1154 UTILITY AND UTILIZATION OF TRANSABDOMINAL ULTRASOUND IN PEDIATRIC PATIENTS WITH ACUTE RECURRENT OR CHRONIC PANCREATITIS
Nicholas NorrisDavid M. TroendleMichael WilschanskiFuchenchu WangGretchen A. CressMaisam Abu‐El‐HaijaAnkur ChughReuven Zev CohenElissa M. DownsDouglas S. FishmanCheryl E. GariepyMatthew J. GieferTanja GonskaAmit S. GroverDouglas LindbladQuin LiuAsim MaqboolJacob MarkBrian A. McFerronMegha S. MehtaVéronique D. MorinvilleKenneth W. NgRobert A. NoelChee Y. OoiEmily R. PeritoZachary M. SellersYuhua ZhengYing YuanMark E. LoweAliye Uç
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Preface Contributors The history of chronic pancreatitis Molecular pathogenesis and gentic alterations in chronic pancreatitis Pathogenesis of chronic pancreatitis: Current state and trends Chronic pancreatitis: The role of nerves and neuroimmune interaction Diagnosis of chronic pancreatitis: Function tests Chronic pancreatitis: Diagnostic imaging Chronic pancreatitis: An attempt to classify Difficult decision-making in chronic pancreatitis: An interactive workshop Chronic pancreatitis diabetes mellitus and nutrition Conservative treatment of chronic pancreatitis 100th anniversary of pancreatic enzyme treatment Endoscopic treatment of chronic pancreatitis: Impact on long-term outcome Surgical treatment of chronic pancreatitis: Standard procedures Surgical treatment of chronic pancreatitis: Long-term results Index
Pathogenesis
Pancreatitis, chronic
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Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.
Contrast-enhanced ultrasound
Liver Hemangioma
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Objective To determine whether enteral nutrition(EN) can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.Methods APACHEⅡ score,computed tomography (CT),C reactive protein(CRP),and endotoxin were determined on 62 patients with acute pancreatitis.Patients were stratified according to disease severity and randomised to receive either parenteral nutrition (PN) or EN for seven days and then re-evaluated.Results Systemic inflammatory response syndrome (SIRS),sepsis,organ failure, and ITU stay were globally improved in the enterally fed patients.The acute phase response and disease severity scores were significantly improved following enteral nutrition without change in the CT scan scores.CRP:158± 30.21 to 84±26.33,P0.05,APACHEⅡ scores:(8.2±1.36)to(6.3±1.18),P0.05.In parenterally fed patients these parameters did not change but there was an increase in endotoxin levels.Enterally fed patients showed no change in endotoxin levels.Conclusions EN moderates the acute phase response,and improves disease severity and clinical outcome in acute pancreatitis. Enteral feeding modulates the inflammatory and sepsis respone in acute pancreatitis and is clmically beneficial.
Enteral administration
Inflammatory response
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Abstract This study examines the value of endoscopic pancreatography in chronic pancreatitis. With the cooperation of nine departments in Italy, the authors examined the pancreatograms of 1179 patients with chronic pancreatitis. The pancreatograms were abnormal in 80·6 per cent. There were difficulties in distinguishing between cancer and pancreatitis in 11·3 per cent, and difficulty in deciding whether the radiographs were normal or slightly abnormal in 6·8 per cent. The ability of pancreatography to diagnose chronic pancreatitis increased with the duration of the disease, reaching 92·3 per cent in those patients who had had chronic pancreatitis for 5 or more years. However, the failure to obtain a pancreatogram increased as calcification increased. A good correlation between abnormalities of the pancreatogram and of the pancreatic function tests was demonstrated.
Pancreatic Disease
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Acute pancreatitis is acute pancreatic inflammation which can lead to damage of surrounding tissues and other organic systems. In the case of acute pancreatitis, autodigestion of pancreatic tissue is induced as a result of activation of zymogenic forms of enzyme in the active proteolytic enzymes. In patients with acute pancreatitis occurs severe abdominal pain. The most important diagnostic markers are serum lipase and serum amylase. There are two forms of acute pancreatitis: mild acute pancreatitis and severe acute pancreatitis. The purpose of this study was to analyze and evaluate the nutritive status of a patient suffering from acute pancreatitis at arrival and release from KB Dubrava with a particular focus on patient's diet during hospital stay.
Pancreatic enzymes
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Aims: Acute fluid collections after acute pancreatitis carries risk of serious complications as infected pseudocyst and Wall off Necrose development. Hence, it is important to predict the development of acute fluid collections for treatment and management of acute pancreatitis. In this study, it is aimed to investigate predictive factors for development of acute fluid collections in patients with acute pancreatitis.
Methods: Total of 438 patients diagnosed with acute pancreatitis were screened. According to the Revised Atlanta Classification fluid development after acute pancreatitis was determined and the relationship between fluid development and the hematological/biochemical parameters of the patients at the time of admission was investigated. The best cut-off point of laboratory measurements for fluid development was determined by ROC analysis and the factors that may be most decisive in distinguishing between the patients with and without fluid development were determined by multivariate forward stepwise logistic regression analysis.
Results: It is found that developing acute fluid collections after acute pancreatitis was higher in patients with younger age and male gender. Also the risk of developing acute fluid collections after acute pancreatitis was found to be 6.2 times higher in patients with CRP/Albumin ratio greater than 1.09; 2.5 times higher in patients with ALP below 199.5 U/L; 1.9 times higher in patients with WBC greater than 11,6 ×10⁹/L and 1.5 times higher in patients with PLR above 197.1. Also the risk of developing acute necrotic collections after acute pancreatitis was 3 times higher in patients with serum calcium level below 8,6 mg/dl.
Conclusion: It has been determined that, presence of high CRP/albumin ratio, high NLR and low serum ALP level can be used as an indicator in predicting acute pancreatic and peripancreatic fluid development.
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Objective To analyze the application value of ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma. Methods The imaging data of 50 patients with primary gallbladder carcinoma confirmed by operation and pathology were retrospectively analyzed. All patients underwent ultrasound examination. 40 cases underwent CT examination and 25 cases underwent MRI examination. The imaging findings were observed and analyzed, respectively. Meanwhile, the findings were compared with the results of operation and pathological examination. The accuracy of the three kinds of examinations in the diagnosis of primary gallbladder carcinoma was compared. ResultsCompared with operation and pathological results, the diagnostic accordant rates(accuracy) of ultrasound, CT and MRI were 64.0%, 73.3% and 88.0%. The diagnostic accuracy of MRI was significantly higher than that of ultrasound, and the difference was statistically significant(P0.05). Conclusion Ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma have their own advantages and disadvantages, and the diagnostic accordant rates of MRI was the highest while of ultrasound was the lowest.
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e c e n t s u r ve y s o n c h r o n i c pancreatitis carried out around the world shows that alcohol remains the main factor associated with chronic pancreatitis, even if at a frequency lower than that reported previously.It has further confirmed that heavy alcohol consumption and smoking are independent risk factors for chronic pancreatitis.Autoimmune pancreatitis accounts for 2%-4% of all forms of chronic pancreatitis, but this frequency will probably increase over the next few years.The rise in idiopathic chronic pancreatitis, especially in India, represents a black hole in recently published surveys.Despite the progress made so far regarding the possibility of establishing the hereditary forms of chronic pancreatitis and the recognition of autoimmune pancreatitis, it is possible that we are more inaccurate today than in the past in identifying the factors associated with chronic pancreatitis in our patients.
Etiology
Autoimmune Pancreatitis
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The article tells about current issues in the treatment of chronic pancreatitis in adults. Particular attention is paid to the use of enzyme preparations as replacement and symptomatic therapy in chronic pancreatitis. There is a brief description of antispasmodics used for relief of abdominal pain in chronic pancreatitis.
Pancreatitis, chronic
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