Natália Lásztity

Protein status in pancreatitis--transthyretin is a sensitive biomarker of malnutrition in acute and chronic pancreatitis.

Abstract Malnutrition may develop in acute pancreatitis (AP), accompanied by hypermetabolism and high nutritional requirements, and in chronic pancreatitis (CP). We measured the incidence of protein malnutrition in AP and CP by comparing different serum biomarkers of protein metabolism and inflammation. Thirty-five patients with acute (27 moderate, 8 severe), and 35 with chronic, pancreatitis were enrolled in the study. Serum transthyretin, albumin, transferrin and C-reactive protein (CRP) concentrations were measured in AP at admission, after 1 and 2 weeks of jejunal feeding, and in patients with CP at follow-up. In AP, at admission the transthyretin level was low in 74%, transferrin in 48%, and albumin in 29% of patients. In severe pancreatitis, transthyretin levels were significantly lower than in moderate forms (7.5±2.43 vs. 14.39±6.8 mg/dl, p<0.005). Transthyretin levels increased significantly after 2 weeks of jejunal feeding (p<0.05). In CP, transthyretin levels were decreased in 37%, transferrin in 27%, and albumin in 12% of patients. We found significantly lower transthyretin levels in alcohol-related CP than in other forms (18.5±8.3 vs. 30.2±5.7, p<0.01). Transthyretin correlated positively with albumin and transferrin and negatively with CRP. Transthyretin seems to be a sensitive biomarker of protein status and metabolic stress. Monitoring nutritional status through measurement of serum proteins is important for optimal treatment of AP and CP.

Effects of Oligofructose Containing Diet in Obese Persons

UNLABELLED In the treatment of obesity the introduction of a low-calorie diet is a fundamental requirement. The enhancement of the fiber content of food causing satiety may contribute to the observation of dietary prescriptions. Oligofructoses belong to the group of dietary fibers. AIM To study the effects of the consumption of a low-energy diet (2,000 kcal/day) completed with Jerusalem artichoke concentrate in obese adolescents and adults. METHODS 12 obese students (6 boys and 6 girls) and 6 obese women were put on a low-calorie regimen for 12 weeks, whereas 16 obese students (10 boys and 6 girls) and 17 obese women consumed the same low-calorie diet completed with Jerusalem artichoke concentrate containing 14 g/day oligofructose. Sensation of fullness was estimated. In addition to anthropometric parameters serum biomarkers of lipid and carbohydrate metabolism and adipokines were determined. RESULTS The consumption of the low-calorie diet completed with Jerusalem artichoke concentrate resulted in a diminished sensation of hunger. Body mass index and body fat percentage decreased significantly. In girls and women, the serum levels of triglycerides were also significantly reduced and the rate of insulin resistance estimated on the basis of homeostasis model assessment was also improved. CONCLUSIONS The results of this pilot study appear to demonstrate that the Jerusalem artichoke concentrate produced by a new technology can be a promising component of future diet therapy.

Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group

Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group

Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

Pancreatic cancer. Evidence based management guidelines of the Hungarian Pancreatic Study Group

A pancreasrak gyakran kesőn diagnosztizalt korkep, amely a legrosszabb korlefolyasu betegsegek csoportjaba sorolhato, ezert a szűrese, diagnosztikaja, kezelese es palliacioja korszerű es bizonyitekokon alapulo utmutatot igenyel. A Magyar Hasnyalmirigy Munkacsoport celul tűzte ki, hogy a jelenleg elerhető nemzetkozi iranyvonalakat, illetve evidenciakat alapul veve a pancreasrak kezelesenek kulcskerdesei vonatkozasaban bizonyitek alapu iranyelveket fogalmazzon meg. A Magyar Hasnyalmirigy Munkacsoport altal kijelolt előkeszitő es konzulens munkacsoport leforditotta, es ahol szuksegesnek talalta, kiegeszitette es/vagy modositotta a nemzetkozi iranyelveket. Osszesen 10 temakorben (Rizikofaktorok es genetika, Szűres, Diagnozis, Staging, Sebeszi kezeles, Patologiai feldolgozas, Szisztemas kezeles, Sugarterapia, Palliacio es szupportiv kezeles, Utankovetes es rekurrencia) 37 relevans iranyelv kerult osszeallitasra. Az evidencia osztalyozasa a National Comprehensive Cancer Network (NCCN) rendszere alapjan kerult meghatarozasra. Az osszeallitott iranyelvek a 2014. szeptember 12-ei konszenzustalalkozon kerultek bemutatasra es megvitatasra. A resztvevők 15 iranyelvet teljes (95% feletti) egyetertessel, mig 22 iranyelvet erős (70% feletti) egyetertessel fogadtak el. A Magyar Hasnyalmirigy Munkacsoport kezelesi iranyelvei az első, bizonyitek alapjan keszult pancreasrak-kezelesi utmutato hazankban. Az iranyelv komoly segitseget nyujthat a pancreasrak oktatasahoz, a mindennapi betegellatashoz es a megfelelő finanszirozas kialakitasahoz. Ezert a szerzők biznak abban, hogy ezen iranyelvek minel szelesebb korben alapreferenciakent fognak szolgalni Magyarorszagon. Orv. Hetil., 2015, 156(8), 326–339.Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

Pain in the Early Phase of Pediatric Pancreatitis (PINEAPPLE Trial): Pre-Study Protocol of a Multinational Prospective Clinical Trial

Background: There are unexpectedly large differences between the incidences of acute pancreatitis (AP) as indicated by different hospitals. Retrospective studies suggest that the reason behind this is the large differences that exist between the local managements of abdominal pain at emergency units. Unfortunately, no evidence-based medicine (EBM) guidelines are available to give proper instruction concerning the necessity of serum pancreatic enzyme measurement during abdominal pain. Summary: Pain in Early Phase of Pediatric Pancreatitis (PINEAPPLE) is an observational, multinational observational clinical trial to explore the route from the first sign of abdominal pain to the diagnosis of pancreatitis (PINEAPPLE trial). The PINEAPPLE-R subtrial is a retrospective review on the records of children (patients under 18) appearing at emergency units - a review of their clinical symptoms, results of imaging examinations and laboratory parameters. The PINEAPPLE-P subtrial is a prospective trial designed to develop a fast and simple EBM guideline that helps to evaluate (in a reliable and cost-efficient way) the necessity of pancreatic enzyme test and abdominal ultrasonography (or even computed tomography) when a child has abdominal pain. The trial has been registered at the ISRCTN registry and has received the relevant ethical approval. Key Message: The PINEAPPLE trial will help to recognize AP in children in a highly efficient manner.

Autoimmun pancreatitis. A Magyar Hasnyálmirigy Munkacsoport bizonyítékon alapuló kezelési irányelvei

Az autoimmun pancreatitis ritka megbetegedes, amely megjeleneseben akar hasnyalmirigy-daganatot utanozhat, azonban ez utobbival ellentetben nem műteti, hanem gyogyszeres kezelest igenyel. A betegseg korrekt diagnozisa, differencialdiagnosztikaja es a betegek megfelelő kezelese korszerű es bizonyitekokon alapulo kezelesi utmutatot igenyel. A Magyar Hasnyalmirigy Munkacsoport celul tűzte ki, hogy a jelenleg elerhető nemzetkozi iranyvonalakat, illetve evidenciakat alapul veve az autoimmun pancreatitis kezelesenek kulcskerdesei vonatkozasaban bizonyitekalapu iranyelveket fogalmazzon meg. A Magyar Hasnyalmirigy Munkacsoport altal kijelolt előkeszitő es konzulens munkacsoport leforditotta, es ahol szuksegesnek talalta, kiegeszitette es/vagy modositotta a nemzetkozi iranyelveket. Osszesen 4 temakorben (Alapok, Diagnozis, Differencialdiagnosztika, Terapia) 29 relevans kerdest allitott ossze. Az evidencia osztalyozasat az UpToDate ® rendszere alapjan hatarozta meg. Az osszeallitott iranyelvek a 2014. szeptember 12-ei konszenzustalalkozon kerultek bemutatasra es megvitatasra. A resztvevők minden kerdest csaknem teljes (95% feletti) egyetertessel fogadtak el. A Magyar Hasnyalmirigy Munkacsoport kezelesi iranyelvei az első, bizonyitek alapjan keszult autoimmun pancreatitis kezelesi utmutato hazankban. Az iranyelv komoly segitseget nyujthat az autoimmun pancreatitis oktatasahoz, a mindennapi betegellatashoz es a megfelelő finanszirozas kialakitasahoz. Ezert a szerzők biznak abban, hogy ezen iranyelvek minel szelesebb korben alapreferenciakent fognak szolgalni Magyarorszagon. Orv. Hetil., 2015, 156(8), 292–307.

Is there a unique measuring method to assess obesity

UNLABELLED In the literature there is not available a uniformly accepted method for assessing the degree of obesity. AIM To determine how far insulin resistance, serum levels of leptin and resistin are altered in persons categorized on the basis of body-mass index (BMI), body fat percentage, and abdominal circumference. METHODS 101 volunteer boys and 115 girls participated in the studies. Body height was measured, body mass, abdominal circumference, and body composition were determined by InBody3 bioimpedance instrument. Body mass index and body fat percentage were calculated by the instrument. Concentrations of serum glucose, insulin, leptin, and resistin were determined. Insulin resistance was calculated using the homeostasis model: HOMA IR . RESULTS Body fat percentage, serum levels of leptin and resistin were significantly higher in girls than in boys. Increases in BMI, body fat percentage, and abdominal circumference were associated with the significant elevation of both HOMA IR and serum leptin concentrations. In overweight boys categorized by body fat percentage as obese the serum leptin concentrations were significantly higher than in their non-obese counterparts. CONCLUSION Determination of body composition would be important concerning the follow-up of biochemical changes occurring in the body during the course of both epidemiological studies and nutritional interventions.

Pancreasrák. A Magyar Hasnyálmirigy Munkacsoport bizonyítékon alapuló kezelési irányelvei

A pancreasrak gyakran kesőn diagnosztizalt korkep, amely a legrosszabb korlefolyasu betegsegek csoportjaba sorolhato, ezert a szűrese, diagnosztikaja, kezelese es palliacioja korszerű es bizonyitekokon alapulo utmutatot igenyel. A Magyar Hasnyalmirigy Munkacsoport celul tűzte ki, hogy a jelenleg elerhető nemzetkozi iranyvonalakat, illetve evidenciakat alapul veve a pancreasrak kezelesenek kulcskerdesei vonatkozasaban bizonyitek alapu iranyelveket fogalmazzon meg. A Magyar Hasnyalmirigy Munkacsoport altal kijelolt előkeszitő es konzulens munkacsoport leforditotta, es ahol szuksegesnek talalta, kiegeszitette es/vagy modositotta a nemzetkozi iranyelveket. Osszesen 10 temakorben (Rizikofaktorok es genetika, Szűres, Diagnozis, Staging, Sebeszi kezeles, Patologiai feldolgozas, Szisztemas kezeles, Sugarterapia, Palliacio es szupportiv kezeles, Utankovetes es rekurrencia) 37 relevans iranyelv kerult osszeallitasra. Az evidencia osztalyozasa a National Comprehensive Cancer Network (NCCN) rendszere alapjan kerult meghatarozasra. Az osszeallitott iranyelvek a 2014. szeptember 12-ei konszenzustalalkozon kerultek bemutatasra es megvitatasra. A resztvevők 15 iranyelvet teljes (95% feletti) egyetertessel, mig 22 iranyelvet erős (70% feletti) egyetertessel fogadtak el. A Magyar Hasnyalmirigy Munkacsoport kezelesi iranyelvei az első, bizonyitek alapjan keszult pancreasrak-kezelesi utmutato hazankban. Az iranyelv komoly segitseget nyujthat a pancreasrak oktatasahoz, a mindennapi betegellatashoz es a megfelelő finanszirozas kialakitasahoz. Ezert a szerzők biznak abban, hogy ezen iranyelvek minel szelesebb korben alapreferenciakent fognak szolgalni Magyarorszagon. Orv. Hetil., 2015, 156(8), 326–339.Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

Pancreasrák. A Magyar Hasnyálmirigy Munkacsoport bizonyítékon alapuló kezelési irányelvei @@@Pancreatic cancer. Evidence based management guidelines of the Hungarian Pancreatic Study Group

A pancreasrak gyakran kesőn diagnosztizalt korkep, amely a legrosszabb korlefolyasu betegsegek csoportjaba sorolhato, ezert a szűrese, diagnosztikaja, kezelese es palliacioja korszerű es bizonyitekokon alapulo utmutatot igenyel. A Magyar Hasnyalmirigy Munkacsoport celul tűzte ki, hogy a jelenleg elerhető nemzetkozi iranyvonalakat, illetve evidenciakat alapul veve a pancreasrak kezelesenek kulcskerdesei vonatkozasaban bizonyitek alapu iranyelveket fogalmazzon meg. A Magyar Hasnyalmirigy Munkacsoport altal kijelolt előkeszitő es konzulens munkacsoport leforditotta, es ahol szuksegesnek talalta, kiegeszitette es/vagy modositotta a nemzetkozi iranyelveket. Osszesen 10 temakorben (Rizikofaktorok es genetika, Szűres, Diagnozis, Staging, Sebeszi kezeles, Patologiai feldolgozas, Szisztemas kezeles, Sugarterapia, Palliacio es szupportiv kezeles, Utankovetes es rekurrencia) 37 relevans iranyelv kerult osszeallitasra. Az evidencia osztalyozasa a National Comprehensive Cancer Network (NCCN) rendszere alapjan kerult meghatarozasra. Az osszeallitott iranyelvek a 2014. szeptember 12-ei konszenzustalalkozon kerultek bemutatasra es megvitatasra. A resztvevők 15 iranyelvet teljes (95% feletti) egyetertessel, mig 22 iranyelvet erős (70% feletti) egyetertessel fogadtak el. A Magyar Hasnyalmirigy Munkacsoport kezelesi iranyelvei az első, bizonyitek alapjan keszult pancreasrak-kezelesi utmutato hazankban. Az iranyelv komoly segitseget nyujthat a pancreasrak oktatasahoz, a mindennapi betegellatashoz es a megfelelő finanszirozas kialakitasahoz. Ezert a szerzők biznak abban, hogy ezen iranyelvek minel szelesebb korben alapreferenciakent fognak szolgalni Magyarorszagon. Orv. Hetil., 2015, 156(8), 326–339.Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.