Evaluation of the Effects of Noniodinized and Iodinized Ionic Contrast Media and Gadoteric Acid in Acute Necrotizing Pancreatitis

Apodaca-Torrez, Franz Robert; Goldenberg, Alberto; Lobo, Edson José; Farah, Jose F.; Triviño, Tarcísio; Montero, Edna Frasson de Souza; Schraibman, Vladimir; Benvenuto, R; Neto, Ricardo Artigiani

doi:10.1097/mpa.0b013e3180a6f366

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…In a report on a rat model of cerulean-induced pancreatitis, the injection of contrast seemed to increase the rates of pancreatic necrosis and mortality [ 6 ]. However in a taurocholate-induced model of experimental pancreatitis, the authors have suggested that neither ionic nor non-ionic contrasts increase pancreatic necrosis [ 16 ]. Recent clinical studies have shown that early CT does not aggravate AP and, on the contrary, provides important prognostic information [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis

Sharma

Gupta

et al. 2014

Gastroenterology Report

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Background: Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear.Methods: The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4–5 days after the onset of pain) and the late CT group (CT done in days 6–14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index.Results: Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05).Conclusions: Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis

Sharma

Gupta

et al. 2014

Gastroenterology Report

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“…Among these bile salts, the taurine‐conjugated bile salt Na‐TC is the most widely used and best characterized to date in inducing AP. The Na‐TC ductal infusion model has been shown to induce pancreatic oedema, haemorrhage and necrosis in large animals, such as rabbits, 62 swans, 63 dogs 64 and pigs 65,66 . However, the pancreatic injury in these large animals is not sufficient to produce multiple organ dysfunction syndromes (MODS).…”

Section: Induction Of Ap By Bile Saltsmentioning

confidence: 99%

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research

Wan

Huang

Latawiec

et al. 2012

HPB

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Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30-50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca(2+) overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP.

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“…Cerca de um terço dos entrevistados realizam a TC na admissão destes doentes. Discutem-se os problemas relacionados à utilização de contraste na PA, que poderia transformar uma PA leve em necrótica 14 . O fator custo também deve ser considerado, além do fato de que o principal fator local que influencia o prognóstico de um doente com PA é a necrose, que só pode ser vista na TC a partir do terceiro dia do início do surto e idealmente a partir do quinto dia 15 .…”

Section: Emprego De Antibióticos Na Pancreatite Agudaunclassified

Pesquisa nacional sobre condutas na pancreatite aguda

Campos

Parreira

Utiyama

et al. 2008

Rev. Col. Bras. Cir.

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; Edivaldo Utiyama, TCBC-SP 3 ; Samir Rasslan, TCBC-SP 4 RESUMO: Objetivo: Avaliar como a pancreatite aguda é vista e tratada pelo cirurgião brasileiro. Método: Trata-se de um questionário prospectivo enviado aos membros do Colégio Brasileiro de Cirurgiões (CBC). Dois mil questionários foram enviados obtendo-se 618 respostas (30,9%). O questionário constituía de perguntas relacionadas à experiência do cirurgião e ao tratamento da PA. Resultados: Cento e oitente e dois entrevistados (33,6%) disseram tratar até cinco casos por ano e 147 (27,2%) tratam de seis a 10 casos por ano. Dentre os critérios utilizados para a definição de PA, o mais citado foi a avaliação clínica por 306 (57,4%) entrevistados, seguido dos critérios de Ranson por 294 (55,2%) e TC por 262 (49,2%). Com relação ao uso da TC, 275 (51,5%) entrevistados responderam que realizam a TC em todos os doentes com PA. O suporte nutricional parenteral foi o método de escolha indicado por 248 (46,6%) entrevistados. A infecção da coleção e/ou necrose pancreática é a principal indicação operatória com 447 (83,6%) respostas. O melhor período para operar um doente com PA grave foi considerado até quatorze dias por 278 (54,2%) entrevistados. Com relação aos antibióticos, 371 (68,6%) entrevistados disseram que utilizam antibióticos no tratamento da PA grave. Conclusão: Estes resultados demonstram uma ampla variação no tratamento da PA no Brasil. A pouca experiência dos cirurgiões e os temas controversos são os fatores principais responsável para esta falta de padronização. A realização de um Consenso nacional baseado nos novos conceitos e na experiência mundial é crucial para ajustar estas condutas (Rev. Col. Bras. Cir. 2008; 35(5): 304-310).Descritores: Pancreatite/terapia; Doença aguda; Pesquisa; Consenso; Condutas na prática dos médicos.

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Evaluation of the Effects of Noniodinized and Iodinized Ionic Contrast Media and Gadoteric Acid in Acute Necrotizing Pancreatitis

Abstract: Ionic and nonionic contrast media and gadoteric acid did not produce adverse effects in the present model of acute necrotizing pancreatitis.

Cited by 5 publications

References 27 publications

Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis

Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research

Pesquisa nacional sobre condutas na pancreatite aguda

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