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Minimally Invasive Surgery for Necrotizing Pancreatitis: A Case Report

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Surgical Science 2024年第9期15卷 514-521页

作者： Néstor Veriel Méndez Huerta Luis Fernando Zorrilla Núñez noelia Obregón Gaxiola César Jair Treviño Arizmendi Gerardo Iván Muñoz Morales Marco Alejandro Arizmendi Villarreal Pamela Denisse Valdez Navarro Marco Antonio Hernández Guedea Gerardo Enrique Muñoz Maldonado Service of General Surgery Hospital Universitario Dr. Jos Eleuterio Gonzlez Universidad Autnoma de Nuevo Len Monterrey Mxico

Introduction: Necrotizing pancreatitis management is complex and varies significantly among clinicians. Minimally invasive approaches like transgastric necrosectomy via laparoscopy are emerging as effective treatment options. This case report underscores the technique’s efficacy, clinical outcomes, and role in reducing complications. Clinical Observation: A 59-year-old male with a history of smoking and alcoholism presented with severe abdominal pain, nausea, and vomiting. Over the following weeks, he developed symptoms including asthenia, weight loss, and melena. Diagnostic workup revealed severe anemia and Balthazar E necrotizing pancreatitis, with significant intra-abdominal fluid collections and signs of infection. After initial conservative management, the patient underwent transgastric necrosectomy via laparoscopy due to deteriorating clinical status. The procedure involved removing necrotic tissue and performing a cystogastroanastomosis and jejunostomy. Postoperative care included fasting, parenteral nutrition, broad-spectrum antibiotics, and enzymatic replacement. The patient recovered well, with reduced necrotic tissue on follow-up imaging, and was discharged twelve days post-surgery [1]. Conclusion: Transgastric necrosectomy by laparoscopy is a valuable first-line surgical option for patients with symptomatic necrotizing pancreatitis, particularly in cases without prior interventions. This minimally invasive technique helps reduce major complications and mortality, offering a less invasive alternative to traditional open necrosectomy. The multidisciplinary approach and careful postoperative management were crucial to the patient’s favorable outcome. The case highlights the potential of transgastric necrosectomy as an effective treatment strategy in managing complex pancreatitis cases, including those with associated duodenal perforation [2].

关键词： Necrotizing Transgastric Pancreatic Necrosectomy Pancreatitis Case Report

Optimization of Exenatide plus Detemir Treatment for Morbid Obese Patients with Insulin Dependent Diabetes Resistant to Conventional Treatment. Effect of Exenatide on Patients with Mellitus Diabetes Type 2

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Pharmacology & Pharmacy 2014年第4期5卷 433-443页

作者： Alfonso Lopez Ruiz Maria Angeles Nunez Sanchez noelia Victoria Garcia-Talavera Espin Amparo Meoro Aviles Cristina del Peso Gilsanz Ricardo Soriano Sanchez Maria Teresa Gallego Garcia Jose Soriano Palao Maria Dolores Ortuno Sacramento Tomas Navarro Collaborative Groups of the Diabetes and Obesity Unit of the Hospital Reina Sofia Unidad de Diabetes y Obesidad del área VII Murcia Este Hospital General Universitario Reina Sofía de Murcia Murcia Espa&ntildea

The purpose of this study was to analyze the effects of the treatment with Exenatide joint to insulin detemir. The study was carried out with obese patients with type 2 diabetes mellitus (DM2) and deficient control, despite intensive insulin therapy combined with oral antidiabetics. A longitudinal study was made with 15 patients controlled by the Endocrinology and Nutrition Section of the Reina Sofía University Hospital, Murcia. These patients were treated with Exenatide joint to insulin during 3, 6 and 12 months. Statistically meaningful differences (p < 0.05) were observed in the reduction of HbA1c in the 3 and 6 months treatment groups (initial HbA1c: 9.55% ± 1.086%, weight: 119.94 kg, insulin requirement: 0.71 IU/kg/day;after 3 months: HbA1c: 7.77% ± 1.164%, weight: 98.13 kg, insulin requirement: 0.59 IU/kg/day;after 6 months: HbA1c: 7.21%, weight: 97.93 kg, insulin requirement: 0.55 IU/kg/day). It was observed that the association of Exenatide and insulin promotes an improvement in several indicators such as weight, body mass index (BMI), systolic pressure (SP), diastolic pressure (DP), triglycerides (TG), cLDL, cHDL and total cholesterol (TC), in patients with diabetes resistant to conventional therapy. However, these improvements were statistically no significant (p < 0.05). It is possible to talk of a reduction of cardiovascular risk factors in patients with Exenatide, being thus a suitable option for this kind of individuals. It is important to emphasize the fact that our study showed bigger body-weight reductions results after 6 and 12 months, as compared to the researches quoted.

关键词： Type 2 Diabetes Mellitus Exenatide Cardiovascular Risk Physical and Biochemical Parameters

INMA-Sabadell队列中孕期双酚A及邻苯二甲酸酯暴露与胎儿发育的超声测量(续完)

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环境与职业医学 2016年第9期33卷 919-921页

作者： Maribel Casas Damaskini Valvi Ana Ballesteros-Gomez Mireia Gascon Mariana F.Fernández Raquel Garcia-Esteban Carmen I?iguez David Martínez Mario Murcia Nuria Monfort noelia Luque Soledad Rubio Rosa Ventura Jordi Sunyer Martine Vrijheid 袁亚群(翻译) 金泰廙(审校) Centre for Research in Environmental Epidemiology(CREAL) Universitat Pompeu Fabra(UPF) CIBER Epidemiología y Salud Pública(CIBERESP) Department of Analytical Chemistry University of Cordoba ISGlobal Barcelona Centre for International Health Research(CRESIB)Hospital Clínic-Universitat de Barcelona Instituto de Investigación Biosanitaria de Granada(Granada.ibs) University of Granada Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO/CSISP Universidad de Valencia Hospital del Mar Medical Research Institute(IMIM) 不详

暴露于ΣMWPm与任何胎儿大小或胎儿发育结局（见补充材料，表8）及所评估的出生结局（表2及补充材料表S7）都没有显著相关性。代谢物MnBP与12-20孕周HC增长降低有显著相关性（-4．88％；95％CI：-8．36，-1．36），且与EFW增长减低也有... 详细信息

暴露于ΣMWPm与任何胎儿大小或胎儿发育结局（见补充材料，表8）及所评估的出生结局（表2及补充材料表S7）都没有显著相关性。代谢物MnBP与12-20孕周HC增长降低有显著相关性（-4．88％；95％CI：-8．36，-1．36），且与EFW增长减低也有显著相关性（-4．32％；95％CI：-8．33，-0．27）（图3及补充材料表S8）。

关键词：胎儿发育邻苯二甲酸酯超声测量双酚A 中孕期队列相关性出生结局

INMA-Sabadell队列中孕期双酚A及邻苯二甲酸酯暴露与胎儿发育的超声测量(待续)

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环境与职业医学 2016年第8期33卷 820-825页

作者： Maribel Casas Damaskini Valvi Ana Ballesteros-Gomez Mireia Gascon Mariana F.Fernández Raquel Garcia-Esteban Carmen I?iguez David Martínez Mario Murcia Nuria Monfort noelia Luque Soledad Rubio Rosa Ventura Jordi Sunyer Martine Vrijheid 袁亚群金泰廙 Centre for Research in Environmental Epidemiology(CREAL) Universitat Pompeu Fabra(UPF) CIBER Epidemiologíay Salud Pública(CIBERESP) Department of Analytical Chemistry University of Cordoba ISGlobal Barcelona Centre for International Health Research(CRESIB)Hospital Clínic-Universitat de Barcelona Instituto de Investigación Biosanitaria de Granada(Granada.ibs) University of Granada Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO/CSISP Universidad de Valencia Hospital del Mar Medical Research Institute(IMIM)

[背景]产前暴露于双酚A（BPA）及邻苯二甲酸酯会影响胎儿发育；然而该类研究很少，且得出的结果不一致。[目的]对一个西班牙出生队列中488对母婴进行研究，评估产前暴露于BPA及邻苯二甲酸酯是否与胎儿发育相关。[方法]检测第一和第三孕... 详细信息

[背景]产前暴露于双酚A（BPA）及邻苯二甲酸酯会影响胎儿发育；然而该类研究很少，且得出的结果不一致。[目的]对一个西班牙出生队列中488对母婴进行研究，评估产前暴露于BPA及邻苯二甲酸酯是否与胎儿发育相关。[方法]检测第一和第三孕期两次尿液样本中BPA及8种邻苯二甲酸酯[4种邻苯二甲酸二（2-乙基己基）酯代谢物（DEHPm），邻苯二甲酸单卞酯（MBzP）以及3种低分子量邻苯二甲酸酯代谢物（LMWPm）]。另外，估计股骨长度（FL）、头围（HC）、腹围（AC）、双顶径（BPD）的生长曲线，估计孕期（12—20周，20～34周）的胎儿体重，并测量出生体重、出生长度、出生头围以及胎盘重量。[结果]总体上，结果并不支持孕期暴露于BPA或DEHPm与胎儿发育参数相关。产前MBzP暴露与20～34孕周的FL呈正相关，MBzP浓度每增加一倍，平均FL增加3．7％（95％CI：0．75，6．63％）。MBzP与男婴出生体重呈正相关（48g；95％CI：6，90），但在女婴中没有相关性（-27g；95％CI：-79，25）（交互作用P=0．04）。LMWPm邻苯二甲酸单丁酯（MnBP）与12—20孕周的HC呈负相关[平均HC降低了4．88％（95％CI：-8．36，-1．36％）]。[结论]本研究首次将暴露生物标志重复测量值与胎儿期多种发育参数相结合，发现暴露于BPA或邻苯二甲酸酯与胎儿发育不相关。邻苯二甲酸酯代谢物MBzP与MnBP与部分胎儿发育参数相关，但这些结果还需要重复验证。

关键词：邻苯二甲酸酯胎儿发育超声测量出生队列中孕期双酚A 邻苯二甲酸二(2-乙基己基)酯产前暴露

Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

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World Journal of Gastroenterology 2017年第4期23卷 703-711页

作者： Marisol Luján-Sanchis Enrique Pérez-Cuadrado-Robles Javier Garcia-Lledo José-Francisco Juanmartinena Fernandez Luca Elli Victoria-Alejandra Jiménez-García Juan Egea-Valenzuela Julio Valle-Munoz Cristina Carretero-Ribón Ignacio Fernández-Urién-Sainz Antonio López-Higueras noelia Alonso-Lazaro Mileidis Sanjuan-Acosta Francisco Sanchez-Ceballos Bruno Rosa Santiago González-Vázquez Federica Branchi Lucía Ruano-Díaz César Prieto-de-Frías Vicente Pons-Beltrán Pilar Borque-Barrera Begona González-Suárez Sofía Xavier Federico Argüelles-Arias Juan-Manuel Herrerías-Gutiérrez Enrique Pérez-Cuadrado-Martínez Javier Sempere-García-Argüelles Digestive Diseases Unit General University Hospital of Valencia Small Bowel Unit Hospital Morales Meseguer Digestive Diseases Unit General University Gregorio Maranón Unit of Gastroenterology and Endoscopy Complejo Hospitalario de Navarra Center for prevention and Diagnosis of Celiac Disease Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Unit of Gastroenterology and Endoscopy University Hospital Virgen Macarena Gastroenterology department Hospital Virgen de la Arrixaca Department of Gastroenterology Complejo Hospitalario de Toledo Department of Gastroenterology University of Navarra Clinic1 Endoscopy Digestive Unit Digestive Diseases AreaUniversitari i Politècnic La Fe Hospital1 Digestive Diseases Unit University Hospital Nuestra Senora de Candelaria1 Digestive Diseases Unit Clinical Hospital San Carlos1 Digestive Diseases Unit Hospital da Senhora da Oliveira-Guimaraes1 Endoscopy Digestive Unit Hospital Clinic de Barcelona

AIMTo analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE).METHODSThis is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were *** overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn’s). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated *** has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.

关键词： Capsule endoscopy Celiac disease Anti-transglutaminase antibodies Gluten-free diet Non-celiac gluten sensitivity