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OBJECTIVE@#To explore the clinical manifestations, diagnosis, treatment and prognosis of blastic plasmacytoid dendritic cell neoplasm(BPDCN).@*METHODS@#The clinical features, bone marrow morphology and immunophenotyping, treatment and prognosis of 4 patients with BPDCN were analyzed retrospectively.@*RESULTS@#4 patients had bone marrow， spleen and lymph nodes involvement， 2 patients had skin lesions， and 3 patients had central nervous system infiltration． Tailing phenomenon of abnormally cells could be seen in bone marrow. The immunophenotyping showed that CD56, CD4 and CD123 expression was observed in 4 patients， and CD304 in 3 patients． One patient refused chemotherapy and died early. Both patients achieved complete remission after the initial treatment with DA+VP regimen, 1 of them achieved complete remission after recurrence by using the same regimen again． One patient failed to respond to reduced dose of DA+VP chemotherapy, and then achieved complete remission with venetoclax+azacitidine.@*CONCLUSION@#The malignant cells in BPDCN patients often infiltrate bone marrow, spleen and lymph nodes, and have specical phenotypes, with poor prognosis. The treatment should take into account both myeloid and lymphatic systems. The treatment containing new drugs such as BCL-2 inhibitors combined with demethylation drugs is worth trying.
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Humans , Dendritic Cells , Retrospective Studies , Skin Neoplasms/pathology , Antineoplastic Agents/therapeutic use , Bone Marrow/pathology , Myeloproliferative Disorders , Hematologic Neoplasms/drug therapyABSTRACT
BACKGROUND@#Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.@*METHODS@#The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.@*RESULTS@#A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.@*CONCLUSION@#For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.
Subject(s)
Humans , Randomized Controlled Trials as Topic , Fluid Therapy , Hypovolemia , Pancreatitis/therapyABSTRACT
Objective:To investigate clinical outcome and the risk factors for death in acute pancreatitis (AP) patients complicated with acute kidney injury (AKI).Methods:The clinical data of 232 AP patients complicated with AKI admitted to the Center of Severe Pancreatitis of Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into survival group ( n=162) and death group ( n=70) based on the survival status. The two groups' clinical characteristics, biochemical indexes, and renal function indexes were compared. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors for death in AP patients complicated with AKI. Results:Sixteen patients(6.9%) among the 232 had AKI Ⅰ, 15(6.5%) had AKI Ⅱ, and 201(86.6%) had AKI Ⅲ. Forty-one patients (17.7%) became AKI with a disease course <7 days, 184 patients (79.3%) gradually progressed to acute kidney disease with a disease course of 7-90 days, and 7 patients (3.0%) eventually progressed to chronic kidney disease with a disease course >90 days. Renal replacement treatment (RRT) was administered in 179 patients (77.2%), lasting an average of 14 (7-25) days. 138 patients (59.5%) had their renal function recovered while they were hospitalized, including 9 patients (6.5%) who did so within 7 days, 69 patients (50.0%) within 30 days, and 127 patients (92.0%) within 90 days. The average recovery time was 16 (7-28) days. Seventy patients (30.2%) died during hospitalization, including 8(3.5%) within 7 days, 42(18.1%) within 30 days, and 68(29.3%) within 90 days. Univariate analysis revealed that the proportions of biliary etiology, neutrophil to lymphocyte ratio (NLR), serum cystatin C, sequential organ failure assessment(SOFA) score, AKI Ⅲ proportion, number of patients undergoing RRT, and duration of AKI were significantly higher in the death group compared to the survival group. The number of patients complicated by infected pancreatic necrosis (IPN) and having surgical intervention was also significantly greater than that in the survival group, while the proportion of patients whose renal function recovered was much lower than that in the survival group. The differences were all statistically significant (all P value <0.05). Multivariate logistic analysis showed that SOFA( OR=1.182, 95% CI 1.000-1.396, P=0.049), and IPN( OR=8.403, 95% CI 3.748-18.838, P<0.001) were independent risk factors for death. Conclusions:SOFA score and IPN at admission were independent risk factors for death in AP patients with AKI. Vigilance should be given as soon as possible to improve the outcome of patients through clinical intervention.
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Objective: To develop and validate a deep learning model based on fundus photos for the identification of coronary heart disease (CHD) and associated risk factors. Methods: Subjects aged>18 years with complete clinical examination data from 149 hospitals and medical examination centers in China were included in this retrospective study. Two radiologists, who were not aware of the study design, independently evaluated the coronary angiography images of each subject to make CHD diagnosis. A deep learning model using convolutional neural networks (CNN) was used to label the fundus images according to the presence or absence of CHD, and the model was proportionally divided into training and test sets for model training. The prediction performance of the model was evaluated in the test set using monocular and binocular fundus images respectively. Prediction efficacy of the algorithm for cardiovascular risk factors (e.g., age, systolic blood pressure, gender) and coronary events were evaluated by regression analysis using the area under the receiver operating characteristic curve (AUC) and R2 correlation coefficient. Results: The study retrospectively collected 51 765 fundus images from 25 222 subjects, including 10 255 patients with CHD, and there were 14 419 male subjects in this cohort. Of these, 46 603 fundus images from 22 701 subjects were included in the training set and 5 162 fundus images from 2 521 subjects were included in the test set. In the test set, the deep learning model could accurately predict patients' age with an R2 value of 0.931 (95%CI 0.929-0.933) for monocular photos and 0.938 (95%CI 0.936-0.940) for binocular photos. The AUC values for sex identification from single eye and binocular retinal fundus images were 0.983 (95%CI 0.982-0.984) and 0.988 (95%CI 0.987-0.989), respectively. The AUC value of the model was 0.876 (95%CI 0.874-0.877) with either monocular fundus photographs and AUC value was 0.885 (95%CI 0.884-0.888) with binocular fundus photographs to predict CHD, the sensitivity of the model was 0.894 and specificity was 0.755 with accuracy of 0.714 using binocular fundus photographs for the prediction of CHD. Conclusion: The deep learning model based on fundus photographs performs well in identifying coronary heart disease and assessing related risk factors such as age and sex.
Subject(s)
Humans , Male , Retrospective Studies , Deep Learning , Fundus Oculi , ROC Curve , Algorithms , Risk Factors , Coronary Disease/diagnostic imagingABSTRACT
Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.
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Objective@#To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN).@*Methods@#The patients with severe acute pancreatitis (SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People′s Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints.@*Results@#A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases; the median number of SAPEN operations was 1 (range 1-3), and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80.0%. 5 patients (12.5%) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died.@*Conclusions@#SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.
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Objective To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN). Methods The patients with severe acute pancreatitis ( SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People's Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints. Results A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases;the median number of SAPEN operations was 1 ( range 1-3 ) , and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80. 0％. 5 patients (12. 5％) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died. Conclusions SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.
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Objective To observe the clinical outcomes and safety of continuous negative pressure irrigation (NPI) and endoscopic necrosectomy(ED) for treating infected pancreatic necrosis(IPN). Methods A retrospective review of the data of 163 severe acute pancreatitis(SAP) patients with IPN who were treated by four-step drainage from January 2012 to December 2013 at the SAP therapy center of Nanjing General Hospital was performed. All patients were divided into 7 groups including PCD alone, PCD+NPI, PCD+NPI+ED, PCD+ON, PCD +NPI +ON, PCD +ED +ON and PCD +NPI +ED +ON group based on the drainage strategy of percutaneous catheter drainage(PCD),NPI, ED and open necrosectomy(ON), and the feasibility and safety were analyzed. Results All the patients underwent PCD therapy. Each patient underwent a median of 3 drainage procedures and the median total drainage duration was 11 days. No significant procedure-related complication was observed. Around 40% of the patients recovered after receiving PCD alone. Thirty-four patients(20.9%) underwent ON. The mean hospitalization duration was 38 days and the mean ICU stay was 19 days. There were 25 cases with new-onset organ functional failure,26 patients with sepsis,32 patients with gastric and intestinal fistula,34 patients with intra-abdominal bleeding,8 patients with portal vein thrombosis and 3 patients with gastric outlet obstruction. 28 patients(17.2%) died. Conclusions This four-step approach is effective in treating IPN when compared with other step-up strategies. NPI and ED could offer distinct clinical efficacy without adding no extra risk to patients.
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Objective Up to the present time, no reports are seen at home or abroad on the clinical characteristics of severe acute pancreatitis (SAP) with persistent inflammation-immunosuppression-catabolism syndrome (PICS), and few studies have been conducted on the risk factors for PICS.This article summarizes the clinical characteristics of PICS in SAP patients and presents a multivariate regression analysis of its risk factors.Methods This is a retrospective study on the clinical data about 214 cases of SAP treated for over 14 days in the Surgical Intensive Care Unit (SICU) from January 1, 2014 to December 31, 2015.According to the diagnostic criteria of PICS, we divided the SAP patients into a PICS group (n=149) and a non-PICS group (n=65).We compared the systemic and pancreatitis-specific complications and mortality rates in the SICU and at 12 months after discharge.We also performed a multivariate regression analysis on the risk factors of PICS.Results The incidence rates of biliary SAP and multiple-organ dysfunction syndrome (MODS) were significantly higher in the PICS (44.3% and 93.3%) than in the non-PICS group (29.2% and 55.4%) (P=0.038).The results of multivariate regression analysis showed that the risk factors for PICS included obesity (OR=2.3;95% CI: 1.0-5.2), biliary causes (OR=4.2;95% CI: 1.4-13.0), and MODS (OR=4.4;95% CI: 1.3-14.4).The survival rate at 12 months after discharge was remarkably lower in the PICS than in the non-PICS group (88.5% vs 98.2%, P=0.036).Conclusion The incidence rate of PICS is high in SAP patients.Obesity, biliary causes and MODS are independent risk factors for PICS.The complication of PICS may be an important indicator of the poor prognosis of SAP.
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Objective Acute pancreatitis exhibits different clinical and ultrasonic features in patients complicated with acute acalculous cholecystitis ( AAC) at different stages .The aim of this study was to analyze the ultrasonic characteristics of acute pancreati-tis complicated with AAC at different stages . Methods We retrospectively analyzed the clinical data about 41 cases of acute pancrea-titis with moderate to severe AAC .According to whether AAC developed within or after 2 weeks of the onset of acute pancreatitis , we divided the patients into an early-stage group (n=18) and a late-stage group (n=23).We recorded the gallbladder size, gallbladder wall thickness , fluid around the gallbladder , biliary sludge deposition and the Murphy′s sign by ultrasonography , obtained AAC-related clinical and laboratory data concerning body temperature , Murphy′s sign, WBC count and C-reactive protein level , and analyzed the ultrasonic features of AAC at different stages in the acute pancreatitis patients. Results All the patients experienced a fever of >38.5℃, 38.89%with chills in the early onset group and 47.83%in the late onset group .Increases were observed in patients of the early-and late-stage groups in the WBC count ( 94.44%vs 82.61%) , the C-reactive protein level ( 100%vs 91.30%) , and the fluid volume around the gallbladder (94.44%vs 60.86%, P<0.05), but incidence rate of gallbladder wall thickening was significantly lower in the former than in the latter group (11.11%vs 78.26%, P<0.01). Conclusion AAC developing at different stages of acute pancreatitis has different ultrasonic features , with higher incidence rates of fluid around the gallbladder in the early stage and gallbladder wall thickening in the late stage.
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Central venous catheters (CVCs) are widely used in various puncture and drainage operations in intensive care units (ICUs) in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation process. We came across a patient with severe acute pancreatitis (SAP) who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracocentesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.
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Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model.Methods After baseline data were recorded,24 pigs were randomly allocated into three groups as follows:one SAP-alone group,and two SAP + ACS groups (decompression at 6 and 12 hours,respectively).We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium taurocholate to induce severe acute pancreatitis (SAP).Systemic hemodynamic profiles,urine output,systemic oxygenation,and serum biochemical parameters of the animals were obtained.Results After induction of ACS,the hemodynamics and oxygenation of the study animals deteriorated significantly.The survival time of the 12-hour group was significantly shortened (P =0.008 vs.6 hours).Early decompression (6 h) restored systemic hemodynamics,oxygenation,organ function,and inflammatory intensity to a level comparable to that of the SAP-alone group.In contrast,animals in 12-hour group developed more severe hemodynamic suppression,oxygenation and organ dysfunction and inflammatory process.For instance,the cardiac output levels in the three groups were 2.70 ±0.50 for the SAP group,2.75 ±0.48 for the 6 hour-group and 2.19 ±0.43 for the 12 hour-group.Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS,and also improve systemic hemodynamics,organ function and inflammatory intensity.
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Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis (SAP) swine model with intra-abdominal hypertension (IAH) Methods By self-controlled study,SAP model was made by infusing sodium taurocholate (5％) into the pancreatic duct in 6 domestic swine.Mechanical ventilator mode was volumeassist control with tidal volume 10 ml/kg ; FiO2 40％ and PEEP 5 cm H2O (routine ventilation) given to SAP model swine.After 3 h ventilation,pneumo-peritoneum was made with N2 gas to increase the intraabdominal pressure (IAP) to 25 mm Hg in SAP swine.Three more hours later,PEEP was adjusted as the measurement of esophageal pressure (Pes guided ventilation) to such a level that trans-pulmonary pressure stayed above 0 cm H2O during end-expiratory occlusion.During the investigation period,heart rate (HR),cardiac output index (CI),central venous pressure (CVP),mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor,and oxygen partial pressure of artery (PaO2) and carbon dioxide partial pressure of artery (PaCO2) were measured by blood-gas analysis.In addition,systemic oxygen delivery (DO2) and systemic oxygen consumption (VO2) were calculated by using the data of blood-gas analysis of arterial and central venous blood.Results No swine model was subjected to barotrauma.After routine mechanical ventilation,there were significant differences in HR,CI,MAP,CVP,PAWP,Ppeak,Pplat,Pes,pulmonary compliance (Cstat),PaO2,and DO2 between SAP and IAH in swine (all P ＜ 0.05).Compared with routine ventilation,however,PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure (all P ＜ 0.05).The lactate decreased significantly after esophageal pressure guided ventilation (all P ＜ 0.05).There were no significant changes in PaCO2,HR,MAP,CVP and PAWP in IAH swine after mechanical ventilation with routine parameters (all P ＞ 0.05).Conclusions There were remarkable effects on oxygen metabolism in response to mechanical ventilation guided by esophageal pressure.In case of clinical application of mechanical ventilation,the results of this study are in favor of setting transpulmonary pressure according to measurements of esophageal pressure in SAP patients with IAH in an early stage.
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<p><b>OBJECTIVE</b>To evaluate the impact of lesion size on the detection rate of non-palpable breast malignant lesions and determine whether lesion size should prompt biopsy of non-palpable breast lesions.</p><p><b>METHODS</b>The study included 816 ultrasonographically detected non-palpable breast lesions. We divided the lesions into five groups based on their largest diameters: ≤0.5cm, 0.6-1.0cm, 1.1-1.5cm, 1.6-2.0 cm, and >2.0 cm. The detection rate of malignancies of different sizes were compared among these lesions, Breast Imaging Reporting and Data System (BI-RADS) category 2-3 lesions, and BI-RADS grades 4-5 lesions. The feasibility of using lesion size as biopsy indicator for BI-RADS category 2-3 non-palpable breast lesion was analyzed using ROC curve.</p><p><b>RESULTS</b>Of these 816 lesions, 100 (12.3%) were found to be malignant lesions. The detection rate of malignancy significantly increased along with the increase of lesion size (P<0.05). When the BI-RADS category was not considered, the frequency of malignancy in the >2.0 cm group was significantly higher than in other groups (P<0.05) The frequencies of malignancy in the 0.6-1.0 cm group, 1.1-1.5 cm group, and 1.6-2.0 cm group were higher than that in ≤0.5 cm group, but the difference was not significant (P>0.05) For BI RADS category 4 and 5 lesions, the frequency of malignancy in >2.0 cm group was higher than in other groups, but significant difference was only seen between >2.0 cm group and ≤0.5 cm group (P<0.05).</p><p><b>CONCLUSIONS</b>Lesion size may influence the detection rate of malignancy of non palpable breast lesions, and can be used as biopsy indicator of non palpable breast lesions in BI-RADS 2,3 category When we use 1.25cm as threshold,the sensitivity and specificity may be satisfying.</p>
Subject(s)
Female , Humans , Breast , Pathology , Breast Neoplasms , Diagnostic Imaging , Pathology , Sensitivity and Specificity , Ultrasonography, MammaryABSTRACT
<p><b>OBJECTIVE</b>To assess the effect of intra-abdominal hypertension (IAH) on hemodynamics of severe acute pancreatitis (SAP) in porcine model.</p><p><b>METHODS</b>Following baseline registrations, SAP was induced in 12 animals. The N(2) pneumoperitoneum was used to increase the intra-abdominal pressure to 30 mmHg (1 mmHg = 0.133 kPa) in 6 of 12 SAP animals thereafter and keep constant during the experiment. The investigation period was 12 h. Heart rate, cardiac output (CO), central venous pressure (CVP), mean arterial pressure and pulmonary arterial wedge pressure (PAWP) were continuously measured with the aid of balloon tipped flow-directed catheter and electrocardiography monitor. Oxygen partial pressure of artery (PaO(2)), carbon dioxide partial pressure of artery (PaCO(2)), ScvO(2), base excess (BE), and blood lactic acid (LAC) were measured by acid-base analysis.</p><p><b>RESULTS</b>In the IAH group, CO decreased significantly at 12 h, CVP and PAWP increased significantly at 3 h, 6 h and 12 h compared with SAP group (all P < 0.05). Peak inspiration pressure increased immediately after pneumoperitoneum in the IAH group, to (50.2 ± 3.1) cmH(2)O (1 cmH(2)O = 0.098 kPa) and (49.8 ± 0.9) cmH(2)O at 6 h and 12 h respectively. The pH, PaO(2), ScvO(2) and BE showed a tendency to fall in the IAH group. PaCO(2) and LAC were increased significantly in the IAH group (all P < 0.05).</p><p><b>CONCLUSIONS</b>There were remarkable and relatively irreversible effects on global hemodynamics in response to sustained IAH of 12 h with the underlying condition of SAP. Abdominal decompression is beneficial for patients of SAP with IAH.</p>
Subject(s)
Animals , Female , Male , Disease Models, Animal , Hemodynamics , Physiology , Intra-Abdominal Hypertension , Pancreatitis, Acute Necrotizing , SwineABSTRACT
<p><b>OBJECTIVE</b>To assess the effect of decompression in different time on systemic hemodynamics and oxygen metabolism in a 24 h lasting porcine model of severe acute pancreatitis (SAP) incorporating intra-abdominal hypertension (IAH).</p><p><b>METHODS</b>Following baseline registrations, SAP was induced in all 18 animals. A N(2) pneumoperitoneum was used to increase the intra-abdominal pressure (IAP) to 25 mmHg (1 mmHg = 0.133 kPa) in 12 of 18 SAP animals. After 6 hours, decompression was applied in 6 of these 12 pigs and the other 6 animals received decompression at 9 h since the induction of IAH. The investigation period was 24 h. Heart rate (HR), cardiac output (CO), central venous pressure (CVP), mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and electrocardiography monitor; Oxygen partial pressure of artery (PaO(2)), carbon dioxide partial pressure of artery (PaCO(2)) and central venous oxygen saturation (ScvO(2)) were measured by blood-gas analysis. Besides that, systemic oxygen delivery (DO(2)) and systemic oxygen consumption (VO(2)) were calculated according to blood-gas analysis in arterial and central venous blood.</p><p><b>RESULTS</b>After decompression, HR, CO, MAP, CVP, PAWP, PaO(2) and DO(2) showed no significant differences in the 6 h group when compared to SAP pigs. In the 9 h group, however, CO decreased significantly and HR, CVP, PAWP increased significantly after decompression than SAP only animals (all P < 0.05). PaO(2), ScvO(2) and DO(2) showed lower after 3 h of decompression compared with another two groups. VO(2) increased higher in IAH groups during 6 h of experiment than SAP pigs (all P < 0.05). Then VO(2) showed a trend to fall and no differences in three groups.</p><p><b>CONCLUSIONS</b>There are remarkable and relatively irreversible effects on global hemodynamics and oxygen metabolism in response to the decompression in different time after sustained IAH with the underlying condition of SAP. The results of this study are in favor of a decompression in patients of SAP with IAH in early time.</p>
Subject(s)
Animals , Decompression, Surgical , Methods , Disease Models, Animal , Hemodynamics , Intra-Abdominal Hypertension , Metabolism , General Surgery , Oxygen Consumption , Pancreatitis , Metabolism , General Surgery , Partial Pressure , SwineABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical effectiveness of percutaneous US- or CT-guided drainage and laparotomy for patients with infective pancreatic necrosis.</p><p><b>METHODS</b>Data of 90 infective pancreatic necrosis patients admitted from January 2008 to December 2009 were included. They were divided into two groups by the different treatment choices. Twenty-seven patients in the percutaneous group received percutaneous US- or CT-guided drainage as first choice. After that a sump suction apparatus was applied for controlled drainage. If no improvement was achieved after 3 days, they would received operation soon. While patients in the laparotomy group received surgical drainage at the time when the diagnosis of infected pancreatic necrosis was confirmed. Continuous drainage was also applied for these ones.</p><p><b>RESULTS</b>The percutaneous group had a significant low rate of reoperation (7.1% vs. 14.3%, P < 0.05) and postoperative residual abscesses (7.1% vs. 28.6%, P < 0.05). Furthermore, 48.1% of patients in percutaneous group successfully avoid laparotomy. In the regard of complications, the percutaneous group presented lower incidence of both single organ dysfunction (7.4% vs. 28.6%, P < 0.05), intestinal fistula (7.4% vs. 27.0%, P < 0.05) and long-term complications (3.7% vs. 22.2%, P < 0.05). In addition, the percutaneous group costed less medical resources as evidenced by shorter ICU duration (21.2 ± 9.7 vs. 28.7 ± 12.1, P < 0.01), shorter hospital duration (48.2 ± 12.5 vs. 59.6 ± 17.5, P < 0.05) and less expenditure (191 762 ± 5892 vs. 341 689 ± 10 854, P < 0.05).</p><p><b>CONCLUSIONS</b>Percutaneous drainage can effectively lower the surgical rates and the rates of complications and reoperations in patients with infective pancreatic necrosis. Besides that, it could also reduce the cost of medical resources.</p>