OBJECTIVE The objective of this study is to evaluate the possibilities of interventional ultrasonography in the treatment of liquid collections created during and after an acute pancreatitis. PATIENTS AND METHODS Ultra-sound controlled percutaneous drainage of peripancreatic liquid collections was done in 58 patients (44 men and 14 women, average age 47.8 within the span of 15-68) in the period between May 1995 and September 2001. Pseudocystitis of pancreas formed after an acute pancreatitis was drained in 19 cases, abscess collections were drained in 14 cases, and in 25 cases a catheter was entered in peripancreatic liquid collections and steatonecrotic masses in the initial phase of acute haemorrhagic necrotic pancreatitis. Pigtail catheters 5 to 7 F were placed to serve for drainage and instillation of medicaments. RESULTS In the group of patients to whom a catheter was placed in liquid collections and steatonecrotic masses, two lethal outcomes were recorded. However, they were not the result of the intervention, but of emboly of lungs and coagulopathy. One patient with peripancreatic abscess collections was operated after the intervention. In other patients, ultra-sound controlled percutaneous drainage was successful. Before our intervention 22 patients had been operated, five of them twice and two of them three times. CONCLUSION Ultra-sound controlled percutaneous drainage gives an important contribution in the treatment of the hardest forms of acute pancreatitis and represents a safe and less aggressive method in the treatment of liquid collections and steatonecroses formed during an acute pancreatitis.

Background The prognostic importance of renal involvement in Systemic Lupus Erythematosus (SLE) is well known. Predominant interstitial nephritis is a rare manifestation of SLE. The prognostic importance of histopathological tubulointerstitial (TIC) changes in renal tissue in patients with lupus nephritis (LN) is very little known. Objectives Our objectives were to more precisely determine TIC in the renal tissue and correlate these data with clinical features, daily proteinuria and 24-hour creatinine clearance in pts with LN. Our long-term goal is to identify pts during clinical quiescence who may be at high risk of developing progression to renal failure from LN. Methods Renal biopsies from 26 pts were analysed with emphasis on TIC. At the time of biopsy all pts had defined clinical evidence of active LN. Presence and intensity of oedema, inflammatory mononuclear infiltrate, fibrosis, hyaline casts and tubular atrophy were determined. TIC were graded from 0 to 3 (absent, mild, moderate and severe). We correlated these results with clinical data of 24-hour creatinine clearance (CC) and 24-hour urine total protein excretion (TP) at pre-treatment and post-treatment period. Results Patients were divided into 4 group: first group with absent TIC (0 score) 6 pts with TP mean 2.17 gr/24 h, CC mean 1.32 ml/s; second group with mild TIC (1–5 score), 12 pts with TP mean 2.61 gr/24 h, CC mean 0.76 ml/s; third group with moderate TIC (6 do 10 score) 5 pts with TP mean 2.67 gr/24 h, CC 0.95 ml/s; forth group with severe TIC (11 to 15 score) 3 pts with TP mean 1.52, CC mean 0.37 ml/s. These analyses we repeated after treatment with corticosteroids and citotoxyc drugs at period of 3 to 6 months and correlated with previous data. Significant results occurred for TP in first group (p < 0.05) and in second group (p < 0.01), as well as in second group for CC (p < 0.05). Significant improvement for both parameters occurred in group of 12 pts with mild TIC. (TP p < 0.01; CC p < 0.05). In group of pts with severe TIC, TP has decreased as well as CC. Conclusion TP decrease as well as increase of CC correlated well with mild degree of TIC. TIC could be prognostic predictors in LN. This has to be proved with a greater number of pts.

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.

observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules, subepithelial capillary network