Acute pancreatitis (AP) is a disease with significant morbidity and mortality. The aim of this study was to evaluate the predictive role of inflammatory markers, particularly interleukins (ILs), in ...the course of AP and to determine the frequency of etiologic factors of AP. We included patients with AP who were treated at our institution from May 1, 2012 to January 31, 2015. Different laboratory parameters, including ILs, and the severity scoring systems Ranson's criteria and Bedside Index of Severity in Acute Pancreatitis (BISAP) were analyzed. AP was classified into mild and severe, and independent parameters were compared between these groups. The predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). A binomial logistic regression was performed to evaluate Ranson's criteria and IL6, IL8, and IL10 (at admission and after 48 hours) in the course of AP. Overall, 96 patients were treated, 59 (61.5%) males and 37 (38.5%) females, average age 62.5 ± 16.8 years (range 22-91 years). The best predictor for the severity of AP was IL6, measured 48 hours after admission (AUC = 0.84). Other useful predictors of the severity of AP were lactate dehydrogenase (p < 0.001), serum glucose (p < 0.006), and difference in the platelet count (p < 0.001) between admission and after 48 hours (p < 0.001), hemoglobin (p < 0.027) and erythrocytes (p < 0.029). The major causes of AP were gallstones and alcohol consumption. According to our results, IL6 and Ranson score are important predictors of the severity of AP.
Izhodišča in namen raziskave: Akutni pankreatitis (AP) je akutno vnetje tkiva trebušne slinavke. Prizadene tako bližnje kot oddaljene organe, lahko poteka kot blago vnetje ali kot hudo, z zapleti, ko ...je potrebno intenzivno zdravljenje. Namen raziskave je bil opredeliti etiologijo obolenja s slikovnimi metodami, vključno z endosonografijo, napovedati potek bolezni z vnetnimi pokazatelji, določitvijo interlevkinov (IL) IL-6, IL-8, IL-10 ter uporabo napovednih točkovnih sistemov. Bolniki in metode: V raziskavo smo vključili bolnike, ki smo jih zdravili zaradi akutnega vnetja trebušne slinavke v obdobju od maja 2012 do januarja 2015 in so izpolnjevali vključitvene kriterije: značilno klinično sliko, trikratni porast aktivnosti serumske amilaze/lipaze in/ali potrditev s slikovnimi preiskavami. Raziskavo je odobrila Komisija Republike Slovenije za medicinsko etiko (št. 36/11/09). Bolnikom smo v prvih 24-tih urah po sprejemu in nato čez 48 ur odvzeli dodatne krvne vzorce za določitev interlevkinov ter razširjene laboratorijske preiskave. Zdravljenje je potekalo v skladu s smernicami in priporočili slovenskega gastroenterološkega združenja ter mednarodnih zdravniških združenj (ESGE, AGA). Opravljena je bila statistična analiza in inteligentna analiza podatkov s tvorjenjem napovednega modela. Rezultati: V končno analizo smo uvrstili 117 bolnikov, prevladovali so moški, v 59 % (69/117), žensk pa je bilo 41 % (48/117). Povprečna starost bolnikov je bila 62,5 let, v razponu 22-91 let, SD 15,4 let. Žolčni kamni so bili najpogostejši vzrok za akutni pankreatitis, v 56 %; alkohol v 33 % in v 14 % ostali vzroki. Po Ransonovem točkovanju in BISAP lestvici je večina bolnikov (81 %) sodila v skupino z blagim potekom vnetja, pri ostalih (19 %) pa je bil potek težji. Le trije bolniki, 2,5 % (3/117) so umrli zaradi večorganske odpovedi. Razvoj psevdociste smo potrdili pri 11 % bolnikov. Pred ERCP smo vsem bolnikom endosonografsko potrdili holedoholitiazo. V analizi smo ugotavljali največjo napovedno vrednost IL-6 ob sprejemu AUC 0.782, pri mejni vrednosti IL-6 = 70.05 je občutljivost 0.80 in specifičnost 0.701, ob kontroli je AUC 0.835, pri mejni vrednosti IL-6 = 35.1 je občutljivost 0.867 in specifičnost 0.75. Ob primerjavi količnika IL-6/IL-10 ob sprejemu, in količnika IL-6/IL-10 ob kontroli, ima višjo napovedno vrednost količnik ob kontroli, AUC = 0.789. Pri mejni vrednosti količnika 7.2, je občutljivost 0.667 in specifičnost 0.663. Zaključek: Kljub sodobnim postopkom zdravljenja, imajo bolniki s hudo potekajočim AP, še vedno pomembno število zapletov. Žolčni kamni in alkohol sta najpogostejši vzroka AP v skupini naših bolnikov. V naši raziskavi smo potrdili vrednost določanja IL-6, IL-8 in IL-10 ob sprejemu in kontroli za napoved poteka bolezni, endosonografija pa je učinkovita slikovna metoda za pojasnitev etiologije. Z napovednimi modeli lažje napovemo potek AP, še posebej ob podpori s sodobnimi laboratorijskimi metodami in endoskopsko-radiološkimi slikovnimi preiskavami.
Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of ...the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient's anatomy and physiology.
BACKGROUND Acute pancreatitis is a disease with variable involvement of peripancreatic tissue anddistal organs. Approximately 80 % of patients have mild form of the disease, edematouspancreatitis, ...while 15–20 % of patient develop necrotising pancreatitis with variouscomplications. The aim of the study was to determine the etiology of the disease and toevaluate treatment in a prospective, cohort study.Patients and Enrolled were patients with acute pancreatitis treated in the period from January 1, 2005methods to October 30, 2007. The diagnosis of was based on characteristic clinical signs andsymptoms, three-fold elevation of serum amylase/lipase level and positive evidence inimaging studies. RESULTS In the study were included 121 patients, av. age 55.6 years, SD ± 16.9. The majority of themwere men, 60 % (72/121), female 40 % (49/121). The predominant etiology was identifiedas gallstones in 52 % and alcohol in 18 %. In 14 % of patients the etiology of the diseasecould not be identified. According to Ranson criteria, the majority of patients, 84.3 % had amild form of acute pancreatitis, while 15.7 had a severe form of this disease. The treatmentwas not successful in 4/121 patients, 3.3 % of patients died due to multiorgan failure. In3 patients, 2.5 % a complication, a pseudocyst of the gland formed. CONCLUSIONS Modern treatment of patients with acute pancreatitis has significantly reduced thecomplication rate and improved the outcome. Among our patients gallstones are the mostimportant cause of acute pancreatitis followed by alcohol abuse
Slovenska priporočila za obravnavo bolnikov z kronično odpovedjo prebavil so povzeta so po smernicah Evropskega združenja za klinično prehrano in metabolizem (angl. ESPEN; European Society for ...Clinical Nutrition and Metabolism) in prilagojena slovenskim izkušnjah zdravljenja odpovedi prebavil. Pretežni del bolnikov z odpovedjo prebavil predstavljajo bolniki s sindromom kratkega črevesa (SKČ), zato je poudarek priporočil na diagnostiki, obravnavi in zdravljenju bolnikov s SKČ. Namen priporočil je vzpostavitev bolj učinkovite prepoznave in obravnave bolnikov z odpovedjo ter vzpostavitvi temeljnih strokovnih izhodišč za zdravljenje teh bolnikov v Sloveniji. Dejavnost zdravljenja kronične odpovedi prebavil z parenteralno prehrano na domu pri odrasli pacientih je bila v Sloveniji formalno vzpostavljena leta 2008, v 13 letih smo zdravili več kot 230 pacientov, v začetku leta 2021 je v 2 centrih (OI Ljubljana, UKC Ljubljana) v zdravljenje vključeno 95 odraslih bolnikov. Pred 6 leti Smo paciente v programu zdravljenja odpovedi prebavil v okviru OI LjubljanA vključili v evropski register premljanja bolnikov na Parenteralni prehrani na domu (PPD), v okviru ESPEN.
Background: Patients with esophageal cancer have still poor prognosis independent of form of therapy. Endoscopic ultrasonography is an excellent diagnostic tool in staging carcinoma for selecting ...proper therapeutically approach.Patients and methods: From January 2002 till June 2005 in 28 patients with oesophageal cancer, endoscopic ultrasound and computed tomography of the chest was performed. The purpose of the study was to compare the assesment of esophageal cancer with surgical and histopathologic findings using TNM classification.Results: Among our patients, 12 (42.9 %) have been treated surgically and 3 (10.7 %) with radiotherapy or neoadjuvant therapy, one patient (3.6 %) refused surgical treatment. Due to advanced disease or other comorbid conditions 12 patients (42.9 %) could not be treated operatively. For 6 patients (21.5 %) surgical treatment was successful and radical, but for 6 (21.5 %) of them just palliative therapy was possible. In 4 patients (14.3 %) we underestimated T-stage. In 10 patients (35.7 %) oesophagus could not be traversed due to advanced malignant stenosis. Accuracy of endosonography and computed tomography for T-staging was 67 %, for N-staging 67 % for endoscopic ultrasound.Conclusions: Endosonography is a accurate imaging method for esophageal cancer staging. The results of our analysis have shown that the disease was confirmed in advanced stage in a significant proportion of patients and that malignant stenosis could not be traversed with the conventional endosonographic instrument.
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