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Acute Pancreatitis

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81. Acute pancreatitis: sometimes caused by medication

Acute pancreatitis: sometimes caused by medication Prescrire IN ENGLISH - Spotlight ''Acute pancreatitis: sometimes caused by medication'', 1 April 2014 {1} {1} {1} | | > > > Acute pancreatitis: sometimes caused by medication Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight Acute pancreatitis: sometimes caused by medication Many drugs expose (...) patients to sometimes severe damage to the pancreas. Acute pancreatitis generally causes severe abdominal pain, nausea and vomiting. Most patients recover with no local or general complications and without a recurrence. However, in some patients, necrosis of the pancreas or the surrounding tissue occurs, with sometimes fatal local and general complications. Treatment is chiefly of the symptoms, for lack of anything better. The most frequent known causes of acute pancreatitis are gallstones

2014 Prescrire

82. Fluid therapy in acute pancreatitis: anybody's guess Full Text available with Trip Pro

Fluid therapy in acute pancreatitis: anybody's guess Fluid therapy in acute pancreatitis: anybody's guess Fluid therapy in acute pancreatitis: anybody's guess Haydock MD, Mittal A, Wilms HR, Phillips A, Petrov MS, Windsor JA CRD summary The review concluded that fluid therapy is considered a cornerstone of the early management of patients with acute pancreatitis and yet the evidence on which it is based remains paltry and of poor quality. These conclusions are likely to be reliable. Authors (...) ' objectives To evaluate the effectiveness of fluid therapy for acute pancreatitis. Searching MEDLINE, EMBASE and The Cochrane Library were searched from 1990. There were no language restrictions. Search terms were reported but the most recent search dates were not. Reference lists of relevant publications were searched. Study selection Randomised or observational studies of fluid therapy in patients with acute pancreatitis were eligible for the review. Normal saline, hydroxyethyl starch, Ringer's lactate

2014 DARE.

83. PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial. Full Text available with Trip Pro

PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial. Differentiating infection from inflammation in acute pancreatitis is difficult, leading to overuse of antibiotics. Procalcitonin (PCT) measurement is a means of distinguishing infection from inflammation as levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment. Algorithms based on PCT (...) measurement can differentiate bacterial sepsis from a systemic inflammatory response. The PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP) trial tests the hypothesis that a PCT-based algorithm to guide initiation, continuation and discontinuation of antibiotics will lead to reduced antibiotic use in patients with acute pancreatitis and without an adverse effect on outcome.This is a single-centre, randomised, controlled, single-blind, two-arm pragmatic clinical and cost

2019 Trials Controlled trial quality: predicted high

84. Effects of euphorbia kansui on the serum levels of IL-6, TNF-α, NF-κB, sTNFR and IL-8 in patients with severe acute pancreatitis. (Abstract)

Effects of euphorbia kansui on the serum levels of IL-6, TNF-α, NF-κB, sTNFR and IL-8 in patients with severe acute pancreatitis. In this study, effects of euphorbia kansui on serum levels of inflammatory factors in patients with severe acute pancreatitis were investigated, and the mechanisms underlying the role of Euphorbia kansui in the treatment of severe acute pancreatitis were discussed. 36 patients hospitalized in the Third Affiliated Hospital of Wenzhou Medical University from March (...) 2017 to May 2018 due to severe acute pancreatitis were selected and divided into two groups using a randomized grouping method. ELISA (enzyme-linked immunosorbent assay) was used to detect expressions of various inflammatory cytokines, such as tumor necrosis factor α (TNF-α), soluble TNF receptors (sTNFR), nuclear factor-κB (NF-κB), interleukin-6 (IL-6), and interleukin-8 (IL-8), in the serum of patients at different time points. The results showed no significant difference between the two groups

2019 Journal of biological regulators and homeostatic agents Controlled trial quality: uncertain

85. Comparison of the Preference of Nutritional Support for Patients With Severe Acute Pancreatitis. (Abstract)

Comparison of the Preference of Nutritional Support for Patients With Severe Acute Pancreatitis. This study aimed to compare the preference of different methods of nutritional support for patients with severe acute pancreatitis (SAP). Patients with SAP were divided into the enteral nutrition group (EN group, 16 cases), total the parenteral nutrition group (TPN group, 14 cases), and the enteral plus total parenteral nutrition group (EN+TPN group, 15 cases). At 7 days after admisson, TPN and EN (...) +TPN groups showed significantly increased Ranson scores compared with the EN group (p < .05). At 14 and 21 days after admisson, TPN and EN+TPN groups exhibited significantly increased Acute Physology and Chronic Health Evaluation (APACHE) II scores, Ranson scores, and intra-abdominal pressure compared with the EN group (p < .05 or p < .01). The incidences of multiple organ dysfunction syndrome and its complication in the EN group were significantly lower than the TPN and EN+TPN groups (p < .05

2019 Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates Controlled trial quality: uncertain

86. Prevention of Infectious Complications in Acute Pancreatitis: Results of a Single-Center, Randomized, Controlled Trial. (Abstract)

Prevention of Infectious Complications in Acute Pancreatitis: Results of a Single-Center, Randomized, Controlled Trial. This study aimed to investigate the efficiency of imipenem to prevent infectious complications in predicted severe acute pancreatitis (AP).Consecutive AP patients were randomized to imipenem 3 × 500 mg intravenously daily or an identical placebo. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant (...) antibiotic treatment, pregnancy, and patients younger than 18 years. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection, positive blood cultures, sepsis, and other infections were assessed as the primary outcome. Secondary outcomes included mortality, persistent organ failure, systemic inflammatory response syndrome, local complications, serious adverse events, and need for surgical intervention.Forty-nine patients were randomized to each group. Infectious

2019 Pancreas Controlled trial quality: predicted high

87. Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. Full Text available with Trip Pro

Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. Systemic alterations in coagulation are associated with complications of acute pancreatitis (AP). D-dimer, a fibrin degradation product, was recently described as a marker of pancreatitis outcome. Early prediction is essential for reducing mortality in AP. The present study aims to assess the relationship between elevated serum D-dimer levels and the severity of AP.We performed an observational retrospective (...) levels > 2.5 mg/L (934 patients had mild AP (MAP); 1086, moderately severe AP (MSAP); and 458, severe AP (SAP)). Patients with D-dimer levels > 2.5 mg/L (n = 1205) had higher incidences of SAP (75.5% vs. 24.5%), acute peripancreatic fluid collection (APFC) (53.3% vs. 46.7%), acute necrotic collection (ANC) (72.4% vs. 27.6%), pancreatic necrosis (PN) (65.2% vs. 34.8%), infected pancreatic necrosis (IPN) (77.7% vs. 22.8%), organ failure (OF) (68.5% vs. 31.5%), persistent organ failure (POF) (75.5% vs

2019 BMC Gastroenterology

88. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Full Text available with Trip Pro

Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure (...) severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores.Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group

2019 Medicine

89. Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase: A case report. Full Text available with Trip Pro

Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase: A case report. Acute pancreatitis is an inflammatory disorder of the pancreas, and its correct diagnosis is an area of interest for clinicians. In accordance with the revised Atlanta classification, acute pancreatitis can be diagnosed if at least 2 of the following 3 criteria are fulfilled: abdominal pain; serum lipase (or amylase) activity at least 3 times the upper limit of normal; or characteristic findings (...) of acute pancreatitis on contrast-enhanced computed tomography (CT) or, less often, magnetic resonance imaging or transabdominal ultrasonography. Diagnostic imaging is essential in patients with no or slight enzyme elevation. If enzymes are normal in cases with abdominal distension, there is clinical doubt about the diagnosis of acute pancreatitis, so an early CT scan should be obtained and other life-threatening disorders excluded.A 50-year-old male presented with a 1-day history of abdominal bloating

2019 Medicine

90. New insights into acute pancreatitis. (Abstract)

New insights into acute pancreatitis. The incidence of acute pancreatitis continues to increase worldwide, and it is one of the most common gastrointestinal causes for hospital admission in the USA. In the past decade, substantial advancements have been made in our understanding of the pathophysiological mechanisms of acute pancreatitis. Studies have elucidated mechanisms of calcium-mediated acinar cell injury and death and the importance of store-operated calcium entry channels (...) to classify the severity of acute pancreatitis into prognostically meaningful groups, and several landmark clinical trials have informed management strategies in areas of nutritional support and interventions for infected pancreatic necrosis that have resulted in important changes to acute pancreatitis management paradigms. In this Review, we provide a summary of recent advances in acute pancreatitis with a special emphasis on pathophysiological mechanisms and clinical management of the disorder.

2019 Nature reviews. Gastroenterology & hepatology

91. Pharmacologic management and prevention of acute pancreatitis. (Abstract)

Pharmacologic management and prevention of acute pancreatitis. The present article will focus in pharmacologic agents that have been studied to improve acute pancreatitis outcomes, and to prevent the disease at different levels.Too little and too much early fluid resuscitation can be harmful. The optimal volume, rate, and duration of intravenous fluid therapy is still unknown. Nonopioid analgesics should be the first line of analgesia in patients with acute pancreatitis. A few pharmacologic (...) agents evaluated in acute pancreatitis have resulted in positive pilot trials; however, larger randomized clinical trials (RCTs) are needed before final conclusions. Statin use is associated with lower incidence of acute pancreatitis in the general population and ongoing studies are evaluating its preventive role in acute pancreatitis recurrences. The preventive role of rectal indomethacin in post-endoscopic retrograde cholangiopancreatography pancreatitis is indisputable, with subject selection

2019 Current opinion in gastroenterology

92. Acute pancreatitis and vasoplegic shock associated with leptospirosis - a case report and review of the literature. Full Text available with Trip Pro

Acute pancreatitis and vasoplegic shock associated with leptospirosis - a case report and review of the literature. Leptospirosis or Weil's disease is caused by pathogenic spirochete bacteria called Leptospira. It is considered the most common zoonosis in the world and is usually transmitted by urine of rodents and dogs with an incubation time of 7-14 days. The clinical spectrum ranges from a subclinical infection to a fulminant septic course.Here, we report the case of a German patient (...) with acute pancreatitis associated with Leptospira interrogans causing fulminant septic shock. The patient was successfully treated with intravenous antibiotics and left the hospital fully recovered after 18 days.To our knowledge, this is the first case of leptospirosis with acute pancreatitis as the leading clinical manifestation in Central Europe. Serologic and molecular genetic tests for leptospirosis should be considered, if no other causes for pancreatitis can be identified.

2019 BMC Infectious Diseases

93. MMP-2 and MMP-9 gene polymorphisms act as biological indicators for ulinastatin efficacy in patients with severe acute pancreatitis. Full Text available with Trip Pro

MMP-2 and MMP-9 gene polymorphisms act as biological indicators for ulinastatin efficacy in patients with severe acute pancreatitis. Severe acute pancreatitis (SAP) is a severe form of inflammatory disease with a high mortality rate. Ulinastatin, as a urinary trypsin inhibitor (UTI), is a glycoprotein playing a critical role in SAP. Consequently, we identified the hypothesis that both matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) gene polymorphisms might promote

2019 Medicine

94. Prediction of mortality and organ failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis: A retrospective study. Full Text available with Trip Pro

Prediction of mortality and organ failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis: A retrospective study. This study explored the predictive value of coagulation and fibrinolysis markers with acute pancreatitis (AP)-related mortality and organ failure.We retrospectively reviewed and analyzed coagulation and fibrinolysis markers and clinical outcomes of the patients with AP.A total of 273 patients with AP were enrolled, 7 patients died and 28 patients (...) , 3 seconds, 0.5 g/L, 3 mg/L FEU, 5 mg/L and 10%, respectively. The risk of mortality can increase up to 1.62, 5.17, and 5.60 fold for every 10 × 10/L, 2 seconds and 5 seconds of increase in platelet, PT and APTT, respectively. There is approximate 2-fold increase in risk of organ failure for every 2 seconds of TT increase. In receiver operating characteristic analysis, there is no difference in the predictive power of bedside index for severity in acute pancreatitis (BISAP) with them in mortality

2019 Medicine

95. Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor: A case report. Full Text available with Trip Pro

Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor: A case report. Acute lymphoblastic leukemia (ALL) is a malignant disease originating from abnormal proliferation of B or T lymphocytes in bone marrow (BM). Invasion of the pancreas is extremely rare in adults.In this article, we report a case presenting that ALL invades the pancreas, as well as liver, kidney, and duodenum detected by magnetic resonance image. The patient was misdiagnosed (...) as pancreatic tumor at initial since hemogram was unremarkable.The diagnosis of ALL was established based on the endoscopic ultrasonography-guided fine-needle aspiration and bone marrow examination, showing BCR/ABL gene positive.The patient was actively treated with chemotherapy. Hematological remission was obtained and the lesions in the pancreas disappeared.The patient finally died of complication from fungal pneumonia and central nervous system involvement 12 months after diagnosis.Under the context

2019 Medicine

96. Index Admission Cholecystectomy for Acute Biliary Pancreatitis Favorably Impacts Outcomes of Hospitalization in Cirrhosis. (Abstract)

Index Admission Cholecystectomy for Acute Biliary Pancreatitis Favorably Impacts Outcomes of Hospitalization in Cirrhosis. Despite higher rates of gallstones in patients with cirrhosis, there are no population-based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high-risk population.We utilized the Nationwide Readmission Database (2011-2014) to evaluate all adults admitted with ABP (...) in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; p < 0.001) and ERCPs (23.3% vs 29.9%; p < 0.001). Multivariate analysis revealed that severe acute pancreatitis (OR: 14.8; 95% CI: 5.3-41.2), sepsis (OR: 12.6; 95% CI: 5.8-27.4), and decompensation (OR: 3.1; 96% CI: 1.4-6.6) were associated with increased index-admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1-3.0) and 30-day readmission (OR: 5.6; 95% CI: 3.3-9.5) were predictors of calendar-year

2019 Journal of gastroenterology and hepatology

97. Changes in pathogen spectrum and antimicrobial resistance development in the time-course of acute necrotizing pancreatitis. (Abstract)

Changes in pathogen spectrum and antimicrobial resistance development in the time-course of acute necrotizing pancreatitis. In contrast to the first peak of multiorgan failure in acute pancreatitis, the second peak is mostly triggered by septic complications. Our aim was to analyze the spectrum of pathogens and antimicrobial resistance development in relation to the time course of the disease and its clinical outcome.Retrospective analysis of 122 patients with acute necrotizing pancreatitis (...) : 1.38-10.05)], and multiresistant bacteria [p=0.007, OR= 5.08 (95%CI: 1.55-16.66)].Antimicrobial treatment of infected pancreatic necrosis becomes more challenging over time, owing to a change in spectrum favoring difficult-to-treat pathogens and an increase in multiresistant bacteria associated with worse clinical outcomes (WHO trial registration number: DRKS00014785).This article is protected by copyright. All rights reserved.

2019 Journal of gastroenterology and hepatology

98. Impact of visceral adiposity on severity of acute pancreatitis: a propensity score-matched analysis. Full Text available with Trip Pro

Impact of visceral adiposity on severity of acute pancreatitis: a propensity score-matched analysis. The relationship between visceral adiposity and acute pancreatitis (AP) has not been completely elucidated. This study evaluated the significance of visceral adipose tissue (VAT) and the ratio of VAT to skeletal muscle tissue (VAT/SMT) in the prognosis of AP patients.Based on a 1:2 propensity score matching, 306 hospitalized patients were enrolled in the study analysis from 2010 to 2017. VAT (...) , Bedside Index of Severity in Acute Pancreatitis [BISAP] score ≥ 3, and the systemic inflammatory response syndrome [SIRS] score ≥ 2) significantly correlated with VAT and the VAT/SMT ratio in AP patients. The multivariate adjusted hazard ratios (HRs) for VAT and the VAT/SMT ratio in the relationship of body parameters and AP mortality were 1.042 (95% confidence interval (CI), 1.019-1.066) and 7.820 (95% CI, 1.978-30.917), respectively. Compared with other prognostic scores, VAT had the highest area

2019 BMC Gastroenterology

99. A case report: acute pancreatitis associated with tacrolimus in kidney transplantation. Full Text available with Trip Pro

A case report: acute pancreatitis associated with tacrolimus in kidney transplantation. Tacrolimus has been widely used for immunosuppressive therapy in solid organ transplantation (SOT) and allo-geneic stem cell transplantation (allo-SCT) over the past 2 decades. Pancreatitis caused by tacrolimus was rarely reported in kidney transplantation previously.Here we presented a case of a 45-year-old male who underwent kidney transplantation and received immunosuppressive therapy of tacrolimus (...) , on day + 67 after transplantation he developed acute pancreatitis with extremely high blood concentration of tacrolimus. We excluded other possible causes and speculated tacrolimus was the probable inducer of pancreatitis. After tacrolimus was discontinued and alternated with cyclosporine, he gradually recovered and was discharged home with no relapse.Tacrolimus can be a probable cause of pancreatitis after kidney transplantation. We recommended clinicians to be aware of the possibility of tacrolimus

2019 BMC Nephrology

100. Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. (Abstract)

Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP.Patients with symptomatic (...) endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention.Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend

2019 Surgical endoscopy Controlled trial quality: uncertain

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