SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis.

OBJECTIVE: Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. PARTICIPANTS: Spanish and international intensive medicine physicians, radiologists, surgeons, gastroenterologists, emergency care physicians and other physicians involved in the treatment of acute pancreatitis. LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION: The GRADE method has been used for drawing them up. DRAWING UP THE RECOMMENDATIONS: The selection of the committee members was performed by means of a public announcement. The bibliography has been revised from 2004 to the present day and 16 blocks of questions on acute pancreatitis in a ICU have been drawn up. Firstly, all the questions according to groups have been drawn up in order to prepare one document. This document has been debated and agreed upon by computer at the SEMICYUC Congress and lastly at the Consensus Conference which was held with the sole objective of drawing up these recommendations. CONCLUSIONS: Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.

[Clinical pathways in acute pancreatitis: recommendations for early multidisciplinary management. Scientific Committee of the SEMICYUC. Working Group on Infectious Diseases (GTEI-SEMICYUC)]. / Hoja de ruta de los cuidados clínicos para la pancreatitis aguda: recomendaciones para el manejo anticipado multidisciplinar (clinical pathways).

There is a growing body of evidence that early management of patients with acute pancreatitis may alter the natural course of disease and improve outcomes of patients. The aim of this paper is to optimize the management of patients with acute pancreatitis during the first 72 h after hospital admission by proposing several clinical care pathways. The proposed pathways are based on the SEMICYUC 2005 Recommendations with incorporation of the latest developments in the field, particularly the determinants-based classification of acute pancreatitis severity. The pathways also incorporate the "alarm signs", the use of therapeutic modalities known as PANCREAS, and the "call to ICU" criteria. Further studies will need to assess whether the adoption of these pathway reduces mortality and morbidity in patients with acute pancreatitis. The previous SEMICYUC guidelines on management of patients with acute pancreatitis in Intensive Care will need to be revised to reflect the recent developments in the field.

[Fracture and embolization of implantable subclavian venous catheter fragments due to costoclavicular compression: pinch-off syndrome]. / Sección y embolización de catéter permanente por síndrome de pinzamiento costoclavicular (pinch-off).

The fracture of an implantable subclavian venous access device and the subsequent embolization of a catheter fragment is a known complication that is usually associated with a set of clinical and radiologic signs of costoclavicular compression. This scenario is also known as pinch-off syndrome. We describe 2 cases of venous port fracture which led us to review the efficacy of follow-up procedures used in our hospital. As a result, we added instructions for radiologic and clinical verification of catheter placement, taking into consideration the dynamic nature of compression. We also established protocols for coordinating the involvement of different services.

Sección y embolización de catéter permanente por síndrome de pinzamiento costoclavicular (pinch-off) / Fracture and embolization of implantable subclavian venous catheter fragments due to costoclavicular compression: pinch-off syndrome

Una de las complicaciones de los dispositivos venososimplantables subclavios es la rotura y posterior embolizaciónde un fragmento de catéter, que habitualmente seasocia a signos clínicos y radiológicos de pinzamientocostoclavicular, también llamado síndrome de “pinchoff”.Describimos dos casos de rotura ocurridas en nuestrohospital que nos llevaron a revisar la eficacia delseguimiento aplicado. Se añadieron instrucciones para lacomprobación radiológica y clínica del catéter, teniendoen cuenta el carácter dinámico del pinzamiento y se establecieronprotocolos de coordinación entre los serviciosimplicados)(AU)

The fracture of an implantable subclavian venousaccess device and the subsequent embolization of acatheter fragment is a known complication that is usuallyassociated with a set of clinical and radiologic signs ofcostoclavicular compression. This scenario is also knownas pinch-off syndrome. We describe 2 cases of venousport fracture which led us to review the efficacy offollow-up procedures used in our hospital. As a result, weadded instructions for radiologic and clinical verificationof catheter placement, taking into consideration thedynamic nature of compression. We also establishedprotocols for coordinating the involvement of differentservices(AU)

Síndrome de Lemierre y Mycoplasma pneumoniae / Lemierre´s syndrome and mycoplasma pneumoniae

Se ha sugerido que una infección faríngea previa viral o bacteriana puede favorecer el desarrollo del síndrome de Lemierre, una entidad hoy en día poco frecuente. Se describe un caso de síndrome de Lemierre en el que coexiste una infección por Mycoplasma pneumoniae, hecho comunicado en la literatura sólo en otros 2 casos. Se trata de una adolescente de 16 años con tromboflebitis yugular izquierda, bacteriemia por Fusobacterium necrophorum y émbolos sépticos en pulmón, que requirió ventilación mecánica por insuficiencia respiratoria grave. A pesar del tratamiento precoz con penicilina G y clindamicina, persistió la fiebre y parte de la afectación pulmonar hasta la introducción, tras la confirmación serológica de infección por M. pneumoniae, de un antibiótico activo frente a este patógeno. Los clínicos debemos saber reconocer fácilmente esta enfermedad porque su presentación clínica es muy característica, y debemos considerar la posibilidad de coinfección con otros microorganismos, incluido M. pneumoniae

It has been suggested that a previous viral or bacterial pharyngitis may predispose to Lemierre´s syndrome, an uncommon entity nowadays. A case of Lemierre´s syndrome and co-infection with Mycoplasma pneumoniae is described, association published before in only 2 other cases. A 16-year-old girl with trombophlebitis of the left jugular vein, Fusobacterium necrophorum bacteremia and septic emboli in the lung requiring mechanical ventilation due to severe respiratory insufficiency. Despite early treatment with penicillin G and clindamycin, fever and part of pulmonary affectation persisted until that an antibiotic agent active against M. pneumoniae was instaurated, after its serological confirmation. The physicians should be easily recognized this disease because of its characteristic clinical findings, and co-infection with other organisms including M. pneumoniae, should be considered

[Lemierre's syndrome and Mycoplasma pneumoniae]. / Síndrome de Lemierre y Mycoplasma pneumoniae.

It has been suggested that a previous viral or bacterial pharyngitis may predispose to Lemierre's syndrome, an uncommon entity nowadays. A case of Lemierre's syndrome and co-infection with Mycoplasma pneumoniae is described, association published before in only 2 other cases. A 16-year-old girl with trombophlebitis of the left jugular vein, Fusobacterium necrophorum bacteremia and septic emboli in the lung requiring mechanical ventilation due to severe respiratory insufficiency. Despite early treatment with penicillin G and clindamycin, fever and part of pulmonary affectation persisted until that an antibiotic agent active against M. pneumoniae was instaurated, after its serological confirmation. The physicians should be easily recognized this disease because of its characteristic clinical findings, and co-infection with other organisms including M. pneumoniae, should be considered.

[Cystic neoplasms of the pancreas: a review of the literature apropos 5 cases]. / Neoplasias quísticas de páncreas: revisión de la literatura a propósito de cinco casos.

Cystic neoplasms of the pancreas make up a group of uncommon tumors. Their relevance lies upon their favorable prognosis after resection and the fact of being commonly mistaken with pseudocysts. Based on five patients treated at our hospital in the last few years we make an update review of the literature on these tumors. To note the role that imaging and puncture-aspiration techniques can play for diagnosis. We conclude that when a cystic lesion of the pancreas is found, the diagnosis of cystic neoplasm must be considered, thus avoiding delays in surgical resections which may condition the patient's prognosis.

[Early detection of breast cancer in Navarra. Diagnostic approach in women sent to a referral hospital]. / Detección precoz del cáncer de mama en Navarra. Conducta diagnóstica en las mujeres enviadas a un hospital de referencia.

BACKGROUND: Breast cancer screening programs represent an important increase in the number of patients to be evaluated and a higher proportion of subclinical lesions detected in reference hospitals. The authors' experience related to an early detection program initiated in Navarra, Spain (PDPCM) is herein presented. METHODS: The diagnoses made in 319 women referred from the PDPCM to the authors' hospital for mammographic suspicion of malignancy were reviewed. Directed surgical biopsy was carried out in 89 women (27.9%) without previous cytologic study. Fine needle aspiration punction and cytology (FNAP-cytology) were performed as the first diagnostic test in 216 lesions (67.7%) 53 of which were palpable and 163 nonpalpable. Aggressive techniques were not indicated in 14 cases (4.4%). RESULTS: A total of 136 carcinomas (42.6%) were diagnosed and benign lesions were find at biopsy in 112 (35.1%) women. The fifty-seven lesions (17.9%) which did not show malignancy on FNAP-cytology were not biopsied given the insufficient degree of suspicion. Only one false negative has appeared in this group from 27 to 48 months after the first consultation. The global diagnostic reliability was of 99.68%. CONCLUSIONS: Directed surgical biopsy is the most reliable technique for the diagnosis of nonpalpable breast lesions in early stages and is always necessary when there is medium or high radiologic suspicion of malignancy. Fine needle aspiration puncture is a very useful technique to confirm malignancy and to avoid unnecessary biopsies in low suspicion lesions.