Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route

BACKGROUND

Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP.

METHODS

MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration.

RESULTS

A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29-0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27-0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21-0.44, p < 0.001) in comparison with hydroxyethyl starch (HES). High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41-5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04-1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51-5.19, p = 0.001) compared to moderate fluid rate infusion.

CONCLUSIONS

In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high-rate infusion.

Simple liver cyst presenting with clinical signs and symptoms of right-sided heart failure

Simple hepatic cysts are one of the most common benign lesions in the liver. Despite being frequently asymptomatic, if they reach large sizes in certain anatomical locations, they can appear under atypical symptomatology and cause significant morbidity. We present the case of a giant simple liver cyst as an exceptional cause of right-sided heart failure. Laparoscopic deroofing of the cyst achieved an outstanding improvement of the patient´s cardiac condition. A high diagnostic suspicion, a multidisciplinary approach and adequate treatment are essential for a favourable outcome.

Reactive lymphoid hyperplasia of the liver. A case report

Reactive lymphoid hyperplasia of the liver is an unusual benign lesion of unknown pathogenesis. The largest reported series to date includes only 7 cases. Reactive lymphoid hyperplasia can be radiologically confused with malignant tumors such as hepatocellular carcinoma or metastases. Histological differential diagnosis should be chiefly made with lymphomas, Castleman disease and primary biliary cirrhosis. We report the clinicopathological findings in a 54-year-old woman with an incidental hepatic lesion when she consulted for hematuria. After histological, immunohistochemical and molecular studies, the diagnosis of reactive lymphoid hyperplasia was made.

Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience

INTRODUCTION

In selected patients, radiofrequency ablation (RFA) is a well-established treatment for hepatocellular carcinoma (HCC). However, subcapsular or lesions close to adjacent viscera preclude a percutaneous approach. In this setting laparoscopic-RFA (LRFA) is a potential alternative. The aim of this study was to analyse the safety and feasibility of LRFA in patients with HCC.

PATIENTS AND METHODS

Retrospective study of patients with HCC meeting strict inclusion criteria who underwent LRFA at a single Institution from December 2000 to March 2013.

RESULTS

Forty-one patients underwent 42 LRFA of 51 nodules. The median size of the nodule was 2.5 (range 1.2-4.7) cm. Thirty-one tumours were subcapsular and 17 located near the gallbladder. Major complications occurred in 17 patients. The initial complete response (ICR) rate was 94% and was lower among tumours located adjacent to the gallbladder. At the end of the follow-up period, the sustained complete response (SCR) rate was 70% and was lower in tumours adjacent to the gallbladder while increased for subcapsular tumours. The 1-, 3- and 5-year overall survival rate was 92.6%, 64.5% and 43%, respectively.

CONCLUSION

LRFA of HCC is safe, feasible and achieves excellent results in selected patients. LRFA should be the first-line technique for subcapsular lesions as it minimizes the risk of tumoural seeding and improves ICR. Proximity to gallbladder interferes in treatment efficacy (lower rate of ICR and lower rate of SCR).

[Intrahepatic cholangiocarcinoma on a hydatidic cyst]

Cholangiocarcinomas are malignant tumors arising from the bile ducts. One of the factors associated with the development of malignancy is parasitic infections by helminths trematodes that cause liver fluke infections. This association is very common in south-east Asia, but association with liver hydatidosis has not been reported in the scientific literature. We report a case in which these two diseases were associated and required non-radical surgical treatment, since radiological findings were not suspicious for these entities.