Acute pancreatitis

Acute pancreatitis is characterized by the occurrence of necroinflammatory changes in the pancreas. Three types of necrosis may be distinguished: (1) interstitial tissue necrosis, which subsequently may also involve acinar and ductal cells, (2) ductal necrosis, and (3) acinar necrosis. The first type of necrosis is autodigestive in nature and is typical of the most common forms of acute pancreatitis, which are associated with alcohol, bile duct disease, metabolic conditions, and other rare factors. Clinically, these types of pancreatitis may be either mild or severe (Atlanta classification). The mild form is also known as edematous pancreatitis, because there is edematous swelling of the pancreas combined with tiny foci of interstitial (fat) necrosis. Severe or necrotizing pancreatitis shows large areas of often hemorrhagic necrosis of the pancreatic and particularly the peripancreatic tissue. The ductal type of necrosis is rare and may be seen in pancreatitis associated with prolonged circulatory failure. The acinar type of necrosis is caused by infectious agents. Complications of acute pancreatitis, such as pseudocyst, bleeding, and infection, determine the course of the disease.     

Acute pancreatitis in general practice

During an eight-year period, 13 patients suffering from acute pancreatitis were seen in a three-doctor rural practice. The incidence was greater than most published hospital series would suggest. With one unusual exception, all the cases were mild, in that there were no complications or fatalities. In some of the patients the clinical features were such that the diagnosis might have been overlooked. Eight of the patients were managed at home. There was a strong association with biliary tract disease.     

Acute pancreatitis in sickle cell crisis

A case of acute pancreatitis, complicated by pseudocyst formation, is described in a patient with sickle cell crisis. The differential diagnosis is discussed and the literature reviewed.     

Acute pancreatitis in dengue hemorrhagic fever

We reported a case of acute pancreatitis as the complication of dengue hemorrhagic fever (DHF). This complication can cause more severe fatal condition, and difficulties in treatment, although it is rare. Dengue hemorrhagic fever (DHF) is one of the endemic diseases and often come as an outbreak event in South East Asia including Indonesia. Dengue hemorrhagic fever (DHF) is a global public health problem, because until now there has been no medicine to eradicate the dengue virus, no dengue vaccine and difficult to eradicate the mosquitoes as the contagious vector. Diagnosis and treatment of acute pancreatitis as early as possible is important to improve the patient's condition and survival. The patient was a 59 year old male and had been treated conservatively. The patient was admitted to the hospital, oral fasting until the fourth day, given parenteral nutrition, antibiotic and other intravenous medicines. Initial oral liquid diet was given on the fifth day of hospitalization and changed gradually according to the condition. The patient was then improved and discharged from the hospital.     

Acute pancreatitis with cytomegalovirus infection

An autopsy case of necrotizing pancreatitis with cytomegalovirus (CMV) infection is reported. A 50-year-old housewife was admitted because of malignant choroid plexus papilloma of the fourth ventricle. Serum amylase transiently elevated during irradiation and chemotherapy for brain tumor, one month before death. The patient died of a respiratory failure. At autopsy focal necrosis was mainly observed in the peripancreatic adipose tissue and occasionally in the parenchyma of the tail. Fibrosis and inflammatory infiltration was found around the necrosis and interstitium. Cytomegalic cells with intranuclear inclusions and/or cytoplasmic granules were observed frequently in the acini near the necrosis. Immunohistological study revealed CMV antigen in the cytomegalic cells. Herpesvirus-type particles were observed in the nucleus and cytoplasm of the cytomegalic cells. CMV infection of the acini are thought to cause necrotic changes in the pancreas.     

综合医院医生心理健康状况调查

目的：了解综合医院医生心理健康状况.方法：采用症状自评量表（SCL-90）调查了综合医院的328名医生.结果：综合医院的医生中至少1个因子平均分大于3分者占27.74%;综合医院医生的SCL-90各因子得分除恐怖因子外,其他因子分均高于国内正常人的水平,差异均有显著性（P＜0.05）;女医生在躯体化、人际敏感、抑郁、焦虑、敌意、偏执因子上的得分均高于男医生,男医生在强迫因子上的得分高于女医生,且差异都具有显著性（P＜0.05）;急诊科和外科医生的SCL-90各因子得分明显高于内科和精神科医生.结论：综合医院的医生尤其是急诊科和外科医生存在明显的心理卫生问题,应该引起社会的重视.     

综合性医院老年病人抑郁症状的调查分析

目的 :分析综合性医院老年病人的抑郁症状特征及影响因素。方法 :应用中文版流调用抑郁量表 (CES -D) ,调查同济医院住院和门诊的 3 15例老年患者 (年龄≥ 60岁 )。结果 :①在 3 15例老人患者中 ,共有 70例老年患者 (占 2 2 2 % )肯定有抑郁症状 ,5 3例 (16 8% )可能存在抑郁症状 ;②CES -D总分女性组明显高于男性组 (t=2 0 3 2 ,P <0 0 1) ,且教育程度越低抑郁症状越明显 (F =3 75 6,P <0 0 1) ;③CES -D总分的多元逐步回归分析提示所有被调查老人及内科组老人的CES -D总分明显受其教育程度的影响。结论 :在综合性医院对老年病人进行抑郁症状的常规筛查是必要的