Abstract Aim To evaluate the efficacy of step-up approach to infected necrotising pancreatitis. Methods Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection ...was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality. Results Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86 (68.6%) and multiorgan failure in 25/86 (29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9–47) and 15 (7–34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient. Conclusions The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients.
To evaluate the relationships between simple renal cysts and arterial hypertension and whether their evacuation decreases the blood pressure (BP).
In a cross-sectional design, we analyzed 184 study ...participants with cysts and compared hypertensive and nonhypertensive among them. Outcomes were the number, the size and the location of a cyst. In a cross-over design, we first evaluated the change in absolute value of SBP, DBP and mean BP in 62 hypertensive patients who underwent percutaneous evacuation of a cyst and then the decrease of BP as a categorical variable that comprised all study participants.
There were 55% giant renal cysts among hypertensive and 24% among nonhypertensive patients (P = 0.0001). The prevalence rates of multiple and peripheral cysts in hypertensive and nonhypertensive patients were similar to those of single and perihilar cysts, respectively. Significant differences in SBP, DBP and mean BP were found between pretreatment readings and 3 days, 1 month, 3 months and 6 months after cyst evacuation (P < 0001). The differences were significant in all hypertensive patients (P < 0.001). There were less hypertensive patients 3 days after treatment than before treatment (P < 0.0001).
An apparent association between the size of a simple renal cyst and hypertension was found, and aspiration of cysts resulted in a reduction of BP. Location and number of cysts were not related to BP.
We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology 2010.The results of their study indicate that percutaneous catheter drainage in ...combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to severe acute pancreatitis.However,there are some points that need to be addressed,including data about the patients in the study and their clinical characteristics,data about ...
To evaluate whether prolonged catheter drainage with negative pressure yields better results than single-session alcohol sclerotherapy in the treatment of symptomatic non-parasitic benign liver ...cysts. Forty patients were randomly assigned to two groups in a 24-month prospective controlled trial. One group was treated with ultrasound-guided prolonged catheter drainage with negative pressure (20 patients with 24 cysts) and the other group with single-session alcohol sclerotherapy (20 patients with 23 cysts). Patient demographics, clinical characteristics, treatment outcome, and complications were analyzed. The median volumes and 95% CI (confidence interval) for the medians and interquartile ranges of all 47 cysts before treatment and on last follow-up were: 389 ml, 143–1,127 ml, 136–1,300 ml, and 0 ml, 0–10 ml, and 0–23 ml, respectively (P<0.0001). The average volume reduction was 92.4% (range, 74.9–100%), 94.2 % (range, 74.9–100%) in the drainage and 90.2% (range, 76.9–100%) in the sclerotherapy group. Twenty-seven cysts (57.4%) disappeared completely, 16 (66.7%) in the drainage and 11 (47.8%) in the sclerotherapy group. No differences in average volume reduction, final volume and disappearance of the cysts between the groups were noted. The hospital stay was 1 day for all patients. Percutaneous treatment is safe and effective for hepatic non-parasitic cysts. Prolonged catheter drainage with negative pressure and single-session alcohol sclerotherapy had similar results.
We read with great interest the article by Vege et al published in issue 34 of World J Gastroenterol 2010. The article evaluates the ability of contrast-enhanced computerized tomography （CECT） to ...characterize the nature of peripancreatic collections found at surgery. The results of their study indicate that most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue and CECT has a limited role in differentiating various types of collections. However, there are some points that need to be addressed, including data about the stage of acute pancreatitis in which CECT was done and the time span between CECT examination and surgery.
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