Operative treatment of severe pancreatitis in the Päijät-Häme Central Hospital during 1986-1990. A retrospective analysis of 35 patients.

Thirty-five of 556 (6.3%) patients with acute pancreatitis were treated with standard operative technique in our hospital between 1986 and 1990. All of the operated patients had necrotizing course of the disease. The aetiology was alcohol in 80.0%, biliary disease in 11.4%, postendoscopic retrograde cholangiopancreatography (ERCP) in 5.7% and postoperative in 2.8% of the patients. The median delay from admission to hospital to operation was only one (mean 1.9; range 0-10) day. The operative technique consisted of careful debridement of necrotic tissue and continuous high volume lesser sac lavage. The overall mortality was 8.6% (3/35) and morbidity 68.6% (24/35). The low overall mortality rate in necrotizing pancreatitis in this retrospective study supports our concept that our operative technique is effective and early operative intervention is justified in the treatment of necrotizing pancreatitis even if there may have been some unnecessary laparotomies.

Scintigraphy with 99mTc-HMPAO labeled leukocytes in acute cholecystitis.

99mTc-HMPAO labeled leukocyte scanning was performed on 38 patients with clinically suspected acute cholecystitis (AC) to evaluate its diagnostic value. The typical finding was an increasing accumulation of the tracer in the gallbladder wall in a 4 hour series of scintigrams. Leukocyte scan was positive in 16 of 17 patients with surgically and histologically confirmed AC. There were no false-positive findings. The sensitivity, specificity, and accuracy of scintigraphy were 94, 100, and 96%, respectively. In 2 patients with acute acalculous cholecystitis true-positive findings were observed. Scintigraphy with 99mTc-HMPAO labeled leukocytes is a valuable new imaging method in AC.