Position of surgical treatment in step-up management of severe acute pancreatitis.

INTRODUCTION: The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures. METHODS: We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome. RESULTS: The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed. CONCLUSION: After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.

Charcot-Marie-Tooth neuropathy type 1A combined with Duchenne muscular dystrophy.

We report a 24-year-old male with an unusual combination of two inherited neuromuscular disorders--Charcot-Marie-Tooth (CMT) disease type 1A and Duchenne muscular dystrophy (DMD). A phenotypic presentation of this patient included features of both these disorders. Nerve conduction studies revealed demyelinating peripheral neuropathy. Electromyography showed a profound myogenic pattern. The serum creatine kinase level was highly elevated. Muscle biopsy revealed a dystrophic picture with deficient dystrophin immunostaining. CMT1A duplication on chromosome 17p11.2 was found. The frame-shift mutation c.3609-3612delTAAAinsCTT (p.K1204LfsX11) was detected in the dystrophin gene by analysing mRNA isolated from the muscle tissue. The patient inherited both these mutations from his mother. The combination of CMT1A and DMD has not been reported as yet.

Rapid ion-exchange separation of human brain gangliosides.

An extract of human brain gangliosides was separated on a Spheron 1000-DEAE spherous fine-grain macroporous glycolmethacrylate anion-exchanger. Linear gradient elution using ammonium acetate in methanol resulted in the complete separation of mono, di-, tri-, tetra- and pentasialogangliosides in 35 min at the load of 2.4 mg/ml of ion-exchanger. The ganglioside fractions thus obtained were characterized by thin-layer chromatography on silica gel. In conclusion, the scope of rapid separation of gangliosides is discussed, based on a combination of column chromatographic methods.

Ionizing radiation in the disinfection of water contaminated with potentially pathogenic mycobacteria.

Sterile drinking water samples were artificially colonized with M. Kansasii, M. gordonae and M. fortuitum suspensions (the numbers of viable unite in 1 ml were 1.2 x 10(3), 48.5 and 3.2 x 10(3), respectively) prepared from mycobacterial strains replicated in Tween 80-free liquid Dubos medium STO. The contaminated water samples were irradiated from a rotary cobalt-60 source (gamma radiation, E = 1.17 and 1.33 MeV, dose intensity 1 kJ/kg.h at room temperature) with doses 0.7, 1.5, 2.2, 3, 9, 16 and 27 kJ/kg. The disinfecting effectiveness was assessed by direct cultivation tests (0.5 ml volumes of water inoculated on egg medium) and by cultivation on membrane filters after filtrating the whole amount of the water examined (about 500 ml). Fully positive disinfecting effects were recorded in M. kansasii and M fortuitum irradiated with 9 kJ/kg and in M. gordonae after irradiation with 1.5 kJ/kg. The calculated value of D10 = 0.4 kJ/kg (i.e. the dose radiation that reduces the number if viable mycobacteria by an order of magnitude) is suggestive of a strong disinfecting effect of ionizing radiation on the tested strains of potentially pathogenic mycobacteria. The results indicate that the use of ionizing radiation to disinfect mycobacteria that are difficult to remove with other methods which, as a rule, cannot ensure the permanent disinfection.