BACKGROUND: Acute pancreatitis remains a common presentation to acute surgical units and carries significant morbidity and mortality. The progression of the disease to necrotizing pancreatitis and multi-organ dysfunct...BACKGROUND: Acute pancreatitis remains a common presentation to acute surgical units and carries significant morbidity and mortality. The progression of the disease to necrotizing pancreatitis and multi-organ dysfunction syndrome (MODS) is associated with a very poor clinical outcome, and persistendy high mortality. Increases in serum endothelin (ET) have been seen in animal models of acute pancreatitis and this study aims to investigate whether there is a change in serum ET-1 in patients with acute pancreatitis and whether any such change is linked to disease severity. METHODS: All patients admitted with acute pancreatitis were prospectively recruited from die emergency admissions at the Norfolk and Norwich University Hospital. Serum ET levels were determined on admission, at 24 hours and 5 days post admission. Healthy adult controls were recruited from dermatology outpatients. RESULTS: A total of 21 patients joined the trial after giving informed consent. There were 3 men and 18 women with a median age of 65 years (range 26-87 years). Serum ET levels were significantly higher in acute pancreatitis patients than in normal controls (P <0. 05). An association was seen between persistendy raised serum ET levels and progression to MODS. CONCLUSIONS: The study does demonstrate a correlation between the circulating levels of ET and acute pancreatitis in humans, although it does not elicit its involvement in the pathogenesis of the disease. The observation that a persistendy high level of circulating ET-1 is associated with progression to MODS may indicate a role for ET in the monitoring of acute pancreatitis patients for recovery or progression to MODS.展开更多
Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to h...Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.展开更多
The HINT project is a four-country collective of Global heritage interpretation. HINT is a two-year project part funded Geoparks researching the uses and benefits of new technologies in by the European Leader Programm...The HINT project is a four-country collective of Global heritage interpretation. HINT is a two-year project part funded Geoparks researching the uses and benefits of new technologies in by the European Leader Programme. The partners are Geopark Shetland （Scotland）, Chablais Geopark （France）, North Pennines Area of Outstanding Natural Beauty （England） and Geopark de Hondsrug （The Netherlands）. Each partner has developed a pilot project to investigate the practicalities of interpreting and communicating heritage, especially geological heritage, using a particular technology. An overview of each of the four pilot projects is given. The overall aim of the pilot projects is to develop best practice in using new technologies for heritage interpretation and to share information and ideas within the project partnership and with geoparks and heritage organizations around the world. This paper, developed by the HINT partners, aims to give an insight into the practical process of developing interpretive tools using new technologies. Some common problems are highlighted and some ways in which these can be addressed are shown.展开更多
基金GI Research fund, Department of Upper GI Surgery,Norfolk and Norwich University Hospital NHS Trust.
文摘BACKGROUND: Acute pancreatitis remains a common presentation to acute surgical units and carries significant morbidity and mortality. The progression of the disease to necrotizing pancreatitis and multi-organ dysfunction syndrome (MODS) is associated with a very poor clinical outcome, and persistendy high mortality. Increases in serum endothelin (ET) have been seen in animal models of acute pancreatitis and this study aims to investigate whether there is a change in serum ET-1 in patients with acute pancreatitis and whether any such change is linked to disease severity. METHODS: All patients admitted with acute pancreatitis were prospectively recruited from die emergency admissions at the Norfolk and Norwich University Hospital. Serum ET levels were determined on admission, at 24 hours and 5 days post admission. Healthy adult controls were recruited from dermatology outpatients. RESULTS: A total of 21 patients joined the trial after giving informed consent. There were 3 men and 18 women with a median age of 65 years (range 26-87 years). Serum ET levels were significantly higher in acute pancreatitis patients than in normal controls (P <0. 05). An association was seen between persistendy raised serum ET levels and progression to MODS. CONCLUSIONS: The study does demonstrate a correlation between the circulating levels of ET and acute pancreatitis in humans, although it does not elicit its involvement in the pathogenesis of the disease. The observation that a persistendy high level of circulating ET-1 is associated with progression to MODS may indicate a role for ET in the monitoring of acute pancreatitis patients for recovery or progression to MODS.
文摘Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.
文摘The HINT project is a four-country collective of Global heritage interpretation. HINT is a two-year project part funded Geoparks researching the uses and benefits of new technologies in by the European Leader Programme. The partners are Geopark Shetland （Scotland）, Chablais Geopark （France）, North Pennines Area of Outstanding Natural Beauty （England） and Geopark de Hondsrug （The Netherlands）. Each partner has developed a pilot project to investigate the practicalities of interpreting and communicating heritage, especially geological heritage, using a particular technology. An overview of each of the four pilot projects is given. The overall aim of the pilot projects is to develop best practice in using new technologies for heritage interpretation and to share information and ideas within the project partnership and with geoparks and heritage organizations around the world. This paper, developed by the HINT partners, aims to give an insight into the practical process of developing interpretive tools using new technologies. Some common problems are highlighted and some ways in which these can be addressed are shown.
