Acute pancreatitis in children. An Italian multicentre study

AIM: To evaluate the clinical, morphological and aetiological aspects of acute pancreatitis in children in Italy. PATIENTS: The hospital records of 50 consecutive patients with acute pancreatitis observed in 5 Italian Pediatric Departments were reviewed. RESULTS: A total of 25 males and 25 females (median age 10.5 years, range 2-17) were studied. Of these patients, 48 (96%) had abdominal pain. The pancreatitis was associated with biliary disease in 10 patients (20%); it was due to viral infection in 6 patients (12%), pancreatic duct abnormalities in 4 (8%, familial chronic pancreatitis in 3 (6%), trauma in 5 (10%) and other causes in 5 (10%); the pancreatitis was of unknown origin in 17 patients (34%). Previous attacks of the disease had occurred in 14 patients. A diagnosis of mild pancreatitis was made in 41 patients (82%) and of severe disease in 9 (18%). One patient with severe pancreatitis died from multiorgan failure. Patients with severe pancreatitis had significantly higher serum concentrations of C-reactive protein than patients with mild pancreatitis. Hospital stay was similar for patients with the mild form and those with the severe form of the disease. CONCLUSIONS: In Italian children, acute pancreatitis is of unknown origin in about one-third of the children and is recurrent in 28% of the cases. The disease is severe in 18% of the case

Pancreatic Ductal Adenocarcinoma Associated with Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP), in contrast to other benign chronic pancreatic diseases, can be cured with immunosuppressant drugs, thus the differentiation of AIP from pancreatic cancer is of particular interest in clinical practice. There is the possibility that some patients with AIP may develop pancreatic cancer, and this possibility contributes to increasing our difficulties in differentiating AIP from pancreatic cancer. We herein report the case of a 70-year-old man in whom pancreatic adenocarcinoma and AIP were detected simultaneously. We must carefully monitor AIP patients for the simultaneous presence of pancreatic cancer, even when a diagnosis of AIP is confirmed

TREATMENT OF INTRABONY DEFECTS AFTER IMPACTED MANDIBULAR THIRD MOLAR REMOVAL WITH BIOABSORBABLE AND NON-RESORBABLE MEMBRANES.

Background: Mandibular second molar (M2) periodontal defects after third molar (M3) removal in high-risk patients are a clinical dilemma for clinicians. This study compares the healing of periodontal intrabony defects at distal surfaces of mandibular M2s using bioabsorbable and non-resorbable membranes. Methods: Eleven patients with bilateral probing depths (PDs) ≥6 mm distal to mandibular M2s and intrabony defects ≥3 mm, related to the total impaction of M3s, were treated with M3 extraction and covering of the surgical bone defect with a bioabsorbable collagen barrier on one side and a non-resorbable expanded polytetrafluoroethylene (ePTFE) barrier contralaterally. The PD, clinical attachment level (CAL), M2 mobility, and furcation class probing were evaluated preoperatively and 3, 6, and 9 months postoperatively. Intraoral periapical radiographs were taken immediately preoperatively and 3 and 9 months postoperatively. Results: Both treatment modalities were successful. At 9 months, the mean PD reduction was 5.2 \ub1 3.9 mm for bioabsorbable sites and 5.5 \ub1 3.0 mm for non-resorbable sites; the CAL gain was 5.9 \ub1 3.3 mm and 5.5 \ub1 3.4 mm, respectively. The outcome difference between the two sites for PD and CAL did not differ statistically (P >0.05) at any assessment time. Conclusion: Bioabsorbable collagen membranes in guided tissue regeneration treatment of intrabony defects distal to the mandibular M2 obtained the same marked PD reductions and CAL gains as non-resorbable ePTFE membranes after M3 extraction

Ursodeoxycholic acid improves liver tests in chronic hepatitis - Results of a randomised controlled trial

Objective: The present study was designed to investigate the effect of ursodeoxycholic acid (UDCA), a drug widely utilised in the management of cholestatic conditions, on liver function tests and symptom relief in a group of patients with chronic hepatitis of different aetiologies. Patients and Design: 219 patients (128 males, 91 females) with a histological diagnosis of chronic hepatitis were enrolled in a multicentre randomised trial with UDCA (300mg twice daily orally) and folic acid as a placebo. Treatment was carried out for 6 months. Biochemical markers of liver disease activity and scores for dyspeptic and systemic symptoms were determined. 213 patients completed the study (112 in the UDCA group, 101 in the placebo group). Results: UDCA induced a significant decrease (p < 0.001) in serum ALT, AST and gamma-GT; folic acid induced a significant reduction (p < 0.05) of ALT at 4 and 6 months of treatment, and of AST at 6 months. As assessed by ANCOVA, the changes in enzyme levels were significantly (p < 0.001) more pronounced in the UDCA group compared with placebo. This was accompanied by a significantly higher (p < 0.05) percentage of patients showing normalisation of liver enzymes. Analysis of the interference of pre-existing factors on the biochemical outcome showed a more marked effect of UDCA in reducing ALT in patients with elevated gamma-GT. Finally, the frequency and score of most symptoms were significantly reduced (p < 0.05) with ursodeoxycholic acid. Conclusions: The effectiveness and tolerability of ursodeoxycholic acid make it worth consideration as a useful therapeutic tool in the treatment of chronic hepatitis

Uselessness of a questionnaire for osteoporosis and role of bone mass measurements in predicting tooth loss.

Background: We evaluated whether the number of teeth lost is associated with risk factors for osteoporosis and whether bone mass measurements can add further information. Methods: 455 free living women were enrolled. All the subjects filled in a questionnaire on risk factors for osteoporosis. BMD was measured both by DXA and QUS. Results: On the basis of the questionnaire score 65.1% of the subjects were in the low risk category, 11.0% in the moderate risk category, 19.3% in fairly high risk category and 4.6% in the high risk category. Close relationships (P&lt;0.001) were observed between bone mass loss and the questionnaire risk categories. The number of teeth lost significantly increased from normal to osteoporosis groups. High correlations were also found between osteosonographic parameters and the number of teeth lost. Among questionnaire items a significant positive correlation was found only between the number of teeth lost and both age class (P&lt;0.001) and years since menopause (P&lt;0.001). A multiple regression showed that only age class (P&lt;0.001) and UBPI (P=0.041) were independently linked to tooth loss. Conclusion: Our results showed that age is the main determinant of tooth loss and that QUS adds further information in identifying patients at a higher risk of tooth loss