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Hemorrhagic pancreatitis, especially in the setting of multiorgan dysfunction and generalized peritonitis, is characterized by a very high mortality rate. We herein describe the unique case of a patient who survived 27 consecutive laparotomies. This favourable outcome highlights the complexity of the underlying pathology as well as the challenges faced by the treating team.

Background/aims: The aim of this study was to analyze the risk for surgical complications after kidney transplantation in patients with diabetes mellitus (DM) compared to patients without DM., Methodology: Between January 2002 and December 2005 270 consecutive kidney transplantations from deceased donors in adult recipients were performed. Data of these patients were analyzed on the presence of DM. Recipients with DM (n=32) were compared with patients without DM (n=238) concerning delayed graft function, wound infections, urinary leakage, postoperative bleeding and urinary infections., Results: No statistically significant differences were found in the occurrence of delayed graft function, postoperative bleeding and urinary tract infections between both groups. Although the percentage of postoperative wound infections and urinary leakages was elevated in the DM group it was not statistical significant., Conclusion: In patients with terminal kidney insufficiency the presence of DM type II is a frequent co-morbidity and is per se not a contraindication for kidney transplantation. Because of the elevated cardiovascular risk profile patients with DM have to be evaluated very diligent before being listed for kidney transplantation. Nevertheless beside the additional short term risk caused by kidney transplantation it is the only modifiable risk with possible long term reduction for these patients.

Background/aims: Long-term positive end-expiratory pressure (PEEP) ventilation, particular with PEEP up to 15 mbar may impair graft-function in liver transplant (LT) patients. The aim of our study was to evaluate the impact of long-term high PEEP (at least 48 hours) on liver graft function. We retrospectively reviewed the records of 50 patients, who required artificial ventilation for at least 1 week with a PEEP level > or = 10mbar due to pulmonary complication caused mainly by sepsis (n = 19), pneumonia (n = 7) and lung edema associated with reperfusion syndrome or primary non-function of the graft (n = 13). Patients who required a PEEP > or = 10mbar within the first two days after transplantation (group A, n = 23) showed significant decrease of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin on day 3 and day 7 after initiation of high PEEP, whereas prothrombin time (PT) significantly increased on day 7. Group B (patients ventilated with PEEP > or = 10mbar after more than 2 days after transplantation, n = 27) showed a significant decrease of bilirubine and a significantly increase of PT on day 7., Conclusion: Long-term ventilation with PEEP levels of at least 10mbar does not harm graft function in patients following LT.