RESUMO
OBJECTIVE: To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments. SUMMARY: The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy in due time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery. METHODS: A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately. RESULTS: Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infected necrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p<0.05) while the total hospital stay was 46.47 vs. 57.26 days (p<0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p<0.05) for conservative medical treatment vs. surgical treatment, respectively. Between the first and the twelfth month the evaluated patients who attended consultation, after discharge, showed: pancreatic pseudocyst 9/36 (25%) vs. 8/34(23.5%); recurring abdominal pain 3/36 (8.3%) vs. 4/34 (11.8%); and relapsing acute pancreatitis 3/36 (8.3%) vs. 2/34 (5.8%); while 4/36 (11.1%) vs. 3/34 (8.8%) did not show any problem. There were not significant differences between the conservative and the surgical medical treatment, respectively. CONCLUSIONS: Patients suffering acute pancreatitis with sterile necrosis can undergo conservative medical treatment which will result in a lower mortality rate, while the hospital stay, in comparison with acute pancreatitis with infected necrosis, will not be affected.
Assuntos
Unidades de Terapia Intensiva , Pancreatite Necrosante Aguda/terapia , APACHE , Amilases/sangue , Antibacterianos/uso terapêutico , Biópsia por Agulha , Diagnóstico Diferencial , Humanos , Tempo de Internação , Pâncreas/patologia , Pseudocisto Pancreático/diagnóstico , Pancreatite Necrosante Aguda/sangue , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia , Recidiva , Fatores de TempoRESUMO
OBJETIVO: Determinar el pronostico del tratamiento medico y quirúrgico de pacientes con pancreatitis aguda necrótica. INTRODUCCION: El tratamiento de pancreatitis aguda severa es multidisciplinario y requiere la evaluación de los pacientes día a día, esto permite observar los cambios y dar terapia oportuna. El tratamiento incluye: admisión en UCI, fluidos, nutrición y antibióticos, así como otros soportes de vida para paciente critico. Con esto, los pacientes pueden ser tratados conservadoramente o si fuese necesario, con intervención quirúrgica. METODOS: Un estudio retrospectivo de pacientes con pancreatitis aguda necrótica, que ingresaron a la Unidad de Cuidados Intensivos, entre enero del 2004 a agosto del 2006. Los pacientes con pancreatitis aguda necrótica sin signos de sepsis fueron sometidos a tratamiento medico conservador. Se realizó una punción aspiración con aguja fina, a partir de la cuarta semana, a los pacientes con pancreatitis aguda necrótica y sepsis persistente. Previamente se descartó y erradicó todos los focos infecciosos no pancreáticos. Todos los pacientes con coloración Gram. ó cultivo positivo fueron sometidos a cirugía de inmediato. RESULTADOS: Setenta pacientes con pancreatitis aguda necrótica fueron incluidos, de los cuales 36 (51%) tuvieron pancreatitis aguda necrótica estéril con tratamiento medico conservador y 34 (49%) tuvieron pancreatitis aguda necrótica infectada con tratamiento quirúrgico. El promedio de edad fue 55.19 vs. 57.65 (p=0.57). El promedio de amilasas 1421.74 vs. 1402.45. (p=0.96). El índice de severidad tomográfica fue 8.47 vs. 8.79 (p=0.36). Apache II fue 8.22 vs. 9 (p=0.46). El promedio de órganos fallados 0.39 vs. 0.68. (p=0.19). La estancia en UCI fue de 10.75 vs. 26.5 días (p < 0.05). La estancia hospitalaria total fue 46.47 vs. 57.26 días (p < 0.05). La mortalidad (3/36) 8.3% vs. (9/34) 26.5% (p < 0.05) para el tratamiento medico...
OBJECTIVE: To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments. SUMMARY: The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy indue time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery. METHODS: A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately. RESULTS: Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infectednecrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p < 0.05) while the total hospital stay was 46.47 vs. 57.26 days (p < 0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p < 0.05) for conservative medical treatment vs. surgical treatment, respectively...
Assuntos
Humanos , Pancreatite Necrosante Aguda/cirurgia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/terapia , Estudos RetrospectivosRESUMO
INTRODUCTION: Stress Urinary Incontinence (SUI) may be managed by transobturator approach. We developed a three-dimensional model, for understanding the surgical anatomy and manual training as well, in order to reduce the learning curve for pelvic surgeries. OBJECTIVE: To demonstrate in synthetic models, the anatomical basis for the management of SUI and cystocele. METHOD: The anatomical model includes: pelvic bones, the main layers of the pelvic muscles, ligaments and fascias. The surgical devices were transobturator needles, synthetic slings and meshes for anterior vaginal wall repair. The workshop was carried out with an anatomical overview and hands-on training in this tridimentional models and finally surgery in animals. At the end, a questionnaire was applied to verify the impact of this tool in the learning process and trainee satisfaction. RESULTS: As far as the anatomical concept, 90% (n=72) of the participants classified this model as very good and 10% (n=8) as good. As a tool for understanding the tridimentional pelvic floor anatomy applied to transobturator procedures there were 100% of approval. CONCLUSIONS: This synthetic model allows for understanding the pelvic floor tridimentional anatomy and surgical procedures as well. Further skill is got in the animal model reducing the learning curve for transobturator procedures.