Management of sterile @entity39 in instances of severe acute XXXX .

@entity1 @entity788 @entity39 @entity7031 @entity1851
BACKGROUND: The clinical management of sterile pancreatic @entity39 is still a matter of debate. In this study we analyzed the clinical course and outcome of @entity1 with @entity788 treated surgically versus nonsurgically. STUDY DESIGN: Between May 1982 and December 1993, 249 @entity1 with @entity788 ( @entity788 ) entered this study, of which 172 (69 percent) had intraoperatively or fine needle aspiration-proven sterile @entity788 . One hundred seven of 172 @entity1 underwent surgery (S group) with necrosectomy and continuous postoperative closed lavage and 65 of 172 were treated by nonsurgical means ( @entity7031 group). RESULTS: Median Ranson and admission APACHE II scores were 4.7 (range, 1 to 10) and 11 (range, 1 to 29) in the S group, significantly higher than those in the @entity7031 group with 3.0 (range, 0 to 6) (p = 0.022) and 8 (range, 1 to 23) (p = 0.036). After 48 hours of intensive care treatment, APACHE II scores persisted at 10.5 (range, 1 to 29) in the S group and decreased to 6 (range, 0 to 15) (p = 0.013) in the @entity7031 @entity1 . Median @entity1851 ( @entity1851 ) levels on admission were 179 mg/L and 68.5 mg/L (p = 0.023), respectively. Within 72 hours, 61 (94 percent) of 65 @entity7031 -managed @entity1 responded to intensive care therapy, whereas organ complications persisted or increased and thus led to surgery in the S group. Mortality rates were 13.1 percent in the surgically treated @entity1 and 6.2 percent in the nonsurgically treated @entity1 (p = @entity7031 ). CONCLUSIONS: Most @entity1 with limited and sterile pancreatic @entity39 respond to intensive care treatment. Indication for surgery in sterile @entity788 should be based on persisting or advancing organ complications despite intensive care therapy. APACHE II scores and admission @entity1851 levels represent a helpful tool in decision making for surgical or nonsurgical management of @entity788 .
