Feasibility of minimally invasive approaches in patients with infected necrotizing pancreatitis

BACKGROUND: Minimally invasive procedures to treat infected necrotizing pancreatitis (INP) are gaining popularity. The proportion of patients suitable for this approach remains unknown. METHODS: Preoperative computed tomography (CT) scans were reviewed from 106 consecutive patients who had surgery for INP between 2000 and 2003 in 11 Dutch hospitals. Collections related to the pancreas were classified according to their distance from the left abdominal wall. Five radiologists judged 'accessibility' for drain placement and the likelihood that there was a fluid component that would drain ('drainability'). Agreement between radiologists was determined. RESULTS: CT scans of 80 (75 per cent) patients were available (59 men; age range 29-80 years). The median interval between hospital admission and preoperative CT scan was 20 days. In 55 (69 per cent) patients, the lateral border of the collection was less than 5 cm from the left abdominal wall. Placement of a drain was deemed feasible in 67 (84 (range 77-89) per cent) patients; mean(s.d.) kappa 0.428(0.096). In 45 (56 per cent) patients, a drain could be placed through the left retroperitoneum. In 43 (54 (range 49-82) per cent) patients, collections were judged to contain a drainable fluid component. Interobserver agreement on 'drainability' was poor, mean(s.d.) kappa 0.289(0.101). CONCLUSION: Most peripancreatic collections in INP were considered accessible to a minimally invasive approach.     

The band III ligand dipyridamole protects human RBCs during photodynamic treatment while extracellular virus inactivation is not affected

BACKGROUND: Recently, the potential usefulness of dipyridamole (DIP) in protecting RBCs against the harmful side effects of photodynamic sterilization was demonstrated. In the present study, the use of DIP for selective protection of RBCs was investigated under conditions more relevant for blood bank practice. STUDY DESIGN AND METHODS: WBC-reduced RBC suspensions (30% Hct) were treated with 1,9-dimethylmethylene blue and red light, and the influence of the inclusion of DIP on photohemolysis was assessed as a function of sensitizer concentration, light dose, and storage time. Furthermore, the possible interference of DIP with inactivation of extracellular virus by use of a panel of different viruses (HIV-1, pseudorabies virus [PRV], bovine viral diarrhea virus [BVDV], VSV, encephalomyocarditis, and canine parvovirus) was investigated. RESULTS: In WBC-reduced RBC suspensions (30% Hct), DIP exerted a clear protective effect against photohemolysis. Part of this protection was achieved with concentrations near the dissociation constant for band III binding. Importantly, efficiency of inactivation of extracellular HIV-1, PRV, BVDV, and VSV was not significantly impaired by the inclusion of DIP. Phototreatment conditions, resulting in a 4 to 5 log inactivation of extracellular HIV-1 and PRV, resulted in a high level of hemolysis after 28 days of storage. This long-term hemolysis could be decreased, but not completely prevented, by the inclusion of DIP. CONCLUSION: Photohemolysis in RBC concentrates can be reduced substantially by the application of DIP, while the efficacy of inactivation of HIV-1 and other viruses remains unchanged.