Systemic Complications In Patients Research Articles

Current specific immunotherapy for allergic rhinitis: perspectives from otorhinolaryngologists.

Current specific immunotherapy for allergic rhinitis: perspectives from otorhinolaryngologists.

Complicaciones en pacientes sometidos a Angioplastia Coronaria Transluminal Percutánea

This research aimed to identify the local and systemic complications in patients undergoing Percutaneous Transluminal Coronary Angioplasty and risk factors that may influence the occurrence of these complications. It is a prospective cross-sectional study with a quantitative approach of the data that were collected from 127 patients in the Unit of Hemodynamic and in the Unit of Intensive Terapy of the hospital field of study. Data were analyzed using descriptive statistics. To investigate the association between risk factors and complications after Percutaneous Transluminal Coronary Angioplasty was used Chi-square test. It was observed that 79 (62.2%) patients had complications. Of these, 39 (49.4%) had local complications, 25 (31.7%) systemic complications and 15 (18.9%) had associated local and systemic complications. There was a statistically significant association (p<0,05) between the continuous use of anticoagulants after Percutaneous Transluminal Coronary Angioplasty and presence of complications. It was evident that most of the patients had complications and use of anticoagulant after the procedure is associated with these complications.

The impact of major operative fractures in blunt abdominal injury

Abdominal injury has been shown to be an independent risk factor for pulmonary complications in patients with extremity injuries. We propose to characterize orthopedic patients with severe abdominal trauma. We hypothesize that operative fractures of the thoracolumbar spine, pelvis, acetabulum, or femur increase systemic complications in patients with blunt abdominal injury. A retrospective review of patients presenting to a Level I trauma center with abdominal injury between 2000 and 2006 was performed. Adult patients between the ages of 18 years and 65 years with high-energy, blunt trauma resulting in severe abdominal injury (abdomen Abbreviated Injury Scale [AIS] score ≥ 3) and Injury Severity Score (ISS) of 18 or greater were included. Patients were divided into two comparison groups as follows: the fracture group had operative fractures of the pelvis, acetabulum, thoracolumbar spine, and/or femur, and the control group did not sustain these fractures of interest. Systemic complications were documented. Unadjusted and multivariable logistic regression analyses were performed. The control group included 91 patients, and the fracture group included 106 patients with 136 fractures of interest. With unadjusted analysis, the fracture group had more complications (34% [36 of 106] vs. 18% [16 of 91], p = 0.010), including adult respiratory distress syndrome (8% [8 of 106] vs. 1% [1 of 91], p = 0.040), and sepsis (11% [12 of 106] vs. 3% [3 of 91], p = 0.056). Logistic regression modeling demonstrates that the presence of an operative fracture increased the odds of developing at least one complication approximately three times (odds ratio, 2.88, p = 0.006), after controlling for presence of chest injury and type of injured abdominal organ. Operative fractures of the thoracolumbar spine, pelvis, acetabulum and femur increase the risk of developing systemic complications in patients with blunt abdominal injury. Further study is necessary to optimize treatment protocols for these high-risk patients.

The Role of IL-6, IL-8, IL-10, sTNFr, CRP and pancreatic elastase in the predicition of systemic complications in patients with acute pancreatitis

The Role of IL-6, IL-8, IL-10, sTNFr, CRP and pancreatic elastase in the predicition of systemic complications in patients with acute pancreatitis

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

The Role of IL-6, 8, and 10, sTNFr, CRP, and Pancreatic Elastase in the Prediction of Systemic Complications in Patients with Acute Pancreatitis

Background and Aim. Early assessment of severity in acute pancreatitis (AP) is a key measure to provide rational and effective management. The aim of our study is to determine the prognostic value of interleukins (IL) 6, 8, and 10, soluble receptor for tumor necrosis factor (sTNFr), pancreatic elastase (E1), and C-reactive protein (CRP) as predictors of systemic complications in AP. Patients and Methods. A hundred and fifty patients with confirmed AP were enrolled in the study. The severity of AP was defined according to Atlanta criteria. Measurements of interleukins and sTNFr were performed on the first day of admission. CRP and E1 levels were assessed on admission and after 48 hours. ROC analysis was performed for all parameters. Results. Interleukins and sTNFr significantly differentiated patients with systemic complications from those without. Elevation of IL-6 showed the highest significance as a predictor (P = 0.001). CRP and elastase levels did not differ between mild and severe cases on admission, but reached statistical significance when measured on the third day (P = 0.002 and P = 0.001, resp.). Conclusion. Our study confirmed that IL-6, IL-8, IL-10, and sTNFr measured on admission, and CRP and pancreatic elastase measured on third day of admission represent valuable prognostic factors of severity and systemic complications of AP.

Successful Pregnancy and Delivery in a Patient with Bladder Exstrophy

Bladder exstrophy (BE) is a rare congenital anomaly. Owing to the advanced reconstructive surgical techniques and effective antibiotics, the incidence of urinary and systemic complications in patients with BE has decreased and the life expectancy has increased. However, this brings along social, sexual, and psychological problems; particularly, successful pregnancy and delivery is extremely rare in females with BE. We present a pregnancy of an 18-year-old female with BE, who has been followed at our university hospital since birth.

The status of dental and jaw bones in children and adolescents after kidney and liver transplantation

Systemic complications in patients after renal or liver transplantation may be localized in the oral cavity. Calcium-phosphate disturbances may affect the structure and metabolism of mandible bones, promote calcification of dental pulp, and in children may cause developmental defects of teeth. The aim of this study was to evaluate the incidence of dental and bone abnormalities in children and adolescents after kidney and liver transplantation with respect to the type of the transplanted organ and maintenance immunosuppression. Overall, 23 kidney and 25 liver recipients (mean age: 13.95±4.2 yrs) were evaluated. Twenty patients received ciclosporin A (CsA) and 28 tacrolimus (TAC). Twenty-one kidney and 14 liver recipients were treated with steroids. Mean time after transplantation was 3.62±2.98 years. The severity of caries and percentage of odontogenic abnormalities (76.0% vs. 60.86%) was higher in liver transplant recipients. Positive correlations were found between discoloration of the deciduous teeth and liver transplantation, between enamel hypoplasia and kidney transplantation, and between treatment with CsA and its dose and blood concentration (p<0.05). Pulp stones were present in 13.04% of kidney vs. 8.0% in liver recipients, more often in those treated with CsA than with TAC. Jaw bone abnormalities were present in 30.43% kidney recipients vs. 12% liver recipients. Both kidney and liver recipients present dental and bone abnormalities. The incidence of specific types of oral lesions is different in renal and liver graft recipients; however, it is also correlated with specific immunosuppression.

Renal excretion of phenol from physicians after nail matrix phenolization: an observational prospective study

Animal studies have shown that many signs of acute poisoning result from phenol entry into the systemic circulation by absorption or ingestion. While no evidence of systemic complications in patients who have undergone phenol nail matrixectomies have been reported, the safety of phenol vapour inhalation by physicians performing this treatment has yet to be investigated. The goal of this study was to determine whether the levels of phenol to which physicians are exposed to during a phenol-based matrixectomy procedure are within the limits of safe exposure. A continuous prospective study was carried out to measure the urinary phenol concentrations from physicians after performing chemical matrixectomy for ingrown toenails. The highest concentration of urinary phenol was measured at almost 10 mg/L within the first 2 h after exposure, and subsequently decreased approximately 1 mg/L every 2 h for the first 10 h post exposure. The levels dropped to 3 mg/L at 72 h post exposure. The risk associated with phenol exposure while performing chemical phenol matrixectomy was well below the current safety limits when the physician is exposed to 90% phenol vapour for approximately 20 min. Thus, no further specific safety recommendations are required for physicians performing this procedure.

Campylobacter fetus subspecies fetus spondylodiscitis

Campylobacter spp. are common causes of gastrointestinal infections. Campylobacter fetus is a much rarer pathogen in humans, and usually causes bacteraemia and systemic complications in patients with predisposing conditions. We report a case of spondylodiscitis caused by C. fetus subsp. fetus as revealed by vertebral biopsy culture. This identification was confirmed by sequencing the 16S rRNA gene and by phylogenetic analysis. Treatment consisted of 6 weeks antimicrobial therapy combined with a strict initial immobilization, followed by a re-education program. The patient's recovery was uneventful.

Commentary on an article by Stephen S. Tower, MD: “Arthroprosthetic Cobaltism: Neurological and Cardiac Manifestations in Two Patients with Metal-on-Metal Arthroplasty. A Case Report”

This issue of The Journal of Bone and Joint Surgery includes a report on two patients with metal-on-metal total hip replacements who developed systemic neurological and cardiac complications associated with an elevation in serum cobalt levels. Causality is suggested by the fact that the systemic symptoms improved in at least one of the two patients following revision surgery. The report is unusual because of the rarity of the occurrence of metal-induced systemic complications in patients with total hip replacement and the fact that the author was one of the patients. As millions of patients worldwide have undergone total hip replacement, these cases represent rare events indeed. Metal-on-metal bearing surfaces in total hip arthroplasty have been in use for over fifty years. The earliest iterations of these devices lost favor in the 1970s and were replaced by metal-on-ultrahigh molecular weight polyethylene implants. As the indications for total hip replacement were extended to younger, more active patient populations with higher activity demands, clinically important problems such as osteolysis and aseptic loosening related to bearing surface performance were reported with increasing frequency. So-called alternative bearing materials were developed with the goal of reducing wear debris and decreasing osteolysis, aseptic loosening, and other wear-related failures. Metal-on-metal bearings generally demonstrated reduced volumetric wear in comparison with metal-on-polyethylene bearings in hip simulator and implant-retrieval studies. Metal-on-metal bearings allow the use of thinner acetabular components and larger femoral heads, which have been associated with a lower rate of postoperative hip dislocation. Thinner acetabular components also facilitate hip resurfacing. As is the case with metal-on-polyethylene bearings, ceramic-on-polyethylene bearings, and ceramic-on-ceramic bearings, there are potential risks associated with metal-on-metal bearings that accompany the potential clinical benefits. One such risk associated with metal-on-metal bearings is the potential for adverse biological responses to elevated levels of cobalt and chromium in local and remote tissues. This risk is not unique to metal-on-metal bearings as other metal devices with accelerated damage due to wear or corrosion can lead to elevated levels of metal in local and remote tissues. In fact, four of the six reported cases to date that have demonstrated chromium and cobalt-associated neurological and/or cardiac complications had bearing couples other than metal-on-metal. In orthopaedic surgery, metal devices are used for joint replacements, fracture fixation, spine fusion, and tumor reconstruction and therefore are essential for the orthopaedic surgeon. However, if metal release is extensive as a result of wear or corrosion, adverse local and systemic biological responses can ensue. At the present time, there is no generally accepted threshold beyond which serum or blood concentrations of cobalt and chromium are known to be toxic in patients with a metal implant. As there are known risks of revision surgery, undertaking such a procedure on the basis of the blood or serum metal level alone and in the absence of symptoms is problematic. The value of these case reports would have been enhanced if there had been additional clinical, histological, and radiographic detail demonstrating implant orientation (particularly in Case 2, in which this information is quite limited) and if there had been additional detail regarding the methodology of the metal measurement in serum. The latter is particularly critical given the known variability in these measurements, which makes comparison of the metal concentrations in different published series difficult. Nonetheless, there are important lessons that can be learned from these two cases: (1) routine periodic surveillance by an orthopaedic surgeon is recommended for patients with total joint replacements to identify and treat, in a timely fashion, any prosthetic-related complications; (2) surveillance should include both an evaluation of the replaced joint and a discussion of the overall health of the patient; (3) determination of concentrations of metal in the blood or serum may be helpful for the evaluation of patients with local pain and/or otherwise unexplained systemic symptoms and should be used in concert with other clinical and radiographic information; (4) the orthopaedic surgeon should be cognizant of these rare systemic complications of metal devices undergoing accelerated wear and corrosion; and (5) expeditious revision surgery should be considered for a symptomatic patient with evidence of accelerated wear or corrosion who demonstrates local and/or systemic complications associated with the device.

Mannheim Peritoneal Index in the Prediction of Postoperative Complications in Patients with Peritonitis

Objective: to study the diagnostic and prognostic values of the Mannheim peritoneal index (MPI) in the development of postoperative local and systemic complications in patients with peritonitis. Materials and methods. The case histories of 92 patients with generalized peritonitis of varying etiology (other than pancreatogenic one) were analyzed. The patients were retrospectively divided into 3 groups according to the outcomes and occurrence of postoperative local complications. The postoperative complications were classified by the procedure developed by A. L. Kostyuchenko et al. as local and systemic ones. When the patients had two signs or more of the systemic inflammatory response syndrome, they were stated to have systemic complications and to be diagnosed as having abdominal sepsis with the pattern of organ dysfunctions being described in accordance with the sepsis classification proposed by R. S. Bone et al. (1992). The number of organ dysfunctions was daily counted in each patient over time in the postoperative period. On the first postoperative day, MPI was calculated in scores for each patient; the mean MPI was estimated for all patient groups. The predictable mortality was calculated using the MPI plot. Results. All the patients with generalized peritonitis in the development of local postoperative complications were observed to have sepsis in the postoperative period, without developing local complication in 84.6% of the patients. A direct correlation was found between the MPI and the quantity of organ dysfunctions (r=0.6; p=0.001). In patients with local postoperative complications being developed, the MPI values were higher (p&lt;0.05) than in those without them. The mortality rates that have been predicted by means of MPI (16.3%) and actual (15.2%) are actually in agreement. Conclusion. There is evidence for the diagnostic and prognostic values of MPI in the development of local and systemic postoperative complications in patients with peritonitis. MPI calculation from postoperative day 1 along with later dynamic estimation of the number of organ dysfunctions makes it to objectively assess not only prognosis, but also the pattern of postoperative peritonitis. The major advantage of MPI is the simplicity of calculation, which permits its use in clinics. Key words: peritonitis, prognosis, complications, sepsis, Mannheim peritoneal index.

Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (rct) randomized controlled study

Optimal timing of stabilization for spinal injuries is discussed controversially. The goal of this study is to investigate the neurological recovery and its influencing factors in thoracolumbar spine fractures after surgical decompression and stabilization within 8 h of spinal cord injury versus surgery which is performed between 3 and 15 days. Twenty-seven patients undergoing thoracolumbar stabilization with neurological deficit for an acute thoracolumbar spinal injury at the level of Th8-L2 vertebra at Selcuk University between March 2004 and December 2006 were recorded. Patients with neurological deficit and medically stable for surgery underwent immediate stabilization within 8 h defined as group I (n = 12) and patients underwent operation in 3-15 days after thoracolumbar injury were defined as group II (n = 15). Patients were assessed for neurologic deficit and improvement as defined by the scoring system of American spinal injury association (ASIA). In spite of comparable demographic data, patients in group I had a significantly shorter overall hospital and intensive care unit stay and had lesser systemic complications such as pneumonia and also exhibited better neurological improvement than group II (p < 0.05). Early surgery may improve neurological recovery and decrease hospitalization time and also additional systemic complications in patients with thoracolumbar spinal cord injuries. Thus early stabilization of thoracolumbar spine fractures within 8 h after trauma appears to be favorable.

Mejoría de la calidad de vida y efectos adversos en pacientes con enfermedad arterial obstructiva crónica tratados con alprostadil-alfa-ciclodextrina por vía venosa periférica

Objectives To evaluate local and systemic complications in patients treated with alprostadil alpha-cyclodextrin (AAC) through the peripheral venous route, as well as changes in the quality of life of these patients. Method A descriptive, observational, prospective study was performed. All patients admitted to the Angiology and Vascular Surgery Unit of the University Hospital of Albacete who fulfilled the criteria for therapeutic indication of AAC administration between September 2001 and April 2002 were included. Each patient received the treatment according to a protocol previously established through consensus in the unit. Sociodemographic variables, associated disease, type and degree of arterial disease, local and systemic complications with administration of each of the cycles, and quality of life at the beginning and end of the treatment were studied. Results Forty-four patients were studied. A total of 65.5% had arterial disease in the most advanced stage. The most frequent systemic complications were allergic reactions and nausea; treatment had to be discontinued in 11.4% of patients. Local complications consisted of pain and erythema in the area of the venous line (mean 1.29 every 10 treatment doses); there was a mean of 0.97 line changes every 10 doses and 38.6% of the changes was due to phlebitis. The results of the EUROQOL questionnaire showed improvement in: mobility, ability to perform personal care, ability to perform daily activities, pain, and anxiety/depression. Conclusions Treatment with AAC according to the established protocol is safe and improves perceived quality of life.

Impact of Preoperative Testing on Ophthalmologic and Systemic Outcomes in Cataract Surgery

Purpose To evaluate the incidence of ophthalmologic and systemic complications in patients who undergo cataract surgery without preoperative tests compared to subjects undergoing cataract surgery preceded by preoperative tests. Methods The randomized controlled study included 1276 consecutive patients admitted to the Institute of Ophthalmology of the University of Modena and Reggio Emilia for cataract surgery. The patients were randomly divided into two groups: 638 were assigned not to undergo preoperative evaluation based on routine medical tests and electrocardiograms; the other 638 underwent preoperative evaluation based on said tests. Ophthalmologic and systemic complications were assessed intraoperatively and 1 month after surgery. Results Eleven intraoperative complications occurred in the group without preoperative tests and eight in the group with preoperative tests; at 1 month six complications were recorded in the group without tests and five in the group with tests. Systemic adverse events occurred intraoperatively in four patients, whereas no systemic adverse event was recorded at 1 month in either group. No statistically significant differences were observed between the two groups. Conclusions The findings of this study have broad applicability, because the sample is representative of the population existing in numerous social and healthcare settings; they are of value for administrative purposes, because they may be taken as reference in resource allocation plans; and they have medicolegal implications, as the resulting conduct of healthcare providers is supported by a rigorous scientific study.

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. Cohort analytic study. Tertiary care center. Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

Extracellular phospholipases A2 in relation to systemic inflammatory response syndrome (SIRS) and systemic complications in severe acute pancreatitis.

The pathophysiology of severe acute pancreatitis (AP) resembles other conditions with systemic inflammatory response syndrome (SIRS) such as sepsis predisposing to remote organ failure. Because extracellular phospholipases A2 (PLA2) have been implicated in AP, their serum concentrations were analyzed with respect to SIRS and systemic complications in patients with severe AP. The serum samples were collected daily for 12 days in 57 patients with severe AP. SIRS, early organ complications, local complications, and outcome of AP were recorded. Time-resolved fluoroimmunoassays were used for group I and group II PLA2 measurements. Thirty-nine (68.4%) patients fulfilled the criteria of SIRS within 12 days from admission. Pancreatic necrosis was detected in 43 (75.4%) patients. Infected necrosis was found preoperatively or at operation in five (8.8%) patients. Twenty-six (45.6%) and eight (14.0%) patients had respiratory or renal failure, respectively. Seven (12.3%) patients died of their disease. All patients with systemic complications fulfilled the criteria of SIRS. The increasing number of positive SIRS criteria was associated with increased frequency of systemic complications. Pancreatic necrosis was not significantly associated with SIRS. The serum concentration of group II PLA2 was significantly higher in patients with SIRS (p < 0.05) compared with patients without from day 7 onward. The concentration of group II PLA2 increased (p < 0.01) in patients with SIRS but decreased in patients without. The serum concentration of group II PLA2 did not differ significantly with respect to systemic complications. The concentration of group I PLA2 decreased (p < 0.05) similarly in patients with and without SIRS or systemic complications during follow-up, respectively. Early systemic complications of severe AP are associated with SIRS with increasing frequency as the number of positive SIRS criteria increases. Group II PLA2 but not group I PLA2 may have pathophysiologic importance in severe AP-associated SIRS. Increasing serum concentration of group II PLA2 seems to reflect the ongoing systemic inflammation in severe AP-associated SIRS.

Graft-versus-host reactions in dermatology

Graft-versus-host reactions frequently produce cutaneous and systemic complications in patients receiving bone marrow transplants. Characteristic skin involvement typically heralds graft-versus-host reactions and significantly contributes to the morbidity associated with marrow transplants. Familiarity with these reactions and their treatment is important to dermatologists involved in the care of marrow transplant recipients. (J Am Acad Dermatol 1998;38:369-92.) Learning objective: At the conclusion of this learning activity, participants should be able to understand the requirements for development of graft-versus-host disease and the role of bone marrow transplantation and related risk factors. The immunopathophysiologic mechanisms of acute, chronic, and syngeneic graft-versus-host disease should be understood, and participants should be able to describe the clinical aspects of graft-versus-host reactions as well as treatment options for acute and chronic forms of the disease.

The neuropathology of organ transplantation: Comparison and contrast in 500 patients 1

The main objective of this report is to compare and contrast the type and frequency of neuropathological findings following liver, heart, lung, heart-lung, kidney and bone marrow transplantation and to provide an overview of the major systemic complications in patients that received allografts. This is a retrospective analysis of the complete autopsy records and clinical histories of 500 adults who underwent organ transplantation at the University of Pittsburgh Medical Center during the interval of March, 1981 through July, 1997. This study is based on the neuropathological and systemic findings among 225 liver, 101 heart, 40 lung, 28 heart-lung, 74 kidney and 32 bone marrow transplants. Clinico-pathological correlations were made. All patients received base-line immunosuppressive therapy with one or more of the following drugs: cyclosporine, corticosteroids and azathioprine. Since August, 1989, the primary immunosuppressive agent is FK-506 (Tacrolimus). Some patients received antilymphocyte globulin (OKT3), when acute rejection was imminent. Light microscopic examination of tissue sections, stained with hematoxylin and eosin and in some cases with special stains were made. Ultrastructural evaluation were also performed in selected cases. All of the studies were carried out at the University of Pittsburgh Medical Center, Department of Pathology, Neuropathology Division. Cerebrovascular complications were the most frequent and were seen in 51% of the liver, 59% of the heart, 58% of the lung, 50% of the heart-lung, 49% of the kidney and 44% of the bone marrow allografts. Aspergillus sp. infection was the most common of all CNS infections followed by viral, bacterial and protozoal. Primary Central Nervous System Lymphoma (PCNSL) was seen in 2% of the liver, and 2% of the heart recipients. Post transplant lymphoproliferative disorder (PTLD) involving the brain was seen in 2% of the liver allografts, 3% of the heart, and 7% of the heart-lung recipients. PTLD systemically was seen in 6% of the liver, 7% of the heart, 5% of the lung, 11% of the heart-lung and 4% of the kidney allografts. Graft-versus-host disease was seen only in 41% of the bone marrow recipients. There was no statistically significant difference between the incidence of the total CNS complications among the different organ transplant groups (p value > 0.10), but there was a statistically significant difference in the systemic complications among the organ transplant groups (p value < 0.001). In conclusion that immunocompromised patients with impaired cellular and humoral immunity are at risk for the development of opportunistic infections and hematologic abnormalities. PTLD appears to be different in its pathogenesis from that of PCNSL which occurs anew in the brain of these patients. The neurological complications may be reduced by earlier recognition and better understanding of their etiopathogenesis.

The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis

Background—Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and...