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Kirschner J, Crawford T, Ryan M, Finkel R, Swoboda K, De Vivo D, Bertini E, Hwu H, Sansone V, Pechmann A, Montes J, Krasinski D, Chin R, Berger Z, Zhu C, Raynaud S, Paradis A, Johnson N. VP.51 Impact of nusinersen on caregiver experience and health-related quality of life (HRQoL) when initiated in the presymptomatic stage of SMA in NURTURE. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Darras B, Hagenacker T, Finkel R, Mercuri E, Montes J, Kuntz N, Farrar M, Sansone V, Berger Z, MacCannell D, Shen C, Paradis A, Bohn J, Wagner J, Somera-Molina K. P.100 Rationale/design of the phase 3b ASCEND study of investigational higher dose nusinersen in participants with SMA previously treated with risdiplam. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Day J, Finkel R, Pascual S, Ryan M, Mercuri E, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Makepeace C, Foster R, Irzhevsky V, Berger Z. FP.22 Results from the end of Part A of the ongoing 3-part DEVOTE study to explore higher doses of nusinersen in SMA. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Proud C, Parsons J, Masson R, Brandsema J, Finkel R, Swoboda K, Finanger E, Liu Y, Makepeace C, Paradis A, Berger Z, Wagner J, Somera-Molina K. P.101 Baseline characteristics/initial safety in RESPOND: phase 4 study of nusinersen in children with SMA who previously received onasemnogene abeparvovec. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Toledo PF, Cárdenas G, Berger Z, Simian D, Araya F. Neostigmine® Improves Pancreatic Duct Visualization in Magnetic Resonance Cholangiopancreatography and Could Be a Cheap Alternative for Secretin. Turk J Gastroenterol 2022; 33:704-709. [PMID: 35946885 PMCID: PMC9524412 DOI: 10.5152/tjg.2022.21864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Paulina F. Toledo
- Division of Gastroenterology, Department of Internal Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gonzalo Cárdenas
- Department of Radiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Zoltán Berger
- Division of Gastroenterology, Department of Internal Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
- Corresponding author: Zoltán Berger, e-mail:
| | - Daniela Simian
- Division of Gastroenterology, Department of Internal Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francisca Araya
- Department of Radiology, Hospital Clínico Universidad de Chile, Santiago, Chile
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Berger Z, Orellana F, Cocio R, Torres F, Simian D, Araneda G, Toledo P. Pancreatic steatosis: A frequent finding in a Chilean population. Rev Gastroenterol Mex (Engl Ed) 2021; 88:118-124. [PMID: 34974993 DOI: 10.1016/j.rgmxen.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Pancreatic steatosis is an incidental radiologic finding in asymptomatic patients, and its clinical importance is unclear. Primary aim: to study the prevalence of pancreatic steatosis (PS) in consecutive patients registered at our hospital, that underwent computed axial tomography (CAT) scanning of the abdomen and pelvis, excluding known pancreatic diseases. Secondary aim: to review the association of PS with the demographic and clinical data of the patients, as well as with hepatic steatosis (HS). MATERIALS AND METHODS An observational study was conducted on adult patients that had CAT scans of the abdomen and pelvis. DEFINITIONS a) tissue density was measured in Hounsfield units (HU) in five 1 cm2 areas of the pancreas, three areas of the spleen, and in segments VI and VII of the liver; b) fatty pancreas: a difference < -10 HU between the mean pancreas and mean spleen densities; and c) fatty liver: density < 40 HU. We registered the epidemiologic and laboratory data of the patients. The association of those factors with the presence of PS was analyzed using SPSS version 24.0 software, and statistical significance was set at a p < 0.05. RESULTS Of the 203 patients, PS was found in 61 (30%). The patients with PS were significantly older and had a higher body mass index. We found no significant association with the rest of the parameters studied, nor with HS (55 patients). None of the patients had symptoms attributable to a disease of the exocrine pancreas. CONCLUSIONS Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.
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Affiliation(s)
- Z Berger
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - F Orellana
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - R Cocio
- Departamento de Imagenología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - F Torres
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - D Simian
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - G Araneda
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - P Toledo
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
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Espino A, Vargas JI, Mancilla C, Muñoz P, Martínez W, Menéndez A, Jara D, Mansilla R, Schiappacasse G, Santamarina M, Huete Á, Candia R, Silva F, Castillo C, Richter H, Mejía R, Vial P, Robles I, Martínez J, Jarufe N, Briceño E, Lembach H, Zoroquiain P, Roa JC, Walker K, Torres J, Carreño L, Castiblanco A, Fernández W, Ríos Á, Chandia J, Ayala MJ, Rojas T, Verdugo J, Berger Z. [Chilean consensus on diagnosis and management of pancreatic cystic neoplasms]. Rev Med Chil 2021; 149:1773-1786. [PMID: 35735345 DOI: 10.4067/s0034-98872021001201773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022]
Abstract
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
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Affiliation(s)
- Alberto Espino
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Ignacio Vargas
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carla Mancilla
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Pablo Muñoz
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Waldo Martínez
- Cirugía Digestiva, Clínica Colonial, Huechuraba, Santiago, Chile
| | | | | | - Rodrigo Mansilla
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Puerto Montt, Chile
| | - Giancarlo Schiappacasse
- Departamento de Radiología, Facultad de Medicina, Universidad de Desarrollo, Santiago, Chile
| | - Mario Santamarina
- Departamento de Radiología, Hospital Naval Almirante Nef, Viña del Mar, Valparaíso, Chile
| | - Álvaro Huete
- Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Candia
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Silva
- Hospital Regional de Coyhaique, Coyhaique, Chile
| | - Cecilia Castillo
- Cirugía Endoscópica, Hospital Clínico San Borja Arriarán; Endoscopía, Clínica Alemana de Santiago, Santiago, Chile
| | - Hugo Richter
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Mejía
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Vial
- Departamento de Gastroenterología, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Jorge Martínez
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Berger Z, S AMM. Paradoxical Stimulatory Response of Remanent Sphincter of Oddi to Buscapina After Endoscopic Sphincterotomy. J Neurogastroenterol Motil 2021; 27:632-638. [PMID: 34642284 PMCID: PMC8521478 DOI: 10.5056/jnm20180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Endoscopic removal of bile duct stones has become the treatment of choice, which includes endoscopic sphincterotomy (EST) in the majority of cases, destroying at least partially the Oddi sphincter (OS). Loss of sphincter function in variable grade has been described, but changes in innervation are not known. Methods Endoscopic manometry of OS was performed in 14 patients after EST with specialized perfused catheter. Pressure values were registered before and after 10 mg Buscapina injected intravenously. Results Choledocho-duodenal pressure gradient was absent in all of 14 patients. Basal OS pressure was zero in 7 and conserved in normal range in the remaining 7. Phasic motor activity was registered in 11 patients and was absent in 3 patients. After 10 mg Buscapina intravenous injection, instead of habitual inhibition, increase in basal OS pressure and in frequency of phasic contractions was observed in 9 patients. This response was not related to age of patients, neither with time elapsed between the EST and manometry, nor the estimated size of papillotomy orifice. Duodenal peristalsis was invariably inhibited in all patients. Conclusions EST destroys not only the smooth muscle of OS, also alters the innervation interrupting the duodeno-sphincteric nerve circuit. This finding questions the use of Buscapina or other anticholinergic agent as spasmolytic in patients after EST.
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Affiliation(s)
- Zoltán Berger
- Division of Gastroenterology, Clinical Hospital Universidad de Chile, Santiago, Chile
| | - Ana María Madrid S
- Division of Gastroenterology, Clinical Hospital Universidad de Chile, Santiago, Chile
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Proud C, Parsons J, Brandsema J, Finkel R, Swoboda K, Foster R, Makepeace C, Paradis A, Berger Z, Somera-Molina K. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mercuri E, Finkel R, Day J, Pascual SP, Ryan M, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Nuzzo R, Makepeace C, Garafalo S, Berger Z. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Almeida P, Almeida C, Gompertz M, Berger Z. Association between autoimmune pancreatitis and ulcerative colitis: a report of 12 patients. Rev Esp Enferm Dig 2021; 112:682-687. [PMID: 32578999 DOI: 10.17235/reed.2020.6677/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION pancreatic manifestations in inflammatory bowel disease (IBD) mainly include acute pancreatitis secondary to drugs and, less frequently, autoimmune pancreatitis, in particular type 2 autoimmune pancreatitis. METHODS retrospective study of patients diagnosed with ulcerative colitis (UC) and autoimmune pancreatitis (AIP) in control at two centers in Santiago, Chile, between 2007 and 2018. Clinical data, laboratory results, images and response to treatment were recorded. RESULTS twelve patients were identified with both diseases, the average age was 34 years and 42 % were male. In all cases, a likely diagnosis with type-2 AIP was established based on pancreatic magnetic resonance imaging (MRI), association with IBD and a rapid response to therapy with corticosteroids. Samples for histology were obtained from two patients, which showed inconclusive results. AIP recurrence was reported in only one case. A total of 58 % of patients had extensive UC, 100 % received 5-ASA therapy and 33 % were treated with azathioprine. Only one patient had a serious flare-up, none developed complications and none required biologics or surgery. CONCLUSION an association between UC and type-2 AIP was confirmed in our cases. No increase in IBD severity was observed in this group of patients.
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Affiliation(s)
- Paula Almeida
- Gastroenterología, Hospital Clínico Universidad de Chile, Chile
| | - Carla Almeida
- Gastroenterología, Hospital Clínico Universidad de Chile, Chile
| | - Macarena Gompertz
- Gastroenterología, Clínica Quilín - Hospital Clínico Universidad de Chile, Chile
| | - Zoltán Berger
- Gastroenterología, Hospital Clínico Universidad de Chile, Chile
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Young SD, Montes J, Glanzman A, Gee R, Day J, Finkel R, Darras B, De Vivo D, Gambino G, Foster R, Wong J, Kandinov B, Berger Z. SMA - CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Berstein G, Zhang Y, Berger Z, Kieras E, Li G, Samuel A, Yeoh T, Dowty H, Beaumont K, Wigger-Alberti W, von Mackensen Y, Kroencke U, Hamscho R, Garcet S, Krueger JG, Banfield C, Oemar B. A phase I, randomized, double-blind study to assess the safety, tolerability and efficacy of the topical RORC2 inverse agonist PF-06763809 in participants with mild-to-moderate plaque psoriasis. Clin Exp Dermatol 2020; 46:122-129. [PMID: 32767679 PMCID: PMC7756278 DOI: 10.1111/ced.14412] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transcription factor retinoic acid-related orphan receptor 2 (RORC2/RORγT) mediates interleukin (IL)-17A and IL-17F expression. IL-17A plays a central role in the pathogenesis of several inflammatory disorders, including psoriasis. The RORC2 inhibitor PF-06763809 has been hypothesized to inhibit IL-17A production in T-helper 17 (Th17) cells, thereby reducing psoriasis symptoms. AIM To assess the safety, tolerability and effect on skin infiltrate thickness of PF-06763809 in participants with mild/moderate chronic plaque psoriasis. METHODS This was a randomized, double-blind, first-in-human study (trial registration: ClinicalTrials.gov NCT03469336). Participants received each of the following six treatments once daily for 18 days: three topical doses (2.3%, 0.8%, 0.23%) of PF-06763809, a vehicle and two active comparators (betamethasone and calcipotriol). Primary endpoints included change from baseline in psoriatic skin infiltrate thickness [echo-poor band (EPB) on ultrasonography] at Day 19, and safety. Change in psoriasis-associated gene expression (Day 19), evaluated by real-time reverse transcription PCR of skin biopsies, was an exploratory endpoint. RESULTS In total, 17 participants completed the study. Change from baseline in the EPB on Day 19 for all three doses of PF-06763809 was not significantly different from that of vehicle (P > 0.05). A significant reduction in EPB from baseline was observed with betamethasone on Day 19 relative to all other treatments (P < 0.0001). Treatment-related adverse events were mild/moderate. There were no significant differences in gene expression on Day 19 between vehicle and PF-06763809-treated skin lesions. CONCLUSION Using a psoriasis plaque test design, PF-06763809 was found to be well tolerated with an acceptable safety profile in participants with psoriasis, but without reduction in skin infiltrate thickness or disease biomarkers.
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Affiliation(s)
- G Berstein
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - Y Zhang
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - Z Berger
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - E Kieras
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - G Li
- Early Clinical Development, Pfizer Inc., Collegeville, PA, USA
| | - A Samuel
- Formulation and Process Design, Pfizer Inc., Groton, CT, USA
| | - T Yeoh
- Formulation and Process Design, Pfizer Inc., Groton, CT, USA
| | - H Dowty
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - K Beaumont
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | | | | | | | - R Hamscho
- Rothhaar Studien GmbH, Berlin, Germany
| | - S Garcet
- Rockefeller University, New York, NY, USA
| | | | - C Banfield
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - B Oemar
- Inflammation and Immunology Research Unit, Pfizer Inc., Cambridge, MA, USA
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Berger Z, Mancilla C, Tobar E, Morales MP, Baró M, Carrasco M, Cordero J, Cruz R, Cruz R, Lara C, Ledesma S, Ramírez G, Sierralta A, Godoy L, Valdés E. Acute pancreatitis in Chile: A multicenter study on epidemiology, etiology and clinical outcome. Retrospective analysis of clinical files. Pancreatology 2020; 20:637-643. [PMID: 32386970 DOI: 10.1016/j.pan.2020.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epidemiology of acute pancreatitis (AP) is variable in different geographical regions. OBJECTIVES To compare etiology and severity of AP to published data from South America and the rest of world, study impact of demographical factors and treatment on its outcome in Chilean hospitals. METHODS Multicenter observational study. Data of consecutive patients with AP were collected at the moment of discharge from 11 centers and retrospectively analyzed. RESULTS Data of 962 patients were included in the analysis, 447 men and 515 women. Mean age was 48,2 years. Biliary etiology was significantly more frequent in women (70%) than in men (52%). Conversely, alcohol was responsible for about 17% of AP in men but exceptional in women. Mild AP was seen in 73.4%, moderately severe in 14.1% and severe in 13%. The overall mortality was 2.5% (24 of 962): 0.3%, 3.1% and 15.1% in mild, moderately severe and severe cases, respectively. No difference was found in the mortality and severity of biliary versus alcoholic AP, while hypertriglyceridemia induced AP was more severe, without increased mortality. Severity and mortality increased with age. ERCP was performed in 16% of biliary pancreatitis. Adherence to main guidelines was heterogeneous: more than half of mild AP patients were admitted to critical care units and antibiotics were used in about 25% them. CONCLUSION This is the first multicenter study in Chile on AP. When compared to literature, we found similar severity distribution and an acceptably low mortality. Biliary etiology was dominant, but alcohol was also important in men.
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Affiliation(s)
- Zoltán Berger
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile; Clínica Dávila, Section of Gastroenterology, Recoleta 464, Recoleta, Santiago, Chile.
| | - Carla Mancilla
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - Eduardo Tobar
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - María Paz Morales
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile
| | - Michel Baró
- Hospital Puerto Montt Dr. Eduardo Schütz Schroeder, Department of Medicine, Los Aromos 65, Puerto Montt, Los Lagos, Chile
| | - Mauricio Carrasco
- Hospital Regional Copiapó San José del Carmen Los Carrera, 1320, Copiapó, Atacama, Chile
| | - Julián Cordero
- Hospital Mauricio Heyermann, Angol Ilabaca 752, Angol, Araucanía, Chile
| | - Rodrigo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Ricardo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Christián Lara
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Sergio Ledesma
- Hospital Regional Dr. Leonardo Guzmán, Azapa 5935, Antofagasta, Chile
| | - Gustavo Ramírez
- Hospital San José, Department of Medicine, San José 1196, Independencia, Santiago, Chile
| | - Armando Sierralta
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Luis Godoy
- Hospital Clínico Magallanes, Department of Gastroenterology, Av. Los Flamencos, 01364, Punta Arenas, Chile
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15
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Berger Z, Lea-Plaza Puig MI, Varela C, Becerra M, Capetillo M, Vargas J. [IgG4 related hypertrophic gastropathy. Report of one case]. Rev Med Chil 2019; 147:119-124. [PMID: 30848775 DOI: 10.4067/s0034-98872019000100119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Zoltán Berger
- Departamento de Gastroenterología, Clínica Dávila, Santiago, Chile
| | | | | | - Marina Becerra
- Departamento de Gastroenterología, Clínica Dávila, Santiago, Chile
| | - María Capetillo
- Servicio de Anatomía Patológica, Clínica Dávila, Santiago, Chile
| | - Juan Vargas
- Servicio de Anatomía Patológica, Clínica Dávila, Santiago, Chile
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Da Costa D, Guidotti F, Cabello N, Trigo F, Contreras C, Vergara F, Miranda JP, Montenegro C, Muñoz P, Berger Z. [Helicobacter pylori infection detected during upper gastrointestinal endoscopy]. Rev Med Chil 2018; 146:555-561. [PMID: 30148918 DOI: 10.4067/s0034-98872018000500555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. AIM To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. MATERIAL AND METHODS We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. RESULTS RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). CONCLUSIONS HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.
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Affiliation(s)
- Daniel Da Costa
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francesca Guidotti
- Sección de Medicina Interna, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | | | | | - Juan Pablo Miranda
- Unidad de Paciente Crítico, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cristián Montenegro
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Pablo Muñoz
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Zoltán Berger
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
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Abstract
Morphine produces contraction of Oddis sphincter, which can be severe and of longer duration in some pathological conditions. This exaggerated response can manifest as a colicky biliary pain, frequently accompanied by a dramatic increase in hepatic enzymes. We report a 32 years old female who consulted in the emergency room for severe low abdominal pain of gynecologic origin, which was completely controlled by morphine. However, she presented a sudden epigastric colicky pain irradiating in the back, which persisted for several hours in spite of the repeated administration of analgesics. Transaminases elevated from previously normal value to over 1,000 U/L, and returned to the normal level without further treatment after several days. Magnetic resonance cholangiography showed normal fine bile duct, without stones. This transient increase in hepatic enzymes was considered as a consequence of high biliary pressure secondary to morphine-induced spastic contraction of Oddis sphincter and a consecutive hepatocellular necrosis.
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Berger Z, Mancilla C. Racial Differences in Chronic Pancreatitis. An Explanation for South America? Am J Gastroenterol 2017; 112:814-815. [PMID: 28469211 DOI: 10.1038/ajg.2017.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Zoltán Berger
- Department of Internal Medicine, University of Chile, Clinical Hospital, Gastroenterology Section, Santiago, Chile
| | - Carla Mancilla
- Department of Internal Medicine, University of Chile, Clinical Hospital, Gastroenterology Section, Santiago, Chile
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Abstract
Autoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided in some cases. We report the history of a 63-year-old male presenting with jaundice and pruritus. AIP was confirmed by imaging and elevated IgG4 blood levels, and the patient completely recovered after corticosteroid therapy. One year later, he presented with a recurrent episode of AIP with elevated IgG4 levels, accompanied by the appearance of multiple intrapancreatic cystic lesions. All but 1 of these cysts disappeared after steroid treatment, but the remaining cyst in the pancreatic head was even somewhat larger 1 year later. Pancreatoduodenectomy was finally performed. Histology showed the wall of the cystic lesion to be fibrotic; the surrounding pancreatic tissue presented fibrosis, atrophy and lymphoplasmacytic infiltration by IgG4-positive cells, without malignant elements. Our case illustrates the rare possibility that cystic lesions can be part of AIP. These pseudocysts appear in the pancreatic segments involved in the autoimmune disease and can be a consequence of the local inflammation or related to ductal strictures. Steroid treatment should be initiated, after which these cysts can completely disappear with recovery from AIP. Surgical intervention may be necessary in some exceptional cases.
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Affiliation(s)
- Macarena Gompertz
- Gastroenterology Section, Department of Internal Medicine, Santiago, Chile
| | - Claudia Morales
- Department of Pathology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Hernán Aldana
- Department of Radiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Jaime Castillo
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Zoltán Berger
- Gastroenterology Section, Department of Internal Medicine, Santiago, Chile
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Díaz A, Yunge P, Urzúa Á, Berger Z. [Endoscopic treatment in chronic pancreatitis: long-term results in 18 patients]. Rev Med Chil 2015; 143:1121-8. [PMID: 26530194 DOI: 10.4067/s0034-98872015000900004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraductal stones, ductal abnormalities and pancreatic pseudocysts are part of chronic pancreatitis (CP). The goal of treatment is pain relief, resolution of local complications and relapse prevention. Endoscopic therapy (ET) can be considered in those who do not respond to medical treatment. AIM To evaluate the indication, immediate and long-term results of ET in CP patients. PATIENTS AND METHODS Review of a database of patients with CP analyzing results of ET in 18 patients aged 16 to 60 years (13 males). Demographics, etiology, endoscopic technique, indication for treatment, pain relief, relapses and complications were recorded. RESULTS The etiology of CP was alcohol consumption in 5, idiopathic in 11, hereditary in one and autoimmune in one case. The follow-up period was 6 months to 14 years. Seven patients had diabetes mellitus type 3c and eight had moderate to severe exocrine pancreatic insufficiency. Pancreatic papillotomy was performed in all patients, with removal of some stones, without attempting a complete clearance of the pancreatic duct. In addition, a 7-10 French stent was placed in the main pancreatic duct in 15 patients with varying permanence (months to years). The stent was changed guided by recurrence of clinical symptoms. During the follow-up period, 10 patients remained asymptomatic and in three, pain or relapse were significantly reduced. Stenting failed in one patient for technical reasons. Two patients were operated. There were neither immediate nor late complications from ET. CONCLUSIONS Long-lasting improvement of CP was observed in 13 of 18 patients treated with ET, without complications associated with the procedure.
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Berger Z, Berger Salinas A, Szánthó Pongrácz G. La vitamina C y algo más: Un premio Nobel poco conocido en Chile. Rev Med Chil 2015; 143:1065-9. [DOI: 10.4067/s0034-98872015000800015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
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Delnomdedieu M, Vitolo O, Pickering E, Duvvuri S, Berger Z, Murphy M, Papapetropoulos S, Zaleska MM. J19 Paving the way for a Promising PDE10 drug with an Enzyme Occupancy Study, A 28 Day Safety Study Assessing Corticostriatal Activity and a 6 Month Safety and Efficacy Study in HD Patients. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Berger Z. [Focal autoimmune pancreatitis versus pancreatic cancer: value of steroid treatment in the diagnosis]. Rev Med Chil 2014; 142:413-7. [PMID: 25117030 DOI: 10.4067/s0034-98872014000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/07/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differential diagnosis of pancreatic cancer and focal forms of autoimmune pancreatitis is complicated since serological tests, IgG4 and CA 19-9 have a low sensibility and specificity. CT scan and magnetic resonance imaging provide clear differentiation in the majority, but not in all cases. Endosonography is the most precise diagnostic procedure and allows to obtain samples for cytology or even histological studies. AIM To report the experience with 18 cases of focal autoimmune pancreatitis and three cases of pancreatic cancer. MATERIAL AND METHODS Review of medical records of 18 patients with focal autoimmune pancreatitis and 3 cases of pancreatic cancer. RESULTS The eighteen patients with focal autoimmune pancreatitis were treated with prednisone 0.5 mg/kg/day obtaining a complete clinical and morphological recovery in all. However, 3 had a relapse and one was operated. During follow up, none has developed a pancreatic cancer. The 3 patients with pancreatic cancer did not respond to steroidal treatment. CONCLUSIONS The quick and dramatic response to steroids of autoimmune pancreatitis, may be useful and is recommended for the differential diagnosis with pancreatic cancer.
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Gompertz M, Lara I, Fernández L, Miranda JP, Mancilla C, Watkins G, Palavecino P, Berger Z. [Mortality of acute pancreatitis in a 20 years period]. Rev Med Chil 2014; 141:562-7. [PMID: 24089269 DOI: 10.4067/s0034-98872013000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/18/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mortality for acute pancreatitis (AP) in Chile has fluctuated between 7 ana 10% in last years. AIM To evaluate AP mortality over a period of 20 years in a clinical hospital in Santiago, Chile. MATERIAL AND METHODS Review of the database of hospital discharges with the diagnosis of acute pancreatitis, between 1990 and 2010 and the medical records of those patients. Age, gender, length of hospital stay, surgeries, percutaneous interventions and mortality were registered. To compare the evolution of the disease over time, patients were divided in two groups: those hospitalized between 1990 and 1999 and those hospitalized between 2000 and 2010. RESULTS We reviewed the records of 1367 patients with a median age of 48 years (48% men). In the first period, 93 of 637 (14.6%) patients died, whereas in the second period, 22 of 730 patients died (3.0%). In the first and second period, 41.9 and 25.3% of patients were subjected to surgical procedures. The hospital stay was shorter in the second group, compared with the first (14.2 and 25.9 days respectively). CONCLUSIONS There was a decrease in mortality caused by AP in the last 10 years, probably associated with a better interdisciplinary management of these patients.
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Affiliation(s)
- Macarena Gompertz
- Sección de Gastroenterología, Departamento de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
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Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA, Cramer H. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur 2014. [DOI: 10.1016/j.dza.2014.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Gompertz M, Fernández L, Lara I, Miranda JP, Mancilla C, Berger Z. [Bedside index for severity in acute pancreatitis (BISAP) score as predictor of clinical outcome in acute pancreatitis: retrospective review of 128 patients]. Rev Med Chil 2013; 140:977-83. [PMID: 23282769 DOI: 10.4067/s0034-98872012000800002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is essential to optimize management and to improve outcomes. AIM To assess BISAP score as a predictor of severity of AP. PATIENTS AND METHODS Retrospective review of AP patients between January 2009 and December 2010. BISAP, APACHE II and Balthazar scores were calculated. Length of stay, local complications, organ failure and mortality were registered. Accuracy of the scoring system for predicting severity was measured by the area under the receiver operating curve (AUC). RESULTS The medical records of 128 patients, median age 46.5 years (55.5% men), were reviewed. Mean hospital stay was 15 days, 18 patients (14%) had local complications, 7 patients (5.4%) developed organ failure and 2 patients died (1.6%). The AUC for BISAP score to detect organ failure was 0.977 (95% IC 0.947-1.000). A BISAP score > 3 had a sensitivity, specificity, positive and negative predictive value of 71.4, 99.1, 83.3 and 98.3% respectively. An APACHE II score > 8 had a sensitivity and specificity of 71.5 and 86.8% respectively. The figures for a Balthazar score > 6 were 42.8 and 98.3% respectively. There was a significant correlation between BISAP score and length of hospital stay. CONCLUSIONS BISAP score was a useful method for predicting the severity of PA, with the advantage of being simple and based on parameters obtained on the first day of hospitalization. Its sensitivity and specificity were superior to APACHE II and Balthazar score in this cohort.
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Affiliation(s)
- Macarena Gompertz
- Sección de Gastroenterología, Departamento de Medicina Interna, Hospital Clínico Universidad de Chile, Santiago, Chile
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Shekelle PG, Wachter RM, Pronovost PJ, Schoelles K, McDonald KM, Dy SM, Shojania K, Reston J, Berger Z, Johnsen B, Larkin JW, Lucas S, Martinez K, Motala A, Newberry SJ, Noble M, Pfoh E, Ranji SR, Rennke S, Schmidt E, Shanman R, Sullivan N, Sun F, Tipton K, Treadwell JR, Tsou A, Vaiana ME, Weaver SJ, Wilson R, Winters BD. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Evid Rep Technol Assess (Full Rep) 2013:1-945. [PMID: 24423049 PMCID: PMC4781147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To review important patient safety practices for evidence of effectiveness, implementation, and adoption. DATA SOURCES Searches of multiple computerized databases, gray literature, and the judgments of a 20-member panel of patient safety stakeholders. REVIEW METHODS The judgments of the stakeholders were used to prioritize patient safety practices for review, and to select which practices received in-depth reviews and which received brief reviews. In-depth reviews consisted of a formal literature search, usually of multiple databases, and included gray literature, where applicable. In-depth reviews assessed practices on the following domains: • How important is the problem? • What is the patient safety practice? • Why should this practice work? • What are the beneficial effects of the practice? • What are the harms of the practice? • How has the practice been implemented, and in what contexts? • Are there any data about costs? • Are there data about the effect of context on effectiveness? We assessed individual studies for risk of bias using tools appropriate to specific study designs. We assessed the strength of evidence of effectiveness using a system developed for this project. Brief reviews had focused literature searches for focused questions. All practices were then summarized on the following domains: scope of the problem, strength of evidence for effectiveness, evidence on potential for harmful unintended consequences, estimate of costs, how much is known about implementation and how difficult the practice is to implement. Stakeholder judgment was then used to identify practices that were "strongly encouraged" for adoption, and those practices that were "encouraged" for adoption. RESULTS From an initial list of over 100 patient safety practices, the stakeholders identified 41 practices as a priority for this review: 18 in-depth reviews and 23 brief reviews. Of these, 20 practices had their strength of evidence of effectiveness rated as at least "moderate," and 25 practices had at least "moderate" evidence of how to implement them. Ten practices were classified by the stakeholders as having sufficient evidence of effectiveness and implementation and should be "strongly encouraged" for adoption, and an additional 12 practices were classified as those that should be "encouraged" for adoption. CONCLUSIONS The evidence supporting the effectiveness of many patient safety practices has improved substantially over the past decade. Evidence about implementation and context has also improved, but continues to lag behind evidence of effectiveness. Twenty-two patient safety practices are sufficiently well understood, and health care providers can consider adopting them now.
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LaVoie M, Smith K, Berger Z. P3.099 The influence of subcellular localization on LRRK2. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
This study aimed to investigate co-morbidity and coping strategies among older patients who suffer from different levels of posttraumatic stress disorder (PTSD) following myocardial infarction. Ninety-six older myocardial infarction (MI) patients were recruited from two general practices and completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the COPE Scale. Ninety-two older patients with no previous MI experience constituted the control. Using the PDS, 30, 42 and 28% had full, partial and no-PTSD respectively. There were significant differences between the patient groups and the control on all GHQ-28 sub-scales. Significant differences were also identified between the patient groups in the following coping strategies: seeking emotional social support, suppression of competing activities, restraint coping, focusing on and venting of emotion, mental and behavioural disengagement. Controlling for bypass surgery, previous mental health difficulties, angioplasty, heart failure and angina, MANCOVA results did not change the overall results of the GHQ-28 but changed the results of coping in that seeking emotional social support and behavioural disengagement stopped being significant. Coping was a partial mediator between different levels of post-MI PTSD and co-morbidity. Depending on the severity of PTSD symptoms, co-morbidity and coping strategies can vary among older patients. Older patients with full-PTSD tend to use both maladaptive coping strategies as well as problem-focused coping.
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Affiliation(s)
- M C Chung
- Clinical Psychology Teaching Unit, University of Plymouth, Plymouth, UK.
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Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by progressive inflammation and fibrosis of the biliary tract, evolving to cirrhosis. It is commonly associated with inflammatory bowel disease (IBD). AIM To communicate the clinical characteristics of patient with PSC seen in two reference centers. PATIENTS AND METHODS Review of medical records of patients with PSC confirmed by liver biopsies. The clinical picture, laboratory abnormalities, imaging studies and treatment were recorded. RESULTS Thirty three patients (aged 16 to 73 years, 64% female) were identified. They corresponded to 1.7% of liver biopsies done between 1991-2003. Clinical presentation was a cholestatic picture in 40%, right upper abdominal pain in 36%, a dysenteric syndrome in 9% and varied symptoms in 15%. Laboratory tests showed cholestasis in 94% and positive anti ANCA, SMA, ANA and AMA antibodies in 28, 18, 15 and 9% of cases, respectively. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography were diagnostic in 43 and 58% of patients, respectively. There was an association with ulcerative colitis in 12% of cases. Liver biopsies showed grade I PSC in 76% and grade II-III in 6% of patients. It also showed a concomitant chronic hepatitis and primary biliary cirrhosis in 12 and 6% of cases, respectively. Treatment consisted on ursodeoxycholic acid (UDCA) in 45%, UDCA plus 5-aminosalicylic acid derivatives in 12% and UDCA plus immunosuppresors in 12% of patients. Two patients had to be transplanted. CONCLUSIONS PSC is an uncommon cause of chronic liver disease. It is suspected in cholestatic patients and confirmed with a liver biopsy. It can be associated with other autoimmune hepatic and extrahepatic diseases.
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Affiliation(s)
- Ivonne Orellana
- Sección de Gastroenterología, Hospital Clínico, Universidad de Chile, Santiago, Chile
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Berger Z. Páncreas en diabetes y diabetes en enfermedades pancreáticas. Medwave 2004. [DOI: 10.5867/medwave.2004.08.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Berger Z, Quera R, Poniachik J, Oksenberg D, Guerrero J. [heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases]. Rev Med Chil 2002. [PMID: 12080874 DOI: 10.4067/s0034-98872001001200002] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypertriglyceridemia over 1,000 mg/dl can provoke acute pancreatitis and its persistence can worsen the clinical outcome. On the contrary, a rapid decrease in triglyceride level is beneficial. Plasmapheresis has been performed in some patients to remove chylomicrons from the circulation, while heparin and/or insulin have been administered in some other cases to rapidly reduce blood triglycerides. Heparin and insulin stimulate lipoprotein-lipase activity and accelerate chylomicron degradation. AIM To report five patients with acute pancreatitis treated with heparin and insulin. PATIENTS AND METHODS Five patients (4 females and 1 male) seen in the last two years, who suffered acute pancreatitis induced by hypertriglyceridemia are reported. Initial blood triglyceride levels were above 1,000 mg/dl (range 1,590-8,690 mg/dl). Besides the usual treatment of acute pancreatitis, heparin and/or insulin were administered intravenously in continuous infusion. Heparin dose was guided by usual parameters of blood coagulation, and insulin dose, by serial determinations of blood glucose. Pancreatic necrosis was demonstrated in 4 patients. RESULTS Serum triglyceride levels decreased to < 500 mg/dl within 3 days in all cases. No complication of treatment was observed and all patients survived. Early and late complications of pancreatitis occurred in one patient. CONCLUSION Administration of heparin and/or insulin is an efficient alternative to reduce triglyceride levels in patients with acute pancreatitis and hypertriglyceridemia.
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Affiliation(s)
- Z Berger
- Sección de Gastroenterología, Unidad de Paciente Crítico, Hospital Clínico, Universidad de Chile, Santos Dumont 999.
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Papapietro K, Marin M, Díaz E, Watkins G, Berger Z, Rappoport J. [Digestive refeeding in acute pancreatitis. When and how?]. Rev Med Chil 2001; 129:391-6. [PMID: 11413991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Digestive refeeding in acute pancreatitis represent a difficult issue. It requires the resolution of intestinal ileus and carries a risk of reactivation. AIM To evaluate criteria that may guide in early refeeding avoiding unnecessary prolonged fasting. PATIENTS AND METHODS Thirty patients with acute pancreatitis were evaluated in a prospective trial. The severity of the pancreatitis was evaluated according to APACHE II score and Balthazar CT scan alterations. The criteria proposed to start early refeeding were absence of nausea and vomiting, decreased abdominal pain, presence of bowel sounds and lowering of serum amylase levels. Balthazar CT scan classification, was used to decide between oral or enteral refeeding. RESULTS Eighty percent of patients had alterations in pancreatic density, necrosis or pancreatic or peripancreatic liquid collections in the CT scan (corresponding to Balthazar stages C, D, or E). Ten patients fullfilled the criteria for enteral refeeding at 8.1 +/- 3.5 days (range 3 to 15 days), and 21 patients fulfilled criteria fo enteral refeeding at 8.7 +/- 4.5 (range 4-19). No patient had a reactivation of his pancreatitis. CONCLUSIONS Digestive refeeding can be done safely by using the criteria proposed in this study. Pancreatic necrosis or peripancreatic fluid collections do not contraindicate refeeding. Oral feeding may be employed (as the first option) in selected patients, without increasing the risk of complication, regardless of CT scan alterations of the pancreas.
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Affiliation(s)
- K Papapietro
- Unidad de Nutrición Intensiva, Departamento de Cirugía y Centro de Gastroenterología Hospital Clínico de la Universidad de Chile
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Berger Z, Bardi A, Brahm J, Latorre R, Maiza E, Morales A, Oksenberg D, Poniachik J, Pimentel C. [The physician-patient relationship and the health care system]. Rev Med Chil 1999; 127:1139-42. [PMID: 10752281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Berger Z, Gil LC, Latorre R, Madrid AM, Maiza E, Oksenberg D, Pimentel C, Brahm J. [Duodenogastric reflux]. Rev Med Chil 1999; 127:243-5. [PMID: 10436707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Berger Z, Papapietro K. [Long nasojejunal feeding tube: endoscopic method for placing and its use for enteral nutrition in acute pancreatitis]. Rev Med Chil 1999; 127:53-8. [PMID: 10436679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Enteral nutrition can be useful for the feeding of patients with acute pancreatitis, specially in the later phases of the disease. AIM To describe an endoscopic placement method for long nasojejunal tubes and assess its efficacy. To communicate a preliminary experience with enteral nutrition in patients with acute pancreatitis. PATIENTS AND METHODS An endoscopic placement method for nasojejunal tubes is described. In 24 patients with acute pancreatitis, 28 tubes were placed using this method, after the second week of evolution. In 15 patients with brain damage, traditional nasojejunal feeding tubes were placed without endoscopy. The position of both types of tubes was determined by fluoroscopy with the aid of contrast media. RESULTS The endoscopic placement method was simple and the tube was placed beyond the ligament of Treitz in all patients. No traditional tube was placed in the jejunum and contrast media filled the duodenum in all cases. In patients with acute pancreatitis, enteral nutrition was well tolerated, 5 patients had a higher stool frequency and one, had an asymptomatic increase in serum amilase levels. CONCLUSIONS Long nasojejunal tubes can be easily placed beyond the ligament of Treitz with endoscopic aid and can be used for enteral feeding in patients with acute pancreatitis.
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Affiliation(s)
- Z Berger
- Departamento de Medicina, Hospital Clínico de la Universidad de Chile.
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Pap A, Topa L, Berger Z, Flautner L, Varró V. Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis. Scand J Gastroenterol Suppl 1998; 228:98-106. [PMID: 9867119 DOI: 10.1080/003655298750026624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pain and functional deterioration in chronic pancreatitis is multifactorial. Early surgery in non-alcoholic patients with mild to moderate chronic pancreatitis can relieve pain and prevent progression of pancreatic insufficiency for some time, but the good results are only short term. Endoscopic intervention can relieve pain and recover pancreatic function without surgery. METHODS AND RESULTS To achieve the burned out state of chronic pancreatitis, occlusion of the pancreatic duct was first attempted by our team with Ethibloc at ERCP. Temporary obstruction of the pancreatic duct did not result in a long-lasting symptom and relapse-free situation because of early recovery of pancreatic function. On the contrary, endoscopic simple and double papillotomy, pancreatic drainage with citrate lavage, biliary endoprosthesis with multiple stents and endoscopic decompression of pseudocysts with or without jejunal feeding resulted in pain-free patients for a considerable time and in several cases significant functional recovery occurred. In cases where pain remained, percutaneous celiac plexus block with long-lasting steroids can be applied and only if all of these treatments fail should surgery be recommended. CONCLUSION Endoscopic intervention can successfully substitute for surgery for chronic pancreatitis in individual cases.
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Affiliation(s)
- A Pap
- Second Dept. of Medicine, St. Imre Hospital, Budapest, Hungary
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Berger Z, Pimentel C, Madríd AM, Defilippi C. [Endoscopic manometry of Oddi's sphincter]. Rev Med Chil 1997; 125:1343-50. [PMID: 9609056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic manometry is the gold standard for the diagnosis of sphincter of Oddi dysfunction. AIM To report the results of the first 30 endoscopic manometries of sphincter of Oddi performed in a Gastroenterology Service. PATIENTS AND METHODS Thirty manometries were performed in 28 patients aged 30 to 70 years old (14 females). The papilla was cannulated with a perfused catheter, measuring pressure with external transducers. RESULTS Deep cannulation of the papilla was achieved in 88%. Procedure-related complications were not observed in these cases. Normal values were registered in 11 cases with a basal sphincter pressure 15.6 +/- 10.7 mm Hg, contractions with an amplitude of 92.3 +/- 35.7 mm Hg and 6.0 +/- 2.4/min frequency. The clinical suspicion of hypertonic dyskinesis was confirmed in 5 cases with an elevated basal pressure of 43.69 +/- 13.3 mm Hg, an increased frequency of contractions ("tachyoddia") in one, and large spastic contractions of high pressure in other case. In 3 of 5 cases with common bile duct stones, a predominance of retrograde propagation of the contractions was observed with normal pressure. Variable manometric results were observed after endoscopic papillotomy observing a scale from the complete absence of motor activity to normal sphincter function. CONCLUSIONS Endoscopic manometry is a reasonably safe method, of great importance in the diagnosis of functional disorders of the sphincter of Oddi.
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Affiliation(s)
- Z Berger
- Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
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Abstract
CONCLUSION These results provide morphological evidence for an alcohol-induced selective intrapancreatic nerve degeneration. This affected mainly the nerve fibers that are inhibitory of the exocrine pancreas, and might represent the morphological background of hypersecretory state of the pancreas in chronic alcoholism. METHODS Intrapancreatic intrinsic nerves were studied by immunohistochemistry and electron microscopy after 4 mo of alcohol consumption and compared with control mice. RESULTS A dense network of nerve fibers was observed in the normal mouse pancreas around the blood vessels and ending on the exocrine cells. The presence of VIP, NPY, PP, SP, and serotonin in these nerves was demonstrated by immunohistochemistry. Four months of alcohol consumption did not result in apparent morphological changes of the pancreas. However, the majority of periacinar nerve terminals showed degenerative changes. Synaptic vesicles were diminished in number in some other nerve processes, whereas the perivascular nerve fibers were relatively well preserved. A slight decrease was found in the intensity of VIP and SP immunoreactivity, and the PP fibers almost disappeared.
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Affiliation(s)
- Z Berger
- Second Department of Internal Medicine, St Imre Hospital, Budapest, Hungary
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Topa L, Lakatos L, Berger Z, Pap A. [Experience with insertion of an endoscopic endoprosthesis in a case of inoperable bile duct calculi]. Orv Hetil 1996; 137:2413-6. [PMID: 8992438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Endoscopic sphincterotomy for removal of stones from the common bile duct is an established procedure. Large stones, however, can be unavailable for basket trapping and/or extraction in some cases. In these patients, which are at high risk for surgery, endoscopic insertion of biliary endoprosthesis seems to be an alternative approach to dissolution therapy or ESWL. During the last 5 year, among 4081 ERCP-s 879 examinations demonstrated common bile duct (CBD) stones in our institutions. In 81 of these cases, an endoprosthesis was inserted into the CBD after extended endoscopic sphincterotomy because of failure of extraction of the large stones. Also ursodeoxycholic-acid treatment was initiated thereafter. Mean age of patients was 76 yrs (range 46-95 yrs), 51 females and 30 males. Acute complications after procedure were: mild bleeding not requiring transfusion, and 1 perforation treated surgically some days after prosthesis placement. Late complications until now included: peritonitis in 1 case, and recurrent jaundice due to drain clogging in 12 patients. These patient were treated with replacement of endoprosthesis. Remaining patients are well since the procedure and in 26 cases controlled about 17 months after endoprosthesis placement endoscopy verified significantly smaller or no stones in the common bile duct and in 4 cases even the endoprosthesis has disappeared. CONCLUSION endoscopic insertion of a biliary endoprosthesis is a safe and effective treatment for the huge CBD stones in high risk patients in whom endoscopic sphincterotomy and attempts to remove the stones are not successful. In more than 30% of cases dissolution of stones with ursodeoxycholic acid may be expected.
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Affiliation(s)
- L Topa
- Szent Imre Kórház II. Belgyógyászat, Budapest
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Pozsar J, Berger Z, Simon K, Kovacsai A, Marosi E, Pap A. Biphasic effect of prostaglandin E1 on the severity of acute pancreatitis induced by a closed duodenal loop in rats. Pancreas 1996; 12:159-64. [PMID: 8720663 DOI: 10.1097/00006676-199603000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effect of prostaglandin E1 (PGE1) on the severity of acute pancreatitis induced by a closed duodenal loop in the rat was tested. PGE1 was administered subcutaneously at various doses (3, 6, 12, and 24 microgram/kg) at hourly intervals, from the induction of acute pancreatitis up to the 24th hour. A saline-treated group served as the control. The mortality rate was recorded, and pancreatic histology was evaluated by a scoring system. Serum amylase activity and pancreatic amylase, trypsin, protein, and desoxyribonucleic acid (DNA) contents were determined at 24 h. Administration of PGE1 influenced the severity of acute pancreatitis biphasically. Serum amylase was reduced significantly (p < 0.01) at a dose of 12 microgram/kg/h, but less at 24 microgram/kg/h. Pancreatic weights did not differ in the groups. Pancreatic amylase, trypsin, and protein contents showed significant elevations (p < 0.01), yet the mortality rate was reduced using 6 and 12 microgram/kg/h doses of PGE1 compared to controls, but not at higher and lower doses. The DNA content was significantly higher at the 6 microgram/kg/h dose, compared to the control. The extent of necrosis and the severity of hemorrhage were reduced significantly (p < 0.05) at doses of 6 and 12 microgram/kg/h of PGE1, but less at 24 microgram/kg/h. Leukocyte infiltration was not affected. In conclusion, optimal doses of PGE1 can ameliorate, but higher doses increase, the severity of acute pancreatitis in this experimental model.
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Affiliation(s)
- J Pozsar
- Second Department of Internal Medicine, St. Imre Hospital, Budapest, Hungary
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Topa L, Berger Z, Pap A. [Annular pancreas in an adult]. Orv Hetil 1994; 135:1481-3. [PMID: 8052501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Annular pancreas is a rare congenital anomaly which can remain symptom free for a long time and be manifested mainly in adults. 1130 endoscopic retrograde pancreatographies were performed in the author's laboratory during 3.5 years, and annular pancreas was seen in 2 cases. Duodenal obstruction with consecutive ulcers was the clinical manifestation in a young woman requiring duodeno-jejunostomy. Annular pancreas was an accidental finding in an other old woman presenting obstructive jaundice caused by several big stones in the main bile duct. A short review of the literature is given concerning the diagnostic possibilities, eventual complications and treatment modalities of this rare anomaly. It is emphasised that the diagnosis became possible due to the modern radiologic and endoscopic methods.
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Affiliation(s)
- L Topa
- Szent Imre Kórház II. Belgyógyászat, Budapest
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Berger Z, Topa L, Pap A. [Treatment of empyema of the gallbladder by endoscopic drainage]. Orv Hetil 1994; 135:185-7. [PMID: 8290244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Medical history of an old female patient is described. Gallstones were extracted from the main bile duct after endoscopic papillotomy when she was 83 ys old. Eighteen months later, she presented an obstruction of the cystic duct with a consecutive empyema of gallbladder. The obstruction was relieved mechanically by inserting a catheter through guide-wire in the cystic duct and moving the impacted stone into the gallbladder. A naso-cholecystic drain was placed and kept in the gallbladder for six days to assure free passage of bile and to administer local antibiotic treatment. The patient quickly recovered, she has not presented any repeated cholecystitis or cholangitis in the last year. It was pointed out, that the endoscopic access to the gallbladder became possible. This technique offers an alternative way in the treatment of patients with high operative risk.
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Affiliation(s)
- Z Berger
- Szent Imre Kórház II. Belgyógyászat, Budapest
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Pozsár J, Berger Z, Simon K, Kovácsai A, Bertók L, Pap A. Influence of bile on the severity of acute experimental pancreatitis induced by closed duodenal loop in rat. Acta Chir Hung 1992; 33:247-55. [PMID: 1345383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The study was performed to assess the ethiological role of bile in acute pancreatitis provoked by closed duodenal loop in rat. In group I a closed duodenal loop was created by method of Nevalainen. A similar operation was performed in group II, but the common pancreatico-biliary duct was ligated just under the liver. In the control group (group C) only the mobilization of duodenum was performed. After 24 hours the mortality rate was 20% in group I, but 0% in group II and C. The amount of ascitic fluid showed significant elevation in group I versus II and group C, and in group II as compared to group C, too. The serum amylase was significantly higher in group I than group II and group C, and in group II was also higher as compared to group C. Serum total protein differed significantly between all groups, while albumin and total calcium were significantly lower in group I than group II, but group II was only slightly reduced versus group C. Histology showed no differences between groups I and II, but both differed significantly from group C. In conclusion bile seems to be an aggressive factor in pathogenesis of acute pancreatitis induced by closed duodenal loop in rat, but other factors may play more important roles.
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Affiliation(s)
- J Pozsár
- 2nd Dept. Med., St. Imre Hospital, Budapest, Hungary
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Abstract
Transepithelial solute transport and bicarbonate secretion are major functions of pancreatic duct cells, and both functions are thought to involve the presence of chloride channels in the apical membrane of the cell. After being isolated from a human pancreatic adenocarcinoma, the Capan-1 cell line conserves most of the properties of ductal cells and thus constitutes a useful system for investigating the role of chloride channels. Using patch-clamp techniques, we identified three different chloride-selective channels in the apical membrane of confluent Capan-1 cells. Two were non-rectifying chloride channels with low (50 pS) and high (350 pS) unitary conductances. Both channels were active in cell-attached recordings, and they were consistently located together in the same patch. Maxi Cl- channels displayed multiple subconductance states, and were reversibly inactivated by either positive or negative voltage changes, which indicates that they were optimally opened at the cell resting potential. The third was an outwardly rectifying chloride channel with a unitary conductance of 38 pS and 70 pS at negative and positive potentials respectively. Rectifying Cl- channels were clustered in discrete loci. They were silent in situ, but became active after patch excision. In inside-out excised patches, the three channels displayed a high selectivity for Cl- over monovalent cations (Na+ and K+) and gluconate. They were blocked by 20-200 microM 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) and were insensitive to changes in the Ca2+ concentration. Our results show that the apical membrane of Capan-1 cells contains a high density of chloride channels; these channels may provide pathways for transepithelial solute transport as well as for bicarbonate secretion.
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Affiliation(s)
- F Becq
- Laboratoire de Biologie Cellulaire, Université Paul Sabatier, Toulouse, France
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Issoual D, Berger Z, Laugier R. CCK and PYY do not participate in the delayed inhibition of pancreatic secretion, after stimulation by duodenal oleic acid infusion. Regul Pept 1991; 36:45-57. [PMID: 1796181 DOI: 10.1016/0167-0115(91)90194-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The role played by CCK in the stimulation of pancreatic secretion by duodenal infusion of oleic acid in conscious rats was studied using a potent and specific CCK receptor antagonist. CR-1409 did not alter basal secretion, which does not require CCK. The three doses of CR-1409 that were used (2, 4 and 8 mg/kg/h) suppressed the protein response to duodenal infusion of oleic acid and significantly enhanced the delayed inhibition normally observed in control rats (-81%, -87% and -88% vs. -51% of basal in controls). CR-1409 dose-dependently reduced the volume of pancreatic secretion after duodenal infusion of oleic acid (0.40 +/- 0.02, 0.36 +/- 0.02, 0.34 +/- 0.03 vs. 0.48 +/- 0.04 ml/30 min for 2, 4, 8 mg/kg/h and controls, respectively) and revealed a delayed inhibition of volume and a slight reduction of bicarbonate secretion. CCK appears to be directly responsible for the protein and also water response to duodenal infusion of oleic acid, and to be indirectly involved in bicarbonate stimulation. PYY antiserum significantly augmented protein output after duodenal infusion of oleic acid (10.75 +/- 1.40, 14.10 +/- 1.60 vs. 8.60 +/- 1.20 mg/30 min, 1 microliter, 2 microliters and controls), but failed to modify the delayed inhibition: PYY modulates the response to duodenal infusion of oleic acid and is not involved in the delayed inhibition, which was shown to be also present for volume, but which is normally masked by the action of CCK.
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Affiliation(s)
- D Issoual
- Unité de Recherches de Physiopathologie des Régulations Hormono-nutritionnelles, INSERM U-260, Faculté de Médecine, Marseille, France
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Lechene de la Porte P, Iovanna J, Odaira C, Choux R, Sarles H, Berger Z. Involvement of tubular complexes in pancreatic regeneration after acute necrohemorrhagic pancreatitis. Pancreas 1991; 6:298-306. [PMID: 1713674 DOI: 10.1097/00006676-199105000-00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Localized acute necrohemorrhagic pancreatitis was induced in rats by multiple trypsin injections. Morphological alterations were monitored by light and electron microscopy until complete recovery. In the acute phase, typical pictures of focal acute necrohemorrhagic pancreatitis were observed. In the postacute phase, fibrosis and tubular complexes are characteristic of damaged areas. Tubular complexes appear from the dedifferentiation of acinar cells. They are characterized by duct-like cells bordering wide, empty luminae. In the recovery phase, cellular proliferation was accompanied by differentiation, with progressive acquisition of the morphological characteristics of acinar cells at the periphery of the tubular complexes. In that instance, cellular proliferation was concomitant with the development of collagen septa in tubular complexes. In these structures both duct-like and acinar-like cells presented mitoses. Cell division persisted in the dedifferentiated cells until tubular complexes disappeared. A very similar process was observed in the embryonic pancreas, where organized parenchyma originated from proliferation and differentiation of protodifferentiated cells. We concluded that pancreatic repair following necrohemorrhagic pancreatitis involves proliferation of cells from intact acini and from tubular complexes, at variance with edematous pancreatitis, where regeneration is exclusively due to acinar cell proliferation.
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Lászik GZ, Berger Z, Pap A, Tóth GK, Varró V. Course and regression of acute interstitial pancreatitis induced in rats by repeated serial subcutaneous cholecystokinin-octapeptide injections. Int J Pancreatol 1989; 5:347-58. [PMID: 2607183 DOI: 10.1007/bf02924299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of this study was to examine histologic and biochemical alterations in experimental acute interstitial pancreatitis (AIP) induced by serial repeated supramaximal cholecystokinin-octapeptide (CCK-OP) stimulation in rats. High doses of CCK-OP (60 micrograms/kg body wt) were administered subcutaneously (sc) six times at hourly intervals for 1 d (Group I) or for 3, 5, or 7 d (Group II). Rats were killed after 1, 3, 5, 7, and 10 d in both groups and also after 13, 20, and 27 d in Group II. During the course of the AIP, the morphological alterations were more pronounced in the repeatedly treated rats, but their appearance and disappearance essentially occurred in parallel in the two groups. Increased mitotic activity of the centroacinar and acinar cells were observed in d 5 and rose further even in Group II. The pancreatic weight and the protein and DNA contents reached a minimum on d 5 in both groups. The lowest enzyme activities did not occur in parallel. Thereafter, functional regeneration occurred despite continuing CCK-OP overstimulation in Group II. The toxicity of repeated CCK-OP hyperstimulation, thus, was limited: after its fifth administration, it failed to further aggravate the acute pancreatic damage or prevent the regeneration. This might be explained by a decreased CCK-OP sensitivity of the preexisting acinar cells, and/or increased CCK-OP tolerance of newly-formed ones.
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Affiliation(s)
- G Z Lászik
- Department of Pathology, Albert Szent-Györgyi Medical University, Szeged, Hungary
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