Association between parenteral and enteral nutrition is the best way, preferred in ICU, on early stages. CPR/PCT monitoring performed every 4 days is the best Tofacitinib JAK3 way to describe disease trend. First CT scan should be done at least 72 h after onset of disease just enough to demonstrate necrotic areas. Subsequently CT scan was weekly performed during the first 6 weeks or only at onset of fever and abdominal pain. Magnetic Resonance (MR) scan could be useful to show biliary tree, anyway intolerance to MR execution makes useless this method. Conclusion Early EN from our experience is a real prophylaxis against infection, especially in case of severe pancreatitis, and then importance as source of nutrition for these patients. Moreover, use of EN allows to rationalize use of custom formulations for Parental Nutrition (PN).

Nowadays too, there is not a magic bullet to treat severe pancreatitis without surgery, anyway with a large pool of pharmacological tools, we have obtained control of this dismal disease. Fistuloscopy to remove septic debris is important because allowed repeated procedures without many troubles to patients till the complete cleaning of necrotic tissues. SIRS associated with uncontrolled increase of intra-abdominal pressure must be treated by decompressive fasciotomy without peritoneum opening. This surgical approach improves patients outcome. Lack of exact timing to resolve SAP invariably obtains an exhausting series of surgeries in most favourable cases. Eventually, answering to difficult question ��when we have to operate patients ?��, we decide its fate.

According to our experience in case of SAP is mandatory going through all treatment options, as patients are young, otherwise healthy, affected by non neoplastic but inflammatory disease, however severe which after few months from discharge have recovered to normal life.
As it is nowadays well accepted, the minimally invasive approach for the cardiac valve surgery should be the standard of care. The advantages of the minimally invasive approaches are widely accepted for a faster postoperative outcome with lower incidence of bleeding, discomfort and in hospital stay. As the clinical practice in minimally invasive surgery is increasing, some tricks have been proposed to obtain a smaller surgical access.

In case of minimally invasive approach both for mitral and tricuspid surgery, a small right Entinostat thoracotomy (6�C8 cm) in the sub-mammary fold along the anterior clavicular line through the fourth intercostal space yields an excellent direct-vision. The cardiopulmonary bypass is usually established amongst the right femoral artery and a Y shaped venous line among the right femoral vein and the right jugular vein. The aortic vent and the aortic clamp are usually inserted through the thoracotomy and this may worsen the surgical view, requiring a larger skin incision.