JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis

Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100 000 of the population. The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence of acute alcoholic pancreatitis is considered to be associated with high alcohol consumption. Although the incidence of alcoholic pancreatitis is much higher in men than in women, there is no difference in sexes in the risk involved after adjusting for alcohol intake. Other risk factors include endoscopic retrograde cholangiopancreatography, surgery, therapeutic drugs, HIV infection, hyperlipidemia, and biliary tract anomalies. Idiopathic acute pancreatitis is defined as acute pancreatitis in which the etiological factor cannot be specified. However, several studies have suggested that this entity includes cases caused by other specific disorders such as microlithiasis. Acute pancreatitis is a potentially fatal disease with an overall mortality of 2.1%–7.8%. The outcome of acute pancreatitis is determined by two factors that reflect the severity of the illness: organ failure and pancreatic necrosis. About half of the deaths in patients with acute pancreatitis occur within the first 1–2 weeks and are mainly attributable to multiple organ dysfunction syndrome (MODS). Depending on patient selection, necrotizing pancreatitis develops in approximately 10%–20% of patients and the mortality is high, ranging from 14% to 25% of these patients. Infected pancreatic necrosis develops in 30%–40% of patients with necrotizing pancreatitis and the incidence of MODS in such patients is high. The recurrence rate of acute pancreatitis is relatively high: almost half the patients with acute alcoholic pancreatitis experience a recurrence. When the gallstones are not treated, the risk of recurrence in gallstone pancreatitis ranges from 32% to 61%. After recovering from acute pancreatitis, about one-third to one-half of acute pancreatitis patients develop functional disorders, such as diabetes mellitus and fatty stool; the incidence of chronic pancreatitis after acute pancreatitis ranges from 3% to 13%. Nevertheless, many reports have shown that most patients who recover from acute pancreatitis regain good general health and return to their usual daily routine. Some authors have emphasized that endocrine function disorders are a common complication after severe acute pancreatitis has been treated by pancreatic resection

Music, landscape and the sound of place: on hearing Delius's Song of the High Hills

One of the most poignant scenes in Ken Russell’s 1968 film Delius: Song of Summer evocatively depicts the ailing composer being carried in a wicker chair to the summit of the mountain behind his Norwegian cabin. From here, Delius can gaze one final time across the broad Gudbrandsdal and watch the sun set behind the distant Norwegian fells. Contemplating the centrality of Norway in Delius’s output, however, raises more pressing questions of musical meaning, representation, and our relationship with the natural environment. It also inspires a more complex awareness of landscape and our sense of place, both historical and imagined, as a mode of reception and an interpretative tool for approaching Delius’s music. This essay focuses on one of Delius’s richest but most critically neglected works, The Song of the High Hills for orchestra and wordless chorus, composed in 1911 but not premiered until 1920. Drawing on archival materials held at the British Library and the Grainger Museum, Melbourne, I examine the music’s compositional genesis and critical reception. Conventionally heard (following Thomas Beecham and Eric Fenby) as an imaginary account of a walking tour in the Norwegian mountains, The Song of the High Hills in fact offers a multilayered response to ideas of landscape and nature. Moving beyond pictorial notions of landscape representation, I draw from recent critical literature in cultural geography to account for the music’s sense of place. Hearing The Song of the High Hills from this perspective promotes a keener understanding of our phenomenological engagement with sound and the natural environment, and underscores the parallels between Delius’s work and contemporary developments in continental philosophy, notably the writing of Henri Bergson.</p