Ajith K Siriwardena

..In this issue of Critical Care, two expert groups debate the merits of antifungal prophylaxis in patients with acute necrotizing pancreatitis who are receiving antibiotics...

..Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions...

..Based on equivocal clinical data, intravenous antioxidant therapy has been used for the treatment of severe acute pancreatitis. To date there is no randomised comparison of this therapy in severe acute pancreatitis...

..There is no consensus about which patients benefit from portal-superior mesenteric vein resection...

..Use of the endovascular approach avoided the need for two major operative interventions...

..Classifications of chronic pancreatitis based on either histologic (Marseilles) or endoscopic (Cambridge) criteria are not widely used...

..Exploiting this knowledge, we used human recombinant activated protein C (Xigris; Eli Lilly, Indianapolis, Ind) known to preserve microvascular patency, in evaluating the role of Xigris in experimental AP...

..This study investigates the effect of GTPs in a cerulein-induced murine model of acute pancreatitis (AP)...

..The aim of this work was to explore the feasibility of measurement of gene expression in RNA isolated from ductal juice...

..Serum selenium fell during the course of experimental acute pancreatitis and this effect was not reversed by exogenous selenium supplementation...

..This study undertakes a systematic review of the current literature on tumor M2-PK as a diagnostic tool and provides an overview of the current usage and scope of this emerging biomarker...

..To evaluate contemporary organ dysfunction scoring systems for early prediction of severity in acute pancreatitis (AP)...

..To examine clinical outcome in a consecutive cohort of patients undergoing open necrosectomy for postinflammatory necrosis...

..Simulated portal circulation had no effect on ablation. CONCLUSIONS: In this ex-vivo study radiofrequency produced a temperature and duration dependent ablation with the optimal characteristics being 90 degrees C for 5 minutes...

..We investigated whether antioxidant therapy reduces pain and improves quality of life in patients with chronic pancreatitis...

..The importance of this interaction during the critical early phases of acute pancreatitis is unknown. This study explores patterns of expression of CD105 and TGF-beta in plasma during human acute pancreatitis...

..To undertake a baseline study comparing quality of life (QoL) in patients with chronic pancreatitis (CP) on Antox to those with CP, matched for disease duration, who were not on this medication...

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..Although several studies have examined peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy all provided support at various timepoints with a variety of protocols...

..However, little is known of the pathophysiological characteristics of endogenous protein C early in the disease course of AP. This study undertakes an evaluation of protein C levels in AP...

..The aim of this study was to determine the incidence of KRAS and EGFR mutations in pancreatic and periampullary cancers and their relationship with survival...

..Modulation of the coagulation cascade, although probably essential to the mode of action of drotrecogin alfa, can lead to an increased risk of bleeding...

..CONCLUSION: Current evidence does not justify the incorporation of laparoscopic biliary bypass techniques into contemporary evidence-based management algorithms for patients with non-resectable periampullary cancer...

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..The results show that plasma DNA is lower in patients with acute pancreatitis compared to control and that values fall further during the disease course...

..More experience is required to assess the spectrum of complications and if there is true oncological efficacy...

..As any individual unit will have only limited experience, this study aims to provide a structured, systematic appraisal of published experience to identify any consistent trends and disease patterns that may help in practical management...

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..Reasoning that percutaneous access can be achieved transhepatically in patients with stenosis, this study reports the outcome of a policy of biliary repair without the use of a jejunal access loop...

..Minimally invasive necrosectomy is an umbrella term encapsulating the retroperitoneal, endoscopic and laparoscopic approaches. However, current evidence is unclear in terms of which approach to select in any particular setting...

..The present study is a detailed overview of the experimental and clinical evidence for the use of NAC as a pharmaco-protection agent in patients undergoing major liver surgery or transplantation...

..The results show a critical lack of data on long-term patency such that at the present time, metallic endobiliary stents should not be used for benign stricture in those patients with a predicted life expectancy greater than 2 years...

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..CONCLUSIONS: The results of this first pan-European questionnaire demonstrate wide variations in care. Overall, the findings provide a unique insight into the current management of severe acute pancreatitis in Europe...

..Although rare, this is an important differential diagnosis in the management of cystic tumours of the pancreas...

..Baseline assessment data are limited and thus patients in different centres may be presenting at different stages of their illness...

..In particular, not all patients with suspected pancreatic cancer see specialists, many hospital specialists see small numbers of cases and multidisciplinary care is limited...

..40% (0-7.77) for ablated pancreas (P < 0.001; Mann-Whitney U test). CONCLUSION: This study describes the development of a relatively simple, reliable, and reproducible model for evaluation of RF ablation of pancreatic parenchyma...

..TNF-alpha receptor 1 gene deletion and Etanercept administration ameliorate the course of experimental acute pancreatitis in a similar degree. Future studies on clinical applications of Etanercept in pancreatitis seem promising...

..Angiographic embolization can achieve definitive hemostasis and stabilize a critically ill patient to permit disease reappraisal...

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