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.
Instructions for administering some drugs and indications for their use raise certain dilemmas and controversies questioning the appropriateness of the treatment in this way. In this article, some ...controversies regarding the prescribing of statins in patients whose blood cholesterol level is normal and the use of anticoagulants in the elderly patients without blood clots prior to the treatment are described. Also, it is discussed about some controversies regarding the use of the insulin analogues in the treatment of patients with diabetes mellitus.
The purpose of this study was to determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration in the management of liver abscess.
Sixty ...patients with pyogenic liver abscess were randomly assigned to two groups in a prospective study. Antibiotics were administered for 10 days, starting the day of the beginning of percutaneous treatment. One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration. Percutaneous needle aspiration was attempted a maximum of three times. Lack of response to the third aspiration was considered failure of treatment; these patients were treated with PCD but were not included in the PCD group for analysis. Patient demographics, duration of hospital stay, treatment outcome, and complications were analyzed.
Percutaneous needle aspiration was successful in 20 (67%) of the 30 patients after one (n = 12), two (n = 7), or three (n = 1) aspirations. PCD was curative in all 30 patients after one (n = 24) or two (n = 6) procedures. All abscesses 50 mm or less in longest diameter were successfully managed, 10 by percutaneous needle aspiration and 12 by PCD. None of patients in the percutaneous needle aspiration group with multiloculated abscesses (n = 5) was successfully treated. Hospital stay did not differ significantly between the groups. There were no complications related to the procedure.
PCD is more effective than percutaneous needle aspiration in the management of liver abscess. Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller.
In recent years, academic advancement and access to funds that stimulate scientific research have been conditioned by the scientific production of individual scientists as well as the production of ...scientific centers, institutes and universities. This has led to an increase in interest in the accelerated assessment and ranking of scientists and scientific institutions. Scientometry is a sub-discipline of information sciences that measures achievement in science. This book provides the reader with a detailed insight into relevant scientometric methods and criteria, their individual strengths and weaknesses in the process of ranking scientists, scientific centers and institutions, as well as their application to the process of planning scientific projects and isolated medical specialties.
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•This criterion removes discrepancies in evaluating scientific production of scientists.•Overall scientific score is the sum of Author Score and Author Citation Score.•Preventing ...discrimination in assessment of new publications.•Discourages expansion of author lists by authors whose contribution is minor or none.
It is generally accepted that the scientific impact factor (Web of Science) and the total number of citations of the articles published in a journal, are the most relevant parameters of the journal's significance. However, the significance of scientists is much more complicated to establish and the value of their scientific production cannot be directly reflected by the importance of the journals in which their articles are published. Evaluating the significance of scientists' accomplishments involves more complicated metrics than just their publication records. Based on a long term of academic experience, the author proposes objective criteria to estimate the scientific merit of an individual's publication record. This metric can serve as a pragmatic tool and the nidus for discussion within the readership of this journal.
Background Selection of patients with the highest probability for therapeutic ERCP remains an important task in a clinical workup of patients with suspected choledocholithiasis (CDL). Objective To ...determine whether an artificial neural network (ANN) model can improve the accuracy of selecting patients with a high probability of undergoing therapeutic ERCP among those with strong clinical suspicion of CDL and to compare it with our previously reported prediction model. Design Prospective, observational study. Setting Single, tertiary-care endoscopy center. Patients Between January 2010 and September 2012, we prospectively recruited 291 consecutive patients who underwent ERCP after being referred to our center with firm suspicion for CDL. Interventions Predictive scores for CDL based on a multivariate logistic regression model and ANN model. Main Outcome Measurements The presence of common bile duct stones confirmed by ERCP. Results There were 80.4% of patients with positive findings on ERCP. The area under the receiver-operating characteristic curve for our previously established multivariate logistic regression model was 0.787 (95% CI, 0.720-0.854; P < .001), whereas area under the curve for the ANN model was 0.884 (95% CI, 0.831-0.938; P < .001). The ANN model correctly classified 92.3% of patients with positive findings on ERCP and 69.6% patients with negative findings on ERCP. Limitations Only those variables believed to be related to the outcome of interest were included. The majority of patients in our sample had positive findings on ERCP. Conclusions An ANN model has better discriminant ability and accuracy than a multivariate logistic regression model in selecting patients for therapeutic ERCP.
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