1,721,000 research outputs found
Translational research in Post-pancreatectomy Acute Pancreatitis: from intraoperative spectral imaging assistance to clinical treatment.
Full text linkThis doctoral thesis addresses the intricate challenges surrounding post-pancreatectomy acute pancreatitis (PPAP). Despite advancements, PPAP's existence and definition remained uncertain until the International Study Group for Pancreatic Surgery (ISGPS) took steps to provide a standardized definition and grading system. The chapters systematically explore the dynamics of PPAP, from its clinical implications and diagnostic challenges to innovative approaches for early prediction and potential mitigation strategies
Postoperative Acute Pancreatitis Following Pancreaticoduodenectomy: A Determinant of Fistula Potentially Driven by the Intraoperative Fluid Management
No full textOBJECTIVE: The aim of the study is to characterize postoperative acute pancreatitis (POAP). SUMMARY BACKGROUND DATA: A standardized definition of POAP after pancreaticoduodenectomy (PD) has been recently proposed, but specific studies are lacking. METHODS: The patients were extracted from the prospective database of The Pancreas Institute of Verona. POAP was defined as an elevation of the serum pancreatic amylase levels above the upper limit of normal (52 U/L) on postoperative day (POD) 0 or 1. The endpoints included defining the incidence and predictors of POAP and investigating the association of POAP with postoperative pancreatic fistula (POPF). RESULTS: The study population consisted of 292 patients who underwent PD. The POAP and POPF rates were 55.8% and 22.3%, respectively. POAP was an independent predictor of POPF (OR 3.8), with a 92% sensitivity and 53.7% specificity (AUC 0.79). Preoperative exocrine insufficiency (OR 0.39), neoadjuvant therapy (OR 0.29) additional resection of the pancreatic stump margin (OR 0.25), soft pancreatic texture (OR 4.38), and Main Pancreatic Duct (MPD) diameter ≤3 mm (OR 2.86) were independent predictors of POAP. In high-risk patients, an intraoperative fluid administration of ≤3 ml/kg/h was associated with an increased incidence of POAP (24.6 vs. 0%, P = 0.04) and POPF (27.6 vs. 11.4%, P = 0.05). CONCLUSION: This study represents the first clinical application of the only available definition of POAP as a specific complication of pancreatic surgery. POAP is associated with an increased occurrence of POPF and overall morbidity and could potentially be avoided through a specific intraoperative fluid regimen in high-risk pancreas
Postoperative hyperamylasemia (POH) and acute pancreatitis after pancreatoduodenectomy (POAP): State of the art and systematic review
No full textPostoperative hyperamylasemia is a frequent finding after pancreatoduodenectomy, but its incidence and clinical implications have not yet been analyzed systematically. The aim of this review is to reappraise the concept of postoperative hyperamylasemia with postoperative acute pancreatitis, including its definition, interpretation, and correlation
Characterization of postoperative acute pancreatitis (POAP) after distal pancreatectomy
No full textPostoperative acute pancreatitis has recently been reported as a specific complication after pancreatoduodenectomy. The aim of this study was to characterize postoperative acute pancreatitis after distal pancreatectomy
Early and Sustained Elevation in Serum Pancreatic Amylase Activity: A Novel Predictor of Morbidity After Pancreatic Surgery
Full text linkObjective:To characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections. Summary Background Data:A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications. Methods:Analysis of patients who consecutively underwent pancreatectomy from 2016 to 2019. spAMY activity was assessed from postoperative day (POD) 0 to 3. Different patterns of spAMY have been identified based on the spAMY standard range (10-52 U/l). Results:Three patterns were identified: (#1) spAMY values always < the lower limit of normal/within the reference range /a single increase in spAMY > upper limit of normal at any POD; (#2) Sustained increase in spAMY activity on POD 0 + 1; (#3) Sustained increase in spAMY activity including POD 1 + 2. Shifting through spAMY patterns was associated with increase morbidity (21% in #1 to 68% in #3 at POD 7; log rank < 0.001). Almost all severe complications (at least Clavien-Dindo >= 3) occurred in patients with pattern #3 (15% vs 3% vs 5% in #1 and #2 at POD 7, P = 0.006), without difference considering >3-times or >the spAMY normal limit (P = 0.85). POPF (9% in #1 vs 48% in #3, P < 0.001) progressively increased across patterns. Pre-operative diabetes (OR 0.19), neoadjuvant therapy (OR 0.22), pancreatic texture (OR 8.8), duct size (OR 0.78), and final histology (OR 2.2) were independent predictors of pattern #3. Conclusions:A sustained increase in spAMY activity including POD 1 + 2 (#3) represents an early postoperative predictor of overall and severe early morbidity. An early and dynamic evaluation of spAMY could crucially impact the subsequent clinical course with relevant prognostic implications
Blood loss predicts pancreas-specific complications only in high-risk patients: results of a prospective and systematic blood loss estimation during pancreatoduodenectomy
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Recherche translationnelle dans la pancréatite aigüe post-pancréatectomie : de l'assistance par imagerie spectrale au traitement clinique
No full textMon projet de doctorat explore la pancréatite aiguë post-pancréatectomie (PPAP), de la conjecture aux preuves cliniques. Bien que les stratégies de traitement se soient améliorées, la morbidité post-pancréatectomie reste un défi majeur. L'ISGPS a proposé une définition standardisée de la PPAP en 2021, mais des questions persistent. Des études ont révélé des modèles distincts d'activité enzymatique postopératoire, redéfinissant la PPAP. L'imagerie hyperspectrale (HSI) a permis de visualiser les changements hémodynamiques peropératoires, offrant ainsi une meilleure compréhension des complications pancréatiques. L'IRM a identifié les changements précoces du parenchyme pancréatique postopératoire. La POH-PPAP a des implications cliniques et des marqueurs biologiques précoces peuvent guider la prise en charge postopératoire, favorisant ainsi une surveillance proactive. Les thérapies actuelles pour la PPAP sont limitées. Cette thèse vise à éclairer ces questions et à ouvrir la voie à de meilleures pratiques cliniques.My doctoral project explores post-pancreatectomy acute pancreatitis (PPAP), from conjecture to clinical evidence. Although treatment strategies have improved, post-pancreatectomy morbidity remains a major challenge. The ISGPS proposed a standardized definition of PPAP in 2021, but questions persist. Studies have revealed distinct patterns of postoperative enzymatic activity, redefining PPAP. Hyperspectral imaging (HSI) has allowed visualization of perioperative hemodynamic changes, providing a better understanding of pancreatic complications. MRI has identified early changes in postoperative pancreatic parenchyma. POH-PPAP has clinical implications, and early biological markers can guide postoperative management, enabling proactive monitoring. Current therapies for PPAP are limited. This thesis aims to address these questions and pave the way for improved clinical practices
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