Lege Artis Medicinae

[WAYS OF PREVENTION OF SEPTIC COMPLICATIONS IN ACUTE PANCREATITIS]

OLÁH Attila

JUNE 21, 2006

Lege Artis Medicinae - 2006;16(06)

[Similarly to other acute inflammatory responses, the mortality curve of acute pancreatitis has two distinct peaks. The first one, which coincides with a hyperinflammatory phase, is due to the development of an overwhelming systemic inflammatory response syndrome and subsequent multi-organ failure. The second peak of mortality is detected much later, after 14 days from the onset of the disease, when the compensatory antiinflammatory phase results in the infection of the necrotising pancreatic glandular substance. Since no therapy has been shown to efficiently prevent the activation of inflammatory and proteolytic cascades that evoke and sustain the disease, the treatment of acute pancreatitis is basically symptomatic. Beside adequate fluid and volume replacement and pain relief, medical and mechanical support may become necessary if organ failure develops. Recent studies suggest that there are ways to decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. The results of attempts to decrease the frequency of septic complications are controversial. A number of studies support the need of antibiotic prophylaxis but the evidence is weak. Furthermore, the increasingly observed infections by multi-resistant strains of Gram-positive bacteria and Candida species are due to long-term antibiotic use, which strongly questions the grounds for prophylactic antibiotic treatment. Recently, various clinical studies aimed to decrease bacterial translocation in other ways, including probiotic use and enteral feeding. This paper provides a systematic review of the data available in the evidence-based literature on the use of antibiotics and the role of alternative and adjuvant therapy in the treatment of severe acute pancreatitis.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[AUTOIMMUNE PANCREATITIS - AN UNDERDIAGNOSED DISEASE?]

CZAKÓ László

[Autoimmune pancreatitis is a recently recognized type of chronic pancreatitis that is clearly distinct from alcoholic chronic pancreatitis. Its clinical symptoms include jaundice, abdominal pain, weight loss and diabetes mellitus. It may be associated with other autoimmune diseases. IgG levels are elevated and autoantibodies can be detected. Pancreatic imaging reveals a diffuse enlargement of the pancreas and irregular narrowing of the main pancreatic duct. The characteristic histological features are lymphoplasmacytic infiltration and fibrosis. Autoimmune pancreatitis responds dramatically to steroid therapy, in contrast to other types of chronic pancreatitis, which hardly respond to any of the various therapies. It is important to be aware of this disease because it may be mistaken for other forms of chronic pancreatitis or pancreatic cancer, which leads to pancreatic resection when steroid treatment would be sufficient. This review discusses the clinical, laboratory, histological and imaging findings that are seen in autoimmune pancreatitis with particular focus on diagnosis. With the improvement of the diagnostic work-up less unnecessary pancreatic resections are expected to happen in patients with autoimmune pancreatitis.]

Lege Artis Medicinae

[Therapy Culture]

BÁNFALVI Attila

Lege Artis Medicinae

[Crestor symposium in the Buda castle]

NÉMETH Éva

Lege Artis Medicinae

[Personality Protection in Medical Research]

ALEXIN Zoltán

Lege Artis Medicinae

[FUTURE CARRIER AND FAMILY PLANS OF 5TH-YEAR FEMALE MEDICAL STUDENTS]

FEITH Helga Judit, KOVÁCSNÉ Tóth Ágnes, BALÁZS Péter

[INTRODUCTION - The aim of this study was to analyze female medical students' carrier and family attitudes and plans in view of two social problems: (1) the increasing shortage of physicians in Hungary and (2) conflicts and health problems in the life of female doctors caused by professional and family duties. METHOD - The basis of this study is a selfreported questionnaire-based survey performed in the spring of 2004 among 5th-year female medical students in the faculties of general medicine at Semmelweis and Debrecen universities. One hundred and seventeen students (46.2%) responded. RESULTS - The overwhelming majority of students (91.5%) want to work as a physicians, and 63.5% plan to work abroad in health care. As to family planning, 95.7% of the respondents would like to have children, although only 52.8% plan to stay at home in the first three years. CONCLUSION - These data suggest that the majority of Hungarian female medical students want to be engaged in the medical profession and plan to meet both family and career demands. Due to its special requirements, however, this profession may generate future marital, childmother relationship and workplace conflicts.]

All articles in the issue

Related contents

Lege Artis Medicinae

[ENTERAL ADMINISTRATION OF N-3 POLYUNSATURATED FATTY ACIDS IN ACUTE PANCREATITIS]

LÁSZTITY Natália, HAMVAS József, BÍRÓ Lajos, NÉMETH Éva, MAROSVÖLGYI Tamás, DECSI Tamás, PAP Ákos, ANTAL Magda

[BACKGROUND - The main determinant of outcome in acute pancreatitis is the extent of inflammation and pancreatic necrosis. Early administration of n-3 polyunsaturated fatty acids (PUFAs) may prevent the development of severe complications through modulation of eicosanoid synthesis and cytokine release. PATIENTS AND METHODS - In the prospective, randomised clinical trial 14 patients with acute pancreatitis received n-3 PUFAs (3.3 g/day for 5- 7 days) as a supplement to their enteral formula in the form of fish oil, and another 14 patients receiving enteral nutrition served as a control group. Measurements of erythrocyte superoxidedysmutase activity, serum total antioxidant status, C-reactive protein and praealbumin concentrations were performed at admission and at day 3, 7 and 14. Beside routine laboratory and imaging examinations, the fatty acid and vitamin A and E concentrations of the serum lipid fractions were also determined at admission and at day 7 of the jejunal nutrition. The endpoints of the study were the duration of hospitalisation, the duration of jejunal nutrition and the frequency of complications. RESULTS - A significantly higher superoxidedysmutase activity was observed in patients receiving n-3 fatty acids at day 3 of the treatment. The n-3 to n-6 long chain PUFA ratio increased significantly in the serum lipids of the patients receiving n-3 PUFA supplementation, whereas remained unchanged in the controls. Supplementation resulted in a significant decrease in the length of hospitalisation (13.1±6.7 vs. 19.3±7.2 days, p<0.05) and jejunal feeding (10.6±6.7 vs. 17.6±10.5, p<0.05). Complications developed in 6/14 (42%) of the treated group and in 9/14 (64%) of the control patients. CONCLUSION - Enteral administration of n-3 PUFAs in acute pancreatitis may promote earlier recovery by moderating inflammation.]

LAM Extra for General Practicioners

[TREATMENT OF ACUTE PANCREATITIS, WITH SPECIAL REGARD TO PHARMACEUTICAL THERAPY]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]

Lege Artis Medicinae

[Plasmaferesis for the treatment of acute pancreatitis related to extreme hypertriglyceridemia]

BELOPOTOCZKY Gábor, ORENTSÁK Áron, PÁRTOS Gergely, ARÁNYI József, HARIS Ágnes, PENYIGE József, SIKE Róbert, DEMETER Pál

[We present the case of a 43-year-od wo­man, with pancreatitis related to extreme - higher than 100 mmol/L - secondary hy­pertriglyceridemia. Fast clinical improvement and rapid regression of pancreatitis were achieved by appropriate therapy of pancreatitis, the diabetic metabolic disturbance, correcting microcirculation and treating hypertriglyceridemia with plasmapheresis. The authors underline, that the complex therapeutic approach and early plasmapheresis in pancreatitis related to hypertriglyceridemia may prevent necrosis and more severe, even fatal, outcome of the disease. ]

Lege Artis Medicinae

[Possibilites of modern, evidence based prevention of recurrent cystitis]

GANYECZ Máté, KÖVES Béla, TENKE Péter

[Recurrent cystitis is a very common disease in women; every second women experiences at least one episode of acute cystitis during their lifetime, and in 20% of the cases it develops to recurrent cystitis. The disease also has a significant negative impact on quality of life. In 60% percent of the cases mild-severe depression can be shown, which can be reduced by 30-40% with the properly chosen prophylaxis. Therefore the up-to-date knowledge of the evidence based recommendations on disease management is mandatory to all clinicans dealing with this patient group. In case of a recurrent urinary tract infection treatment of the actual episode is not enough. Rather, emphasis has to be placed on appropriate prevention strategy. Alway non-antimicrobial methods has to be preferred as first choice, antibiotic prophylaxis should be considered only when the non-antimicrobials have been unsuccessful. In this review the authors summarise the evidence based management options of recurrent urinary tract infections in detail, based on the guideline recommendations of the European Association of Urology. ]

Lege Artis Medicinae

[Treatment of acute pancreatitis, with special regard to pharmaceutical therapy]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]