ABSTRACT
BACKGROUND/AIMS: Sixteen patients with bacteriologically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical treatment were studied prospectively. METHODOLOGY: The severity of IPN was documented pre-operatively using the following scores: 1) degree of necrosis by CT scan [< 30% in three patients (19%); 30-50% in nine patients (56%); > 50% in four patients (25%)]; 2) Elebute and Stoner's sepsis score (16 +/- 4 points); 3) Goris' score of multiple organ failure (MOF) (5 +/- 2 points). Sequential surgical treatment was carried out by the same surgical team, as follows: 1) abdominal re-explorations through a zipper for the first 7-10 days; 2) open abdomen and repeated peritoneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infection (range: 15-85 days). No patient required further re-exploration. RESULTS: Mortality occurred in 3/16 patients (19%), due to MOF in all 3 cases. The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73 +/- 33 days, without fistulae. These results indicate that by treating severe IPN with the technique of sequential abdominal re-explorations, open drainage and continuous closed lavage, a low 19% mortality can be achieved. CONCLUSION: This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN: these data could facilitate future comparison of results obtained with other treatment modalities.
Subject(s)
Bacterial Infections/complications , Multiple Organ Failure/complications , Pancreatitis, Acute Necrotizing/complications , Adult , Aged , Bacteria/isolation & purification , Bacterial Infections/mortality , Bacterial Infections/surgery , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Multiple Organ Failure/mortality , Pancreatectomy , Pancreatitis, Acute Necrotizing/microbiology , Pancreatitis, Acute Necrotizing/mortality , Pancreatitis, Acute Necrotizing/surgery , Prospective Studies , Severity of Illness Index , Survival Rate , Treatment OutcomeABSTRACT
In a double blind clinical trial 40 female patients, aged between 14 and 65 years, affected by mastodynia associated with benign non neoplastic disease of the breast, underwent oral treatment with nimesulide (200 mg/day) or placebo for a period of 15 consecutive days, during which no other drug therapy was assumed. The administration of nimesulide produced a clinically significant attenuation of mammary tenseness and mastodynia, in most cases up to complete remission of the symptoms. No adverse reaction was observed.
