ABSTRACT
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.
Subject(s)
Critical Care/standards , Pancreatitis/diagnosis , Pancreatitis/therapy , Acute Disease , Hemodiafiltration , Humans , Pancreatitis/classification , Pancreatitis/surgeryABSTRACT
Fundamento. El objetivo de este trabajo es revisar lautilidad de la RM pélvica para la estadificación del cáncerde recto y establecer una correlación radiopatológica.Material y métodos. Se realizó un análisis retrospectivode 120 pacientes con una edad comprendida entre 43 y87 años a los que se realizó una RM pélvica para el estadiajede cáncer rectal en nuestro hospital entre los años2005 y 2010. Se catalogaron los pacientes de acuerdo ala clasificación TNM.Resultados. De los 120 pacientes, 80 fueron tratadoscon RT y/o QT neoadyuvante debido a que presentabanenfermedad localmente avanzada (T3-T4), afectaciónganglionar (N1-N2) o metástasis resecables. Con los40 pacientes que no fueron sometidos a tratamientoneoadyuvante se realizó una correlación entre los hallazgosde la RM y de la anatomía patológica con unaprecisión diagnóstica para predecir el estadio T del72%, el estadio N del 60% y la distancia a la FMR del87,5%.Conclusión. La RM pélvica es una técnica útil para laestadificación locorregional del cáncer de recto, obteniendouna buena correlación radiopatológica aunquela identificación de la afectación ganglionar es todavíaun problema diagnóstico(AU)
Background. Our aim is to asses the accuracy of MRIfor preoperative rectal cancer staging and to establisha histopathologic correlation.Material and methods. A retrospective analysis wasperformed on 120 patients aged between 43 and 87 withhistologically proven rectal cancer who underwent MRIfor preoperative staging in our hospital between 2005and 2010. Patients were categorized according to theTNM classification.Results. Eighty of 120 patients underwent adjuvantchemoradiotheraphy because they had advanceddisease (T3-T4), lymph node involvement (N1-N2) orresectable metastases. With 40 patients who didntundergo neoadjuvant therapy we performed a correlationbetween MRI and histopathological findings witha diagnostic accuracy in predicting T stage of 72%, Nstage of 60% and distance to the mesorectal fascia of87,5%.Conclusion. Pelvic MRI is a useful technique for locoregionalstaging of rectal cancer with a good radiopathologiccorrelation although the identification of nodaldisease is still a diagnostic problem(AU)
Subject(s)
Humans , Male , Adult , Aged, 80 and over , Rectal Neoplasms/diagnosis , Rectal Neoplasms/pathology , Magnetic Resonance Imaging/ethics , /ethics , Rectal Neoplasms/epidemiology , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/therapy , Rectal Neoplasms , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/nursing , Magnetic Resonance Imaging/statistics & numerical data , Magnetic Resonance Imaging/trends , Magnetic Resonance Imaging , /methodsABSTRACT
Cystic lesions of the pancreas are infrequent, estimated at only some 1% of all pancreatic tumours and at some 10% of all pancreatic cysts. The pre-operational diagnosis is important for a suitable treatment, with valuable radiological techniques available today such as ultrasound, computerised tomography and magnetic resonance. In spite of this we have to accept that we are facing a group of tumours whose diagnosis is difficult, due to the great variety of cellular types existing within them.
Subject(s)
Pancreatic Cyst/diagnosis , Pancreatic Pseudocyst/diagnosis , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Pancreatic Cyst/therapy , Pancreatic Pseudocyst/therapy , Prognosis , Tomography, X-Ray ComputedABSTRACT
Las lesiones quísticas de páncreas son infrecuentes, estimándose en sólo un 1 por ciento de todos los tumores pancreáticos y en un 10 por ciento de todos los quistes pancreáticos. El diagnóstico preoperatorio es importante para un adecuado tratamiento, existiendo en la actualidad valiosas técnicas radiológicas como son los ultrasonidos, la tomografía computarizada y la resonancia magnética. A pesar de todo tenemos que aceptar que nos encontramos ante un grupo de tumores de difícil diagnóstico, debido a la gran variedad de tipos celulares que existen en los mismos. (AU)
Subject(s)
Humans , Pancreatic Cyst/pathology , Neoplasms, Cystic, Mucinous, and Serous/pathology , Pancreatic Neoplasms/pathology , Preoperative Care/methods , Pancreatic Neoplasms/surgeryABSTRACT
The cyst of thyroglossal duct (CTD) are the more frequent congenital mass of the neck, so you must consider them in the differential diagnosis of the neck's tumours. We present one case of CTD with certain clinical peculiarities.
Subject(s)
Thyroglossal Cyst , Adult , Female , Humans , Radiography, Thoracic , Thyroglossal Cyst/diagnostic imaging , Thyroglossal Cyst/surgery , Tomography, X-Ray ComputedABSTRACT
We present 26 cases of pyogenic hepatic abscess diagnosed by echography, 14 of which were treated by percutaneous drainage guided by ultrasound. An analysis is made of the clinical and radiological findings, as well as the differential diagnosis of focal hepatic lesions. Due to the lack of clinical specificity in many patients, we recommend fine needle biopsy directed by ultrasound to confirm the suspicion of pyogenic hepatic abscess and isolation of noncausative microorganisms. We think that the treatment of choice in these patients is percutaneous drainage guided by echography.
Subject(s)
Liver Abscess/diagnosis , Ultrasonography , Adult , Aged , Aged, 80 and over , Female , Humans , Liver Abscess/therapy , Male , Middle AgedABSTRACT
Pyogenic liver abscesses in 20 adult patients were reviewed to evaluate if computed tomography (CT), ultrasonography (US) and percutaneous catheter drainage have improved prognosis of this disease. The average delay in diagnosis was 16 days. The CT sensitivity was 94% while the US sensitivity was 78%. The response to treatment with open surgery was compared to percutaneous drainage. Eleven patients were surgically drained with complications in 58% of them. Eight were treated with percutaneous drainage and no complication appeared as a result of treatment. One was found at autopsy. Days of hospitalization in surgically drained patients were significantly higher (p less than 0.01) than percutaneous drained patients. Percutaneous catheter drainage is recommended as method of choice for treating patients with pyogenic liver abscesses.
