Necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), is linked to lower survival rates. Treatment strategies have shifted towards less invasive, step-up approaches, favoring minimally invasive procedures. In this study, we report on the potential of combining the minimally invasive surgical approach with endoscopic necrosectomy as a novel treatment strategy, termed serial percutaneous endoscopic necrosectomy (SPEN), for patients with therapy-refractory NP. A cohort of 19 patients suffering from therapy-refractory NP, defined as persistent necroses after drainage treatment and subsequent video-assisted retroperitoneal debridement (VARD), was treated with SPEN upon failure of the above stated. In contrast to surgery, SPEN does not require general anesthesia or an operating theater. The results were compared with the current data on alternative treatments. The investigated cohort consisted of severely ill patients as most patients experienced organ failure as well as severe disease progression in need of intensive-care unit admission. SPEN was performed 4.3 ± 3.8 times, ranging from 1 to 14 procedures per individual. According to the current Clavien–Dindo classification, only “mild” and no major SPEN procedure-associated complications can be observed. In this report, we present our experience with a novel treatment approach combining surgery and endoscopic interventions for the treatment of NP. While sparing resources, SPEN was shown to be safe and effective. Favorable implications are implied owing to the combination of the best of two worlds: surgery, with its capacity for extensive necrosectomy and endoscopic necrosectomy, which is valued for its applicability as a flexible, low-grade invasive but effective tool that may be dynamically employed depending on individual disease progression.
While seasonal fluctuations in health behaviors such as dieting are well known, little is known about their influence on metabolic bariatric surgery (MBS) consultation timing. This study examines whether the season of first clinical presentation for MBS differs by sex and whether timing impacts early outcomes. Data from 21,396 patients in the German StuDoQ/MBE registry (2014–2019) were analyzed. Monthly and seasonal presentation probabilities were compared by sex. Logistic regression assessed predictors of early-year consultation. Linear mixed models with random intercepts were used to evaluate the effect on weight loss at 3 and 12 months postoperatively. Presentation patterns differed significantly between sexes. Women presented more frequently in spring and summer, while men showed a clear peak in the first quarter, aligning with calendar-based triggers like New Year’s resolutions. These trends suggest sex-specific motivators: body image awareness in women versus functional limitations and external cues in men. Despite seasonal variation in consultation timing, postoperative weight loss outcomes showed no statistically significant differences across all seasons. The timing of MBS consultation might be influenced by seasonal and sex-specific behavioral patterns. However, outcomes are unaffected by the time of year patients enter treatment. Recognizing these trends can inform tailored patient communication and engagement strategies. Future bariatric programs may benefit from sex-sensitive, seasonally adaptive approaches to optimize patient readiness and long-term success. Women present more frequently in spring/summer, likely driven by body image concerns. Men show a peak in early-year presentations, potentially linked to New Year’s resolutions. Seasonal timing does not significantly affect postoperative weight loss outcomes. Personalized and seasonally aware patient counseling could be recommended.
Blood gas analyses form part of routine testing in emergency medicine and intensive care in hospitals in the western world; however, this method has not yet become established in prehospital management, despite the fact that patients are comparable in terms of severity of the illnesses. This study aimed to assess whether the use of prehospital blood gas analysis has medical and/or organizational consequences for patient care. In two regions in Germany, seven emergency physician–staffed response units were equipped with portable blood gas analysis devices. After each use, providers were required to complete a 6-item questionnaire evaluating potential medical and organizational consequences for the patient. A total of 184 patients underwent prehospital blood gas analysis. In 85
Medullary thyroid carcinoma is a rare neuroendocrine tumor of parafollicular C-cells. Calcitonin is the primary tumor marker but presents several limitations, including assay variability and false positives in renal dysfunction, proton pump inhibitor use and smoking. Procalcitonin may offer advantages in stability and specificity. To evaluate the diagnostic performance of procalcitonin compared to calcitonin and carcinoembryonic antigen in patients with medullary thyroid carcinoma, we conducted a retrospective study of 60 patients with histologically confirmed medullary thyroid carcinoma at a single endocrine center. Calcitonin, procalcitonin, and carcinoembryonic antigen levels were analyzed pre- and postoperatively over a 4-year period (2015-2019). Statistical analyses included Spearman's correlation and receiver operating characteristic curve analysis. Subgroup analyses examined the effects of renal dysfunction, proton pump inhibitors, and smoking. Calcitonin and procalcitonin showed a strong correlation (r=0.874 and p<0.001). Procalcitonin maintained high specificity and sensitivity (area under the curve>0.95 across all years) and remained unaffected by the proton pump inhibitor use or renal impairment. Carcinoembryonic antigen correlated with tumor progression but lacked sufficient specificity alone. The combined use of calcitonin and procalcitonin improved diagnostic accuracy. In all patients with detectable tumor burden, procalcitonin was positive. False-positive calcitonin results were observed in patients without evidence of active diseases but with renal dysfunction or proton pump inhibitor use; procalcitonin remained negative in these cases. Procalcitonin is a reliable tumor marker for medullary thyroid carcinoma, especially in postoperative surveillance. Its stability and independence from common confounders make it a valuable complement to calcitonin. The combined assessment of calcitonin and procalcitonin enhances diagnostic performance and should be considered in routine clinical practice.
