Value of clinical criteria to indicate a CT-FNA in the diagnosis of infected acute pancreatitis.

OBJECTIVE: To assess the value of clinical criteria in detecting pancreatic infection (PI) on or after the seventh day of acute pancreatitis attack (AP). METHODS: We determined as clinical criteria of suspicion of PI (SPI): the presence, persistence or recurrence of fever > or = 38 degrees C, leukocytosis > or = 12,000/mm3 and organ failure (OF) in the absence of extrapancreatic infection. Patients with SPI criteria underwent computed tomography - fine needle aspiration (CT-FNA), if CT-FNA was negative and SPI criteria for 72 hours CT-FNA was repeated. RESULTS: We prospectively studied 369 patients with AP and found 48 patients who met SPI criteria (mean age 37 yr, 17-70 yr), 30 male and 18 female. Etiology was biliary (56.2%), alcohol (35.4%) and others (8.4%). We performed 53 CT-FNA in 48 patients and 28 were diagnosed with PI. At the time of CT-FNA 50% of patients had OF. Mean time for CT-FNA in patients with PI was 12.5 +/- 7 days. Mean clinical followup after hospital discharge was one month. No patients with SPI criteria and negative CT-FNA or patients without SPI criteria developed clinical signs of PI. The SPI criteria had a sensitivity of 100%, specificity of 94% (CI 95% 92-97), PPV of 58% (IC 95% 44-72) and NPV of 100%. CONCLUSIONS: The application of SPI criteria on or after the seventh day of onset of AP can be a useful tool in making the decision and defining the time to perform a CT-FNA in order to clarify the clinical scenario between SIRS and sepsis related PI. Our approach can lead to better strategic treatments in the management of these difficult cases.

Endoscopic injection of botulinum toxin in the gastric antrum for the treatment of obesity. Results of a pilot study.

OBJECTIVES: The aim of this study was to observe the effects of endoscopic injections of botulinum toxin (BT) in the gastric antrum on body weight and gastric emptying in obese patients. PATIENTS AND METHODS: Obese patients were selected for the study. By endoscopy, 100 U of BT type A was injected into the prepyloric antral gastric wall. Before and after treatment body weight and solid gastric emptying were evaluated. RESULTS: Twelve patients were included into this study. Four and twelve weeks after the treatment median values of body weight and gastric emptying did not show significant changes compared to baseline values: body weight: (- 0.5 kg and - 1.0 kg respectively, P > 0.05) and gastric retention for solids at 90 min (+ 4.5% and +10.5% respectively, P > 0.05). Abnormal gastric emptying (solid gastric retention at 90 min > 50%) was observed in 22% of patients after 4 weeks and in 25% after 12 weeks. CONCLUSIONS: BT injected into the gastric antrum does not seem to significantly reduce body weight or delay gastric emptying in obese patients.