Bezmialem Vakıf Üniversitesi Kurumsal Akademik Arşiv
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EFFECT OF CHOLECYSTECTOMY ON PREVENTING RECURRENCE OF ACUTE PANCREATITIS
No full textBackground and AimsCurrent guidelines recommend cholecystectomy in patients with acute biliary pancreatitis (ABP) to prevent recurrence. Some studies suggest that a significant portion of patients with idiopathic acute pancreatitis (IAP) results from occult biliary disease and cholecystectomy, after an episode of IAP, reduces the risk of recurrent pancreatitis. However, in these studies, the work-up for potential biliary cause is not extensive and do not include endoscopic ultrasound (EUS), which can detect a biliary disease up to one-third of patients with IAP. In this study, we aimed to ascertain whether cholecystectomy can prevent pancreatitis recurrence in patients with ABP and IAP.MethodsAdult patients (over 18 years) with first episode of acute pancreatitis (AP) who admitted to inpatient clinic between January 1, 2015 and December 31, 2021 at a tertiary referral center were retrospectively reviewed. Medical records were scrutinized and relevant data extracted. In addition, a questionnaire either by mail or telephone was used. Patients with biliary and idiopathic AP were included in the analysis. Patients with chronic pancreatitis, previous pancreatic surgery, pancreatic cancer, and other etiologies were excluded. Primary outcome was recurrence rate. The diagnosis of IAP was confirmed by exclusion of all known etiological factors for AP using extensive work-up, including EUS and/or magnetic resonance cholangiopancreatography (MRCP).ResultsA total of 500 patients with first episode of AP (300 patients with ABP and 200 patients with IAP) were identified. The mean age was 58 years and 267 women, 233 men. The patients were divided into three different groups: Group 1; patients who had their first pancreatitis attack after cholecystectomy, Group 2; patients who had their gallbladder in situ during the first attack and followed by cholecystectomy and Group 3; patients who had their gallbladder in situ during the first attack but did not have cholecystectomy. The number of patients with recurrence after the first episode of AP were not statistically different in whole study group (25%, 19% and 15%, respectively, P = 0.176). In the subgroup of patients with ABP, the recurrence was higher in group 1 as compared with group 2 and 3 (39%, 19% and 14%, respectively, P = 0.018). On the other hand, in the subgroup of patients with IAP, there was no significant difference among the groups in terms of recurrence (15%, 18%, and 17%, respectively, P = 0.999). When patients with in situ gallbladder during their first attack were compared according to their cholecystectomy history (group 2 vs. group 3), no significant difference was found in neither the ABP nor the IAP subgroups (19% vs 14% and 18% vs. 17%, respectively, P > 0.05). In addition, the effect of endoscopic retrograde cholangiopancreatography (ERCP) on recurrence of pancreatitis was evaluated. In subgroup of ABP, ERCP was effective for reducing the recurrence in group 2 (P = 0.008), while it was not found statistically significant in group 1 and 3. In subgroup of IAP, it ERCP did not reduce the recurrence in any of the groups.ConclusionsIn ABP, the recurrence is high in patients who have their first pancreatitis attack after cholecystectomy. Cholecystectomy alone is not effective preventing recurrence in patients with gallbladder in situ during the first episode; however, the risk can be decreased with adding ERCP to cholecystectomy. On the other hand, cholecystectomy is not effective in reducing the recurrence in patients with IAP.Key Words: Acute biliary pancreatitis; Idiopathic acute pancreatitis; Cholecystectomy.References:1. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. American Gastroenterological Association Institute Clinical Guidelines Committee. Gastroenterology. 2018 Mar;154(4):1096-1101.2. Räty S, Pulkkinen J, Nordback I, et al. Can Laparoscopic Cholecystectomy Prevent Recurrent Idiopathic Acute Pancreatitis?: A Prospective Randomized Multicenter Trial. Ann Surg. 2015 Nov;262(5):736-41.3. D S Umans, N D Hallensleben , R C Verdonk, et al. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2020 Feb;107(3):191-199
Identification of potentially inappropriate medications in elderly according to the FORTA and EU (7)-PIM lists: an observational study
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Utility of the gastro-laryngeal tube during transesophageal echocardiography: A prospective randomized clinical trial.
No full textFarklı Sagital İskeletsel İlişkilerde Ağız Sağlığına Bağlı Hayat Kalitesinin Değerlendirilmesi: Literatür İncelemesi
No full textAmaç: İskeletsel maloklüzyonların hayat kalitesine olan etkisini araştıran çalışmaları derlemektir. Gereç-Yöntem: Literatürdeki Ağız Sağlığı Etki Ölçeği ve maloklüzyonların ilişkisini ele alan çalışmalar incelenmiştir. Pubmed, Google Scholar, ScienceDirect elektronik veritabanlarından Ağız Sağlığı Etki Profili, Ağız Sağlığıyla İlgili Yaşam Kalitesi, OHIP14, Ortodonti, Maloklüzyon anahtar kelimeleri kullanılarak ulaşılan çalışmalar değerlendirilmiştir. Ağız Sağlığı Etki Profili [Oral Health Impact Profile (OHIP)] ölçeğinin 14 soruluk kısa versiyonunun kullanıldığı çalışmalar dahil edilmiştir. Bulgular: Choi ve ark. maloklüzyonun şiddetini; kesin tedavi ihtiyacı, sınır vakalar ve tedavi ihtiyacı olmayan olarak 3’e ayırmıştır ve maloklüzyonun şiddeti, yani tedavi ihtiyacı arttıkça daha yüksek bir OHIP skoru gözlendiğini bildirmiştir. Chen ve ark., Masood ve ark. da ortodontik tedavi ihtiyacı indeksi ile OHIP skorlarının korelasyonunu incelediğinde benzer sonuçlar bulmuştur. Liu ve ark. aynı metodolojiyle yaptığı çalışmada tedavi ihtiyacı arttıkça hayat kalitesinin azaldığını bulmuştur; en büyük istatiksel farkın ortodontik tedavi ihtiyacı olan ve olmayan gruplar arasında olduğunu rapor etmiştir. Javed ve ark. Sınıf III iskeletsel ilişkilerde yaşam kalitesinin Sınıf I iskeletsel ilişkiye göre daha düşük olduğunu bildirmiştir. Sınıf II iskeletsel ilişkinin skorları ile diğer maloklüzyonlarla arasında anlamlı fark bulunmamıştır. Buna karşılık Frejman ve ark. Sınıf ll ve lll dentofasiyal deformiteler sahip yetişkin hastaları çalışma grubu, Sınıf l ilişkiye sahip hastaları kontrol grubu olarak ayırıp OHIP skorlarını incelediğinde, deformite grubunda daha kötü hayat kalitesi ve düşük özgüven olduğu bulmuştur. Lee ve arkadaşları da deformite grubu ve kontrol grubu olarak ikiye gruba ayırdığı hastalarda benzer sonuçlar bulmuştur. Sonuç: Literatürde ortodontik tedavi ihtiyacı ile ağız sağlığına bağlı hayat kalitesini değerlendiren çalışmalar incelendiğinde ortodontik tedavi ihtiyacını gösteren indekslerin skorları ile OHIP14 skorunun arasında bir korelasyon gözlendiği konusunda konsensus vardır; ancak Sınıf I, II ve III iskeletsel ilişkiye sahip hastaları değerlendiren çalışmaların yetersiz olması ve metodoloji farklılıkları nedeniyle genelleme yapmak zordur. Bu konuda vertikal yön farklıklarını da ele alan daha fazla çalışmalar yapılmasına ihtiyaç vardır. Anahtar Kelimeler: Ağız Sağlığı Etki Ölçeği, Sagital İskeletsel İlişki, Ortodontik Tedav
Hızlı Maksiler Ekspansiyon Protokolünde Farklı Tekniklerin Sonlu Elemanlar Analiziyle Karşılaştırılması
No full textDegenerative Temporomandibular Joint Disorders Treated with Custom Fossa-Eminence Hemijoint Replacement: Two Case Reports.
No full textAffection through works of art and its contribution to ESP
No full textThis presentation starts with the narrative of Adam and Eve portrayed in multiple forms of art form, such as paintings or novels. After the video session, the participants will be invited to make comments on the paintings and question the fundamental concepts of Nutrition and Dietetics profession. The latter half of the presentation will discuss \"The Anatomy Lesson of Dr. Nicolaes Tulp\" (by Rembrandt), and put forward how and why art matters in language learning
