A demarkált pancreasnecrosis kezelése. Irodalmi áttekintés The treatment of walled-off pancreatic necrosis. Review

Absztrakt A súlyos akut pancreatitis késői szövődménye a demarkált necrosis, amely valamilyen intervenciós kezelést igényel. Jelen közlemény célja a különböző kezelési módok indikációinak, technikai kérdéseinek, korlátainak elemzése. A súlyos akut pancreatitis kezdetétől 4–6 hét kell ahhoz, hogy a demarkált necrosis kialakuljon. A necrectomiát ez után javasolt tervezni. A transluminalis endoszkópos necrectomia a gyomor és a nyombél mögött elhelyezkedő demarkált necrosisok esetén kecsegtet jó eredménnyel. A kiterjedt hasnyálmirigy-elhalások kezelésére napjainkban is a sebészi kezelés a leggyakrabban alkalmazott eljárás. A nyitott necrectomia a ligamentum gastrocolicumon vagy a mesocolonon keresztül végezhető, amelyet nyitott vagy zárt bursaomentalis-öblítéssel vagy -tamponálással lehet kiegészíteni. A másik alternatíva a transgastricus necrosectomia, amely nem igényel külső drenázskezelést. Mindkét sebészi kezelést lehet laparoszkóp segítségével végezni. Emellett lokalizált necrosisok esetén egyéb minimálisan invazív módszerek is alkalmazhatók. A demarkált necrosisok kezelésében a különböző sebészi kezelések mellett a transluminalis endoszkópos és a minimálisan invazív sebészi módszerek jó eredménnyel alkalmazhatók. Orv. Hetil., 2016, 157(47), 1866–1870. | Abstract Walled-off pancreatic necrosis is a late complication of severe acute pancreatitis that generally needs some interventions. The aim of this review is to analyse the indications, technical aspects and limits of these therapeutic options. The development of the walled-off pancreatic necrosis needs 4–6 weeks from the onset of the disease. The necrosectomy is recommended after this time. Endoscopic necrosectomy offers good results if the necrosis is in retrogastric or retroduodenal localisations. Open necrosectomy can be performed through the gastrocolic ligament or the mesocolon. It is suggested to complete necrosectomy with open or closed omental bursa drainage or packing. The transgastric necrosectomy does not need external drainage. Surgical procedures can be performed with laparoscopy either. In localized necrosis other minimal invasive approaches can be used. Conclusions: In addition to the transluminal endoscopic or minimal invasive necrosectomies different types of surgical procedures has an important role in the treatment of walled-off pancreatic necrosis. Orv. Hetil., 2016, 157(47), 1866–1870

Some statistical remarks on the giant GRB ring

We studied some statistical properties of the spatial point process displayed by GRBs of known redshift. To find ring-like point patterns we developed an algorithm and defined parameters to characterize the level of compactness and regularity of the rings found in this procedure. Applying this algorithm to the GRB sample we identified three more ring-like point patterns. Although, they had the same regularity but much less level of compactness than the original GRB ring. Assuming a stochastic independence of the angular and radial positions of the GRBs we obtained 1502 additional samples, altogether 542 222 data points, by bootstrapping the original one. None of these data points participated in rings having similar level of compactness and regularity as the original one. Using an appropriate kernel we estimated the joint probability density of the angular and radial variables of the GRBs. Performing MCMC simulations we obtained 1502 new samples, altogether 542 222 data points. Among these data points only three represented ring-like patterns having similar parameters as the original one. By defining a new statistical variable we tested the independence of the angular and radial variables of the GRBs. We concluded that despite the existence of local irregularities in the GRBs' spatial distribution (e.g. the GGR) one cannot reject the Cosmological Principle, based on their spatial distribution as a whole. We pointed out the large-scale spatial pattern of the GRB activity does not necessarily reflects the large-scale distribution of the cosmic matter

Extending the FIP bias sample to magnetically active stars: challenging the FIP bias paradigm?

Context. The different elemental abundances of the photosphere and the corona are striking features of not only the Sun, but of other stars as well. This phenomenon is known as the first ionisation potential (FIP) effect, and its strength can be characterized by the FIP bias, the logarithmic abundance difference between low- and high-FIP elements in the corona, compared to the photosphere. The FIP bias was shown to depend on the surface temperature of the star. Aims: We aim to extend the Teff−FIP bias relationship to a larger stellar sample and analyse the effect of other astrophysical parameters on the relation (e.g. surface gravity, age, activity indicators). Methods: We compiled FIP bias and other parameters for 59 stars for which coronal composition is available, now including evolved stars. Using principal component analysis and linear discriminant analysis, we searched for correlations with other astrophysical parameters within the sample that may influence the stellar FIP bias. Results: Adding stars to the Teff−FIP bias diagram unveiled new features in its structure. In addition to the previously known relationship, there appears to be a second branch: a parallel sequence about 0.5 dex above it. While the Teff remains the main determinant of the FIP bias, other parameters such as stellar activity indicators also have influence. We find three clusters in the FIP bias determinant parameter space. One distinct group is formed by the evolved stars. Two groups contain main sequence stars in continuation separated roughly by the sign change of the FIP-bias value. Conclusions: The new branch of the Teff−FIP bias diagram contains stars with higher activity level, in terms of X-ray flux and rotational velocity. The Rossby number also seems to be important, indicating possible dependence on the type of dynamo operating in these stars influencing their FIP bias. The two main-sequence clusters run from the earliest spectral types of A-F with shallow convection zones through G-K-early-M stars with gradually deeper convection zones, and they end with the fully convective M dwarf stars, depicting the change of the dynamo type with the internal differences of the main sequence stars in connection with the FIP-bias values

A súlyos akut pancreatitis sebészi kezelése

Irodalmi összefoglaló a súlyos akut pancreatitis sebészi kezeléséről. A hagyományos, nyitott technikák és a minimál invazív beavatkozások irodalmi adatok alapján történő összehasonlítása. A súlyos akut pancreatitis kezelésének elvi felépítése, step-up management. A konzervatív és szemikonzervatív kezelési stratégiák fontossága a műtét időpontjának elhalasztásában.egységes, osztatlanáltalános orvostudományimagyarnappal