Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

AbstractBackgroundThe optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists.MethodsAn online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy.ResultsThe response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive).DiscussionThe step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2–3 weeks of infected necrotizing pancreatitis

Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study

Background: Pancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study. Methods: An online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts. Results: The response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis. Conclusion: This international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation

Four modes of optical parametric operation for squeezed state generation

We report a versatile instrument, based on a monolithic optical parametric amplifier, which reliably generates four different types of squeezed light. We obtained vacuum squeezing, low power amplitude squeezing, phase squeezing and bright amplitude squeezing. We show a complete analysis of this light, including a full quantum state tomography. In addition we demonstrate the direct detection of the squeezed state statistics without the aid of a spectrum analyser. This technique makes the nonclassical properties directly visible and allows complete measurement of the statistical moments of the squeezed quadrature

Traegergebundene Metallporphyrine als Oxidationskatalysatoren Schlussbericht

In a joint venture with Degussa AG, singly or quadruply functionalized tetraarylporphyrins and their respective manganese(III) complexes were synthesized. Their potential as catalysts for the oxidation of organic compounds with hydrogen peroxide was tested. The manganese porphyrins were checked both in homogeneous and heterogeneous phase. Heterogeneous phases were obtained by fixation of manganese porhyrins to organic or mineral supports, e.g. via covalent bonds for chloromethylpolystyrene, secondary aminopolysiloxanes, or aminopropyl silica gel, or via ionic bonds for anion exchange resins. For these purposes, the following residues were attached to porphyrins and their chloromanganese(III) complexes: chlorosulfonyl or chlorocarbonyl for covalent fixation, sulfonate or carboxylate for ionic fixation. The complexes were characterized by UV/Vis-, IR-, NMR- and mass spectra. The ionic derivatives were purified by electrophoresis or ultrafiltration. Supported manganese(III) porphyrins were transformed into nitridomanganese(V) derivatives which were identified by UV/Vis diffuse reflectance spectroscopy. The screening of the new manganese porphyrin phases was done by Degussa. Tetraphenylporphyrin, tetrakis(o,o'-dichlorophenyl)porphyrin, or tetrakis(o,o'-dichlorophenyl)octachloroporphyrin were subjected to functionalizations. Procedures for direct monofunctionalization of the two porphyrins mentioned in the first place were elaborated. (orig.)SIGLEAvailable from TIB Hannover: F95B1642+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Binding pancreaticojejunostomy – a safe and reliable anastomosis procedure

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