The harmless acute pancreatitis score (HAPS) identifies non-severe patients: A systematic review and meta-analysis.

Introduction: We previously described a scoring system to identify patients with harmless acute pancreatitis as defined by absence of pancreatic necrosis, no need for artificial ventilation or dialysis, and non-fatal course. This scoring system, the Harmless Acute Pancreatitis Score (HAPS), can be quickly calculated from three parameters: absence of abdominal tenderness or rebound, normal hematocrit and normal creatinine level. We aim to assess the positive predictive value (PPV) of the HAPS by performing a meta-analysis of subsequently published studies.

The Duesseldorf warning signs for primary immunodeficiency: is it time to change the rules?

Objective: Different sets of warning signs can be used if primary immunodeficiency (PID) is suspected: those of the Jeffrey Modell Foundation (JMF), the German Patients' Organisation for Primary Immunodeficiencies (DSAI) and the Association of the Scientific Medical Societies in Germany (AWMF). A few studies have tested the JMF criteria, with unconvincing results, but the diagnostic models of the DSAI and AWMF have not been tested at all. We set out to establish the utility of these three scoring systems and compare them with our own set of five warning signs (Duesseldorf criteria).

Acute pancreatitis.

Acute pancreatitis, an inflammatory disorder of the pancreas, is the leading cause of admission to hospital for gastrointestinal disorders in the USA and many other countries. Gallstones and alcohol misuse are long-established risk factors, but several new causes have emerged that, together with new aspects of pathophysiology, improve understanding of the disorder. As incidence (and admission rates) of acute pancreatitis increase, so does the demand for effective management.

Genotype-phenotype and genotype-origin correlations in children with mediterranean fever in Germany - an AID-net study.

Familial Mediterranean fever (FMF) is the most inherited common autoinflammatory disease (AID) with mutations in the MEFV (MEditerraneanFeVer) gene.The Mor- and Pras-Score modified for children and C-reactive protein (CRP) were used to assess FMF disease severity in Germany. We evaluate the applicability of the 2 severity scores and the correlations between ethnic origin, phenotype, and genotype.

COL2A1 mutation as a cause of premature osteoarthritis in a 13-year-old child.

Diagnostic assessment of osteoarthritis in children and adolescents is difficult. Here, we report the sixth family with a COL2A1 mutation R275C. The index patient, her mother and her three brothers had severe coxarthrosis, in some cases requiring surgery.

Agammaglobulinemia and lack of immunization protection in exudative atopic dermatitis.

Unlabelled: Atopic dermatitis is very frequent in the first 6 months of life, and the severe exudative form of this skin disorder is by no means rare. Failure to achieve immunization protection is a potentially life-threatening complication of exudative atopic dermatitis that may go unrecognized. We report the case of a 6-month-old infant with severe exudative atopic dermatitis in whom hypoproteinemia and agammaglobulinemia were attributed to the massive exudation after exclusion of other possible causes.

Pancreatic pseudocysts: prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis.

Background And Aim: Previous studies on the development of pancreatic pseudocysts following acute pancreatitis were monocentric, mostly retrospective, did not fulfil the Atlanta criteria, and featured a mixture of patients with post-acute and chronic pancreatitis. Therefore, the natural course of pancreatic pseudocysts after acute pancreatitis and the reasons for their spontaneous resolution remain unknown.

Methods: This prospective study of 369 patients investigated the prognostic factors for development of pancreatic pseudocysts and for their spontaneous resolution after a first episode of acute pancreatitis.

Association of nephrotic syndrome with immune reconstitution inflammatory syndrome.

Background: Up to 50% of patients with severe immune deficiency experience an excessive inflammatory response called immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy (ART). IRIS has been observed after various opportunistic infections with pathogens such as mycobacteria, including Bacille Calmette-Guérin, cryptococci, human herpesvirus-8, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. Non-acquired immune deficiency-defining illnesses can also deteriorate after commencement of ART.

Exocrine pancreatic function in patients with end-stage renal disease.

Aim: malnutrition is a common problem in patients with end-stage renal disease (ESRD). Several studies showed 30 years ago that more than half of patients with ESRD suffered from exocrine pancreatic insufficiency. However, the studies never investigated whether the functional impairments led to morphological changes of the pancreas or to steatorrhea and thus indicating the need for lifelong pancreatic enzyme substitution.

Treatment of acute pancreatitis: an attempted historical review.

This attempt at a historical review of the treatment of acute pancreatitis summarizes the findings of studies carried out in decades long past and shows their impact on the therapy of this disease today. It identifies in retrospect the correct avenues of research and the blind alleys, and describes the ebb and flow of interest in various forms of management. Acquaintance with the work of previous investigators may prevent the unnecessary rediscovery of old principles of treatment.

Follow-up endoscopy in gastroenterology: when is it helpful?

Background: The indications for follow-up endoscopy have not been established in all diseases that can be diagnosed by endoscopy.

Methods: Selective review of the literature and a survey of national guidelines.

Results: In confirmed erosive or non-erosive reflux disease, follow-up endoscopy is indicated only in the presence of complications or Barrett's esophagus.

High serum creatinine in acute pancreatitis: a marker for pancreatic necrosis?

Objectives: High serum creatinine is a well-known unfavorable prognostic parameter in acute pancreatitis. Elevated creatinine at 48 h after admission was recently described as a marker for pancreatic necrosis. As pancreatic necrosis is a serious complication of acute pancreatitis and its identification by a simple single laboratory test would be very helpful, the aim of this study was to test that statement.

Natural history of acute pancreatitis: a long-term population-based study.

Objectives: It is unknown whether after an initial attack of acute pancreatitis, the inflamed gland heals completely, or whether and under what circumstances the disease progresses to chronic pancreatitis. Therefore, the aim of this study was to investigate the progression of disease from acute to chronic pancreatitis.

Methods: During a 20-year period, 532 patients who were hospitalized after an initial attack of acute pancreatitis were followed up for an average of 7.

Secretion and absorption (methods and functions).

With the development and wide availability of endoscopic procedures, the importance of secretion and absorption tests for the diagnosis of gastrointestinal diseases has decreased. Still, only in about half of the patients with abdominal complaints an organic cause can be established by imaging techniques and/or conventional laboratory tests. In the other patients diagnosis may partly be clarified by gastrointestinal function tests.

Temporal trends in incidence and severity of acute pancreatitis in Lüneburg County, Germany: a population-based study.

Background/aims: Several European studies have reported an increase in acute pancreatitis. Therefore, we decided to investigate whether acute pancreatitis in one area of Germany also displays changes in frequency, etiology, and severity over time.

Methods: The study included 608 patients with a first attack of acute pancreatitis, all from Lüneburg County, northern Germany, admitted to the Municipal Hospital of Lüneburg between 1987 and 2006.

The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease.

Background & Aims: Only severe acute pancreatitis requires treatment, according to the principles of intensive care medicine in an intensive care or intermediate care unit. The aim of the study was to define and evaluate a simple clinical algorithm for rapid initial identification of patients with a first attack of acute pancreatitis who do not require intensive care.

Methods: This prospective study included 394 patients who were admitted to the Municipal Clinic of Lüneburg, Germany, between 1987 and 2003.

Hyperamylasaemia and/or hyperlipasaemia: incidence and underlying causes in hospitalized patients with non-pancreatic diseases.

Objective: There are no recommendations on how to proceed in patients with increased pancreatic enzyme activities but non-pancreatic diseases. The objective of this study was to investigate prospectively in a general medical hospital the incidence, causes and clinical impact of hyperamylasaemia and/or hyperlipasaemia in these patients.

Material And Methods: During a 4-month period in 2004, amylase and lipase activities were measured in all patients (n, 1765) admitted to the Department of Internal Medicine of the Municipal Clinic of Lüneburg, Germany.