Acute Pancreatitis Research Papers - Academia.edu (original) (raw)

2025, Digestive Diseases and Sciences

The role of reactive oxygen metabolites in extrapancreatic organ dysfunction associated with acute hemorrhagic pancreatitis was studied in dogs. Experimental pancreatitis was induced by the intraductal infusion of activated trypsin and taurocholate. Cardiac output, pulmonary and systemic blood pressure, pulmonary wedge pressure, central venous pressure, heart rate, blood gases and serum amylase were measured. Cardiac index, pulmonary and systemic vascular resistance, and the right and left stroke work were calculated. Systemic arterial and venous blood pressure and cardiac index gradually declined over 6 hr, while pulmonary mean blood pressure and pulmonary vascular resistance increased. Pretreatment of pancreatitis with catalase and superoxide dismutase prevented the rise in mean pulmonary blood pressure, moderated the rise in pulmonary vascular resistance, and decreased the rate and extent of the fall in cardiac index. These data suggest that reactive oxygen metabolites may play some role in the extraabdominal organ manifestations of acute pancreatitis.

2025, Digestive Diseases and Sciences

2025, Lesión y reparación de la vía biliar: Serie de casos desde 1989 hasta 2020

Bile Duct Injury and Repair: Case Series from 1989 to 2020
BACKGROUND: The benign lesion of the bile duct is a complication of difficult diagnosis and treatment;
which has increased due to the use of laparoscopic cholecystectomy (LC) in the management of cholecystolithiasis.
Rates of 0.2 to 0.4% of bile duct injuries have been reported, becoming a significant cause of
mortality at the time of repair.
METHODS: This is an observational, descriptive study, a retrospective case series, based on primary sources
of information. The universe of the study are the patients who underwent surgery for bile duct injury
from 1989 to 2020, in a private clinic in the city of Cuenca-Ecuador.
RESULTS: In more than 30 years, 24 bile duct injury repairs were performed, which occurred: 6 during
conventional surgery and 18 during laparoscopic surgery. 54.2% of the lesions occurred less than two
centimeters from the confluence of the hepatic ducts. 58.4% of lesions were repaired with Roux-en-Y
anastomosis. Antibiotic therapy and drainage were administered to 100% of the patients; 45.83% of
the drains placed were tubular drains. 70.8% of the patients didn´t have complications after the repair
procedure; the complications that occurred are: bilioma, fistulas, stenosis, cholangitis.
CONCLUSION: In most patients who had bile duct injury, the injury occurred during laparoscopic surgery.
The injury was most often located less than two centimeters from the confluence of the hepatic ducts.
The most frequently performed repair procedure was the Roux-en-Y anastomosis. The most frequent
complication after repair was cholangitis.
KEYWORDS: ACCIDENTAL INJURIES, BILE DUCTS, ROUX – EN – Y ANASTOMOSIS, BILIARY FISTULA, BILIARY
TRACT SURGICAL PROCEDURES.

2025, Turkish journal of surgery

There has been coverage of Toll-like receptor 4 and Toll-like receptor 2 gene polymorphisms in inflammatory episodes in a number of studies. In view of the inflammatory nature of acute pancreatitis, we aimed to determine the predictive value of mutations in Asp299Gly and Thr399Ile of the Toll-like receptor 4 gene, and the intron 2 microsatellite polymorphism of the Toll-like receptor 2 gene on the occurrence of acute biliary pancreatitis. The study included 86 patients for the Toll-like receptor 4 Thr399Ile polymorphism, 100 patients for the Toll-like receptor 4 Asp299Gly polymorphism with acute biliary pancreatitis, and 101 healthy volunteers. At the same time, 93 patients and 92 healthy volunteers were included in the study to research the Toll-like receptor 2 intron 2 microsatellite polymorphism. Genotypes were determined using the restriction fragment length polymorphism analysis of PCR products and by an allele-specific PCR. The Toll-like receptor 4 Thr399Ile homozygotes mutant...

2025, Annals of Hepato-Biliary-Pancreatic Surgery

Backgrounds/Aims: Inflammatory mediators of the innate immune response play fundamental roles in the pathogenesis of acute pancreatitis. The correlation between interleukin-8 (IL-8) gene polymorphism with types of acute pancreatitis and severity of pancreatitis, was evaluated in this study. Methods: According to the diagnostic criteria, 176 patients with acute pancreatitis were grouped into biliary (n=83) and nonbiliary pancreatitis (n=93). Healthy blood donors (n=100) served as controls. Serum alanine transaminase, aspartate transaminase, total and direct bilirubin, amylase, lypase, white blood cell count and c-reactive protein levels were evaluated to correlate with IL-8 rs4073 (-251T/A) polymorphism, which was analyzed using a real-time polymerase chain reaction method with melting point analysis. The IL-8 AA genotype was detected with a significantly higher frequency among the patients with acute biliary pancreatitis having higher alanine transaminase levels than the median range. Homozygote alleles were significantly higher among patients with acute biliary pancreatitis having amylase levels higher than the median range. Conclusions: Determination of the frequency of IL-8 polymorphism in acute pancreatitis is informative and provides further evidence concerning the role of IL-8 in laboratory tests.

2025, Hpb

Background: In 2016, Ethicon revealed the newly designed Harmonic HD 1000i Shears. A non-university tertiary care center was one of the first centers in the country to test this device to see if the improvements from its previous model would translate to better technical outcome. Methods: We retrospectively analyzed 61 patients who underwent the Whipple procedure performed at a nonuniversity tertiary care center from January 2015 to present. All Whipple procedures performed prior to September 15, 2016 used the Harmonic Ace+7 with Advanced Hemostasis, while those performed afterwards used the Harmonic HD 1000i. Perioperative outcomes were compared between the two groups. An unpaired Student's t test was used to determine the statistical difference between the two means, with a p-value of 0.05 as the accepted level of significance. Results: Of the total 61 patients who underwent the Whipple procedure, 43 were performed using Harmonic Ace+7 Shears with Advanced Hemostasis, while the other 18 were performed using Harmonic HD 1000i Shears. There was no statistical difference in mean EBL (451.4 AE 500.9 mL vs 566.1 AE 693.2 mL) or mean LOS (9.5 AE 6.4 days vs 11.5 AE 7.9 days) between the Harmonic Ace+7 group and the Harmonic HD group. However, the mean OT (223.3 AE 57.6 min vs 182.8 AE 36.6 min, p = 0.04) was significantly shorter in the Harmonic HD group. The Harmonic HD 1000i is a safe and effective instrument with comparative, and in the case of operative time, improved perioperative and postoperative outcomes to its predecessor, Harmonic Ace+7. The redesigned blade which improves the instrument's dissecting capability, the decreased sealing time, and the simplified activation buttons in the new model all contribute to the shorter operative time.

2025, Journal of Gastrointestinal Surgery

The indications for early endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are unclear, and the examination is often requested or performed without substantial supporting evidence. Several trials have been performed to determine the benefit of early ERCP in pancreatitis, yet the results of these studies are inconsistent. To more closely analyze these studies, we performed an evidence-based review of the outcomes of early ERCP in gallstone pancreatitis. To obtain the best available evidence, a PubMed search using the MeSH terms "gallstones" and "pancreatitis" was performed and further refined to identify appropriate studies. We included five randomized trials, a meta-analysis, and a Cochrane Database Systematic Review in our detailed examination of the pertinent literature. Collectively, these studies suggest that early ERCP does not alter mortality in gallstone pancreatitis. In addition, few patients with mild pancreatitis benefit from the procedure, whereas some studies indicate that patients with severe pancreatitis or documented biliary obstruction may experience fewer complications if ERCP is performed. The data in the studies are confounding because of heterogeneity of the patient population and the inability to confirm gallstones in up to one third of patients. In conclusion, ERCP is not indicated for patients with mild pancreatitis. In select patients with severe disease or biliary obstruction, ERCP may be indicated. A multicenter trial designed to study the effect of early ERCP in severe pancreatitis only may provide additional useful information in patients with documented gallstones.

2025, Gastrointestinal Endoscopy

Large and/or impacted PD and CBD stones often require ML at ERCP for successful endoscopic extraction. Many have reported on the outcome of refractory pancreatic-biliary stones. Rate and spectrum of complications is not well described. Complications are varied and include failure of basket to open in confined space, trapped basket surrounding a stone, fracture of basket wires, malfunction of ML crank handle, and ductal injury. METHODS: 6 tertiary referral centers participated in this comprehensive review. All centers identified the total # of cases requiring ML of large or resistant PD and CBD stones. Centers reviewed each case for type(s) of complication, Rx attempted, and success of Rx. A 56 data point questionnaire was filled by all investigators for each complication. Completed forms were returned for data analysis at the host institution. RESULTS: 695 ML cases were identified. 628 were biliary (90.4%) while 67 were pancreatic (9.6%). Complications were distributed at follows: 21 of 628 biliary (3.3%) and 7 of 67 pancreatic (10.5%). Of the 28 complications, 19 were single complications, 9 cases were multiple. Complications in the biliary group included: trapped (TR)/broken (BR) basket ( ), wire fracture (FX) (n=8), failure to open (n=4), broken (BR) handle (n=4), perforation/duct injury (n=3). Complications in the pancreatic group included: TR/BR basket (n=6), wire FX (n=3), failure to open (n=1), BR handle (n=3). Rx of complications in the biliary group included: sphincterotomy (ES) extension (n=7), electrohydraulic lithotripsy (EHL) (n=11), stent (n=3), per-oral Soehendra lithotripsy (n=8), surgery (n=1). Rx of complications in the pancreatic group included: ES extension (n=2), EHL (n=2), stent (n=3), Soehendra (n=4), extracorporeal lithotripsy (ECL) (n=1), surgery (n=1). Pt with perforated viscus died at 30d. CONCLUSIONS: The vast majority of ML in expert centers involve the bile duct. The complication rate of pancreatic ML is 3 fold greater than biliary ML. The most frequent complication of biliary and pancreatic ML is trapped/broken baskets. Extension of ES and EHL are the most useful treatment options.

2025, Fudahospital

Pancreatic cancer The Role of the Pancreas and Problems Related to Pancreatic Cancer. It performs exocrine and endocrine functions. These enzymes are critical for protein, fat and carbohydrate digestion in the small intestine. If the pancreas is sick, like in the case of cancer, then those functions cannot be performed optimally. In this regard, pancreatic cancer brings about malabsorption syndromes, severe endocrine disorders like diabetes, accelerated breakdown of body systems, and possibly fatal multi-organ decline.

2025, Frontiers in Surgery

BackgroundColorectal cancer (CRC) is considered one of the most frequent neoplasms of the digestive tract with a high mortality rate. Left hemicolectomy (LC) and low anterior resection (LAR) with minimally invasive laparoscopic and robotic approaches or with the open technique are the gold standard curative treatment.Materials and methodsSeventy-seven patients diagnosed with CRC were recruited between September 2017 and September 2021. All patients underwent a preoperative staging with a full-body CT scan. The goal of this study was to compare both types of surgeries, LC-LAR LS with Knight–Griffen colorectal anastomosis and LC-LAR open with Trans-Anal Purse-String Suture Anastomosis (the TAPSSA group), by positioning a No-Coil transanal tube (SapiMed Spa, Alessandria, Italy), in terms of postoperative complications such as prolonged postoperative ileus (PPOI), anastomotic leak (AL), postoperative ileus (POI), and hospital stay.ResultsThe patients were divided into two groups: the fi...

2025

Magnetic Resonance Imaging (MRI) is an advanced, non-invasive diagnostic modality that revolutionized medical imaging by providing unparalleled soft tissue contrast without the risks of ionizing radiation. This paper comprehensively explores the foundational principles, equipment, personnel qualifications, procedural techniques, potential complications, and clinical significance of MRI, particularly in the context of gadolinium-based contrast agents. MRI utilizes a powerful static magnetic field, gradient fields, and radiofrequency pulses to manipulate the nuclear spin of hydrogen protons, generating detailed cross-sectional images. The equipment consists of a high-field magnet, gradient coils, radiofrequency coils, and sophisticated computer systems that reconstruct signals into diagnostic images. Personnel working in MRI environments are stratified into levels based on safety training, with the MR technologist playing a pivotal role in patient care and image acquisition. Preparation involves meticulous screening for metallic implants, insertion of intravenous lines for contrast administration, and patient education to mitigate anxiety. The scanning technique emphasizes patient immobility, controlled use of contrast agents, and adherence to safety protocols. Although MRI is generally safe, potential complications include claustrophobia, nephrogenic systemic fibrosis in at-risk populations, and rare hypersensitivity reactions. Clinically, MRI is indispensable for diagnosing neurological, musculoskeletal, cardiovascular, and oncologic diseases, offering unique insights into both anatomy and pathology. This paper also underscores the importance of interdisciplinary collaboration in optimizing MRI outcomes and enhancing patient care.

2025, Updates in Surgery

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment...

2025, Updates in Surgery

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients' management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.

2025

Aims and Background: Thymosin alpha 1 (Tα1) has shown promise as an adjuvant treatment for sepsis. This study evaluated the efficacy and safety of Tα1 versus placebo, both combined with standard care, in patients with sepsis. Methods: This was a multicenter, randomized, double-blind, placebo-controlled Phase III trial. Patients received four injections of Tα1 (2 vials twice daily) or placebo subcutaneously from Day 1 to Day 7 along with standard care. The primary endpoint was the change in Sequential Organ Failure Assessment (SOFA) score. Secondary endpoints included incidence of emerging infections, pathogen clearance rate, ICU/ventilator/vasoactive-agent-free days, changes in lymphocyte markers (CD4/CD8, NLR), TNFα , CRP, mortality, and adverse events (AEs). Results: Of 131 screened, 123 patients were enrolled across 10 sites. Mean SOFA score reduction was greater in the Tα1 arm (-3.5 ±1.7) versus placebo (-1.13 ±1.2), showing statistical significance. ICU and vasoactive-agent-free days were also significantly higher in the Tα1 arm. Both groups showed reductions in TNF, NLR, and CRP; however, only the Tα1 group showed statistically significant reductions from baseline on Day 7. Mortality was lower in the Tα1 group. Treatment-emergent AEs occurred in 48.4% of Tα1 patients and 72.1% of placebo patients, mostly mild and resolved without sequelae. Septic shock occurred in 3 (Tα1) vs. 5 (placebo) patients. Conclusion: Tα1 appears to be a safe and effective adjunct to standard care in sepsis, demonstrating significant improvements in organ dysfunction and clinical outcomes.

2025, British Journal of Surgery

2025, Annals of King Edward Medical University

This is a retrospective as well as prospective study of 46 patients with acute pancreaitis who were managed in North Surgical Unit of Mayo Hospital, Lahore. This study was carried out with special emphasis on need of surgical treatment and its outcome. No age group or sex was found immune to this disease. It was more common in 3rd to 4th decade of life and female sex. The commonest etiology is gall stones (54%) followed by alcohol (8%) and idiopathic (15%). Pain epigastrium is a constant symptom. Judicious use of serum amylase urinary amylase and ultrasonography can help in early diagnosis of the acute pancreatitis. Complications are best diagnosed on CT scan. Majority of patients were treated successfully by conservative measures (44%) but developed complications which carried high morbidity and mortality. Surgical treatment of associated gall stones has prevented recurrent attacks of acute pancreatitis. Hence cholecystectomy for associated gall stones is recommended during same ad...

2025, Acta gastroenterologica Latinoamericana

Pancreatic panniculitis is an uncommon condition that can occur in association with pancreatic disease. Most of the cases reported to date were associated with acute or chronic pancreatitis and pancreas cancer. Recently, development has been described in kidney transplant patients and secondarily to allograft pancreatitis in a pancreas-kidney transplant recipient. Both findings suggest that immunological processes may be involved in the pathogenesis of this entity. We report for the first time a case of acute pancreatitis associated with pancreatic panniculitis in a patient who underwent a liver transplant 10 months before. A 69-year-old man with a history of epigastric pain of a few days of evolution was presented with painful subcutaneous nodules on both legs. Blood chemistry showed raised serum amylase and lipase levels. Ultrasonography and multislice CT scan were suggestive of an acute pancreatitis. A skin biopsy showed typical features of pancreatic panniculitis which included ...

2025, Gastrointestinal Endoscopy

therapeutic cases (15 SG), and 3 cases performed via percutaneous transhepatic biliary drainage tracts (3 SG). Diagnostic C altered management in 75% of patients using SG and 92% of patients using non-SG. Malignancy (nϭ48) was the most common diagnosis. Non-SG scopes included pediatric scopes (nϭ12) used primarily through choledochoduodenostomies, the Olympus mother daughter system and various prototypes.Therapeutic C achieved fragmentation of stones in 80% of SG cases (12/15) and 75% of non-SG cases (3/4). Complete eradication of stones occurred in 27% (4/15) of SG cases and 25% (1/4) of non-SG cases. P altered management or diagnosis in 67% (16/24) of SG cases and 55% (6/11) of non-SG. IPMN (nϭ18) was the most common finding. Pancreatic cystoscopy did not alter management (0/7). Conclusions: In this retrospective analysis, 205 patients were reviewed with a mean age of 63.5 and a slight female predominance. Direct visualization of the bile ducts in both the SG and non-SG groups affected management in at least 75% of the cases in which it was used. In the P group the effect was slightly smaller (Ͼ55%). Efficacy in complete stone eradication was limited to about 25% of patients regardless of which scope system was used. In this single center, retrospective review the efficacy of the SG system appears to compare favorably with other endoscopic tools used to visualize the pancreaticobiliary system.

2025, PubMed

Objective: to evaluate the capacity of Imipenem as a prophylactic treatment for decreasing the number of infected necrosis and surgeries, as well as for diminishing septic complications and the mortality rate among patients with severe acute necrotizing pancreatitis. Material and methods: from May 2005 to December 2007 a prospective randomized study was conducted in order to evaluate the efficacy of a prophylactic antibiotic therapy in patients with pancreatic necrosis. During this time period 58 patients entered the study protocol. Patients were divided in two groups; the first one underwent antibiotic therapy with Imipenem while the second group received no prophylactic treatment at all. All patients received early enteral nutrition. Results: both studied groups had comparable age, gender ratio, and C.R.P and necrosis percentages. When comparing general morbidity in both groups no difference was found between the group receiving a prophylactic antibiotic and the group that did not receive it (58% vs. 56%). Moreover, when the septic complications were evaluated, it was confirmed that these were more frequent among the group of patients receiving Imipenem (29%), in comparison to the group that did not received antibiotics (15%). 12.5% of the patients that received Imipenem developed pancreatic necrosis infection, while said infection only appeared in 6% of the patients in the group that did not receive antibiotic prophylaxis; nevertheless, none of the comparisons reached statistical significance. The number of patients who required surgery was similar in both groups. When comparing the hospital stay, it was observed that this was longer among the patients receiving prophylactic therapy. No patient died during the study. Conclusion: The present study finds no benefits in the use of antibiotic therapy with Imipenem regarding the risk of developing pancreatic necrosis infection and septic complications, and neither when trying to reduce the number of surgeries among patients with severe acute pancreatitis with necrosis.

2025, Acta gastroenterologica Latinoamericana

to evaluate the capacity of Imipenem as a prophylactic treatment for decreasing the number of infected necrosis and surgeries, as well as for diminishing septic complications and the mortality rate among patients with severe acute necrotizing pancreatitis. from May 2005 to December 2007 a prospective randomized study was conducted in order to evaluate the efficacy of a prophylactic antibiotic therapy in patients with pancreatic necrosis. During this time period 58 patients entered the study protocol. Patients were divided in two groups; the first one underwent antibiotic therapy with Imipenem while the second group received no prophylactic treatment at all. All patients received early enteral nutrition. both studied groups had comparable age, gender ratio, and C.R.P and necrosis percentages. When comparing general morbidity in both groups no difference was found between the group receiving a prophylactic antibiotic and the group that did not receive it (58% vs. 56%). Moreover, when ...

2025

Acute pancreatitis (AP) is one of the most common inflammatory diseases of the gastrointestinal tract and a steady rising diagnosis for inpatient hospitalization. About one in four patients, who experience an episode of AP, will develop chronic pancreatitis (CP) over time. While the initiating causes of pancreatitis can be complex, they consistently elicit an immune response that significantly determines the severity and course of the disease. Overall, AP is associated with a significant mortality rate of 1-5%, which is caused by either an excessive pro-inflammation, or a strong compensatory inhibition of bacterial defense mechanisms which lead to a severe necrotizing form of pancreatitis. At the time-point of hospitalization the already initiated immune response is the only promising common therapeutic target to treat or prevent a severe disease course. However, the complexity of the immune response requires finebalanced therapeutic intervention which in addition is limited by the fact that a significant proportion of patients is in danger of development or progress to recurrent and chronic disease. Based on the recent literature we survey the disease-relevant immune mechanisms and evaluate appropriate and promising therapeutic targets for the treatment of acute and chronic pancreatitis. KEYWORDS acute pancreatitis, chronic pancreatitis, immune response, fibrosis, therapy Frontiers in Immunology frontiersin.org 01

2025, World journal of emergency medicine

Harmless acute pancreatitis score (HAPS), neutrophile/lymphocyte ratio and red blood cell distribution width (RDW) are used to determine the early prognosis of patients diagnosed with nontraumatic acute pancreatitis in the emergency department (ED). Patients diagnosed with acute pancreatitis (K 85.9) in the ED according to the ICD10 coding during one year were included in the study. Patients with chronic pancreatitis and those who had missing data in their files were excluded from the study. Patients who did not have computed tomography (CT) in the ED were not included in the study. Ultimately, 322 patients were included in the study. The median age of the patients was 53.1 (IQR=36-64). Of the patients, 68.1% (n=226) had etiological causes of the biliary tract. The mortality rate of these patients within the first 48 hours was 4.3% (n=14). In the logistic regression analysis performed by using Balthazar classification, HAPS score, RDW, neutrophile/lymphocyte ratio, age, diabetes mel...

2025, Journal of Stem Cell Research & Therapy

Background: Acute pancreatitis (AP), a sudden inflammation of the pancreas, can cause severe complications and high mortality despite treatment. The use of mesenchymal stem cells (MSCs) for the treatment of AP has attracted significant attention in novel treatment strategy; however, the mode of action of spleen-derived MSCs (sp-MSCs) in AP remains unknown. Method: MSCs isolated from mouse spleen (msp-MSCs) were used to investigate the effects in animal models of cerulean-induced acute pancreatitis (CAP) and pancreatic ischemia injury (PII). Results: Msp-MSCs had multipotent differentiation capacities and immunoregulatory functions. A greater number of Qtracker-labeled msp-MSCs were detected in pancreas of mice with CAP than of control mice. Infused msp-MSCs reduced serum levels of amylase, lipase, and myeloperoxidase, and pancreatic edema, necrosis level, expression of inflammation cytokines, and CD3 + T cell infiltration. In PII model, infused msp-MSCs promoted cell growth and thus improved pancreatic dysfunction. Msp-MSCs exert protective effects on CAP-and PII-induced pancreatic injury and might be developed as a potential therapeutic agent for pancreatitis treatment.

2025, Journal of Stem Cell Research & Therapy

2025

AIM:To determine the correlation between success rate of probing and age in patients with nasolacrimal duct obstruction (NLDO) .

2025, Acta chirurgica Iugoslavica

Acute pancreatitis is illness with unpredictable outcome. In some patients course of illness is progressive and leading to multiple organ dysfunction syndrome often resulting with lethal outcome. During last decade the treatment protocols have changed. Basic patophysiologic mechanisms leading to progression of the illness, as well as, contemporary diagnostic and treatment possibilities that can prevent occurrence of severe consequences and improve outcome are presented.

2025, Nuclear Medicine Communications

Objective To demonstrate the localization of leukocytes in the pancreas during acute pancreatitis and to evaluate the potential use of 99m Tc-HMPAO-labelled leukocytes in the diagnostic assessment of patients with acute pancreatitis. The study was performed with 20 patients (11 females, nine males; ranging in age from 26 to 86 years, mean 55 years). Labelled leukocyte scintigraphy using planar imaging was performed on all patients, seven of whom were also examined by single photon emission computed tomography (SPECT). According to Ranson criteria, 10 patients had mild pancreatitis (group A), six had severe pancreatitis (group B) and four had necrotic pancreatitis (group C). Twelve patients had biliary pancreatitis and the other eight patients had no obvious cause. Results All patients of group C, four of group B, two of group A had a positive leukocyte scan. The positive leukocyte scintigraphy value for the detection of a lethal course of acute pancreatitis was 100%; of a severe course, 66.7%; and of a mild course, 20%. These findings are statistically significant (P = 0.005 in chi-squared tests result). The results of leukocyte scintigraphy compared with those of CT were also statistically significant (P = 0.001 in chi-squared tests). All the patients diagnosed with pancreatic necrosis by CT had a positive leukocyte scan, but only three of 13 patients without pancreatic necrosis that could be detected by computed tomography had a positive leukocyte scan. Conclusions There was a significant correlation between the severity of the disease and leukocyte infiltration. Considering these results, we believe that leukocyte infiltration in acute pancreatitis can be demonstrated rapidly and accurately and by noninvasive 99m Tc-HMPAO labelled leukocyte scintigraphy.

2025, Canadian Journal of Gastroenterology

Placement of standard polyethylene prostheses into rhc biliary rree presupposes use of a therapeutic endoscope in most instances, as well as access to a fu ll range of accessory equipment to include sphincterotomes, guidewires, dilattng and ba lloon catheters, and stents of variable length and tliameter. Paradoxically, most patients with ma lignant scenoses can be scented without sphincterotnmy, whereas the latter usually is required in a patient with benign stricture m whom multiple interventions are inevitable. Placement caveat:; include proper scope positioning, dilat ion of tight stenoses, assurance of adequate guidewire above the stricture, use of stiffening catheters and assurance of subsequent biliary decompression postprosthesis insertion.

2025

Yersinia pseudotuberculosis is a facultative intracellular gram-negative coccobacillus that primarily causes enteric disease but may also present with systemic manifestations, particularly in vulnerable populations. Though less prevalent than Yersinia enterocolitica, Y. pseudotuberculosis has drawn increasing attention due to its ability to mimic common abdominal pathologies such as appendicitis, as well as its association with post-infectious autoimmune sequelae. The pathogen is cold-tolerant, environmentally resilient, and transmitted predominantly through ingestion of contaminated food or water, especially raw vegetables. The diagnosis remains challenging due to its slow growth and low yield in standard cultures; however, adjunctive imaging and serological testing improve diagnostic accuracy. Treatment is supportive in most cases, with antibiotic therapy reserved for systemic or high-risk infections. Fluoroquinolones remain the most effective agents based on both in vivo and in vitro evidence. Complications include reactive arthritis, uveitis, renal involvement, and, rarely, sepsis and death. Recognition of its diverse clinical spectrum and the need for a multidisciplinary management approach is essential to reduce morbidity and improve outcomes. This review aims to provide an exhaustive understanding of Y. pseudotuberculosis infection, encompassing etiology, pathophysiology, epidemiology, clinical evaluation, diagnostic strategies, management principles, and public health implications.

2025, Intensive Care Medicine

Purpose: Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated. A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported. Results: Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks' gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05-3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02-1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30-5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09-3.90), p = 0.03). Delivery was

2025, Critical Care

Rational To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Methods Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression. Results From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) (P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standar...

2025, Dermatology reports

Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science. Dermatology Reports is, therefore, E-publishing PDF files of an early version of manuscripts that undergone a regular peer review and have been accepted for publication, but have not been through the copyediting, typesetting, pagination and proofreading processes, which may lead to differences between this version and the final one.

2025, Journal of Institute of Medicine

Pseudoaneurysm of peripancreatic vessels is a rare complication of chronic pancreatitis. Being close to the pancreas, splenic artery is the most frequently affected vessel whereas right gastroepiploic artery pseudoaneurysm is very rare. Rupture of such pseudoaneurysm is a rare cause of upper gastrointestinal (GI) bleeding. We report a patient of chronic pancreatitis with past history of pancreatic duct stenting who presented with massive upper GI bleeding and stent migration. Bleeding from pseudoaneurysm of right gastroepiploic artery was detected in angiography. Coil embolization was done but later rebleeding occurred and was managed with laparotomy and ligation of the pseudoaneurysm. Patient improved during postoperative period.

2025, Revista Da Associacao Medica Brasileira

BACKGROUND/AIMS: To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS: Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC).

2025, Revista Medica del Uruguay

Introducción: durante muchos años se han utilizado distintos scores clínicos, paraclínicos e imagenológicos con el fin de predecir la morbimortalidad en la pancreatitis aguda. Dichos scores han demostrado diversa utilidad, aunque la complejidad de los mismos a la hora de su implementación ha limitado su uso en la práctica clínica habitual. Objetivo: establecer la relación del síndrome de respuesta inflamatoria sistémica (SIRS) y su duración con la mortalidad y el desarrollo de complicaciones. Material y método: se realizó un estudio multicéntrico, analítico y observacional de todos los pacientes con pancreatitis aguda (96) diagnosticados desde mayo de 2015 a mayo de 2016 en el Hospital Central de las Fuerzas Armadas (43,8%), en el Hospital de Clínicas (30,3%) y en el Hospital Español (21,9%). Resultados: el 67% de las pancreatitis agudas se desarrollaron de forma leve, 25% de forma moderada y 8% de forma severa. El 42% tenía SIRS al momento del diagnóstico y 15% mantuvieron el SIRS por más de 48 horas. El SIRS mantenido se asoció significativamente con la existencia de necrosis pancreática, falla orgánica persistente, necesidad de cuidados intensivos, presencia de complicaciones locorregionales, número aumentado de tomografías, severidad de la pancreatitis aguda y mortalidad. La mortalidad en pacientes con SIRS transitorio fue nula y con SIRS mantenido de 27%. Conclusión: el SIRS mantenido por más de 48 horas se asocia significativamente a todos los marcadores de severidad. Su ausencia o su presencia por menos de 48 horas no se asocian a mortalidad y las complicaciones locorregionales son menores.

2025, Journal of the Pakistan Medical Association

Acute pancreatitis (AP) is a multi-causal disease with a high rate of hospitalisation. Only a few clinical studies have investigated the aetiological background, severity, and outcome of AP in Pakistan. Hence, this study was carried out to determine the aforementioned factors and correlate them with outcomes in a tertiary care setting. This was a cross-sectional, retrospective study conducted at the

2025, Acta Paediatrica

ABSTRACT.A total of 50 children with hGH deficiency have been enrolled in a multicentre open trial of recombinant somatropin in France. Recombinant somatropin, 0.2 IU/kg s.c, was administered 3 times/week (0.6 IU/kg/week). Results are available after 3 months’treatment for 24 of the patients (11 prepubertal, 13 pubertal). The mean growth rate increased from 3.8 ± 1.5 cm/year to 9.9 ± 3.6 cm/year. Only one child developed anti‐hGH antibodies with a very low binding capacity of 0.02 mg/litre; adverse events were uncommon and probably unrelated to treatment.

2025, Indian Journal of Critical Care Medicine

Intra-abdominal infections are known to complicate the course of acute pancreatitis. Invasive fungal infections (Candida spp.) are not the uncommon microorganisms which isolates from intra-abdominal specimen in acute necrotizing pancreatitis. However, we are reporting first case of invasive gastric mucormycosis in a postpartum acute pancreatitis patient.

2025, Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Invasive candidiasis (IC) is associated with increased morbidity in severe acute pancreatitis (SAP). There is limited information regarding the predisposing factors, Candida species distribution and in vitro susceptibility. Current data have been derived from a larger prospective nonintervention study conducted on 200 critically ill patients which was done to study the antifungal prescription practices, collect epidemiological data, and perform an external validation of risk prediction models for IC under senior research associateship program of Council of Scientific and Industrial Research New Delhi. Of these critically ill patients, thirty had SAP and were included for analysis. There were 23 males and 7 females. Out of eight patients (27%) who developed IC, three had isolated candidemia, two had isolated deep-seated candidiasis while three had both candidemia and deep-seated candidiasis. SAP patients with IC had a longer duration of Intensive Care Unit stay, hospital stay, days o...

2025, Southern African Journal of Critical Care

Background and aims. Approximately 20% of acute pancreatitis progresses to a severe form characterised by multiple extrapancreatic organ dysfunction. Elevated intra-abdominal pressure (IAP), a frequent finding in these patients, further adds to the mortality. Currently used prognostication indices have their own set of limitations. We evaluated IAP at intensive care unit (ICU) admission as a predictor of mortality in severe acute pancreatitis (SAP). A retrospective analysis of 50 patients with SAP admitted to the ICU of a tertiary-care Indian institute over a period of 3 years was done. Data relating to demographic profile, cause of pancreatitis, ICU admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, IAP, interventions instituted and mortality were analysed. Results. Biliary stones (38%) were the most common cause of acute pancreatitis. Survivors differed from non-survivors with respect to organ failure, APACHE II and SOFA scores and IAP on admission. There was a significant correlation between IAP on ICU admission and admission SOFA (r=0.56, p<0.001) and APACHE II (r=0.54, p<0.001) in predicting mortality. Patients with elective admission had a mortality rate of 53% (20/38) compared to 83% (10/12) for those admitted as emergencies. Analysis of receiver operating characteristic curves for detecting mortality revealed an area under the curve of 0.915 (95% confidence interval (CI) 0.83 -0.99) for IAP, 0.826 (95% CI 0.71 -0.93) for SOFA, and 0.831 (95% CI 0.71 -0.94) for APACHE II. IAP at ICU admission is a useful predictor of severity of illness and mortality in SAP.

2025, Indian Journal of Gastroenterology

Background Severe acute pancreatitis (SAP) is a disease with high morbidity and mortality. We undertook a study of patients with SAP admitted to the intensive care unit (ICU) of a tertiary referral hospital. Methods Between 2002 and 2007, 50 patients with SAP were admitted in our intensive care unit (ICU). Data were collected from their medical records and their clinical profile, course and outcome were retrospectively analyzed. Patients were categorized into survivor and nonsurvivor groups, and were further classified based on interventions such as percutaneous drainage and surgical necrosectomy. Results SAP contributed 5 % of total ICU admissions during the study period. Median age of survivors (n020) was 34 against 44 years in nonsurvivors (n030). Median Acute Physiology and Chronic Health Evaluation (APACHE) II score in nonsurvivors was 16.5 (8-32) vs. 12.5 (5-20) in survivors (p00.002). Patients with APACHE II score ≥12 had mortality >80 % compared to 23 % with score <12 (p<0.001). Median Sequential Organ Failure Assessment (SOFA) scores on admission and on days 3, 7, 14, and 21 were significantly higher in nonsurvivors compared to survivors (p<0.05). Mean (SD) intraabdominal pressure was 23 (3.37) mmHg in nonsurvivors vs. 19.05 (2.51) in survivors (p<0.05). Patients with renal failure had significant mortality (p<0.001). Length of ICU stay, requirement for vasopressor, total parenteral nutrition, and the amount of blood and blood product transfusions differed significantly between patients with and without intervention. Conclusions APACHE II and SOFA scores and other clinical data correlated with outcome in SAP admitted to ICU. Keywords Severe acute pancreatitis . Acute physiology and chronic health evaluation score . Sequential organ failure assessment score . Percutaneous drainage . Necrosectomy R. K. Singh (*) : B

2025

A 61-year-old has undergone to our observation for pancreatic abdominal pain. On admission, the blood chemistry tests showed more than 3fold raised in pancreatic enzymes, while no indices of cholestasis or hepatic cytolysis were present. An abdominal ultrasound revealed a pancreas increased in volume and dishomogeneous, without local or extra-local complications, letting argue an episode of mild acute pancreatitis (AP) occurred. The patient was treated with bowel rest, broad spectrum antibiotics and gabexatemesilate until the normalization of the pancreatic function. A clinical interview was conducted, from which it emerged that the patient was hospitalized for another 2 episodes of AP in the last 3 years. A diagnosis of acute recurrent pancreatitis has been formulated. From both letters of discharge, AP was termed “idiopathic”. A magnetic resonance cholangiopancreatography (MRCP), performed at our Center, was very suggestive for a pancreas divisum (PD) (Figure 1a). As the main indi...

2025, World Journal of Gastroenterology

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 infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

2025, Scandinavian Journal of Gastroenterology

2025, European Journal of Internal Medicine

Background: Several authors consider that surgical intervention is the gold standard for treatment of pancreatic abscesses. Recently, considerable interest has been generated in the minimally invasive management of pancreatic abscess with mixed results reported in the literature. Aim: To evaluate the efficacy of percutaneous aspiration and/or drainage for patients with pancreatic abscesses. Methods: We performed a retrospective analysis of 62 patients with 87 pancreatic abscesses treated by percutaneous management from 1989 to 2009. All patients received appropriate antibiotic therapy. Patients with pancreatic abscess b 50 mm in diameter were initially treated by ultrasound-guided percutaneous needle aspiration (PNA) and those with abscess ≥ 50 mm were initially treated by ultrasound-guided percutaneous catheter drainage (PCD). Surgery was planned only when there was no clinical improvement after the initial percutaneous treatment. Primary outcome was conversion rate to surgery. Results: Two patients (3.2%) received supportive treatment only and one of them died. PNA was performed in 16 patients (25.8%), and 8 of them required PCD because of recurrence of abscess. In 44 patients (70.1%), PCD was performed initially. PCD was performed twice in 6 patients and 3 times in 2 patients. There were 5 patients converted to surgery (8.1%) and one of them died. Medians (interquartile ranges) of hospital stay and catheter dwell-time were 17 (12-26) and 12 (9-21) days, respectively. There were no complications related to the procedure. Conclusions: Percutaneous aspiration and/or drainage are effective and safe for the treatment of pancreatic abscesses.

2025, Clinical Therapeutics

Purpose: Clinical trial evidence supports greater glycemic control with canagliflozin than with sitagliptin. The objective of this study was to provide real-world evidence comparing outcomes in routine clinical practice among patients initiating each medication. Methods: With the use of a health care administrative database, patients initiating canagliflozin were compared with patients initiating sitagliptin (first prescription fill as index date). Baseline (6 months before index date) demographic and clinical (eg, comorbidities and diabetes-related complications) characteristics were compared, and propensity score matching was used to control for baseline differences between cohorts. Outcomes included change in glycosylated hemoglobin (HbA 1c ) and persistence with medication over a 9-month period after index date. Findings: Before matching, the canagliflozin cohort (N ¼ 3993) was younger than the sitagliptin cohort (N ¼ 12,153) and was composed of fewer women and Medicare Advantage enrollees, with lower mean baseline comorbidity scores (all p o 0.001). Before matching, the canagliflozin cohort (valid n ¼ 1482) had a significantly (p o 0.001) higher baseline HbA 1c (8.60) than the sitagliptin cohort (valid n ¼ 3697; HbA 1c , 8.32). After matching (n ¼ 1472 per cohort), patients were well balanced on baseline characteristics, and HbA 1c values were not significantly different (p ¼ 0.634) between the cohorts. Patients initiating canagliflozin had greater reductions in HbA 1c than patients in the sitagliptin cohort (-0.93% versus -0.57%, respectively; p ¼ 0.004), with similar mean (median) time from index date to follow-up HbA 1c of 185.4 (199.0) and 184.3 (190.5) days, respectively (p ¼ 0.802). Only 29.8% of canagliflozin patients discontinued during follow-up compared with 41.5% of sitagliptin patients (p o 0.001); the average days of persistence on index therapy was longer for canagliflozin patients (152 days) than for sitagliptin patients (139 days; p o 0.001). Implications: In this observational study, patients initiating canagliflozin had greater reduction in HbA 1c and longer persistence with medication than did patients who initiated sitagliptin, over a 9-month period. Better understanding of antihyperglycemic treatment, HbA 1c results, and differences among patients in demographic/clinical characteristics as well as persistence with treatment will inform optimal diabetes treatment choice in routine practice. (Clin Ther.