Gyermekkori pancreatitis. A Magyar Hasnyalmirigy Munkacsoport bizonyitekon alapulo kezelesi iranyelvei.

Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant clinical questions were defined. (Evidence was classified according to the UpToDate(R) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical questions were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition of pediatric pancreatitis in everyday practice and establishing proper finance and, therefore, the authors believe that these guidelines will widely serve as a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 308-325

Serum C-reactive Protein and White Blood Cell Level as Markers of Successful Percutaneous Drainage of Acute Sterile Peripancreatic Fluid Collection

AbstractBackground: Percutaneous drainage is not a widely used therapeuticmethod recently for evacuating peripancreatic sterilefluid collections in patients with severe acute pancreatitis.However, many clinical studies have proved its positive effects.Aim: We tested the changes in serum laboratory parameters:C-reactive protein (CRP), complement factor 3-4 (C 3-4),tumor necrosis factor-α (TNF-α), amylase, lipase and whiteblood cell (WBC) count in patients treated by percutaneousdrainage.Patients and Methods: 10 patients with severe acute pancreatitiswith peripancreatic fluid collection were monitored.Laboratory parameters and the amount of drained fluid weremeasured on the 1st, 5th and 10th day. Statistical analysis wasperformed by using Statistica for Windows (Version 7.0)software. P values less than 0.05 were considered statisticallysignificant.Results: We found significant positive correlation betweenthe CRP and WBC serum level and volumes of the drainedfluid. We used these parameters as markers of successfulpercutaneous drainage in case of patients with severe acutepancreatitis complicated with sterile peripancreatic fluid.There was no significant change in the levels of C 3-4,tumor necrosis factor-α, amylase and lipase.Conclusions: Monitoring of serum CRP and WBC levels maybe recommended for follow up after percutaneous drainageof peripancreatic fluid

Appendicitis within Morgagni Hernia and simultaneous Paraesophageal Hernia

BACKGROUND: Morgagni hernia is a congenital diaphragmatic defect that rarely presents with symptomatic findings in adults. The presence of one diaphragmatic defect may decrease the occurrence of a separate diaphragmatic defect. Appendicitis may be a unique presentation of incarcerated bowel in a Morgagni defect. CASE PRESENTATION: Review of recent literature and presentation of a patient with Morgagni defect. Only five cases of simultaneous Morgagni hernia and paraesophageal hernia have been described in the English-language literature since 1958. Here, we report the first case of acute appendicitis within an incarcerated right Morgagni hernia in a 76-year-old patient who also had a paraesophageal hernia. CONCLUSION: This case illustrates that there is no role for watchful waiting in the management of Morgagni Defects when diagnosed in adult patients