Complications after splenectomy and their prophylaxis

Complications after splenectomy and their prophylaxi

Особливості харчової підтримки у хворих на гострий панкреатит (огляд літератури)

Nutrition is an essential part of the treatment of patients with acute pancreatitis. Obviously, in mild and moderately cases, there is no need to use artificial nutrition methods, on the contrary it is recommended to start oral intake of food. However, what food and the timing of its start are still being discussed. However, if the patient's condition is severe to begin enteral nutrition is recommended, which reduces the risk of infection, the length of stay in the hospital, mortality. Parenteral nutrition is prescribed when the enteral is not possible. However, it remains debatable what kind of nutrition to use better, more effective way of use, and also the correct algorithm of actions at the same time. A review of the literature is devoted to all these issues. Summarizing, it can be argued about the need for more studies on nutrition in patients with acute pancreatitis.Питание является существенной частью лечения больных острым панкреатитом. Очевидно, в легких и средней тяжести случаях отпадает необходимость применять искусственные методы питания, наоборот рекомендуется начать пероральный прием пищи. Однако, какое питание и сроки его начала еще обсуждаются. Если же состояние пациента тяжелое, целесообразно начать энтеральное питание, которое уменьшает риск присоединения инфекции, продолжительность пребывания в стационаре, смертность. Парентеральное питание назначается, когда энтеральное невозможно. Однако остаются дискуссионными, какой вид питания применять лучше, более эффективный путь введения, а также правильный алгоритм действий при этом. Рассмотрению всех этих вопросов посвящен данный обзор литературы. Подытоживая, можно утверждать о необходимости проведения большего количества исследований по питанию у больных острым панкреатитом.Харчування є істотною частиною у лікування хворих на гострий панкреатит. Очевидно, у легких та середньої тяжкості випадках нема необхідності застосовувати штучні методи харчування, навпаки, рекомендовано розпочати пероральне приймання їжі. Проте вид харчування і терміни його початку ще обговорюються. Якщо ж стан пацієнта тяжкий, доцільно розпочати ентеральне харчування, яке зменшує ризик приєднання інфекції, тривалість перебування в стаціонарі, смертність. Парентеральне харчування призначають лише, якщо ентеральне неможливе. Однак залишаються дискусійними, який вид харчування застосовувати краще, ефективніший шлях, а також правильний алгоритм дій при цьому. Огляд літератури присвячений розгляду усіх цих питань. Підсумовуючи, можна стверджувати про необхідність проведення більшої кількості досліджень із питання харчування у пацієнтів із гострим панкреатитом

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

The Role of Proinflammatory Cytokines and Adhesion Molecules in Vascular Disorders and Organ Dysfunction in Acute Pancreatitis Patients

Introduction. The incidence of acute pancreatitis (AP) in the world has increased over the last years, mainly due to alcohol consumption. The increasing of the AP severity is characterized by pancreatic necrosis, local complications and systemic organ dysfunction and is about 20.0% of all cases of AP. Despite the successes of intensive care, early mortality from AP remains high. The main component in the pathogenesis of acute pancreatitis is the transition from local to the system inflammation that causes the increasing of the disease severity. Changes of microcirculation and endothelial dysfunction are an important step on the way from the mild to severe course of the disease. Aim. To determine the pathogenetic role of proinflammatory cytokines, adrenal molecules and E-selectin in the occurrence of vascular disorders and organ dysfunction in patients with acute necrotic pancreatitis. Materials and methods. The study involved 53 AP patients (28 – severe, 25 – mild). We measured interleukin-6, interleukin-18, ICAM-1 and E-selectin in the blood plasma. Flow in the visceral arteries was assessed with the help of the Doppler sonography. Organ dysfunction was evaluated on the SOFA scale. The severity of pancreatitis in patients was determined according to the criteria of J. H. C. Ranson. Results. Patients with AP during the hospitalization showed an increase of the levels of IL-6 and IL-18 in 12.11 and 2.02 times, respectively. However, a differentiated assessment of the individual forms of AP revealed a significant increase in both proinflammatory cytokines only in the case of acute necrotic pancreatitis, whereas IL-18 was not significantly elevated in patients with edematous pancreatitis. At the same time, the mean values ​​of IL-6 and IL-18 in patients with acute necrotic pancreatitis significantly exceeded the indicators of patients with pulmonary hypertension in 4.25 and 1.84 times, respectively. It has been established that proinflammatory cytokines mediate the damage of organs by their action on the endothelium of blood vessels and leukocytes by the increasing of the expression of adrenal molecules, which in turn leads to rolling, adhesion, aggregation and transmigration of leukocytes in the involved tissues. Cytokines stimulate endothelial cell membrane and cause the increased synthesis of selectin that bind to leukocytes through the appropriate receptors. This leads to roller leukocytes on the walls of postcapillary venules. The activation of intercellular adhesion molecules (ICAM) and vascular cell adhesion molecules (VCAM) on endothelial cells promotes the adhesion of leukocytes to vascular endothelium and their tissue transmigration. Inflammation cells respond to initial events by releasing enzymes and active forms of oxygen that cause damage of the tissues. Conclusions. It was determined that the levels of proinflammatory cytokines and adhesion molecules increase in the blood of AP patients. Their level correlates with the organ dysfunction and disturbances in splanchnic blood flow