title: Modern therapeutic approach of acute severe forms of pancratitis. A review of the literature and experience of Surgical Department No III Cluj.
abstract: The title of "the great abdominal drama" attributed to acute pancreatitis is fully justified by the impressive clinical presentation, the deep consumptive character of physio-pathological processes taking place, the severity of the complications and the complexity of the treatment.
  
  
  METHODS
  The aim of our study was to analyze the results on a number of 81 consecutive patients hospitalized in the Surgical Clinic III Cluj during 28 months, all diagnosed with severe forms of acute pancreatitis. There were two groups of patients, non-surgical (43 cases) and surgical cases (38 cases), respectively. The diagnosis and forms of the disease took into account the clinical picture, serum amylase, CPR and Balthazar procalcitonine,together with the classification of the lesions on CT scan.
  
  
  RESULTS
  All patients were admitted to the intensive care unit and received supportive treatment such as antibiotics, pancreatic exocrine secretion inhibitors and proton pump inhibitors. The surgical act in the 38 cases was indicated by septic intra-abdominal pressure or high functionality threatening vital viscera. Intraoperatively the abscesses were drained, the necrotic areas were removed and cholecystectomy was performed in patients with biliary etiology. Statistically, we obtained significant differences in the incidence of complications between the group of patients operated and those not operated (p = 0.000048), but not in what concerns the length of hospitalization (p = 0.99999) and the number of deaths (p = 0.2102). The overall mortality was 14.41%, comparable to that found in the literature. In none of the patients CT guided drainage of collections was performed prior to surgery, which was a major drawback of the treatment.
  
  
  CONCLUSIONS
  Our results support the importance of an early diagnosis and medical treatment, the delayed surgery being required in high intra-abdominal pressure or SEPS.
authors.affiliation: University of Medicine and Pharmacy, Cluj-Napoca, Romania. na_hajjar@yahoo.com
authors.forename: N Al
authors.initials: NA
authors.lastname: Hajjar
authors.forename: C
authors.initials: C
authors.lastname: Iancu
authors.forename: R
authors.initials: R
authors.lastname: Bodea
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D002763:Cholecystectomy / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D010195:Pancreatitis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011498:Protein Precursors / Q000097:blood; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005765:Gastrointestinal Agents; D011498:Protein Precursors; D054328:Proton Pump Inhibitors; D002116:Calcitonin; D002097:C-Reactive Protein; D000681:Amylases