A case of acute pancreatitis - does step-up protocol always indicated?

Acute pancreatitis (AP) is still one of the most frequent cause of hospitalization. Grading severity of AP due to revised Atlanta classification differentiate: mild, moderately severe and severe AP. Mortality ranges from occasional tomild,8% in moderate, 36%-59% in severe AP.

A CASE REPORT

59-year-old man was hospitalized due to severe acute pancreatitis. Biliary duct obstruction was determined as a reason of AP and intensive treatment was started. The CT scan showed infected post-inflammatory pancreatic cyst. For this reason, endoscopic drainage of the pancreatic cyst to the stomach was performed first and then Jurasz operation. Severe postoperative course required treatment in the Intensive Care Unit (ICU). During the next hospitalization due to the patient's condition deterioration, endoscopic cyst drainage was performed again. Because of ineffectiveness of the performed treatment, the patient was reoperated. Post-operative multi-organ failure, lack of response to the intensive therapy and cachexia because of long-lasting illness, lead into patient's death.

CONCLUSIONS

This case demonstrates problem with severe complications of AP which despite of multidisciplinary treatment combining endoscopy, surgery and pharmacology can finally lead to death.

Environmental life cycle assessment of Italian mozzarella cheese: Hotspots and improvement opportunities

The present study investigated a cradle-to-grave life cycle assessment to estimate the environmental impacts associated with Italian mozzarella cheese consumption. The differences between mozzarella produced from raw milk and mozzarella produced from curd were studied, and differences in manufacturing processes have been emphasized in order to provide guidance for targeted improvements at this phase. Specifically, the third-largest Italian mozzarella producer was surveyed to collect site-specific manufacturing data. The Ecoinvent v3.2 database was used for secondary data, whereas SimaPro 8.1 was the modeling software. The inventory included inputs from farm activities to end of life disposal of wasted mozzarella and packaging. Additionally, plant-specific information was used to assign major inputs, such as electricity, natural gas, packaging, and chemicals to specific products; however, where disaggregated information was not provided, milk solids allocation was applied. Notably, loss of milk solids was accounted during the manufacture, moreover mozzarella waste and transport were considered during distribution, retail, and consumption phases. Feed production and animal emissions were the main drivers of raw milk production. Electricity and natural gas usage, packaging (cardboard and plastic), transport, wastewater treatment, and refrigerant loss affected the emissions from a farm gate-to-dairy plant gate perspective. Post-dairy plant gate effects were mainly determined by electricity usage for storage of mozzarella, transport of mozzarella, and waste treatment. The average emissions were 6.66 kg of CO₂ equivalents and 45.1 MJ of cumulative energy demand/kg of consumed mozzarella produced directly from raw milk, whereas mozzarella from purchased curd had larger emissions than mozzarella from raw milk due to added transport of curd from specialty manufacturing plants, as well as electricity usage from additional processes at the mozzarella plant that are required to process the curd into mozzarella. Normalization points to ecotoxicity as the impact category most significantly influenced by mozzarella consumption. From a farm gate-to-grave perspective, ecotoxicity and freshwater and marine eutrophication are the first and second largest contributors of mozzarella consumption to average European effects, respectively. To increase environmental sustainability, an improvement of efficiency for energy and packaging usage and transport activities is recommended in the post-farm gate mozzarella supply chain.

Environmental life cycle assessment of Italian mozzarella cheese: Hotspots and improvement opportunities

The present study investigated a cradle-to-grave life cycle assessment to estimate the environmental impacts associated with Italian mozzarella cheese consumption. The differences between mozzarella produced from raw milk and mozzarella produced from curd were studied, and differences in manufacturing processes have been emphasized in order to provide guidance for targeted improvements at this phase. Specifically, the third-largest Italian mozzarella producer was surveyed to collect site-specific manufacturing data. The Ecoinvent v3.2 database was used for secondary data, whereas SimaPro 8.1 was the modeling software. The inventory included inputs from farm activities to end of life disposal of wasted mozzarella and packaging. Additionally, plant-specific information was used to assign major inputs, such as electricity, natural gas, packaging, and chemicals to specific products; however, where disaggregated information was not provided, milk solids allocation was applied. Notably, loss of milk solids was accounted during the manufacture, moreover mozzarella waste and transport were considered during distribution, retail, and consumption phases. Feed production and animal emissions were the main drivers of raw milk production. Electricity and natural gas usage, packaging (cardboard and plastic), transport, wastewater treatment, and refrigerant loss affected the emissions from a farm gate-to-dairy plant gate perspective. Post-dairy plant gate effects were mainly determined by electricity usage for storage of mozzarella, transport of mozzarella, and waste treatment. The average emissions were 6.66 kg of CO₂ equivalents and 45.1 MJ of cumulative energy demand/kg of consumed mozzarella produced directly from raw milk, whereas mozzarella from purchased curd had larger emissions than mozzarella from raw milk due to added transport of curd from specialty manufacturing plants, as well as electricity usage from additional processes at the mozzarella plant that are required to process the curd into mozzarella. Normalization points to ecotoxicity as the impact category most significantly influenced by mozzarella consumption. From a farm gate-to-grave perspective, ecotoxicity and freshwater and marine eutrophication are the first and second largest contributors of mozzarella consumption to average European effects, respectively. To increase environmental sustainability, an improvement of efficiency for energy and packaging usage and transport activities is recommended in the post-farm gate mozzarella supply chain.

Cytomegalovirus DNA in arterial walls of patients with atherosclerosis

The biological properties of cytomegalovirus (CMV) are consistent with a potential role in the pathogenesis of atherosclerosis. The evidence of such a role has so far been circumstantial, but CMV nucleic acid is beginning to be reported with increasing frequency in the arterial wall. Arterial specimens from 135 patients who underwent vascular surgery for symptomatic atherosclerotic vessel disease were analyzed by PCR for the presence of CMV nucleic acid. Samples were studied from the atheromatous plaque area and from uninvolved aortic tissues of patients undergoing surgery for vascular disease. One primer pair (LA) was used for detection of a late gene, and two other primer pairs (E1 and E2) were used for the immediate early gene region. Serum antibody to CMV was measured by radioimmunoassay. With the late gene primer, CMV nucleic acid was found in 76% of the tissue specimens tested, whereas the E2 gene primer complementary to the transforming mtr2 region was reactive in 90% of the arterial samples. There was no significant difference in the prevalence of CMV DNA in atherosclerotic plaque tissue and in uninvolved aortic tissue from the patients. A second early gene primer was not reactive with the tissue specimens, although it gave positive results with the positive control of infectious virus. Serum antibody to CMV was detected in 86% of the patients in whose tissue CMV DNA was demonstrated. CMV DNA was detected in a high proportion of atherosclerotic plaque tissues as well as in uninvolved aortic tissue of surgical patients, suggesting that latent CMV infection of the arterial wall may be a common occurrence in patients with atherosclerosis.

Paget's disease of the vulva: search for herpes simplex virus antigens and human papillomavirus antigen and DNA

Specimens from three women with Paget's disease of the vulva were tested for presence of herpes simplex virus type 2 (HSV2) antigens and human papillomavirus (HPV) antigen and DNA. In one of the lesions, the HSV2-associated antigen ICSP 34/35 was demonstrated. Neither HPV antigens nor HPV DNA were detected in the lesions.

Human papillomavirus and herpes simplex virus in vulvar squamous cell carcinoma in situ

Human papillomavirus deoxyribonucleic acid were detected in tissue specimens from 38 to 46 patients (83%) with squamous cell carcinoma in situ of the vulva. Herpes simplex virus type 2--related antigen ICSP 34/35 was demonstrated in 23 of the lesions (50%), and antibodies to herpes simplex virus types 1 and 2 were found in 74% and 65% of the serum samples tested, respectively. Both human papillomavirus deoxyribonucleic acid and herpes simplex virus type 2 antigen were detected in 19 cases (41%). Correlation of human papillomavirus type to the ages of the patients revealed that types 16, 18, and 31 are most often seen in older patients, although the frequencies do not differ significantly. No relationship between the presence or absence of herpes simplex virus type 2--related antigen to age of the patient was observed.

High levels of cytomegalovirus antibody in patients requiring vascular surgery for atherosclerosis

157 caucasian male patients undergoing vascular surgery for atherosclerosis and a matched control group of patients with high cholesterol levels were screened for antibodies to cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV1) and type 2 (HSV2), indicative of persistent infection. The prevalence of CMV antibodies was higher in the surgical group than in the control group (90% and 74%, respectively), and a significantly greater percentage (p less than 0.001) of surgical cases than controls had high titres of CMV antibodies (57% and 26%, respectively). Small but not significant differences in antibodies to HSV1 were observed, and there were no differences in HSV2 antibody titres. For each virus there was no correlation between antibody titre and blood levels of total cholesterol or triglycerides. It is suggested that periodically activated virus may have a role in the pathogenesis of atherosclerosis.

Cytomegalovirus antigen within human arterial smooth muscle cells

Arterial tissues from carotid artery plaques or from punch-biopsy samples of uninvolved areas of the aorta were removed from 132 patients with atherosclerosis during blood-vessel surgery. Cells morphologically identical to smooth muscle cells were cultured from 26 to 126 plaque samples and from 6 of 6 punch-biopsy samples. Immunofluorescence tests of these cells showed that more than 25% of the cell cultures from both types of sample contained antigens of human cytomegalovirus (CMV) but not of herpes simplex virus type 1 or type 2. Replicating CMV was not detected by electron microscopy in the antigen-positive cells, suggesting that the artery walls may be a site of CMV latency.

Herpesvirus-induced antigens in squamous-cell carcinoma in situ of the vulva

Antigens induced by herpes simplex virus Type 2 (HSV2) were found to be associated with squamous-cell carcinoma in situ of the vulva in nine of 10 patients. The HSV2-induced antigens are DNA-binding proteins that are normally present in the nuclei of infected cells, but in the cells of the carcinomas in situ they were found in the cytoplasm. Whole-virion structural antigens were not present, although there was serologic evidence of previous HSV2 infection in patients tested for the presence of antibodies. The observations reported here and the recent parallel rise in the prevalence of both HSV2 infections and vulvar carcinoma in situ, particularly in women under 40 years of age, suggest an association of HSV2 infection with this type of neoplasia, the nature of which remains to be determined.