Santiago Gil

Validation of the determinant-based classification and revision of the Atlanta classification systems for acute pancreatitis.

BACKGROUND & AIMS Two new classification systems for the severity of acute pancreatitis (AP) have been proposed, the determinant-based classification (DBC) and a revision of the Atlanta classification (RAC). Our aim was to validate and compare these classification systems. METHODS We analyzed data from adult patients with AP (543 episodes of AP in 459 patients) who were admitted to Hospital General Universitario de Alicante from December 2007 to February 2013. Imaging results were reviewed, and the classification systems were validated and compared in terms of outcomes. RESULTS Pancreatic necrosis was present in 66 of the patients (12%), peripancreatic necrosis in 109 (20%), walled-off necrosis in 61 (11%), acute peripancreatic fluid collections in 98 (18%), and pseudocysts in 19 (4%). Transient and persistent organ failures were present in 31 patients (6%) and 21 patients (4%), respectively. Sixteen patients (3%) died. On the basis of the DBC, 386 (71%), 131 (24%), 23 (4%), and 3 (0.6%) patients were determined to have mild, moderate, severe, or critical AP, respectively. On the basis of the RAC, 363 patients (67%), 160 patients (30%), and 20 patients (4%) were determined to have mild, moderately severe, or severe AP, respectively. The different categories of severity for each classification system were associated with statistically significant and clinically relevant differences in length of hospital stay, need for admission to the intensive care unit, nutritional support, invasive treatment, and in-hospital mortality. In comparing similar categories between the classification systems, no significant differences were found. CONCLUSION The DBC and the RAC accurately classify the severity of AP in subgroups of patients.

Usefulness of surveillance programmes for early diagnosis of hepatocellular carcinoma in clinical practice.

Background/Aims: Surveillance programmes (SPs) for hepatocellular carcinoma (HCC) in patients with cirrhosis intend to diagnose the tumour in its early stages when an effective therapy can be applied. The aims of this study have been to compare the survival of patients with HCC being diagnosed or not in SPs, and to establish a more accurate profile of the best target population.

Successful Endovascular Treatment of a Large Idiopathic Azygos Arch Aneurysm

Idiopathic azygos vein aneurysms are rare and typically present as incidentally discovered mediastinal masses. Treatment is advisable when the aneurysm enlarges or is complicated by compression symptoms, rupture, or thromboembolic disease. The authors describe successful endovascular treatment of a symptomatic azygos vein aneurysm by means of embolization with coils at the azygos vein close to the dilated arch but respecting the bulb itself. The patient reported symptoms of cough, wheezing, and persistent hiccups, and the procedure resulted in thrombosis of the azygos vein and aneurysm retraction on imaging, accompanied by resolution of symptoms.