Is Abdominal Fat Distribution Measured by Axial CT Imaging an Indicator of Complications and Mortality in Acute Pancreatitis?

BACKGROUND: Obesity is an important risk-stratifying co-morbidity for many pathological conditions. Controversy exists about its influence in outcomes after acute pancreatitis (AP). This study assessed abdominal fat distribution (subcutaneous, retroperitoneal and intra-abdominal) measured using computer tomography (CT) images and related it to outcomes in patients with AP. METHODS: The case notes of patients admitted with AP were identified from computerised records from 2008 to the 2013. Image analysis software was used to assess the individual abdominal fat distributions from CT images. RESULTS: A total of 79 patients were included. There was no relationship between fat distribution and either severity of, or mortality from, AP. Fat distribution was not found to be an independent risk factor on multivariate analysis. There was, however, a positive correlation between retroperitoneal and intra-abdominal fat with APACHE II scores, Ranson and Glasgow score and Multiple Organ Dysfunction score (MODS) on various days following admission (r = 0.421, p = 0.0008; r = 0.469, p < 0.0001; r = 0.398, p = 0.007; r = 0.336, p = 0.011, respectively). On multiple logistical regression analysis, the only variables associated with mortality were Balthazar Severity Index, MODS and EWS with a p value of <0.0001, 0.0019 and 0.0481, respectively. CONCLUSIONS: Obese patients have worse predicted outcomes as measured by the EWS, MODS and Ranson scores. Abdominal fat distribution, however, was not shown to be directly related to AP severity or mortality. The addition of fat parameters may be of use in prognostic CT severity index models, but from this data, it does not appear to be an independent risk factor of adverse outcome.

Ten-year review of otitis media pathogens.

Data collected from 1980 to 1989 by investigators at the Pittsburgh Otitis Media Research Center were examined to detect changes over time in the prevalence of bacteria isolated from middle ear effusions in patients with otitis media. The organisms isolated most commonly from the 7396 effusions cultured at the center were Streptococcus pneumoniae and Haemophilus influenzae. S. pneumoniae predominated in the subgroup of patients with acute otitis media, whereas H. influenzae was isolated most frequently from patients with otitis media with effusion. The most notable changes to occur during the 10-year period were a statistically significant increase in the prevalence of S. pneumoniae in patients with acute otitis media and a progressive rise in the percentage of beta-lactamase-producing strains of H. influenzae and Moraxella (Branhamella) catarrhalis. The latter finding suggests the need for therapeutic alternatives to amoxicillin, which is not active against beta-lactamase-producing organisms, when these organisms are suspected or cultured from the middle ear.

Dietary restriction delays gastric emptying in rats.

In rats allowed to eat for only 2 h per day, gastric emptying of three different meals [poached egg white, glucose (0.5 kcal/ml) and physiological saline, each labelled with 60 MBq of technetium-99m tin colloid visualized using a gamma camera] was markedly slowed 8 h after the last meal. Mean body weight in rats on the restricted feeding schedule was 80% of the weight of free-feeding controls. Gastric emptying curves for all three meals in controls were best described using loge transformed counts. Other models used were linear and square root. For each of the three meals, the percentage remaining in the stomach at 120 min was estimated using linear regression of gastric contents, transformed if necessary to yield the best curve against time. At 120 min, % gastric contents (mean +/- SEM) were 19.5 +/- 5.6 (egg), 15.5 +/- 6.27 (glucose) and 27.1 +/- 7.48 (saline) in control rats. After 4 months restriction, the corresponding figures were 75.2 +/- 4.04, 81.5 +/- 4.75 and 70.3 +/- 5.83. After 3 months of free feeding, emptying rates of the three meals were not significantly different from control values. We conclude that dietary restriction causes profound changes in gastric emptying by unknown mechanisms which may be operating in patients with anorexia nervosa.