Sándor Márton

Acute pancreatitis is a common and heterogeneous inflammatory disorder whose clinical course ranges from a self-limited illness to persistent organ failure, infected pancreatic necrosis, and prolonged critical illness. Contemporary management has moved away from protocolised aggressive fluid loading, prolonged fasting, prophylactic antibiotics, and early open necrosectomy. Instead, current care emphasises repeated physiological assessment, moderate goal-directed resuscitation, early enteral or oral nutrition, organ-specific support, antimicrobial stewardship, and delayed minimally invasive intervention within a multidisciplinary step-up strategy. This narrative review examines acute pancreatitis from an intensive care perspective. Particular attention is given to early risk stratification, intensive care unit triage, haemodynamic and respiratory support, acute kidney injury, intra-abdominal hypertension, nutrition, biliary source control, diagnosis and treatment of infected necrosis, and the timing and selection of endoscopic, radiological, and surgical interventions. The implications of obesity, pregnancy, advanced age, and multimorbidity are also discussed. Recent randomised trials have clarified several clinically important questions: aggressive hydration increases fluid overload without improving outcomes; routine urgent endoscopic retrograde cholangiopancreatography is not beneficial in predicted severe biliary pancreatitis without cholangitis; postponed drainage may avoid invasive intervention in a substantial proportion of patients with infected necrosis; and endoscopic or minimally invasive approaches reduce treatment burden compared with primary open surgery. Persistent organ failure remains the principal determinant of mortality, while infected necrosis further increases risk and complexity. Future progress will depend on dynamic prediction models, biomarker-guided antimicrobial decisions, personalised haemodynamic strategies, phenotype-directed immunomodulation, and regionalised multidisciplinary care.

Background/Objectives: Acute pancreatitis in pregnancy and the early postpartum period (APIP) is an uncommon but potentially life-threatening condition associated with significant maternal morbidity. Physiological adaptations of pregnancy, recent obstetric surgery, and overlapping postoperative symptoms frequently obscure early diagnosis and complicate perioperative and critical care management. This review provides a clinically oriented, anaesthesiology-focused overview of APIP, integrating current evidence with perioperative decision-making, pain management strategies, and intensive care considerations relevant to obstetric practice. Methods: A narrative, clinically structured review of the literature was performed focusing on epidemiology, aetiology, diagnosis, severity stratification, and management of APIP. Anaesthesiology- and ICU-specific aspects are synthesised into a pragmatic management framework. Results: Gallstone disease and hypertriglyceridaemia remain the predominant causes of APIP, with most cases occurring in the third trimester or early postpartum period. Diagnosis relies on pancreatic enzyme elevation and pregnancy-adapted imaging strategies. Early goal-directed fluid resuscitation, effective multimodal analgesia, and timely initiation of enteral nutrition are key determinants of outcome. Therapeutic ERCP and laparoscopic cholecystectomy can be safely performed during pregnancy when clinically indicated and may reduce recurrence in biliary pancreatitis. Neuraxial analgesia provides effective, opioid-sparing pain control and may improve respiratory mechanics and haemodynamic stability. Persistent organ failure remains the strongest predictor of adverse outcome and should prompt early intensive care admission. Conclusions: APIP requires early recognition and severity-adapted, multidisciplinary management. Anaesthesiology-led strategies play a central role in optimising analgesia, haemodynamic stability, and timely escalation of care. Framing APIP within a perioperative and critical care context may improve maternal outcomes in this vulnerable patient population.

Bevezetés: Az elhízás világszerte, így Magyarországon is jelentős népegészségügyi problémát jelent, amely fokozott cardiovascularis és metabolikus kockázattal jár. A bariátriai beavatkozások hatékony kezelési lehetőséget biztosítanak, ugyanakkor a sebészi módszerek invazivitása és irreverzibilitása miatt egyre nagyobb igény mutatkozik minimálisan invazív alternatívák iránt. Célkitűzés: Vizsgálatunk célja az endoszkópos sleeve gastroplastica (ESG) műtéten átesett betegek preoperatív antropometriai jellemzőinek bemutatása, valamint a beavatkozás biztonságosságának és rövid távú hatékonyságának értékelése. Módszer: Prospektív, obszervációs vizsgálatunkba 193, ESG-beavatkozáson átesett beteget vontunk be. A preoperatív antropometriai adatokat, valamint a testsúly- és testtömegindex (BMI)-változást a beavatkozást követő 3., 6., 9. és 12. hónapban értékeltük. A testzsírszázalékot a Deurenberg-képlet alapján becsültük. Eredmények: A vizsgált populáció átlagéletkora 46,1 év volt, az átlagos BMI 39,1 kg/m². A becsült testzsírtartalom 47,5%-nak adódott. Az ESG-t követően a BMI a 3. hónapra a kiindulási érték 87,8%-ára, a 6. hónapra a 83,0%-ára, míg a 12. hónapra a 81,3%-ára csökkent. Sebészi szövődményt nem észleltünk. Következtetés: Az ESG biztonságos, minimálisan invazív eljárás, amely rövid távon klinikailag releváns testsúlycsökkentést eredményez. Orv Hetil. 2026; 167(13): 512–516.

Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, with more than 275,000 hospital admissions annually in the United States [2]. While most cases are mild, 15–20% progress to moderately severe or severe disease characterized by systemic inflammation, organ failure, and local complications [1,3]. Overall mortality remains 3–5%, but increases to 20–35% in patients with persistent organ failure requiring intensive care [7].Early assessment remains challenging. Traditional scoring systems (APACHE II, BISAP, Ranson, mCTSI) demonstrate modest accuracy within the first 24 hours [4,11]. Consequently, emerging biomarkers—including IL-6, IL-8, IL-10 [16–17], pentraxin-3 [8], sCD163 [7], NGAL [10], and presepsin—are critical for identifying early severity. Endothelial dysfunction markers including angiopoietin-2 [19], proADM, endocan, and VEGF provide additional predictive value by reflecting microcirculatory failure and shock. Oxidative stress markers such as MDA and GSH depletion correlate with necrosis and multi-organ dysfunction. ICU physiological predictors—vasopressor requirement, rising lactate, Horowitz-index deterioration, and early AKI—remain the strongest bedside indicators of poor outcome [18]. Modern management emphasizes goal-directed fluid therapy, controlled resuscitation with balanced crystalloids, and selective use of CRRT, although no multicenter RCT has yet confirmed its mortality benefit [20]. This review synthesizes classical and novel biomarkers, endothelial and oxidative markers, and ICU predictors to support a modern, precision-based approach to early risk assessment and managementin acute pancreatitis.

AP is a mild to severe, potentially life-threatening condition caused by inflammation of the pancreas. Most common causes are excessive alcohol consumption and gallstone disease. For patients in intensive care, pain relief is a priority, as one of the main symptoms of AP is severe, often unbearable abdominal pain. Adequate pain management not only improves patients’ comfort but also reduces the systemic stress response and the risk of late complications. The mechanism of pain is complex, with several factors contributing: enzymatic autodigestion, inflammation, oedema, ischaemia and neuronal sensitivity. Intense pain increases the incidence of SIRS, which may also lead to the development of MODS. The main methods of analgesia include: nonopioid analgesics (paracetamol, NSAIDs); opioids: (fentanyl, remi and sufentanyl but their long-term use should be avoided due to their known complications and side effects. Lidocaine infusion, a potent anti-inflammatory and analgesic, is not currently in daily use due to its dangerousness. Epidural analgesia is the most effective and commonly used procedure for severe pain. Appropriate pain management can reduce complications of AP, including sepsis and long hospital stays, and improve patients’ chances of survival and quality of life.

(1) Background and Objectives: Morbid obesity significantly increases the prevalence of comorbidities, such as heart disease, restrictive lung disease, stroke, diabetes mellitus and more. (2) Methods: Patients undergoing gastric sleeve surgery were divided into three groups with BMI between 30–34.9 kg/m² (Group I), 35–39.9 kg/m² (Group II), and over 40 kg/m² (Group III). Preoperative examinations included cardiac ultrasound, respiratory function and laboratory tests, and preoperative comorbidities were also recorded. Following a one-year follow-up, we compared the rate of weight loss in the three groups at six months and one year following surgery, specifically, the effect of surgery on preoperative comorbidities at one year. (3) Results: The weight loss surgeries performed were successful in all three groups. Preoperative laboratory examinations, an echocardiogram and respiratory function results showed no clinically significant difference, except moderate elevations in blood lipid levels. Hypertension was the most common comorbidity. (4) Conclusions: In our patient population, hypertension and diabetes were the only comorbidities with a high prevalence. It can be explained by the relatively younger age among the patients (mean age 44.5 years) and the fact that they had not yet developed the pathological consequences of severe obesity. Consequently, while performing the surgery at a relatively younger age, it seems far more likely that the patient will return to a more active and productive life and enjoy a better quality of life. Additionally, the perioperative risk is lower, and the burden upon health systems and health expenditure is reduced by preventing comorbidities, in particular, multimorbidity. On this basis, it may be advisable to direct patients who do not exhaust the classical indications for bariatric surgery toward the surgical solution at a younger age. Our results suggest it is not worth waiting for comorbidities, especially multimorbidity, to appear.

Akut hasnyálmirigy-gyulladás várandósság alatt ritkán fordul elő, megjelenése – hasonlóan a nem terhes populációhoz – enyhe lefolyású, de akár fatális kimenetelű is lehet. Előfordulása terhességben a harmadik trimeszterben, valamint a szülés után, a postpartum időszakban a leggyakoribb. A hajlamosító tényezők között elsőként az epekövesség szerepel, továbbá a magas trigliceridszint, a zsíros étkezés, az elhízás, az alkoholfogyasztás és a többszöri terhesség. Egy 27 éves kismamának ikerterhesség miatt végzett császármetszése után a 2. napon elviselhetetlen hasi fájdalma alakult ki. Az elvégzett laborvizsgálatok közül az emelkedett amiláz- (1080 U/l) és lipáz- (2670 U/l) szint emelhető ki. Epiduralis kanül behelyezése után komputertomográfiás vizsgálatot végeztünk, amely nem talált a hasnyálmirigyen morfológiai eltérést, illetve obstruktív epeúti elváltozást. Konzervatív terápiát végeztünk, melynek lényege a korán megkezdett enteralis táplálás, a fájdalomcsillapítás és a folyadékterápia volt. A felvételt követő 7. napon a kismama fájdalmai megszűntek, a hasnyálmirigyenzimek szintje normalizálódott, és a beteg a gyermekeivel együtt panaszmentesen távozott. Akut hasnyálmirigy-gyulladás előfordulása terhességben igen ritka, de hirtelen jelentkező, sokszor nem feltétlenül típusos tünetekkel rendelkező fájdalom esetén gondolnunk kell erre a kórképre is, a megfelelő terápia megválasztása érdekében. Orv Hetil. 2023; 164(31): 1231–1234.

The aim of the study was to establish a preventive program with the combined use of amine fluoride toothpaste and gel in groups of adolescents living in different locations in Hungary. Caries and oral hygiene examinations were performed at the beginning of the study and repeated after 1 and 2 years. The adolescents were divided into 3 groups: 1 control and 2 test groups. The control group continued its usual oral care habits. One of the test groups received Elmex toothpaste for unsupervised home use daily and Elmex gel for use once a week, and the other test group received Elmex toothpaste and only placebo gel. The combined use of amine fluoride-containing toothpaste and gel provided a significant reduction in DMFS mean values (38% including white spot lesions, 34% not including white spot lesions, p < 0.05) and in visible plaque index values (18%, p < 0.05) compared to the control group.