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1
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Editor’s preface for the special issue “ACUTE PANCREATITIS”

100%
Ramia J.
Open Medicine
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2014
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vol. 9
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issue 4
529-529
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Severity markers in patients with acute pancreatitis

63%
Kisaoglu A., Aydinli B., Ozturk G., Atamanalp S., Ozogul B., Yildirgan M., Polat K.
Open Medicine
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2014
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vol. 9
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issue 4
556-564
EN
To evaluate the effectiveness of serum levels of resistin and CD14 expression in monocytes, and high-sensitivity C-reactive protein (hsCRP) in early stages of acute pancreatitis and correct prediction of the severity of acute pancreatitis (AP) using scoring systems. The study involved 10 (29.41%) male and 24 (70.59%) female patients (total n=34) followed for AP diagnosis at the Department of General Surgery, Ataturk University Medical School between July 2008 and September 2009. In all the patients, Ranson and APACHE II scores, serum resistin, hsCRP, and monocyte CD14 expression levels were determined. The patients were divided into two groups as mild and severe AP groups. A control group was formed and the intergroup comparisons were made. Values ≥ 3 based on the Ranson scoring scale and values ≥ 8 in APACHE II scoring scale were considered to indicate severe AP. Evaluations were based on the values obtained on the 1st and 7th days for serum resistin and hsCRP levels and monocyte CD 14 expression. In 17 (50%) patients, severe AP was determined. No statistically significant differences were found between the mean serum resistin levels of AP groups, while the difference for the same parameter between the mild and severe AP groups and the control group was statistically significant. In the severe AP group, the mean 1st day and 7th day serum hsCRP levels were statistically significantly higher. The CD14 expression in monocytes was similar in all the groups. Serum hsCRP concentrations and Ranson and APACHE II scores and serum resistin and hsCRP concentrations on the 1st day were positively correlated. Serum hsCRP measurement is effective in determining the severity of acute pancreatitis. Serum resistin measurement may be a useful early marker in determining the inflammatory response in AP. However, CD14 expression in monocytes was not found to be a useful marker in the diagnosis and prediction of the disease severity in AP patients.
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The association between red blood cell distribution width and acute pancreatitis associated lung injury in patients with acute pancreatitis

51%
Peng Y.-F., Zhang Z.-X., Cao W., Meng C.-R., Xu S.-S., Zhang Q.
Open Medicine
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2014
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vol. 10
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issue 1
EN
B ackground: Red blood cell distribution width (RDW) that describes red blood cell volume heterogeneity is a common laboratory test. Our aim was to focus on th e association between RDW and a c ute pancreatitis associated lung injury (APALI). Methodology: A total of 152 acute pancreatitis (AP) patients who conformed to the criteria w ere included in this study. The demographic data, medical histories and laboratory measures was obtained from each patient on admission, further, the medical histories and biological data were analyzed, retrospectively. Results: Increased RDW at admission was observed in patients with APALI compared with the non-APALI groups. Our results exhibited that RDW was an independent risk factor for APALI after adjusting leukocyte, neutrophil percentage, random blood glucose (RBG), total bilirubin (TB) and total bile acid（TBA）(Crude model) (OR=2.671;CI 95% 1.145-6.230; P=0.023), further adjustment based on Crude model for sex and age did not attenuate the significantly high risk of APALI in patients with AP, RWD still remained a ro les as an independent risk factor for APALI (OR=2.653;CI95 % 1.123-6.138; P=0.026). Conclusions: Our study demonstrate that RDW at admission is associated with APALI and should be considered as an underlying risk factor of APALI.
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Incarcerated inguinal hernia? No, acute pancreatitis

51%
Ramia-Angel J., Sancho E., Lozoya R., Gasz A., Santos J.
Open Medicine
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2011
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vol. 6
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issue 6
770-772
EN
A 62-year-old man presented to the Emergency Department with a 2-day history of right testicular pain. The initial diagnosis was orchiepididymitis (later found to be mistaken), and intravenous antibiotic treatment was started. Twenty-four hours later, the patient had mild pain in the right inguinal area and right infra-abdominal area. We performed an inguinal ultrasound that showed an incarcerated mass of mixed echogenicity in the right inguinal area. Surgery was performed because we thought the patient had an inguinal incarcerated hernia. Two days after the surgical procedure, the patient began to have fever and erythema and pain in the back. Abdominal computed tomography (CT) showed an acute pancreatitis with a peripancreatic collection from the pancreas to right inguinal area. We have reviewed similar cases in the literature and note that, infrequently, an inguinal mass can be the first sign of mostly asymptomatic acute pancreatitis.
5
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Severe vascular complications of acute pancreatiti

51%
Głuszek S., Nawacki Ł., Matykiewicz J., Kot M., Kuchinka J.
Polish Journal of Surgery
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2015
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vol. 87(10)
485-490
EN
Acute pancreatitis (AP) develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10- 15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30- 40%. Material and methods. The study included 10 patients treated due to acute pancreatitis in two surgical departments run by one of the authors (S.G.) in the years 2004-2014, who developed a serious complication in the form of haemorrhage into the inflammatory tumour/pancreatic cyst or an adjacent organ. Haemorrhage was diagnosed based on the clinical picture, most often a sudden drop in blood pressure, peritonitis symptoms and imaging findings – abdominal ultrasound and abdominal computed tomography. Therapeutic methods included conservative treatment, endovascular embolisation and, in the absence of efficacy of the above mentioned methods, surgical treatment. Patients age and gender, the etiological factor, comorbidities, Atlanta Classification, treatment outcomes and mortality rate were assessed. Results. Alcohol was the most common etiological factor in the investigated AP cases. The patients received conservative treatment, interventional radiology treatment (endovascular embolisation) or surgical treatment. In the study group, 6 patients required surgical treatment, 3 patients received invasive radiology treatment, and conservative treatment was used in one patient. The mortality rate in the study group was 30%. Conclusions. Haemorrhages into the inflammatory cisterns or adjacent organs (stomach, transverse colon mesentery) secondary to AP are the most severe complications, which are difficult to manage. The successful use of interventional radiology methods to inhibit and prevent the recurrence of bleeding in some of the patients is a significant milestone.
6
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Clinical and epidemiological aspects of acute pancreatitis – 10 years of single-center experience

51%
Jagielski M., Kijowski F., Fruczek M., Sternau-Kuklińska M., Janiak M., Adrych K.
European Journal of Translational and Clinical Medicine
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2019
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vol. 1
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issue 2
41-52
EN
Background: We can observe an increase in acute pancreatitis (AP) incidence in the recent years. Material and methods: Retrospective clinical data analysis of 370 patients with AP, hospitalized between 2007 and 2016 at our Department. Results: AP was diagnosed during 406 hospitalisation in 370 patients [average age 52.15 (21-93), 237(64.05%) male]. AP of high clinical severity was diagnosed in 60/370 (16.22%) patients. Average time of hospitalisation was 16.13 (1-121) days. Mortality was 12/406 (2.96%). The after effect of AP in form of parapancreatic fluid reservoirs was diagnosed in 202/406 (54.59%) cases. Comparing the early phase of the study (2007-2011) and the later one (2012-2016) a shorter time of hospitalisation was proven and a lower mortality of the patients in the later phase of the study. Analysis of patients' blood tests revealed that patients with severe AP have significantly elevated levels of inflammatory parameters and amylase comparing to group with mild and moderate AP, during the first days of hospitalisation. Conclusions: The development of conservative treatment options for AP, especially in early stages of the illness, has significantly shortened the duration of hospitalisation of patients with AP at our Department.
7
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Monocyte and neutrophil direct counts correlate with C-reactive protein plasma concentration in patients with acute pancreatitis

51%
Naskalski J., Maziarz B., Kusnierz-Cabala B., Dumnicka P., Panek J.
Open Medicine
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2007
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vol. 2
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issue 1
26-36
EN
Acute pancreatitis (AP) is associated with the intensive inflammatory response in white blood cells (WBC) and C-reactive protein (CRP). This paper presents the relationship between the CRP plasma concentration and the direct counts of peripheral WBC in AP during the initial five days. The study consisted of 56 patients with AP, 36 patients with mild form of AP and 20 patients with severe form of AP. ABX VegaRetic hematological analyzer was used to perform the count of blood cells, and the immunonephelometric method was performed to measure the CRP concentration levels. AP patients presented with WBC count values in the range of 3.2 − 22.4 × 103/µl and CRP concentration levels in the range 3.3 − 599.8 mg/l. The WBC count correlates with CRP levels during the entire observation period. The relationship of CRP and WBC is expressed in the following regression equation: WBC (103/µl) = 3.66 + 1.40 × logeCRP (mg/l). The highest median neutrophil count (8.15 × 103/µl) was observed on the first day. The count decreased to 5.27 × 103/µl on the fifth day. The most substantial finding in this study involved the values found for the monocytes and CRP (r= 0.53; p<0.001). Day two and day three were the highest (r=0.59, p<0.001). On day two, the regression equation for this relationship is: Monocytes (103/µl) = −0.34 + 0.21 × logeCRP(mg/l). The correlation between direct monocyte count and plasma CRP concentration in AP reflect a CRP-dependent stimulation of IL-6 release from activated blood monocytes.
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Somatostatine analogue in nonoperative treatment of posttraumatic pancreatic pseudocyst in a child: a case report

51%
Marjanovic V., Slavkovic A., Stojanovic M., Stefanovic V., Marjanovic G., Jankovic R.
Open Medicine
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2012
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vol. 7
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issue 1
34-37
EN
Pancreatic pseudocyst is a complication of pancreatic trauma. We describe improved nonoperative treatment of patient with posttraumatic pancreatic pseudocyst with somatostatin analogue. A 9-year-old girl was admitted to our hospital after blunt abdominal trauma with handlebar. Three weeks after abdominal trauma, pancreatic pseudocyst developed. Nonoperative treatment of posttraumatic pancreatic pseudocyst (the largest dimensions 70 × 55 × 65 mm) with somatostatin analogue, octreotide acetate, was applied for the next 52 days. The patient was followed up for 24 months after the discontinuation of octreotide and there were no recurrence of pancreatic pseudocyst. Somatostatin analogue could be usefull in the nonoperative treatment of posttraumatic pancreatic pseudocysts in children.
9
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Prediction of acute pancreatitis in the earliest stages – role of biochemical parameters and histopathological changes

51%
Baj J., Radzikowska E., Maciejewski M., Dąbrowski A., Torres K.
Polish Journal of Surgery
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2017
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vol. 89(2)
31-38
EN
For many years, there has been a search for a set of biochemical parameters that could facilitate the assessment of severity, prognosis, and administration of early and appropriate treatment in acute pancreatitis. Administration of treatment within the first 48 hours since admission is associated with many problems of distinguishing patients with a mild form of acute pancreatitis (AP) from those with a severe form of acute pancreatitis. Study aim: To assess the relationship between the extent of change in the concentration of 10 selected biochemical indicators: amylase, lipase, total bilirubin, creatinine, uric acid, aspartate transaminase, alanine transaminase, glucose, magnesium, and iron and histopathological lesions in the pancreas within 2 and 6 hours since induction of AP. The selected time periods correspond to the first and the second day of the disease in people, respectively. Material and methods: The experiments were conducted in 110 male Wistar rats weighing from 250 to 300 g. Experimental animals were divided into three groups: Z – a group in which the ranges of the studied factors and histological structure were established; K – a group of animals operated on which were injected with 0.9% NaCl into the biliary-pancreatic duct; E – a group of animals operated on in which acute pancreatitis was induced by an injection of 5% sodium taurocholate into the biliary-pancreatic duct. Animals from the K and E groups were randomly assigned to one of five subgroups from which the material for biochemical and histological examinations was collected at 2 h and 6 h since the induction of AP. Whole pancreases were dissected for histological examinations, and the samples were dyed with hematoxylin and saturated alcoholic eosin solution. The degree of pancreatic lesions was assessed according to the Spormann score. Quantitative variables were characterized by arithmetic means, standard deviations, medians, minimum and maximum values, and 95% CIs. Results: In histological preparations from rats from the E group, after 2 hours, edematous lesions, neutrophilic infiltrations in the pancreatic parenchyma, together with single petechiae started to appear and were observed. After 6 hours, the lesions became more intense, and minor foci of coagulation necrosis and minor foci of purulent inflammation in the fatty tissue appeared. Within 2 hours, statistically significant differences in the amount of four markers: creatinine, ALT, amylase, and magnesium were observed. After six hours, statistically significant differences in the amount of two markers: AST and glucose were seen. The correlations between histological assessments according to the Spormann scale and biochemical indicators were investigated, and it was observed that within 2 hours the intensity of pancreatitis increased together with an increase in AST. In group K, within 6 hours, the intensity of inflammatory infiltration increased together with an increase in creatinine concentration (correlation coefficient 0.95; p=0.0138). In group E, in the period of 2 hours, lesion intensity in the form of inflammatory infiltration increased together with an increase in the AST level (correlation coefficient 0.90; p=0.0063) and an increase in the iron level (correlation coefficient 0.78; p=0.0399). In the same group and in the same period, an increase in the AST level (correlation coefficient 0.79; p=0.0343) was associated with an increase in lesion intensity in the form of ecchymoses. Inflammatory infiltration increased (correlation coefficient -0.87; p=0.0117) within 6 hours, whereas the creatinine level decreased. Interesting results were obtained with the use of regression analysis – forward stepwise regression. In the period of 2 hours, if the creatinine level increased by 1, the intensity of lesions in acute pancreatitis decreased by 9.02, according to the Spormann score, while the other variables remained at a stable level. However, if ALT level increased by 1, the intensity of lesions in acute pancreatitis increased by 0.02, according to the Spormann score; and if the amylase level increased by 1, the intensity of lesions in acute pancreatitis increased by 0.01, according to the Spormann score, while the other variables remained at a stable level. Conclusions: Histopathological lesions occurred prior to changes in laboratory test results, whereas significant correlations with Spormann scores were seen in the case of changes in AST and creatinine levels. The study results confirm the fact that diagnostics in acute pancreatitis is very difficult and requires monitoring of many laboratory parameters.
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Etiology of acute pancreatitis

51%
Gimenez T., Calvo A., Vicent J.
Open Medicine
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2014
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vol. 9
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issue 4
530-542
EN
Acute pancreatitis is a common disease with a benign course in the majority of patients, but it is associated with serious morbidity, and mortality close to 20% in up to 20% of cases. The incidence of acute pancreatitis seems to be rising in western countries. About 75% of all cases are caused by gallstones or alcoholism. The relative rate of gallstones versus alcohol as etiology depends on the age and the area of enrolment. A thorough evaluation allows cause identification in another 10% of cases, leaving about 15–20% as idiopathic. The most common causes, and a growing list of less frequent and sometimes very rare and controversial etiologies, are reviewed in this article. A classification on the pathogenic mechanisms of causes of acute pancreatitis based is used in this Review. The approach, or suggested plan of investigations, to determine the etiology of acute pancreatitis, based on the most recently published Guidelines is outlined.
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Minimally invasive techniques in the treatment of severe acute pancreatitis

51%
Poves I., Burdío F., Dorcaratto D., Grande L.
Open Medicine
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2014
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vol. 9
|
issue 4
580-587
EN
Open necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.
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Antibiotics in severe acute pancreatitis

51%
Serrablo A., Tejedor L., Martínez J.
Open Medicine
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2014
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vol. 9
|
issue 4
565-573
EN
Acute pancreatitis (AP) is a local inflammatory response with systemic effects and an adverse evolution in 20% of cases. Its mortality rate is 5–10% in sterile and 15–40% in infected pancreatic necrosis. Infection is widely accepted as the main reason of death in AP. The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret. Up to date, there is no evidence that supports the routine use of antibiotic prophylaxis in patients with severe AP. Treatment on demand seems to be the better option, avoiding excessive treatment and selection of bacterial. In infected acute pancreatitis, antibiotics of choice are imipenem, meronem or tigecycline in patients allergic to beta-lactams. Also fluconazole must be given in determinate clinical situations.
13
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Content available

Clinical and epidemiological aspects of acute pancreatitis – 10 years of single-center experience

51%
Jagielski M., Kijowski F., Fruczek M., Sternau-Kuklińska M., Janiak M., Adrych K.
European Journal of Translational and Clinical Medicine
|
2019
|
vol. 1
|
issue 2
41-52
EN
Background We can observe an increase in acute pancreatitis (AP) incidence in the recent years. Material and methods Retrospective clinical data analysis of 370 patients with AP, hospitalized between 2007 and 2016 at our Department. Results AP was diagnosed during 406 hospitalisation in 370 patients [average age 52.15 (21-93), 237(64.05%) male]. AP of high clinical severity was diagnosed in 60/370 (16.22%) patients. Average time of hospitalisation was 16.13 (1-121) days. Mortality was 12/406 (2.96%). The after effect of AP in form of parapancreatic fluid reservoirs was diagnosed in 202/406 (54.59%) cases. Comparing the early phase of the study (2007-2011) and the later one (2012-2016) a shorter time of hospitalisation was proven and a lower mortality of the patients in the later phase of the study. Analysis of patients' blood tests revealed that patients with severe AP have significantly elevated levels of inflammatory parameters and amylase comparing to group with mild and moderate AP, during the first days of hospitalisation. Conclusions The development of conservative treatment options for AP, especially in early stages of the illness, has significantly shortened the duration of hospitalisation of patients with AP at our Department.
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