Predictive factors for severe evolution in acute pancreatitis and a new score for predicting a severe outcome.

BACKGROUND: Acute pancreatitis (AP) is an acute inflammation of the pancreas with an unpredictable evolution. The aim of this study was to assess the factors associated with severe evolution of AP and to create a new score for predicting a severe outcome. METHODS: The initial group included 334 patients hospitalized in 2006-2009. The validation group included 195 patients admitted in 2010-2011. AP was classified according to the Atlanta criteria. RESULTS: In the initial group, C-reactive protein (CRP), creatinine, white blood count, body mass index (BMI), age and male gender were correlated with severe evolution of AP. Using only parameters available in emergency, by multiple regression analysis we obtained in the initial group the following score for predicting severe evolution of AP: Prediction pancreatic severity I score (PPS I score) = -1.038 + 0.119 × creatinine (mg/dL) + 0.012 × BMI (kg/m²) + 0.027xwhite blood count/1000 (cells/mm³) + 0.195 × gender (1-women, 2-men) + 0.005 × age (years). For a cut-off value >0.325, PPS I score had 71.8% accuracy (AUC=0.790) for predicting a severe evolution of AP. In the validation group the accuracy was 71.7%. Since CRP was proven to be a good predictor of severe evolution in AP, we calculated another score, PPS II, obtained using PPS I and CRP: PPS II score = -0.192 + 0.760 x PPS I + 0.003 x CRP (mg/L). For a cut-off value >0.397, PPS II score had 87.1% accuracy (AUROC=0.942) in the initial group and 75.3% accuracy in the validation group for predicting severe AP. CONCLUSIONS: PPS I and especially PPS II score are accurate predictors of severe outcome in patients with AP.

Contrast enhanced ultrasound for the characterization of hepatocellular carcinoma.

AIM: Contrast-Enhanced Ultrasound (CEUS) is an imaging method that can discriminate between hepatocellular carcinoma (HCC) and other liver lesions. The purpose of this study is to present our experience concerning the use of CEUS in the characterization of HCCs. MATERIAL AND METHOD: We included in our study all the patients evaluated in our Department from September 2009 to October 2010, with focal liver lesions (FLLs) on abdominal ultrasound (US) that were diagnosed as HCCs after CEUS examination, also patients with chronic liver disease with focal liver lesions highly suspected to be HCCs but with an inconclusive pattern on CEUS. One hundred patients with 148 HCCs were included. The enhancement pattern of the nodules was evaluated according to the 2008 EFSUMB Guidelines. Nodules displaying arterial hyperenhancement with "washout" in the portal/venous phase on CEUS were considered diagnostic for HCC. Nodules considered indeterminate after CEUS were evaluated by contrast-enhanced CT or MRI for diagnosis. RESULTS: Among the 100 patients included, 96 were patients with chronic liver disease and 4 were patients without known liver disease. 71 patients had a solitary nodule, 16 patients had two nodules and 13 patients had three or more nodules. 112 HCCs had a typical enhancement pattern and 36 nodules were considered indeterminate after CEUS and were sent to CT/ MRI for diagnosis. CONCLUSIONS: 75.7% of the studied liver nodules were diagnosed by CEUS as HCCs, thus CEUS is an easy method, convenient to perform, avoiding other expensive examinations.

Successful endoscopic treatment of an unusual cause of lower gastrointestinal bleeding using the OVESCO system.

The great majority of foreign bodies swallowed and entering the stomach are usually passed through the entire gastrointestinal tract uneventfully. The ones that remain can cause perforation, obstruction or bleeding. The risk of perforation is increased with long sharp metal objects, animal bones, in subjects with intestinal diseases (Crohn's disease, intestinal stenosis), and in patients with adhesions due to prior abdominal surgery. For a long time, toothpick impaction in the lower gastrointestinal tract has been managed by surgery. Nowadays with the development of endoscopy, a variety of ingested foreign bodies have been successfully managed by endoscopy. We report the case of a male patient, with a toothpick impacted in the rectosigmoid junction, which was diagnosed and successfully managed by colonoscopy.