Prognostic value of early computed tomographic scans in severe acute pancreatitis. French Association for Surgical Research.

BACKGROUND: The prognostic value of computed tomographic (CT) scans in differentiating mild from severe forms of acute pancreatitis is well established. Nonetheless, in patients with a severe form of the disease, some will have a relatively uneventful course while others will have severe complications. This prospective, multicenter study was done to evaluate the prognostic value of early CT scan in a homogenous group of patients with a first attack of severe acute pancreatitis. STUDY DESIGN: Dynamic CT scans were performed within 48 hours after admission. A standardized form was completed for each CT scan, recording the following data: abnormal enhancement of the pancreas itself, characteristics of extrapancreatic collections, and visualization of the portal and splenic veins. Statistical analysis was based on the log rank test and Cox's model and used death and abscess occurrence as the two end points. RESULTS: Two hundred twenty-eight patients from 46 centers were included in the study. The median Ranson and Imrie scores were 3 and 4, respectively. Forty-seven patients died and 72 had an abscess. The CT scan findings indicating an increase in mortality rate were nonenhancement of the neck of the pancreas (p = 0.04) and extrapancreatic collections within the left (p = 0.001) and right (p = 0.02) pararenal posterior spaces. The risk of abscess increased when there was nonvisualization of the splenic vein (p = 0.0001), in the presence of extrapancreatic collections in the right pararenal posterior space (p = 0.03) and when the extrapancreatic collections were heterogenous (p = 0.003). CONCLUSIONS: This study demonstrated that the location of extrapancreatic collections and nonvisualization of the splenic and portal veins on CT scans were not previously recognized prognostic factors of complicated outcome in patients with severe acute pancreatitis.

[Multiple-organ procurement for transplantation]. / Les prélèvements multiples d'organes en vue de transplantation.

In the last few years, the tremendous growth of clinical transplantations has greatly increased the need for grafts. Combined heart, liver and kidney harvesting in a same donor could provide an answer. The results are presented of multiple organ retrieval (MOR) carried out in an University hospital located in an area with 1,350,000 inhabitants. In addition to the usual problems of donor maintenance and legal aspects, it was necessary to carry out a specific work-up for each organ to be harvested. The job of the local coordinator was extremely important in the search for potential recipients and the organization of the procedure (time-table, air transport) in order to give optimal conditions. The priority given to retrieving the heart and in situ cooling of the liver and kidneys guaranteed the good quality of the harvested organs. Over a period of three years, 28 MOR have been carried out. Of the 94 organs harvested, 88 were transplanted in France or another European country (49 kidneys, 23 hearts, 16 livers); 75 are still functioning (47 kidneys, 19 hearts, 9 livers). As a result of this experience, and taking into account the need for organs, all brain dead patients should be considered as potential multiple organ donors, and not just as kidney donors. The intervention of several teams, often quite distant from the site of retrieval, requires careful planning. The surgical procedure, even when performed by a trained team, is often complex, perfect synchronization of the surgical steps of the operation being the most important point.(ABSTRACT TRUNCATED AT 250 WORDS)