The clinical value of the procalcitonin in prediction of severity and outcome in acute pancreatitis.

BACKGROUND/AIMS: Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms. METHODOLOGY: 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement. RESULTS: PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml. CONCLUSIONS: PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.

Report of first experience with endoscopic ultrasonography in Slovak Republic.

BACKGROUND: Endoscopic ultrasonography (EUS) is a method that takes the advantage of a combination of endoscopy and ultrasound, where a miniature probe that functions as a transducer (which functions as both a transmitter and a receiver of ultrasound), is incorporated in the tip of the endoscope. From the introduction, this modality has found it s uninterchangable place all over the world not only in the diagnosis, but also in the therapy of gastrointestinal diseases and the diseases of the surrounded structures and organs. Indications for EUS can be simply divided into three main categories: submucosal abnormalities, staging of tumors of the gastrointestinal tract and pancreatobiliary diseases. In December 2000 we began at the Clinic of Gastroenterology of Slovak Postgraduate Academy of Medicine at St. Cyril and Method s Hospital in Bratislava, Slovak Republic with the EUS evaluation with radial mechanical probe, as the first one in the Slovak Republic. In this article we describe our first experience with the EUS at our clinic. CONCLUSIONS: All together 64 patients were evaluated from December 2000 to the end of March 2001 from all over the Slovakia. In this article we describe in more detailed form the indications and also the findings in our group of patients.

[Endoscopic therapy of pancreatic pseudocysts]. / Endoskopická liecba pseudocýst pankreasu.

BACKGROUND: Pancreatic pseudocysts are a complication of both acute and chronic pancreatitis. Incidence in patients with acute pancreatitis is 2-50%, in patients with chronic pancreatitis 20-40%. Pseudocysts are a cause of many symptoms, e.g. nausea, vomitus, pain, biliary obstruction, bleeding and perforation. Successful treatment of pseudocysts is not only surgical and percutaneous, but also endoscopic. OBJECTIVES: The aim of this study was to answer the following questions. First, what is the clinical success rate of endoscopic drainage of pancreatic pseudocysts? Second, what are the complications? Finally, how often is endoscopic drainage a definite treatment? METHODS: The records of all patients (11) with chronic pancreatitis and endoscopic drainage of symptomatic pseudocysts hospitalized between December 1993 and April 1999 at our clinic were retrospectively studied. RESULTS: Patients (5) were followed for a mean duration of 30 months. Endoscopic drainage was definitive treatment in 80%, after transgastric drainage in 50%, after transpapillary drainage in 100% and after the use of more than one drainage procedure in 0%. The prognostic factors for longterm success of endoscopic drainage could not be evaluated, because of the small number of treated patients. CONCLUSIONS: Endoscopic treatment of pancreatic pseudocysts (endoscopic cystogastrostomy, cystoduodenostomy and transpapillary drainage) is nowadays highly effective method, technically feasible in most patients, with a relative degree of safety when performed by experienced endoscopist. (Tab. 2, Ref. 16.)

Review article: the clinical influence of Helicobacter pylori in effective acid suppression-implications for the treatment of gastro-oesophageal reflux disease.

The relationship between gastro-oesophageal reflux disease (GERD) and Helicobacter pylori is unclear. Recent data indicate that H. pylori probably exerts a protective effect against GERD. In recent years, the interaction between H. pylori, proton pump inhibitors and GERD has been widely studied. Currently available proton pump inhibitors produce significantly higher intragastric pH in H. pylori-positive patients than in those who are H. pylori negative, and this phenomenon may be clinically relevant. The mechanisms responsible for this difference in efficacy are not fully understood, although there are two major theories. Ammonia, produced by H. pylori, is able to neutralize gastric acid, and thus apparently increase the effect of acid suppressive agents (the 'ammonia theory'). The other theory is that decrease in acid output is due to the development of corpus gastritis during treatment with a proton pump inhibitor (the 'gastritis theory'). Treatment strategies to overcome this lowered sensitivity to acid suppression are to increase the frequency/dose of a proton pump inhibitor or to add an H2-receptor antagonist in the evening-but both have pharmaco-economic implications. An agent that could provide adequate pH control regardless of H. pylori status would be highly beneficial in the treatment of GERD, and may also lower treatment costs.

[Hepatorenal syndrome]. / Hepatorenálny syndróm.

BACKGROUND: The association of renal failure with terminal liver insufficiency is referred to as hepatorenal syndrome (HRS). It is characterized by impaired renal function together with abnormalities in arterial circulation and activity of endogenous vasoactive system. In the pathogenesis of HRS, vasodilatation in the splanchnic circulation plays a major role. This leads to underfilling in arterial circulation in this area with subsequent vasoconstriction in renal arteries leading to lower renal circulation and functional renal failure. One of the most difficult tasks in clinical evaluation of patients with cirrhosis is to diagnose renal functions, because the standard methods used in evaluation of glomerular filtration are not reliable. The most important agents in the treatment of patients with cirrhosis, ascites and HRS are identification, prevention of precipitating factors, correction and treatment of prerenal failure and acute tubular necrosis. Up to now, the only effective treatment of HRS is ortothopic liver transplantation, which cannot be applied in all patients. CONCLUSIONS: HRS is a serious complication of liver diseases with a very bad prognosis qouad vitam and qouad sanationem, which is only rarely reversible. After diagnosing HRS, the renal insufficiency is already mostly progressive, and patients have only a minimal chance to improve their renal functions. The only currently proved treatment modality, which is successful in terms of improving renal functions and long-term survival rate is liver transplantation. (Tab. 2, Fig. 1, Ref. 28.)

[Etiology and diagnosis of acute pancreatitis]. / Etiológia a diagnostika akútnej pankreatitídy.

Acute pancreatitis (AP) is an acute inflammatory process of pancreas with varying affliction of other tissues or organs. Both, exocrine and endocrine functions recover following the acute period. Its symptoms include abdominal pain and elevation of pancreatic enzymes within blood, urine and peritoneal fluid. The incidence of acute pancreatitis is approximately 20 cases/100,000 people in Europe and approximately 100 cases/100,000 people in the USA. The fact of mild predominance of this affliction in males is known.

Pulmonary complications in patients with inflammatory bowel disease.

BACKGROUND/AIMS: Between 1996 and 1998 we investigated the occurrence of lung disorders in 82 patients with inflammatory bowel disease (30 patients with ulcerative colitis and 52 patients with Crohn's disease) and a control group of 60 subjects. The aim of our study was to determine the occurrence of pulmonary complications in patients with inflammatory bowel disease, to investigate whether ulcerative colitis or Crohn's disease are connected with a typical lung function disorder, with the inflammatory activity of the disease or if they depend on the presence of other extraintestinal manifestations. METHODOLOGY: We investigated the occurrence of lung disorders in terms of the following parameters: clinical pulmonary symptoms, chest radiography and pulmonary function tests (body plethysmography, pneumotachography, lung transfer capacity for carbon monoxide, and blood gas analysis). RESULTS: Lung function abnormalities were significantly more frequent in patients with inflammatory bowel disease as compared to controls (p<0.001). There was no apparent correlation between these abnormalities and either bowel disease activity or drug administration (sulphasalazine, mesalazine). CONCLUSIONS: Despite the lack of radiological abnormalities, we identified a high incidence of pulmonary function abnormalities (suspicious of interstitial lung disorder) in patients with inflammatory bowel disease; 56.7% of patients with ulcerative colitis and 57.7% of patients with Crohn's disease had reduced lung transfer factor.

[Actinomycosis of the ovary as a cause of cachexia in a young patient]. / Aktinomykóza ovaria jako prícina kachektizace u mladé pacientky.

The authors describe the case of a 40-year-old female patient treated for prolonged periods unsuccessfully with several antibiotics on account of a febrile condition of obscure aetiology and subsequently repeatedly subjected to laparotomy on account of intra-abdominal abscesses. The cause of the fever, abdominal pain and gradual cachectization was an abdominal form of actinomycosis. After establishment of the diagnosis the patient was successfully treated by long-term penicillin administration and recovered completely. The authors discuss experience reported in the literature and therapeutic possibilities in actinomycosis.

[The importance of the determination of primary bile acids in diseases of the digestive tract]. / Význam stanovení primárních zlucových kyselin u chorob zazívacího traktu.

The authors assessed the concentration of primary bile acids in patients with liver diseases, diseases of the gallbladder and biliary pathways, with affections of the pancreas and in a control group. Primary bile acids and their conjugated derivatives were assessed by radioimmunoanalysis from the patients' serum, using radiodiagnostic sets of Farmos Co. Finland. The range of the assessed concentrations was 0.15-15 mumol/l. The total number of examined subjects was 56, blood specimens for estimation of bile acids were collected in the morning after 12 hours fasting. From the investigation ensues that primary bile acids were elevated in diseases of the hepatobiliary tract; in diseases of the gallbladder and biliary pathways an increased ratio of glycocholic to glycochenodeoxycholic acid was found. Elevated concentrations of the two investigated primary bile acids were also found in subjects with tumorous diseases. Consistent with the result of other authors, it is obvious that estimation of bile acids is a sensitive liver function test.

Effects of open-heart surgery on thyroid hormone levels.

The effect of heart surgery with and without cardiopulmonary by-pass on plasma levels of thyroxine (T4) and triiodothyronine (T3) was studied in 19 patients. It was found that even before the operation the plasma levels of T4 and of T3 were significantly lower in the by-pass group of patients in comparison with those without by-pass. This lower level of thyroid hormones could be explained by greater pre-operative stress. This presumption is supported by the finding of the greater pre-operative plasma concentrations of dopamine-beta-hydroxylase and growth hormone in patients of the by-pass group. While in patients not undergoing CPB a tendency to the decrease of plasma thyroid hormones was observed during the early postoperative phase, in patients of the by-pass group a small increase was observed. On the basis of the finding that thyroid hormones exercise powerful and specific effect on myocardial contractility, it is suggested that the low hormone level might have a role in the pathogenesis of postoperative low cardiac output syndrome.

The blood volume and the renin-angiotensin-aldosterone system following open-heart surgery.

The circulating blood volume changes, plasma electrolytes, aldosterone as well as plasma-renin-activity (PRA) were studied in 14 patients following open-heart surgery with cardiopulmonary bypass (CPB) and in 14 patients following cardiac surgery without CPB. In both the groups a postoperative decrease of circulating blood volume was observed. This decrease occurred in spite of the positive fluid balance, and so a shift of fluid from vascular to extravascular compartment was likely. In the bypass group the plasma aldoserone level rose immediately after the operation and reached the peak on the first postoperative day. In the non-bypass group the aldosterone level started to fall after the operation, and reached the lowest level on the third postoperative day. The pattern of the postoperative PRA changes was almost identical with the aldosterone level changes in both the groups studied, which suggests that the activation of renin-angiotensin-aldosterone axis might be responsible for the observed plasma aldosterone changes.