Layer P.,Israelitic Hospital in Hamburg |
Bronisch H.-J.,Katholisches Krankenhaus St. Nepomuk |
Henniges U.M.,Israelitic Hospital in Hamburg |
Koop I.,Amalie Sieveking Krankenhaus |
And 5 more authors.
Pancreas | Year: 2011
Objectives: Intravenous local anesthetics may ameliorate pain and clinical course in patients with major abdominal surgery. Aim: To investigate their effects in acute pancreatitis. Methods: Forty-six consecutive patients with acute pancreatitis randomly received intravenous procaine (2 g/24 h) or placebo for 72 hours in a double-blind fashion. Pain severity (visual analog scale, 0-100), on-demand pain medication (metamizole and/or buprenorphine), and the clinical course were monitored every 24 hours. Results: Data of 44 patients were subjected to intention-to-treat analysis. Although there were no differences between groups before treatment, procaine treatment was associated with a stronger decrease in pain compared with placebo (median visual analog scale decrement, -62 vs -39, P = 0.025). Moreover, there was a greater proportion of patients with adequate (≥67%) pain reduction (75% vs 43%, P = 0.018), less use of additional analgesics (P = 0.042), and overall analgesic superiority (P = 0.015). Compared with placebo, the proportion of patients hospitalized after 2 weeks was reduced by 80% after procaine treatment (P = 0.012). Conclusions: These findings support the hypothesis that systemic administration of local anesthetics might improve pain and accelerate clinical recovery in acute pancreatitis. Copyright © 2011 by Lippincott Williams & Wilkins.
Keller J.,Israelitic Hospital in Hamburg |
Bruckel S.,Israelitic Hospital in Hamburg |
Jahr C.,Israelitic Hospital in Hamburg |
Layer P.,Israelitic Hospital in Hamburg
Pancreas | Year: 2011
Objectives: The noninvasive 13C-mixed triglyceride breath test (13C-MTG-T) has been shown to diagnose severe pancreatic exocrine insufficiency reliably. We hypothesized that sensitivity of the test could be increased by strict limitation of physical activity, correction for gastric emptying velocity, and/or increased lipid dose. Methods: In 10 healthy volunteers and 9 patients with suspected pancreatic disease, a secretin test, a modified 13C-MTG-T (250 mg C-MTG, 26 g fat, breath samples over 8 hours), and a 13C-octanoic acid gastric emptying test were performed. Subjects remained strictly seated during breath testing. Results: Intravenously administered secretin 1 U/kg•h stimulated outputs of all enzymes significantly. Mean basal and stimulated enzyme outputs were similar in patients and healthy controls; however, compared with normal values, 5 patients and 1 control had moderately decreased lipase output. Cumulative 4-, 6-, and 8-hour 13C exhalation was significantly lower in patients than in controls. Sensitivity of 13C-MTG-T (6-h cumulative 13C exhalation <27% of dose) for detection of decreased lipase output was 100%; specificity was 92%. Gastric emptying parameters were similar in patients and controls, and correction for these did not improve accuracy of C-MTG-T. Conclusions: The modified 13C-MTG-T detects moderate pancreatic exocrine insufficiency. © 2011 Lippincott Williams & Wilkins.