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Risk Factors For Development Of Acute Necrotizing Pancreatitis

Abstract

Acute necrotizing pancreatitis (ANP) is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP) based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course.

The aim of the study was to determine patient- and initial treatment-related risk factors for the development of acute necrotizing pancreatitis.

For the purpose of this study a case-control design was chosen, including adult patients treated for AP in the surgical Intensive Care Unit (sICU) of Clinical Center of Kragujevac, from January 2006 to January 2011. The cases (n=63) were patients who developed ANP, while the controls (n=63) were patients with AP without the presence of pancreatic necrosis. The controls were randomly selected from a study sample after matching with the cases by age and sex.

Significant association with the development of ANP was found for the presence of comorbidity (adjusted OR 6.614 95%CI 1.185-36.963), and the use of somatostatin (adjusted OR 7.460, 95%CI 1.162-47.833) and furosemide (adjusted OR 2710.57, 95%CI 1.996-56.035) started immediately upon admission to the sICU.

This study suggests that comorbidities, particularly the presence of serious cardio-vascular disease, can increase the risk for development of acute necrotizing pancreatitis. The probability for the development of ANP could be reduced by the avoidance of the initial use of loop diuretics and somatostatin.

Open access
Risk Factors for Early Postoperative Complications after Surgery for Crohn's Disease

Summary

The aim of this study was to show the influence of various risk factors on early postoperative complications following surgery for Crohn’s disease (CD). In this review, an online internet database was searched, and also systematic review of the literature was performed. Three different studies from different countries were analyzed and compared with the results obtained in our University Clinic of Digestive Surgery - Skopje. The first review shows the influence of positive resection margins in CD on septical complications occurrence in patients undergoing ileocolic resection for CD at the Tel Aviv Medical Centre - Israel. The second review shows the risk factors for complications after bowel surgery in Korean patients with CD using data from the Asan Medical Centre - Seul, Korea. The third review shows that the delay of surgery is associated with inferior postoperative outcome in patients treated for perforating Crohn’s ileitis, and the study was conducted using data from the medical records of patients treated at the Department of Surgery at the University of Regensburg, Germany. Finally, we analyzed the influence of the most common risk factors on early postoperative complications in patients that underwent surgery for Crohn’s disease in a five-year period at the University Clinic of Digestive Surgery in Skopje, Macedonia and compared them with the results in the aforementioned articles.

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Hepato-renal Syndrome: Etiopathogenesis, Diagnosis and Treatment

ABSTRACT

Hepatorenal syndrome (HRS) involves reversible renal failure in patients with advanced cirrhosis or acute liver failure. The aim of the study was to determine the pathogenetic mechanisms of the development of hepatorenal syndrome and to emphasise the clinical importance of early detection and timely treatment of patients with this condition. Th e one-year incidence rate of hepatorenal syndrome in patients with liver cirrhosis is 18-20%. Th e risk factors for the development of hepatorenal syndrome include the following: spontaneous bacterial peritonitis, gastrointestinal bleeding, nephrotoxic drugs, diuretics, non-steroidal anti-inflammatory drugs, and hyponatraemia. The primary plan of treatment is a liver transplantation, while a secondary plan of treatment is the use of a vasoconstrictor in conjunction with albumin. Early diagnosis and prompt appropriate treatment can significantly reduce the mortality rate of patients with hepatorenal syndrome.

Open access
The Influence of HPV16, Smoking and Coitarche in the Development of Cervical Dysplasia in the Stage where Conization is the Treatment of Choice

SUMMARY

The high incidence of premalignant lesions of the cervix in our country and worldwide was the primary aim for conducting this study so as to establish whether HPV16, smoking and coitarche (first intercourse) are significant factors in the developmental stages of cervical dysplasia in the case of which the conization is a surgical treatment of choice.

In the period of three years, one hundred and thirty-six women from the Republic of Macedonia with histologically confirmed CIN were examined as well as 50 control cases with normal cytology and colposcopic findings. The aforesaid epidemiologic factors examined in this study were obtained through special questionnaires. The resulting material was statistically processed to determine whether these factors are risk factors for development of higher stages of cervical dysplasia.

The obtained statistical analysis showed that HPV16, smoking and coitarche under the age of 18 are very important factors in the development of higher stages of CIN where conization is indicated as a treatment of choice.

Our study demonstrated that coitarche under the age of 18, smoking and infection with HPV16 as the most common high risk HPV in our country are the most important factors in causing and development of high grade CIN, where conization is necessary as a treatment of choice. Thus, socially-based organized screening can be of great benefit in early diagnosis and adequate treatment of this highly prevalent disease.

Open access
Changes in the Incidence of Gestational Trophoblastic Disease - 2000-2010 - Our Experience

Changes in the Incidence of Gestational Trophoblastic Disease - 2000-2010 - Our Experience

Gestational trophoblastic disease (GTD) is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus.

The aim of the paper was to report the incidence of GTD in the University Hospital Center during a ten-year period.

The retrospective analysis involved all medical records of women who were treated for GTD in our clinic. Histopathologic report of abortion specimen with gestational trophoblastic disease was registered and we calculated the incidence of births, abortions and total pregnancies.

There were 104 patients who were treated in our clinic. The overall incidence of GTD was 1,26 per 1000 deliveries.

According to our experience, a lower socio economic status may be a risk factor for GTD, apart from younger age, at least one delivery and more abortions in anamnesis.

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The Prevalence of Alcohol Consumption by Adolescents in Serbia and Its Correlation with Sociodemographic Factors – A National Survey

, Shanklin S, Flint KH, Hawkins J, et al. Youth risk behavior surveillance – United States, 2011. MMWR Surveill Summ 2012; 61(4): 1-162. 14. Radovanović S. Faktori rizika za zloupotrebu psihoaktivnih supstanci kod mladih u Srbiji. Doktorska disertacija, Fakultet medicinskih nauka, Kragujevac, 2013. 15. Sharrad S, De Crespigny C, Aylward P, Wiechula R. An exploration of adolescents’ decisions to abstain or refrain from alcohol consumption in Australian social settings: a qualitative systematic review. BI Database System Rev Implement Rep. 2015

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