| Surgical management and complex treatment of infected pancreatic necrosis: 18-year experience at a single center. | |
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MedLine Citation:
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PMID: 16455462 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Infected pancreatic necrosis (IPN), the most severe form of acute pancreatitis, is responsible for most cases of pancreatitis-related morbidity and mortality. Since 1986, 220 patients with IPN have been treated. The surgical treatment was performed on average 18.5 days (range, 8-25 days) after the onset of acute pancreatitis and consisted of wide-ranging necrosectomy, combined with widespread drainage and continuous lavage. In 108 of the 220 cases, some other surgical intervention (distal pancreatic resection, splenectomy, total pancreatectomy, cholecystectomy, colon resection, etc.) was also performed. Following surgery, the supportive therapy consisted of immunonutrition (glutamine and arginine supplementation) and modification of cytokine production with pentoxifylline and dexamethasone. Continuous lavage was applied for an average of 44.5 days (range, 21-95 days), with an average of 9.5 L (range, 5-20 L) of saline per day. The bacteriologic findings revealed mainly enteral bacteria, but Candida infection was also frequently detected (21%). Forty-eight patients (22%) had to undergo reoperation. The overall hospital mortality was 7.7% (17 patients died). In our experience, IPN responds well to adequate surgical treatment, continuous, longstanding widespread drainage and lavage, together with supportive therapy consisting of immunonutrition and modification of cytokine production, combined with adequate antibiotic and antifungal medication. |
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Authors:
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Gyula Farkas; János Márton; Yvette Mándi; László Leindler |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Volume: 10 ISSN: 1091-255X ISO Abbreviation: J. Gastrointest. Surg. Publication Date: 2006 Feb |
Date Detail:
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Created Date: 2006-02-03 Completed Date: 2006-09-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9706084 Medline TA: J Gastrointest Surg Country: United States |
Other Details:
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Languages: eng Pagination: 278-85 Citation Subset: IM |
Affiliation:
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Department of Surgery, Institute of Microbiology. Faculty of Medicine, University of Szeged, PO Box 427, Szeged 6701, Hungary. fg@surg.szote.u-szeged.hu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anti-Inflammatory Agents / therapeutic use Arginine / therapeutic use Candidiasis / surgery* Cause of Death Cholecystectomy Colectomy Dexamethasone / therapeutic use Female Glutamine / therapeutic use Gram-Negative Bacterial Infections / surgery* Humans Immunologic Factors / therapeutic use Male Middle Aged Nutritional Support Pancreatectomy Pancreatitis, Acute Necrotizing / microbiology, surgery* Pentoxifylline / therapeutic use Reoperation Retrospective Studies Splenectomy Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 0/Immunologic Factors; 50-02-2/Dexamethasone; 56-85-9/Glutamine; 6493-05-6/Pentoxifylline; 74-79-3/Arginine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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