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21/37. Acute pancreatitis possibly due to arginine use: a case report.

    arginine has been used by millions of athletes over the past 20 years to enhance production of human growth hormone. The effects of arginine supplementation include increased fat burning and muscle building, enhanced immunity, and improvement in erectile function in men. Excessive doses of basic amino acids such as ethionine, methionine and lysine are known to damage the rat pancreas. Recent studies have demonstrated that excessive doses of arginine induce necrotizing pancreatitis in rats. In this article, we report a 16-year-old male patient hospitalized in our clinic because of severe pain in upper abdomen, nausea and vomiting who was suspected to have arginine-induced acute pancreatitis.
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ranking = 1
keywords = necrotizing
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22/37. L-asparaginase-induced severe necrotizing pancreatitis successfully treated with percutaneous drainage.

    L-asparaginase is a key component of the antileukemic therapy in children with acute lymphoblastic leukemia (ALL). pancreatitis has been noted to be a complication in 2-16% of patients undergoing treatment with L-asparaginase for a variety of pediatric neoplasms. Most cases of pancreatitis associated with L-asparaginase toxicity are self-limiting and respond favorably to nasogastric decompression and intravenous hyperalimentation. However, in rare instances, hemorrhagic pancreatitis or necrosis may occur. L-asparaginase-induced pancreatitis is an uncommon but potential lethal complication of the treatment of leukemia. We present a pediatric patient with leukemia and a severe, L-asparaginase-induced necrotizing pancreatitis, treated successfully with percutaneous drainage used to flush the infected necrotic parts.
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ranking = 5
keywords = necrotizing
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23/37. autopsy case of microscopic polyangiitis with crescentic glomerulonephritis and necrotizing pancreatitis.

    Herein is reported the case of an 84-year-old woman who initially manifested rapidly progressive glomerulonephritis following a urinary tract infection. Laboratory findings showed a high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). Treatment with high-dose i.v. steroids resulted in clinical recovery and an undetectable MPO-ANCA titer. Two months later the patient was readmitted in a state of severe shock. Laboratory examination showed the deterioration of renal function, leukocytosis, and coagulation abnormalities consistent with disseminated intravascular coagulation (DIC). The patient died 12 days later. The post-mortem examination revealed necrotizing pancreatitis due to acute-stage vasculitis typified by fibrinoid necrosis of the arterioles and venules, and crescentic glomerulonephritis with healed-stage vasculitis. In the lungs, capillaritis with diffuse alveolar hemorrhage was not evident, but arteriolitis and phlebitis were occasionally seen. This case represents an unusual complication of necrotizing pancreatitis in the setting of microscopic polyangiitis. Thus, it is important to consider reactivation independent of the titer of ANCA in the course of the disease.
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ranking = 6
keywords = necrotizing
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24/37. Percutaneous treatment of a patient with infected necrotizing pancreatitis.

    BACKGROUND: A 50-year-old man with an acute episode of alcohol-induced chronic edematous pancreatitis and an inflammatory stenosis of the biliary tract was treated by implantation of a plastic endoprosthesis at a rural hospital in germany. Because of his worsening condition, the patient was referred to the intensive care unit of the University Hospital, Regensburg, germany. Contrast-enhanced CT revealed complete necrosis of the body and tail of the pancreas, formation of large retrogastric and paraduodenal fluid collections, and fluid along Gerota's fascia, as well as in the paracolic gutters. Antibiotic treatment was adjusted according to the results of microbiological testing after diagnostic puncture of the necrotic cavity. INVESTIGATIONS: CT scan, CT-guided fine-needle aspiration and fluoroscopy. diagnosis: Infected acute necrotizing pancreatitis. MANAGEMENT: Interventional treatment using large-bore percutaneous catheters to perform percutaneous necrosectomy, fragmentation of necrotic pancreatic tissue with a snare catheter and dormia basket, and aspiration. parenteral nutrition and antibiotics were also administered.
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ranking = 82.436001483053
keywords = acute necrotizing, necrotizing
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25/37. Haemorrhagic complication of acute necrotizing pancreatitis presenting with sudden death.

    Certain complications of acute pancreatitis may lead to death, and of these, haemorrhage caused by rupture of a peri-pancreatic vessel is among the most dangerous. The case reported here was remarkable because the onset of acute necrotizing pancreatitis was completely asymptomatic and the severe haemorrhage of the portal vein that caused the patient's death was only discovered at autopsy. The onset of abdominal pain was immediately followed by death.
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ranking = 392.18000741527
keywords = acute necrotizing, necrotizing
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26/37. Acute necrotizing pancreatitis in an adolescent with type 2 diabetes.

    PURPOSE OF review: The demographics of diabetes among adolescents are changing, with an increasing prevalence of type 2 diabetes. Since adolescents with type 2 diabetes are susceptible to the same complications that accompany type 2 diabetes in adults, pediatricians are now encountering new diagnosis entities. RECENT FINDINGS: A 16-year-old Hispanic male presented to the emergency room with new onset diabetes. Laboratory evaluation revealed the diagnosis of hyperglycemic hyperosmolar nonketotic state. Within the next 24 hours, the patient's clinical status deteriorated with multi organ failure, followed by asystole. At autopsy, the pancreas demonstrated acute necrotising pancreatitis. Hyperglycemic hyperosmolar nonketotic state is a life-threatening emergency among adults with type 2 diabetes, and is now occurring more frequently among adolescents. Acute pancreatitis should be considered as a precipitating event, particularly in those with severe hypertriglyceridemia. SUMMARY: This case illustrates the changing morbidity of diabetes in adolescents and the need to consider acute pancreatitis and hyperglycemic hyperosmolar nonketotic in adolescents with severe metabolic decompensation. Since hypertriglyceridemia is a known risk factor for acute pancreatitis, patients should be monitored, and treated as needed.
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ranking = 4
keywords = necrotizing
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27/37. Acute necrotizing pancreatitis as a rare complication of extracorporeal shock wave lithotripsy.

    Extracorporeal shock wave lithotripsy (ESWL) is considered the standard treatment for most renal and upper ureteral stones. Some centers use ESWL to treat bile duct stones and pancreatic calculi. Although ESWL is generally considered safe and effective, major complications, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of an aortic aneurysm and intracranial hemorrhage, have been reported to occur in less than 1% of patients. Here, we present an extremely rare case of acute necrotizing pancreatitis occurring after ESWL for a right-sided urinary stone, which was treated by non-operative percutaneous interventions.
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ranking = 82.436001483053
keywords = acute necrotizing, necrotizing
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28/37. Laparoscopic debridement of recurrent pancreatic abscesses in the hostile abdomen.

    Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.
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ranking = 1
keywords = necrotizing
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29/37. clostridium perfringens infection of pancreatic necrosis: absolute indication for early surgical intervention.

    It is generally accepted that the surgical treatment of pancreatic necrosis should be delayed as long as possible and after there is laboratory confirmation of infection, determined by image guided fine-needle aspiration. Two cases of severe necrotizing pancreatitis are presented where gas developed in the pancreatic bed, detected by CT scanning, within 2--4 days of the onset of symptoms. bacteriology studies showed clostridium perfringens and other gram negative flora. The presence of retroperitoneal gas in this context is an absolute indication for early surgical intervention.
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ranking = 1
keywords = necrotizing
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30/37. Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).

    BACKGROUND: Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%. OBJECTIVE: Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis. DESIGN: Case report. SETTING: University hospital. patients AND INTERVENTIONS: Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy. RESULTS: Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients. LIMITATIONS: Small number of patients. CONCLUSIONS: The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.
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ranking = 5
keywords = necrotizing
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