Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results i...Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results in systemic inflammatory response syndrome(SIRS). If the SIRS is severe,it can lead to early multisystem organ failure(MOF). After the first 1-2 wk,a transition from a pro-inflammatory response to an anti-inflammatory response occurs;during this transition,the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue,which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However,despite the reduction in overall mortality in the last decade,SAP is still associated with high mortality. In the majority of cases,sterile necrosis should be managed conservatively,whereas in infected necrotizing pancreatitis,the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently,the step-up approach(delay,drain,and debride) may be considered as the reference standard intervention for this disorder.展开更多
Background Fluid therapy for severe acute pancreatitis （SAP） should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for...Background Fluid therapy for severe acute pancreatitis （SAP） should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP. Methods Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group （Group I, n=36） and a controlled fluid expansion group （Group II n=-40）. Hemodynamic disorders were either quickly （fluid infusion rate was 10-15 ml.kg-1-h-1, Group I） or gradually improved （fluid infusion rate was 5-10 ml-kg1.h-1, Group II） through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE II scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome （ACS）, sepsis, and survival rate were obtained. Results The two groups had statistically different （P 〈0.05） time intervals to meet fluid expansion criteria （Group I, 13.5±6.6 hours; Group II, （24.0±5.4） hours）. Blood lactate concentrations were both remarkably lower as compared to the level upon admission （P 〈0.05） and reached the normal level in both groups upon treatment. It was only at day 1 that hematocrit was significantly lower in Group I （35.6%±6.8%） than in Group II （38.5%±5.4%） （P〈0.01）. Amount of crystalloid and colloid in group I （（4028±1980）ml and （1336±816）ml） on admission day was more than those of group II （（2472±1871）ml and （970±633）ml）. No significant difference was found in the total amount of fluids within four days of admission between the two groups （P〉0.05）. Total amount of fluid sequestration within 4 days was higher in Group I （（5378±2751）ml�展开更多
Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with N...Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed. Results Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0–7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion;and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention;and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0–6.0) months. Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.展开更多
AIM To explore the kinetic changes in plasma D(-)- lactate and lipopolyssccharide(LPS)levels,and investigate whether D(-)-lactate could be used as a marker of intestinal injury in rats following gut ischemia/ reperfus...AIM To explore the kinetic changes in plasma D(-)- lactate and lipopolyssccharide(LPS)levels,and investigate whether D(-)-lactate could be used as a marker of intestinal injury in rats following gut ischemia/ reperfusion,burn,and acute necrotizing pancreatitis (ANP). METHODS Three models were developed in rats:① gut ischemia/ reperfusion obtained by one hour of superior mesenteric artery occlusion followed by reperfusion;② severe burn injury created by 30% of total body surface area(TBSA)full-thickness scald burn;and ③ ANP induced by continuous inverse infusion of sodium taurocholate and trypsin into main pancreatic duct. Plasma levels of D(-)-lactate in systemic circulation and LPS in portal circulation were measured by enzymatic- spectrophotometric method and limulus amebocyte lysate (LAL)test kit,respectively.Tissue samples of intestine were taken for histological analysis. RESULTS One hour gut ischemia followed by reperfusion injuries resulted in a significant elevation in plasma D(-)- lactate and LPS levels,and there was a significant correlation between the plasma D(-)-lactate and LPS(r =0.719,P<0.05).The plasma concentrations of D(-)- lactate and LPS increased significantly at 6h postburn, and there was also a remarkable correlation between them (r = 0.877,P < 0.01).D(-)-lactate and LPS levels elevated significantly at 2h after ANP,with a similar significant correlation between the two levels(r = 0.798, P < 0.01 ).The desquamation of intestine villi and infiltration of inflammatory cells in the lamina propria were observed in all groups. CONCLUSION The changes of plasma D(-)-lactate levels in systemic blood paralleled with LPS levels in the portal vein blood.The measurement of plasma D(-)-lactate level may be a useful marker to assess the intestinal injury and to monitor an increase of intestinal permeability and endotoxemia following severe injuries in early stage.展开更多
Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consu...Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.展开更多
Background Traditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis. We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome ...Background Traditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis. We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome in patients with severe acute pancreatitis （SAP）. Methods Forty patients with sustained SAP that required admission to the surgical intensive care unit were enrolled prospectively in the study. All of these patients were divided randomly into the Dachengqi decoction group （n=-20） and control group （n=-20） on admission. Intestinal permeability was assessed by measuring absorption of two metabolically inert markers, lactulose （L） and mannitol （M）, which were administered orally. Serum concentrations of endotoxin （lipopolysaccharide, LPS） and the ratio of lactulose to mannitol in urine （L/M） were detected in all patients. Results Compared with those in the control group, urinary L/M ratio decreased significantly in the Dachengqi decoction group on the 7th day after admission （P=0.001）. Also, serum concentrations of LPS were reduced on the 5th and 7th day after admission （P=-0.006, P=0.008, respectively）. Incidence of multiple organ dysfunction syndrome （MODS） and pancreatic infection was significantly lower in the Dachengqi decoction group compared with those in the control group （P=-0.038, P=-0.025, respectively）. Conclusion Dachengqi decoction may promote the recovery of intestinal mucosal permeability and decrease the incidence of MODS and pancreatic infection in patients with SAP.展开更多
Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones...Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undertaken. Treatment of sterile necrosis should initially be non-operative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB,and the role of enteral feeding.展开更多
To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP) Methods Thirteen ANP patients were involved in this study, includin...To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP) Methods Thirteen ANP patients were involved in this study, including 4 females and 9 ma les, averaging 50 6±10 8 years old CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8 9±2 1 CVVH was maintained for at least 72 hours and the AN69 hemofilter (1 2 m 2) was changed every 24 hours The ultrafiltration rate during CVVH was 2993 9±983 0 m l/h, the blood flow rate was 250-300 ml/min, and the substitute fluid was infused in a pre-diluted manner Low molecular weight heparin was used as anticoagulant Results CVVH was well tolerated in all the patients Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed Two patients died of systemic fungal infections and another died o f intracranial fungi infection, resulting in an ICU mortality of 23 1% Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge The APACHE Ⅱ score before CVVH was 15 2±6 5, but decreased significantly to 8 1±5 3, 7 5±4 9 and 8 0±5 2 at the 24th, 48th and 72nd hour after CVVH, respectively (P<0 01) Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later After CVVH had ceased, the serum levels of two cytokines i ncreased to their peaks at the 120th hour and decreased eventually at the 144th hour The sieving coefficient (SC) of IL-1β and TNFα was 0 33±0 11 and 0 16±0 08 Conclusion CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1β and TNFα; CVVH at early stages of SAP may contribute to the improvement of outcome展开更多
AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis...AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS:Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION:Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis.Large bore drainages did not prove to be more effective in controlling the septic focus.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic... Endoscopic retrograde cholangiopancreatography(ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration.However,adoption of these prophylactic maneuvers by endoscopists is not uniform.In this editorial we discuss the beneficial effects of the aforementioned maneuvers.展开更多
文摘Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results in systemic inflammatory response syndrome(SIRS). If the SIRS is severe,it can lead to early multisystem organ failure(MOF). After the first 1-2 wk,a transition from a pro-inflammatory response to an anti-inflammatory response occurs;during this transition,the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue,which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However,despite the reduction in overall mortality in the last decade,SAP is still associated with high mortality. In the majority of cases,sterile necrosis should be managed conservatively,whereas in infected necrotizing pancreatitis,the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently,the step-up approach(delay,drain,and debride) may be considered as the reference standard intervention for this disorder.
文摘Background Fluid therapy for severe acute pancreatitis （SAP） should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP. Methods Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group （Group I, n=36） and a controlled fluid expansion group （Group II n=-40）. Hemodynamic disorders were either quickly （fluid infusion rate was 10-15 ml.kg-1-h-1, Group I） or gradually improved （fluid infusion rate was 5-10 ml-kg1.h-1, Group II） through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE II scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome （ACS）, sepsis, and survival rate were obtained. Results The two groups had statistically different （P 〈0.05） time intervals to meet fluid expansion criteria （Group I, 13.5±6.6 hours; Group II, （24.0±5.4） hours）. Blood lactate concentrations were both remarkably lower as compared to the level upon admission （P 〈0.05） and reached the normal level in both groups upon treatment. It was only at day 1 that hematocrit was significantly lower in Group I （35.6%±6.8%） than in Group II （38.5%±5.4%） （P〈0.01）. Amount of crystalloid and colloid in group I （（4028±1980）ml and （1336±816）ml） on admission day was more than those of group II （（2472±1871）ml and （970±633）ml）. No significant difference was found in the total amount of fluids within four days of admission between the two groups （P〉0.05）. Total amount of fluid sequestration within 4 days was higher in Group I （（5378±2751）ml�
基金This work was partially supported by Grants from Zheji-ang Province Natural Science Foundation of China(LY17H100004,LY18H100002)Social Development Program of Science Technology Department of Zhejiang Province(2015C33127)the Key Projects of Zhejiang Medicine and Health Research Fund(no.2018268955).
文摘Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed. Results Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0–7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion;and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention;and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0–6.0) months. Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.
基金the Fund for National Outstanding Young Researchers of China
文摘AIM To explore the kinetic changes in plasma D(-)- lactate and lipopolyssccharide(LPS)levels,and investigate whether D(-)-lactate could be used as a marker of intestinal injury in rats following gut ischemia/ reperfusion,burn,and acute necrotizing pancreatitis (ANP). METHODS Three models were developed in rats:① gut ischemia/ reperfusion obtained by one hour of superior mesenteric artery occlusion followed by reperfusion;② severe burn injury created by 30% of total body surface area(TBSA)full-thickness scald burn;and ③ ANP induced by continuous inverse infusion of sodium taurocholate and trypsin into main pancreatic duct. Plasma levels of D(-)-lactate in systemic circulation and LPS in portal circulation were measured by enzymatic- spectrophotometric method and limulus amebocyte lysate (LAL)test kit,respectively.Tissue samples of intestine were taken for histological analysis. RESULTS One hour gut ischemia followed by reperfusion injuries resulted in a significant elevation in plasma D(-)- lactate and LPS levels,and there was a significant correlation between the plasma D(-)-lactate and LPS(r =0.719,P<0.05).The plasma concentrations of D(-)- lactate and LPS increased significantly at 6h postburn, and there was also a remarkable correlation between them (r = 0.877,P < 0.01).D(-)-lactate and LPS levels elevated significantly at 2h after ANP,with a similar significant correlation between the two levels(r = 0.798, P < 0.01 ).The desquamation of intestine villi and infiltration of inflammatory cells in the lamina propria were observed in all groups. CONCLUSION The changes of plasma D(-)-lactate levels in systemic blood paralleled with LPS levels in the portal vein blood.The measurement of plasma D(-)-lactate level may be a useful marker to assess the intestinal injury and to monitor an increase of intestinal permeability and endotoxemia following severe injuries in early stage.
文摘Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.
文摘Background Traditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis. We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome in patients with severe acute pancreatitis （SAP）. Methods Forty patients with sustained SAP that required admission to the surgical intensive care unit were enrolled prospectively in the study. All of these patients were divided randomly into the Dachengqi decoction group （n=-20） and control group （n=-20） on admission. Intestinal permeability was assessed by measuring absorption of two metabolically inert markers, lactulose （L） and mannitol （M）, which were administered orally. Serum concentrations of endotoxin （lipopolysaccharide, LPS） and the ratio of lactulose to mannitol in urine （L/M） were detected in all patients. Results Compared with those in the control group, urinary L/M ratio decreased significantly in the Dachengqi decoction group on the 7th day after admission （P=0.001）. Also, serum concentrations of LPS were reduced on the 5th and 7th day after admission （P=-0.006, P=0.008, respectively）. Incidence of multiple organ dysfunction syndrome （MODS） and pancreatic infection was significantly lower in the Dachengqi decoction group compared with those in the control group （P=-0.038, P=-0.025, respectively）. Conclusion Dachengqi decoction may promote the recovery of intestinal mucosal permeability and decrease the incidence of MODS and pancreatic infection in patients with SAP.
文摘Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undertaken. Treatment of sterile necrosis should initially be non-operative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB,and the role of enteral feeding.
文摘To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP) Methods Thirteen ANP patients were involved in this study, including 4 females and 9 ma les, averaging 50 6±10 8 years old CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8 9±2 1 CVVH was maintained for at least 72 hours and the AN69 hemofilter (1 2 m 2) was changed every 24 hours The ultrafiltration rate during CVVH was 2993 9±983 0 m l/h, the blood flow rate was 250-300 ml/min, and the substitute fluid was infused in a pre-diluted manner Low molecular weight heparin was used as anticoagulant Results CVVH was well tolerated in all the patients Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed Two patients died of systemic fungal infections and another died o f intracranial fungi infection, resulting in an ICU mortality of 23 1% Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge The APACHE Ⅱ score before CVVH was 15 2±6 5, but decreased significantly to 8 1±5 3, 7 5±4 9 and 8 0±5 2 at the 24th, 48th and 72nd hour after CVVH, respectively (P<0 01) Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later After CVVH had ceased, the serum levels of two cytokines i ncreased to their peaks at the 120th hour and decreased eventually at the 144th hour The sieving coefficient (SC) of IL-1β and TNFα was 0 33±0 11 and 0 16±0 08 Conclusion CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1β and TNFα; CVVH at early stages of SAP may contribute to the improvement of outcome
文摘AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS:Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION:Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis.Large bore drainages did not prove to be more effective in controlling the septic focus.
文摘 Endoscopic retrograde cholangiopancreatography(ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration.However,adoption of these prophylactic maneuvers by endoscopists is not uniform.In this editorial we discuss the beneficial effects of the aforementioned maneuvers.
