Navegando por Palavras-chave "Pancreatitis"
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- ItemSomente MetadadadosAcute pancreatitis in pediatrics: a systematic review of the literature(Soc Brasil Pediatria, 2012-03-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Silva, Felipe Duarte; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hosp Israelite Albert Einstein; Hosp Santa CatarinaObjective: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.Sources: Systematic review of MEDLINE and SciELO databases in the last 5 years about acute pancreatitis in children, as well as consultation of relevant references on the texts obtained.Summary of the findings: Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. the main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. the diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population.Conclusions: the early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group.
- ItemAcesso aberto (Open Access)Avaliação da reprodutibilidade da tomografia computadorizada no estadiamento da pancreatite aguda(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-12-01) Freire Filho, Edison de Oliveira [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Bekhor, Daniel [UNIFESP]; Vieira, Renata La Rocca [UNIFESP]; Yamada, André Fukunishi [UNIFESP]; Freire, Maxime Figueiredo de Oliveira [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. MATERIALS AND METHODS: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (kappa). RESULTS: Interobserver agreement was kappa = 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was kappa = 0.796 and 0.732 for unenhanced morphological index; kappa = 0.725 and 0.802 for contrast-enhanced morphological index; kappa = 0.674 and 0.849 for presence of pancreatic necrosis; kappa = 0.606 and 0.770 for pancreatic necrosis extension; and kappa = 0.801 and 0.687 for disease severity index at computed tomography. CONCLUSION: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast-enhancement does not affect the computed tomography morphological index reproducibility.
- ItemSomente MetadadadosContribuição ao estudo da secreção pancreática exocrina em alcoólatras: caracterização do estado de hipersecreção(Universidade Federal de São Paulo (UNIFESP), 1978) Neves, Manoel Martins das [UNIFESP]
- ItemSomente MetadadadosDisfunção pancreática precoce em etilistas assintomáticos(Universidade Federal de São Paulo (UNIFESP), 1992) Neves, Manoel Martins das [UNIFESP]
- ItemAcesso aberto (Open Access)Ethyl-pyruvate reduces lung injury matrix metalloproteinases and cytokines and improves survival in experimental model of severe acute pancreatitis(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2013-08-01) Matone, Jacques [UNIFESP]; Moretti, Ana Iochabel Soares; Apodaca-Torrez, Franz Robert [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)PURPOSE: To investigate if the ethyl-pyruvate solution could reduce mortality in AP and/or diminish the acute lung injury. METHODS: Forty male rats, weighing between 270 to 330 grams were operated. An experimental model of severe AP by injection of 0.1ml/100g of 2.5% sodium taurocholate into the bilio-pancreatic duct was utilized. The rats were divided into two groups of ten animals each: CT - control (treatment with 50ml/kg of Ringer's solution, intraperitoneal) and EP (treatment with 50ml/kg of Ringer ethyl- pyruvate solution, intra-peritoneal), three hours following AP induction. After six hours, a new infusion of the treatment solution was performed in each group. Two hours later, the animals were killed and the pulmonary parenchyma was resected for biomolecular analysis, consisting of: interleukin, myeloperoxidase, MDA, nitric oxide, metalloproteinases and heat shock protein. In the second part of the experiment, another, 20 rats were randomly divided into EP and CT groups, in order to evaluate a survival comparison between the two groups. RESULTS: There were no significant differences in IL-1B,IL-10, MMP-9, HSP70, nitric oxide, MPO, MDA (lipidic peroxidation) concerning both groups. The levels of IL-6 were significantly diminished in the EP group. Furthermore, the MMP-2 levels were also reduced in the EP group (p<0.05). The animals from the EP treatment groups had improved survival, when compared to control group (p<0.05). CONCLUSION: The ethyl-pyruvate diminishes acute lung injury inflammatory response in acute pancreatitis and ameliorates survival when compared to control group, in the experimental model of necrotizing acute pancreatitis.
- ItemAcesso aberto (Open Access)Microcristais biliares na pancreatite aguda idiopática: indício para etiologia biliar oculta subjacente(Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2000-04-01) Chebli, Julio Maria Fonseca [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Silva, Maria Regina Regis [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Neves, Manoel Martins Das [UNIFESP]; Universidade Federal de Juiz de Fora; Universidade Federal de São Paulo (UNIFESP)The main causes of pancreatic inflammation worldwide are biliary lithiasis and alcoholism. However, 10 to 30% of patients have been considered to have idiopathic acute pancreatitis. Recently, some studies showed that a significant rate of the so called idiopathic pancreatitis are caused by microlithiasis and/or biliary sludge, identified by the presence of cholesterol monohidrate and/or calcium bilirubinate microcrystals in the biliary sediment. In the present study, the analysis of microcrystals from bile obtained during endoscopic retrograde cholangiopancreatography was done in patients with pancreatitis (idiopathic, biliary or alcoholic -- 20 in each group). Patients with idiopathic pancreatitis and microcrystals in the bile underwent cholecystectomy whenever possible. Those who refused or were inapt to surgery underwent endoscopic sphincterotomy or received continuous therapy with ursodeoxycholic acid. Patients with idiopathic pancreatitis without biliary crystals did not receive any specific treatment. The prevalence of biliary microcrystals in patients with idiopathic pancreatitis (75%) and biliary pancreatitis (90%) was significantly higher than in those with alcoholic pancreatitis (15%). In the identification of the etiology of biliary pancreatitis, the presence of microcrystals had a sensitivity of 90%, specificity of 85%, positive predictive value of 85,7%, negative predictive value of 89,4% and accuracy of 87,5%. In the patients with recurrent idiopathic pancreatitis, with biliary crystals, there was an statistically significant reduction in the number of pancreatitis episodes after specific treatment. In the follow-up of this group during 23,3 ± 4,8 months, recurrence of pancreatitis occurred only in patients with persistent biliary factor (choledocholithiasis and/or persistence of cholesterol monohidrate). All patients with idiopathic pancreatitis who underwent cholecystectomy had chronic cholecystitis. Moreover, cholelithiasis was present in one case. In the ultrassonographic follow-up of the patients with idiopathic acute pancreatitis with microcrystals in the bile, cholelithiasis was detected in one case. In the subgroup of five patients with idiopathic pancreatitis without biliary microcrystals recurrence occurred in one case. Ultrassonographic study during follow-up did not reveal biliary stones in any of these patients. We concluded that the detection of biliary microcrystals in idiopathic pancreatitis suggested an underlying biliary etiology, even if occult. What's more, early specific therapeutic procedure (cholecystectomy, endoscopic sphincterotomy or ursodeoxycholic acid) in patients with recurrent idiopathic pancreatitis with microcrystals in the bile reduced significantly the recurrence during the follow-up. Finally, acute pancreatitis (specially recurrent) should not be called idiopathic before the microscopic analysis of the bile, aiming to detect or exclude the presence of microcrystals.
- ItemAcesso aberto (Open Access)Parenteral nutrition versus enteral nutrition in severe acute pancreatitis(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2010-10-01) Vieira, Josiel Paiva; Araújo, Gutemberg Fernandes De; Azevedo, José Raimundo Araújo De; Goldenberg, Alberto [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Federal University of Maranhao Surgical Department; UFMA Surgical Department; Sao Domingos Hospital; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.
- ItemAcesso aberto (Open Access)Resultados do tratamento da pancreatite aguda grave(Colégio Brasileiro de Cirurgiões, 2012-10-01) Apodaca-Torrez, Franz Robert [UNIFESP]; Lobo, Edson Jose [UNIFESP]; Monteiro, Lilah Maria Carvas [UNIFESP]; Melo, Geraldine Ragot de [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Herani Filho, Benedito [UNIFESP]; Triviño, Tarcisio [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the results of the Protocol for treatment of patients with severe acute pancreatitis. METHODS: We consecutively analyzed age, gender, etiology, length of hospital stay, type of treatment and mortality of 37 patients with severe acute pancreatitis from January 2002. RESULTS: The patients' ages ranged from 20 to 88 years (average 50 years), 27% were female and 73% male. Mean overall hospital stay was 47 days. Thirteen patients were treated surgically, the average operations per patient was two. There were six deaths among patients undergoing surgical treatment (46%) and two deaths in the group submitted to medical treatment alone (8.3%). The overall mortality was 21%. CONCLUSION: After modification in the form of management of patients with severe acute pancreatitis, there was a decrease in mortality and a trend for conservative management.