Serum C-reactive protein and white blood cell level as markers of successful percutaneous drainage of acute sterile peripancreatic fluid collection.

BACKGROUND: Percutaneous drainage is not a widely used therapeutic method recently for evacuating peripancreatic sterile fluid collections in patients with severe acute pancreatitis.However, many clinical studies have proved its positive effects. AIM: We tested the changes in serum laboratory parameters:C-reactive protein (CRP), complement factor 3-4 (C 3-4),tumor necrosis factor a (TNF-a), amylase, lipase and white blood cell (WBC) count in patients treated by percutaneous drainage. PATIENTS AND METHODS: 10 patients with severe acute pancreatitis with peripancreatic fluid collection were monitored.Laboratory parameters and the amount of drained fluid were measured on the 1st, 5th and 10th day. Statistical analysis was performed by using Statistica for Windows (Version 7.0)software. P values less than 0.05 were considered statistically significant. RESULTS: We found significant positive correlation between the CRP and WBC serum level and volumes of the drained fluid. We used these parameters as markers of successful percutaneous drainage in case of patients with severe acute pancreatitis complicated with sterile peripancreatic fluid.There was no significant change in the levels of C 3-4,tumor necrosis factor-Î+-, amylase and lipase. CONCLUSIONS: Monitoring of serum CRP and WBC levels maybe recommended for follow up after percutaneous drainage of peripancreatic fluid. ABBREVIATIONS: CRP: C-reactive Protein TNFÎ+-: Tumour Necrosis Factor a, C3-4: Complement 3-4 WBC: White Blood Cell CT: Computed Tomography.

Surgical treatment of intercostal hernia with implantation of polypropylene mesh.

The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon, Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence. In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation. Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias. Recurrence is rare in those patients treated with this method.

Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis.

BACKGROUND/AIMS: We have compared the effects of glutamine-rich Stresson Multi Fibre and of Nutrison Fibre nutrients on the changes of some immunological parameters of 16 patients with acute pancreatitis. Laboratory parameters included: total protein, albumin, prealbumin, retinol binding protein, IgG, IgA, IgM, IgE, complement components: C3, C4, acute phase proteins: C-reactive protein, transferrin, CD-markers of peripheral lymphocytes and activity of peripheral phagocytes. METHODOLOGY: Nine patients were supplied with Stresson Multi Fibre and 7 patients with Nutrison Fibre, using a nasojejunal tube. The levels of serum proteins were measured with laser nephelometry, the CD markers of lymphocytes with flow cytometry and the phagocytic activity with chemiluminescence. RESULTS: The treatment with glutamine-rich Stresson resulted in significant elevations in the serum levels of IgG, retinol binding protein, compared to the effects of Nutrison Fibre. In addition, the recovery of treated patients was significantly shorter in the Stresson Multi Fibre group than in the Nutrison Fibre group. CONCLUSIONS: The Stresson Multi Fibre nutrient treatment of patients treated for acute pancreatitis seems to have clinical benefit based upon the fast recovery of IgG, IgM proteins which take part in the immunological defense mechanisms.

[Treatment of acute necrotizing pancreatitis: a comparative study]. / Az akut nekrotizáló pancreatitis kezelésének összehasonlító vizsgálata.

The authors compared the therapeutic results of acute necrotizing pancreatitis during two separate time periods involving 97 and 24 patients, respectively. In the group "A", the time period lasted between May 31, 1991 and December 31, 1997. This group consisted of 97 patients, who, in addition to undergoing intensive treatment and antibiotic prophylaxis, later underwent late necrectomy and closed peripancreatic drainage. Jejunal nutrition only occurred in a limited number of 52 patients (53.6%), and was mostly used after a second operation. The group "B" consisted of patients from the time period between January 1, 1999 and December 31, 1999, and consisted of 24 patients treated in each case with intensive treatment in addition to antibiotic prophylaxis, early nasojejunal nutrition, and if necessary CT-guided percutaneous peripancreatic drainage was used. In the case of surgical intervention necrectomy and closed peripancreatic rinsing drainage was used. In group "A", significantly more early operations were performed than in group "B" (31 patients, 32.0% vs. 2 patients, 8.3%). In group "A" the number of reoperations was also higher as a total of 91 (83.5%) were reoperated as compared to group "B" in which a total of 18 (75.0%) reoperations took place. In the group "B", mortality was also lower (12.5%), than in the "A" group (17.5%). The authors attribute the successful therapy to the early jejunal nutrition, CT-guided percutaneous peripancreatic drainage and to the introduction of prophylactic antibiotics.

C-myc amplification and cluster analysis in human gastric carcinoma.

The tumour samples ot 23 patients (9 male, 14 female, aged 28-85) were randomly selected for the study. DNA was isolated from paraffin embedded tissue for quantitative dot-blot hybridization, in order to determine the amplification values for the c-myc and K-ras oncogenes. The clinical and histological parameters studied were as follows: grade, TNM staging system, Lauren's histological type, localization and the severity of the disease. Amplified c-myc was found in 6 cases. Amplification was concomitant with c-myc overexpression detected with immunohistochemical staining. The amplification--9.1-fold on the average (ranging from 2.12 to 18.2) was significantly associated with the presence of distant metastasis (corr. coeff.: 0.5623, p < 0.01), but with none of the other parameters. No case with K-ras amplification was recorded. The result of the multivariate cluster analysis proved that age was the decisive factor in the segregation process. This age-related distribution (69 vs. 40, p < 0.001), however, did not coincide with either the incidence of distant metastasis or c-myc amplification.

[CT-guided percutaneous drainage in the treatment of acute necrotizing pancreatitis]. / CT-vezérelt perkután drenázs alkalmazása az akut nekrotizáló pancreatitis kezelésében.

The authors analysed the results of the treatment of 24 patients with acute necrotizing pancreatitis. Besides intensive and operative treatment prophylactic antibiotics, early naso-jejunal feeding, CT guided percutaneous peripancreatic drainage are favourable to avoid septic complications and to postpone the first operation. In 11 patients percutaneous drainage was performed. Using percutaneous drainage three patients (33.3%) recovered without operation, the mean drainage time was 23.4 days. The first operation could be postponed in the other 8 patients after percutaneous drainage. No complications occurred as result of the interventions, although in one patient the drain slipped out spontaneously. Due to the complex treatment the total mortality rate was 12.5%.

[The role of percutaneous radiologic interventions in the treatment of pancreatic pseudocysts]. / Perkután intervenciós radiológiai módszerek helye a hasnyálmirigy áltömlók kezelésében.

Authors evaluate the indications and results of percutaneous puncture and drainage of pancreatic pseudocysts. The interventions were performed in 20 patients. The first line treatment is usually surgical. Percutaneous drainage or aspiration is suggested if the patient is symptomatic, the size of pseudocyst is between 3 and 6 cms and when it can be punctured using radiological procedures, without the risk of damaging other organs. Previous peripancreatic operation, high-risk surgical intervention and the refusal of the operation by the patient should also be considered. Percutaneous drainage is an alternative method for the treatment of pancreatic pseudocysts. The advantages of this procedure are: It is minimally invasive, complications are rare and reintervention is possible. Disadvantage is high risk of recurrence.

Evaluation of hemostatic changes and blood antioxidant capacity in acute and chronic pancreatitis.

BACKGROUND/AIMS: We examined changes in hemostasis, in levels of total antioxidant capacity, and pancreatic enzymes (amylase, lipase) in patients with pancreatitis 1, 3 and 7 days after admission to the clinic, in order to evaluate the inflammatory processes in acute and chronic pancreatitis and to identify new prognostic markers. METHODOLOGY: The rate of CD62 expression--a marker of platelet hyperactivity--and the rate of platelet-leukocyte aggregates were measured by flow cytometry. The connection between the parameters measured and the severity of pancreatitis and also the differences of the parameters in acute and chronic pancreatitis were investigated. RESULTS: On the basis of previous studies it was assumed, that there is a connection between the level of parameters measured and the inflammatory process in the pancreas, and also between the defending processes of the body against free radicals. CONCLUSIONS: Based on our results, we suggest to extend the laboratory measurements to the investigation of hemostatic parameters. The measurement of plasma level of fibrinogen, von Willebrand factor and the rate of platelet activation is especially important.

[Results of surgical treatment of liver abscess, with special emphasis of percutaneous puncture and drainage]. / Májtályogok sebészi kezelésének eredményei, különös tekintettel a perkután punkció és tartós drenázs alkalmazására.

Authors present 5 cases of liver abscess treated with US or CT guided percutaneous puncture and/or drainage performed in cooperation of the 2nd Surgical Department and the Radiological Department of the University of Debrecen. They analyse the indications and results of this method. They also include the results of twelve liver abscesses treated surgically. For one or a small number of liver abscesses (Bigger than 5 cm) they prefer percutaneous drainage combined with systematic antibiotic treatment if the condition is not complicated by other surgical diseases, and if the abscesses are accessible for radiological intervention. All patients recovered without recurrence during a one-year follow-up period. The main advantages of this method are smaller trauma and fewer complications.

[Necrosis of the galea as rare complication of infection of a traumatic temporal hematoma]. / Galea nekrózis, mint a traumát követó temporalis haematoma abscedalodás ritka szövódménye.

Authors report a case of infective traumatic temporal haematoma causing septic focus. The suppurative inflammation developed two weeks after the trauma causing necrosis of an extensive part of the galea on a big area of the crown of head. A septic process increased producing necrotic alteration of the affected periosteum of the cranial bone and plegmon in the tissue of the neck. Authors report the surgical plastic procedures that were used to establish a granulating layer and to cover the surface in the area of the removed necrotic part of the galea. Authors emphasize the significance of the danger of the inflammatory infiltration and report the effect of the Curiosin solution on the wound-healing.

Is the presence of distant metastasis associated with c-myc amplification in gastric cancer?

The expression of the c-myc oncogenes has already been reported in human gastric carcinoma. Overexpression can be the consequence of oncogene amplification and often correlates with different prognostic factors. Authors investigated the value of c-myc oncogene amplification in 23 patients (9 male, 14 female, aged 28-85 yrs) with gastric cancer and its correlation to the following clinical and histopathological parameters: grade, TNM stage, Lauren's type, localisation and severity of disease. DNA was isolated from formalin-fixed, paraffin embedded tissue for quantitative dot-blot hybridisation. Amplified c-myc was found in 6 out of 23 cases. Its values ranged from 2.12 up to 18.2 (average 9.1). Significant association was found between the presence of c-myc amplification and distant metastasis (corr. coeff.: 0.5623, p < 0.01). High scores of the other parameters also correlated with c-myc, albeit not significantly. The result of cluster analysis, based on the similarity of the parameter values for the individual patients proved that the age was the decisive factor in creating two groups. The distribution of patients into these groups did not seem to coincide with the presence of c-myc amplification or distant metastasis, inspite of the proved correlation between them.