Biomedical subjects
Publications and source records attributed to Janusz Milewski.
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AIM: Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP. METHODS: One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity. RESULTS: There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10 patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group. CONCLUSION: N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.
Gastroesophageal reflux disease (GERD) is a widespread morbid condition that adversely affects quality of life and results in great utilization of healthcare resources. Recently medical therapy has improved with the introduction of the proton pump inhibitors, but patients must take medicine rather indefinitely often on a daily basis. Surgical therapy with the application of laparoscopic fundoplication has improved too, but still is associated with invasiveness and morbidity. Now third option has emerged--endoscopic antireflux procedures. Three novel forms of endoscopic procedures are under development: plication of the gastroesophageal junction by endoscopic suturing, thermoablation of the muscle of lower esophageal sphincter and gastric cardia (the Stretta procedure), endoscopic implantation of a biopolymer (Enteryx). These procedures seem effective and rather safe, but they are in the early stages of development and the magnitude of their efficacy is yet undetermined. It is necessary to validate these methods and assess safety by long-term placebo-controlled studies.
The concept of intragastric space-occupying balloon developed from observations in psychiatric patients with gastric bezoars. Several gastric balloons consisting of different materials were developed. The BioEnterics Intagastric Balloon System (BIB) is a smooth, spherical, silicone elastomer balloon inducing satiety and restricting food intake. The balloon is indicated to induce weight loss in patients before surgery, to reduce the surgical risk, to select the patients for gastric restrictive surgery. Our experience showed that patients who had good results with the balloon they are good candidates for gastric restrictive surgical procedures. There were few complications: balloon intolerance, spontaneous deflation, oesophagitis, gastritis and rarely gastric ulcers. Conclusion is that in selected patients intragastric balloon can be used as effective and safe approach and could be a great help to induce weight loss and to prepare for surgery.