[Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis -- a prospective randomized clinical study]. / Intravénás glutamin és korai nasojejunalis táplálás együttes alkalmazása súlyos acut pancreatitisben -- prospektív randomizált kettos vak kontrollált klinikai vizsgálat.

INTRODUCTION: Severe acute pancreatitis (SAP) is still one of the great challenges in gastro-intestinal surgery. According to recent studies, intravenously administered glutamine with total parenteral nutrition may be beneficial in the prevention of infectious complications and may reduce mortality rate. However, it has not been investigated yet, whether i.v. glutamine is able to achieve the same effect with early enteral nutrition as well. OBJECTIVES: The objective of our prospective randomized double-blind study was to explore the effects of intravenously administered glutamine with early nasojejunal nutrition in severe acute pancreatitis. PATIENTS AND METHODS: Forty-five patients with severe acute pancreatitis (with a Glasgow score at least 3 and/or a CRP level above 150 mg/ml on admission) were randomized into two groups. Group Glutamine (n = 24) was given 0.5 g/kg/die glutamine intravenously, while the control group (n = 21) received normal amino acid solution in the same quantity for 7 days. Nasojejunal nutrition was introduced 48 hours after admission in case of all patients, and their management was the same in every other aspect, too. The primary end-points of the study were the rate of pancreas-specific infectious complications and organ failure, and the secondary end-points were the necessity for radiological and surgical interventions, length of hospital stay and mortality rate. RESULTS: In group Glutamine, infected acute peripancreatic fluid collections (APFC) were detected in 4 patients, 2 patients had post-necrotic pancreatic/peripancreatic fluid collections (PNPFC), 2 patients had infected pseudocysts and 2 patients had walled-off pancreatic necrosis (WOPN). Ten patients were cured by ultrasound assisted puncture or drainage successfully. No surgical intervention was necessary. In the control group, 4 patients had infected APFC, 2 patients had infected PNPFC, infected pseudocysts and infected WOPN were diagnosed in 3 cases. Radiological intervention was effective in 9 cases, but 3 patients needed surgery. Three patients died of multi-organ failure, thus the mortality rate of the control group was 14%, while the mortality rate of the Glutamine group was zero. The mean hospital stay of the Glutamine group was 10.6 days, which is significantly shorter than the mean hospital stay of the control group, which was 15.9 days (p = 0.00104). DISCUSSION: The results of the Glutamine group are better in every end-points, however, statistically significant difference was detected in one parameter only, the length of hospital stay.

Role of imaging methods in diagnosis of acute pancreatitis.

Diagnosis and treatment of acute pancreatitis is a complex interdisciplinary team problem. Without knowledge of classification and the current opinion of other experts on this disease, the radiologist cannot be an adequate partner in this team. Nonetheless, the radiologist has a very important position, primarily 'thanks to' computed tomography (CT) in diagnosis and fading of the disease and the possibilities offered by minimally invasive treatment of early and late complications of this disease. A turning point from the viewpoint of diagnosing acute pancreatitis was first marked by Balthazar's classification and then establishing the CTSI (severity index for the disease based on CT findings), proposed by Balthazar as well. Radiologists' increasingly more active approach to drainage of acute fluid collections and pseudocysts in patients with acute pancreatitis as well as some possibilities for percutaneous treatment of necroses has led to a reassessment of surgeons' attitudes. A persistent problem is the correct indication and timing of CT scans and the drainage itself. In their concise communication, the authors present data from the literature and summarize their own experience. They highlight the most common mistakes, especially in the indication and timing of individual methods. Finally, they present their views on a practical approach to the use of CT and percutaneous drainage in these patients.

[Application of ultra high frequency irradiation in prophylaxis and treatment of complications of infectious pancreonecrosis].

Local super high frequency irradiation was applied in 9 patients, suffering the pancreonecrosis (PN) inflammatory-purulent complications. Introduction of local super high frequency irradiation to the complex of treatment permits to prevent the PN purulent complications occurrence, to improve the immediate results of the patients treatment.