. Conclusions: Portal blood flow velocities do not change during mild acute pancreatitis in the inflammatory and postinflammatory periods. This observation suggests that mild acute pancreatitis does not increase the risk of portal vein thrombosis.
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Affiliation(s)
- Artautas Mickevičius
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Jonas Valantinas
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Juozas Stanaitis
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Tomas Jucaitis
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
| | - Laura Mašalaitė
- Vilnius University Faculty of Medicine, Clinic of Gastroenterology, Nephro-Urology and Surgery, Biomedical Sciences, Vilnius LT-03101, Lithuania.
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santaros Clinics, Vilnius LT-08661, Lithuania.
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16
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Fei Y, Liu XQ, Gao K, Xue CB, Tang L, Tu JF, Wang W, Li WQ. Analysis of influencing factors of severity in acute pancreatitis using big data mining. Rev Assoc Med Bras (1992) 2018; 64:454-461. [PMID: 30304146 DOI: 10.1590/1806-9282.64.05.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Xiao-qiang Liu
- Health Statistics and Information Center of JiangSu Province, China
| | | | - Cheng-bin Xue
- Health Statistics and Information Center of JiangSu Province, China
| | | | | | - Wei Wang
- Nanjing University of Chinese Medicine, China
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17
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Weng YC, Fan JQ. Protective effect of TMP on pancreas function of acute pancreatitis rats. ASIAN PAC J TROP MED 2015. [DOI: 10.1016/j.apjtm.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Does the presence of obesity and/or metabolic syndrome affect the course of acute pancreatitis?: A prospective study. Pancreas 2014; 43:565-70. [PMID: 24681879 DOI: 10.1097/mpa.0000000000000028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The incidence of acute pancreatitis (AP) is rising with increased prevalence of obesity, which exacerbates pancreatic injury. Metabolic syndrome (MS) is defined as a cluster condition of cardiovascular risk factors, including hyperglycemia, dyslipidemia, hypertension, and central obesity. We analyze if the presence of obesity and/or MS affects the course of pancreatitis. METHODS Data were collected from 140 patients with AP between January 2010 and February 2013. Anthropometric data, including body mass index and waist circumference, were measured. Biochemical tests were used including fasting glucose, triglyceride, low- and high-density lipoprotein cholesterol levels, and total cholesterol level. Atlanta criteria, Acute Physiology and Chronic Health Evaluation II, and Ranson scoring system were used to define severe AP. Patients were classified as having MS based on the International Diabetic Federation criteria. RESULTS The mean body mass index was 30.15 kg/m(2). Sixteen (11.4%) patients had severe AP, whereas 124 (88.6%) patients had mild AP. We found that 62.8% of patients with AP fulfilled the criteria of MS (P = 0.000). Body weight can be used to predict clinical severity of AP with significant P value (P = 0.009). CONCLUSIONS The presence of MS in patients with pancreatitis is noticeable, but it does not affect the course of disease severity, whereas obesity correlates with pancreatitis severity.
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19
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The role of open necrosectomy in the current management of acute necrotizing pancreatitis: a review article. ISRN SURGERY 2013; 2013:579435. [PMID: 23431472 PMCID: PMC3569915 DOI: 10.1155/2013/579435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 12/12/2022]
Abstract
The optimal management of necrotizing pancreatitis continues to evolve. Currently, conservative intensive care treatment represents the primary therapy of acute severe necrotizing pancreatitis, aiming at prevention of organ failure. Following this mode of treatment most patients with sterile necroses can be managed successfully. Surgery might be considered as an option in the late phase of the disease for patients with proven infected pancreatic necroses and organ failure. For these patients surgical debridement is still considered the treatment of choice. However, even for this subgroup of patients, the concept of operative strategy has been recently challenged. Nowadays, it is generally accepted that necrotizing pancreatitis with proven infected necroses as well as septic complications directly caused by pancreatic infection are strong indications for surgical management. However, the question of the most appropriate surgical technique for the treatment of pancreatic necroses remains unsettled. At the same time, recent advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of necrotizing pancreatitis. In light of these controversies, the present paper will focus on the current role of surgery in terms of open necrosectomy in the management of severe acute necrotizing pancreatitis.
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20
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Lozano Bretón CE. Dolor abdominal agudo: Enfoque para el médico de atención primaria. MEDUNAB 2012. [DOI: 10.29375/01237047.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
El dolor abdominal es una causa frecuente de consulta en cualquier servicio de urgencias, y por esto, los médicos de atención primaria deben conocer las patologías que puedan poner en peligro la vida de sus pacientes. Se hace una revisión de las patologías mas frecuentemente asociadas a dolor abdominal en el ámbito de urgencias, y se hace énfasis en los medios por los que se puede llegar al diagnóstico adecuado y los conceptos generales del tratamiento de cada una de estas condiciones.
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Abstract
AIM: To investigate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis of various causes and to analyze the indications for ERCP.
METHODS: One hundred and fourteen cases of acute pancreatitis were divided into two groups: acute biliary pancreatitis and non-biliary pancreatitis. Each group was further divided into two subgroups: one was treated by conservative method, and the other by ERCP. The incidence of severe acute pancreatitis, the time required to relieve abdominal pain and achieve normal amylase level, and the length of hospital stay were compared between different groups and subgroups.
RESULTS: Of 114 cases of acute pancreatitis, 55 received conservative treatment, and 59 received ERCP. The incidence of severe acute pancreatitis was significantly higher in the conservative group than in the ERCP group (27% vs 12%, P < 0.05). In the acute biliary pancreatitis group, the incidence of severe acute pancreatitis was significantly higher in the conservative subgroup than in the ERCP subgroup (30% vs 10%, P < 0.05), and the time required to relieve abdominal pain and the length of hospital stay in the ERCP subgroup were significantly shorter than those in the conservative subgroup (both P < 0.05). In the non-biliary pancreatitis group, the incidence of severe acute pancreatitis was comparable between the conservative subgroup and ERCP subgroup (23% vs 14%, P > 0.05), but the time required to achieve normal amylase level (6.92 d ± 2.26 d vs 8.85 d ± 3.08 d, P < 0.05) and the length of hospital stay (8.1 d ± 3.04 d vs 10.3 d ± 3.80 d, P < 0.05) in the ERCP subgroup were shorter than those in the conservative subgroup.
CONCLUSION: ERCP is effective in the management of acute pancreatitis and can effectively prevent the progression from mild acute pancreatitis to severe acute pancreatitis. ERCP is also effective in the management of non-biliary pancreatitis in terms of shortening the length of hospital stay.
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