Acute Destructive Pancreatitis Research Articles

Hepatic Failure in Pancreonecrosis and the Development of Abdominal Sepsis

It is well known that acute destructive pancreatitis, pancreonecrosis is accompanied by severe endogenous intoxication, often leading to the development of multiple organ failure syndrome, liver failure is one of the important links in this process. The mortality rate of patients with pancreonecrosis related to liver failure is as high as 83%, and approximately 5% of patients with pancreonecrosis have fulminant liver failure. Proven: liver function is closely related to the progression of purulent-necrotic complications in patients with acute destructive pancreonecrosis. The authors present the data of literature on the importance of liver failure in the course and prognosis of acute destructive pancreatitis. The pathogenetic role of lipid peroxidation processes are especially emphasized. The controversial issues of portal and systemic bacteremia and toxemia in the development of pancreatogenic abdominal sepsis are discussed, as well as the involvement of the lymphatic system. The authors’ research aims to analytically dissect and summarize the processes underlying the clinical manifestations of liver failure in pancreatic necrosis and their underlying mechanisms, which may provide new insights for further understanding and better management of liver failure in patients with pancreatic necrosis and abdominal sepsis.

Possibilities for pain relief in acute pancreatitis: a narrative review

Currently, there are no recommendations for managing pain syndrome in patients with acute destructive pancreatitis. A literature search was conducted using PubMed, Cochrane Controlled Clinical Trials Register, and Google Scholar, without restrictions on language, type, or date of the publication. The analysis revealed several possible options for anesthesia in acute destructive pancreatitis. The most commonly used methods for pain relief include narcotic analgesics and nonsteroidal anti-inflammatory drugs. However, in severe forms of acute pancreatitis, nonsteroidal anti-inflammatory drugs should be used with caution due to the risk of acute kidney injury, while opiates may adversely affect the sphincter of Oddi and contribute to the disease progression due to increased ductal pressure. Epidural analgesia also presents limitations, such as risks of hypotension and incompatibility with anticoagulant or antiplatelet therapy. As alternatives, regional anesthesia techniques (paravertebral block and erector spinae plane block) should be considered. Choosing an optimal analgesia method should take into account several factors: pain intensity, disease severity, etiology of acute destructive pancreatitis, comorbidities, and concurrent use of anticoagulants and antiplatelets. Further research into effectiveness of regional analgesia methods is warranted, as they may address both somatic and visceral components of pain and may prove effective and safe in the most severe cases.

Development and justification of the optimal model of acute destructive pancreatitis in an experiment

Development and justification of the optimal model of acute destructive pancreatitis in an experiment

Tactics of infusion therapy in patients with acute destructive pancreatitis: a narrative review

INTRODUCTION: Infusion therapy is the main method of correcting pathological changes that occur during the phase of “aseptic” inflammation in acute pancreatitis. OBJECTIVE: Summarize current data on infusion therapy regimens in patients with acute destructive pancreatitis, the advisability of using various infusion solutions and options for monitoring the effectiveness of therapy. MATERIALS AND METHODS: The study was carried out in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was carried out in the following Internet search engines Pubmed and Cochrane Controlled Clinical Trials Register. To select articles, a literature reference search method was also used. The search strategy did not include restrictions on language, article type, or date. RESULTS: The analysis of literature data revealed two approaches to infusion therapy. The initial interest in “aggressive (4 liters per day or more)” infusion therapy regimens in the first 24 hours of the disease has now been replaced by a trend towards less “aggressive” regimens due to the publication of works on the high incidence of various complications (progression of organ dysfunction, local complications). When considering the qualitative composition of infusion therapy, preference should certainly be given to crystalloids. Basic monitoring of infusion therapy should include non-invasive methods: heart rate, blood pressure, diuresis rate. CONCLUSIONS: The analysis demonstrated different approaches to the tactics of infusion therapy in this category of patients. further research into the effectiveness and safety of infusion therapy, taking into account the varying severity of acute pancreatitis, the possibility of the influence of the qualitative composition of the infusion on the course of this disease and the formation of recommendations for initial and maintenance infusion therapy based on the principles of personalized medicine.

THE SIGNIFICANCE OF LAPAROSCOPY IN THE PROGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

A study was conducted on 102 patients with acute destructive pancreatitis and enzymatic peritonitis, who underwent laparoscopy within the first 72 hours after the onset of the disease. The results of this study led to the development of a scoring system for assessing pathological changes in the abdominal cavity, which allows predicting the severity of the disease. It turned out that the results of laparoscopy with a scoring of changes in the abdominal cavity largely coincide with the assessment of the severity of acute pancreatitis performed using computed tomography using the Balthazar scale (the sensitivity of the method was 84.0% and 86.3%, respectively).

Technologies of Bioimpedance Spectroscopy in Decision Support Systems for the Diagnosis of Socially Significant Diseases

The purpose of the research is to develop methods for the synthesis of hybrid classifiers to assess the risk of socially significant diseases using bioimpedance analysis.Methods. We developed a descriptor approach using impedance spectroscopy results, generating four amplitudephase-frequency responses from four quasi-orthogonal leads. They create the feature spaces necessary for our hybrid classifier in the diagnosis of pancreatic diseases, the autonomous intelligent agents of which are built on various paradigms: probabilistic neural networks, fuzzy logical inference, fully connected feedforward neural networks. We also presented a device structure for creating an informative feature space.Results. Experimental studies of the proposed methods and means of classifying medical rice were carried out on diagnostic tasks according to the classes "acute destructive pancreatitis" – "no acute destructive pancreatitis" and differential diagnosis tasks according to the classes "prostate cancer" ‒ "chronic pancreatitis". They showed that incorporating multi-frequency sensing into neural network-based classifiers allows the development of clinical decision support systems for disease diagnosis that are comparable in performance to existing clinical diagnostic methods. The results were confirmed in groups of male and female patients at different stages of cancer aged 25 to 80 years using a variety of diagnostic methods, including history, physical examination, assessment of comorbidities, laboratory tests, ultrasound, laparoscopy, intraoperative exploration and computed tomography.Conclusion. The use of bioimpedance spectroscopy and hybrid classifier models opens up new opportunities for accessible and objective diagnosis of pancreatic diseases, expanding the capabilities of intelligent medical decision support systems.

Role of superoxide dismutase in acute pancreatitis: from antioxidant protection to gene regulation

We present modern data on the role of superoxide dismutase (SOD) in antioxidant protection and gene regulation in acute pancreatitis. Antioxidant enzymes are essential in pathogenesis of numerous diseases. SOD is one of the key enzymes of antioxidant system. In this review, we analyzed activity of this enzyme depending on various factors, mechanisms and role in physiological and pathological processes, in particular, acute pancreatitis. SOD is significantly less active in patients with severe acute pancreatitis accompanied by renal failure, severe circulatory disorders and high mortality. There are some SOD gene polymorphisms, in particular, acute destructive pancreatitis R213G, contributing to acute inflammation. Thus, SOD is not only one of the key antioxidant enzymes, but also potential transcription factor regulating activity of signaling pathways. These aspects can underlie new therapies for diseases.

A rare case of acute destructive pancreatitis in a patient with chronic kidney disease on peritoneal dialysis: diagnostic and treatment challenges

Patients with chronic kidney disease are susceptible to developing acute pancreatitis. We present a rare clinical case of acute pancreatitis with the formation of pancreatic necrosis in a patient on peritoneal dialysis (PD), debuted with PD–associated peritonitis. On hospitalization, there were no diagnostic criteria for acute pancreatitis; treatment for dialysis peritonitis was ineffective. Repeated ultrasound examination revealed signs of diffuse changes in the pancreas and multi-chamber formation of the small pelvis. Refractory peritonitis, inadequate ultrafiltration, and unclear nature of formation in the pelvic were the grounds for diagnostic laparoscopy and removal of the peritoneal catheter. Abdominal inspection revealed spots of stearin necrosis over the entire surface of the peritoneum and the greater omentum; in the pelvis there were adhesions between the uterus and the rectum. Development of pancreonecrosis was confirmed by abdominal CT scan. Treatment of acute pancreatitis was without effect, type 2 myocardial infarction developed, and with increasing symptoms of multiple organ failure, death occurred.

Exocrine secretion oppression as game changing tool in acute pancreatitis surgical treatment

the aim of the work: to assess changes in tactic of surgical treatment of acute destructive pancreatitis (ADP) due to octreotide prescription in high dose 1 mg/day (OHD).
 Materials and Methods. OHD had been used as treatment of 6 patients with ADP. Within first two days of illness in such way were treated 4 patients (group1), in terms of two weeks after disease beginning OHD treatment had been applied to 2 patients (group2). All patients gave an informed consent to applied treatment.
 There were 2 women and 4 men in the age from 17 to 75 years. Gallstone disease combined with excessive eating lied ground to ADP outbreak in 2 patients, alcohol excessive consumption combined with overeating in 4.
 In our observations acute pancreatitis was diagnosed on integrated assessing results of clinical appearances, and results of laboratory and instrumental examining. OHD had been prescribed to every patient immediately after the diagnosis had been stated.
 Results and Discussion. All patients from group 1 became free from clinical signs of ADP two hours after OHD administering. Prolongation of the OHD use during next two days resulted in normalizing of general clinical state and amylase level. In one patient after two days of OHD treatment clinical signs didn’t normalized. There left some abdominal pain and substantial meteorism.
 Both patients from group 2 obtain stabilization of general clinical status with the clear expression a sign of a local abscess. By means of computed and magnetic tomography almost two local niduses in every patient had been localized and subsequently subjected it to healing through a mini-invasion approach. Both patients recovered.
 Conclusion. Thus, we can suggest that proposed method of OHD treatment cause stabilization of pancreatic parenchyma what may be the reason for observed immediate break of inflammation.
 
 

Development of Bioimpedance Spectroscopy Technology in Medical Decision Support Systems

The purpose of research – development of bioimpedance spectroscopy methods to develop on their basis objective and realistically accessible criteria for assessing the severity and prognosis of diseases, as well as evaluating the effectiveness of treatment methods, developing criteria for the use of conservative therapy options and surgical interventions in severe patients.Methods. The proposed method involves the use of a recurrent modified Voigt model as a biomaterial segment impedance model. For each model of a biomaterial segment, a Cole plot is plotted in a given frequency range. At the stage of determining the parameters of each of the models, a recurrent procedure is performed, which is the solution of systems of nonlinear equations, starting from one link of the Voight model with a subsequent increase in their number at each iteration step, until the value of the approximation error by the Voight model of the Cole experimental plot reaches allowed value.Results. As a result of the study, fundamentally new results have been obtained that allow creating intelligent decision support systems for diagnosing socially significant diseases. A bioimpedance analysis model based on multifrequency bioimpedance measurement has been created, which makes it possible to decompose the biomaterial impedance into structural elements, on the basis of which to determine descriptors for neural network classifiers of medical risk. In the work, an analysis of classifier errors was carried out in classifying the risk of acute destructive pancreatitis, which showed that the maximum value of the quality indicators of various classifier models was 78%, the minimum was 62%, demonstrating close values to the quality indicators of the ultrasound diagnostic method.Conclusion. The use of multifrequency sensing and modified Voight models in neural network classifiers of medical risk makes it possible to build clinical decision support systems for diagnosing socially significant diseases, as well as the ability to improve classification quality indicators and expand the functionality of intelligent medical decision-making systems.

EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF ACUTE DESTRUCTIVE PANCREATITIS

Acute destructive pancreatitis during several years still ranks second, and in some regions the first place in the structure of the urgent surgical pathology, ahead of acute appendicitis and acute cholecystitis. The most common cause of the disease is excessive alcohol usage and gallstone disease, but in 10-30% of patients, the etiology of acute pancreatitis remains uncertain. The study was based on the assessment and treatment of 300 patients with acute destructive pancreatitis. To assess the condition of patients the severity and progression of the disease, dynamic monitoring of the patients' state we were used such integral methods as APACHE II and III, Balthazar, SOFA, Ranson, Glasgow-Imrie, CTSI, SARS. Differentiated approach to surgical treatment in patients with destructive pancreatitis depending on the scale of the initial lesion of the pancreas has allowed an average reduction in the number of purulent complications per patient in 4 times (from 9.7% to 2.3%), lower lethality of purulent complications 3 times (from 16.3% to 5.7%), and consequently reduce the overall mortality in 2.7 times (from 26.0% to 9.9%). During the first 7 days from the onset of the disease, the number of platelets decreased, later, as the symptoms of pancreonecrosis subsided the number of platelets increased. Acute respiratory distress syndrome was characterized by shortness of breath, dry cough, and pain behind the sternum, inadequate condition of the patient, cyanosis, and rough crepitations.

ACUTE DESTRUCTIVE PANCREATITIS IN CHILDREN

Unlike adults, acute pancreatitis in children is a rare disease. The absence of unified standards for the diagnosis, treatment and rehabilitation of children with acute destructive pancreatitis, as well as high rates of complications and mortality, determined the relevance of our study.Materials and methods. Materials and methods. The results of treatment of 11 children with acute destructive pancreatitis were studied. The age of the patients ranged from 2 to 16 years. Laboratory examination in all patients included general and biochemical analyzes of blood, urine, peritoneal and thoracic exudate. All children underwent an ultrasound examination of the abdomen, chest cavity and mediastinum, and plain radiography of the chest and abdominal cavity. Computed tomography was performed in 6 patients (54.5%). Fibrogastroduodenoscopy (FGDS) was performed in 3 patients (27.3%). All patients underwent surgery. In 8 cases (72.7%), a median laparotomy was performed initially. In 3 observations (27.3%), surgical treatment began with video surgical revision of the abdominal organs, and then switched to conversion. Three patients (27.3%) subsequently underwent cystopancreatic jejunostomy. In one child, transcutaneous drainage of a false pancreatic cyst was performed under video surgical control. Synthetic somatostatin analogs and proteinase inhibitors were used as targeted therapy. All patients received long-term antibacterial therapy. Various methods of extracorporeal detoxification were used in 6 patients (54.5%).Statistical processing of the research results was carried out using standard methods with the calculation of relative values (absolute number of observations, % ratio).The approval of the scientific work was received from the Bioethical Commission of the Donetsk National Medical University (Ukraine).The work is a fragment of proactive research work of the Department of General and Children's Surgery of the Donetsk National Medical University (Ukraine). Results. Complications in the early postoperative period were noted in 8 children (72.7%). The group of the most severe complications included progressive enzymatic bacterial peritonitis, early adhesive intestinal obstruction, failure of cystopancreatic ileal anastomosis, profuse arrosive hemorrhage from the pancreas, cystopancreaticodigestive fistula and eventation. In the early postoperative period, 1 child aged 14 years (9.1%) died, and the rest of the patients were discharged in satisfactory condition. The average hospital stay for children was 23.1 days. In 7 patients (63.6%), complaints characterized by "enteric" discomfort occurred later.Conclusions. The principles of surgical and therapeutic tactics in children with acute destructive pancreatitis are based on a differentiated approach depending on the form of pancreatic necrosis and the development of purulent and destructive complications. Further study requires determination of situational surgical tactics, assessment of the effectiveness of combined therapy with somatostatin and proteinase inhibitors, selection of the optimal regimen of nutritional therapy and rehabilitation.

Modern principles of diagnostics of acute destructive pancreatitis

The incidence of acute destructive pancreatitis is steadily increasing worldwide and, according to the recent literature, is 300-900 patients/mil per year. The increased lethality rate of acute destructive pancreatitis in recent decades, which according to global statistics, ranges from 5% to 20% depending on the severity of the disease, is a cause for concern. It should be noted that most patients with acute destructive pancreatitis are working-age patients, which significantly increases the socio-economic aspect of the problem and urgently requires an active search for ways to solve it. It has been established that the leading pathogenetic mechanism of acute destructive pancreatitis development is enzymatic autolysis of pancreatic parenchyma by its enzymes with their subsequent release into the bloodstream and damage of other organs.

ВЗАИМОСВЯЗЬ СОМАТИЧЕСКИХ СИСТЕМНЫХ НАРУШЕНИЙ, ТРИГГЕРА ПАНКРЕОНЕКРОЗА И ПАНКРЕАТОГЕННОЙ ЭНЦЕФАЛОПАТИИ

Aim. To study the influence of systemic disorders on the risk of developing pancreatogenic encephalopathy.Materials and methods.In the period from 2010 to 2020, a prospective non-randomized cohort study was conducted at theclinical base of Department of Faculty Surgery of Volgograd State Medical University. ROC analysis was used to determine the impact of systemic disorders on the risk of developing pancreatogenic encephalopathy (PEP). The influence of the pancreatic necrosis trigger on the risk of multiple organ failure syndrome (MOF) was determined using logistic regression analysis. Results.The study included 429 patients with acute destructive pancreatitis. It was revealed that the debut of systemic disorders occurred on average on the first day of hospitalization. The most common were intestinal and cardiovascular insufficiency –336 (78,3 %) and 242 (56,4 %) cases, respectively. In patients with alcohol-associated pancreatic necrosis (AAPN), intestinal failure was significantly more common [144 (84,7 %) versus 192 (74,1 %),OR = 1,93, CI 1,164–3,210, p= 0,012] and multiple systemic disorders [159 (93,5 %) versus 224 (86,5 %), OR = 1,18, CI 0,659–2,122, p= 0,025] than in patients with non-alcoholic pancreatic necrosis (NAPN).The conducted logistic regression analysis proved an increased risk of PEP in the presence of any organ dysfunction. However, no such relationship was found for acute renal failure. The risk of developing MODS in patients with AAPN increases by 37,5 % compared with patients with non-alcoholic pancreatic necrosis, while the specificity and sensitivity reach 75,3 % and70,0 %, respectively.Conclusions.In patients with alcoholic genesis of pancreatic necrosis, the risk of intestinal failure, as well as multiple systemic disorders, significantly increases. A significant increase in the likelihood of organ and multiorgan disorders in patients with pancreatogenic encephalopathy was revealed.

ЭНДОТЕЛИАЛЬНАЯ ДИСФУНКЦИЯ В ОЦЕНКЕ СТЕПЕНИ ТЯЖЕСТИ ОСТРОГО ПАНКРЕАТИТА

Abstract. Introduction. The questions of the efficacy estimation of the treatment carried out at various forms of acute pancreatitis and the choice of the optimal terms of surgical treatment are still debatable. The given work is an attempt to find effective indications for the adequate treatment of patients with this pathology. Aim. Aim is to estimate the number of desquamated peripheral blood endothelial cells and degree of their coloring in patients with acute pancreatitis in the dynamics of the disease. Material and methods. We studied desquamated endothelial cells in 22 patients divided into 2 groups: group A – with acute edematous pancreatitis, and group B – with acute destructive pancreatitis with surgical treatment. We were studied the dynamics of the number of desquamated peripheral blood endothelial cells and degree of their coloring in both ways of treatment and their compliance with the scales that shows the severity of the disease. Results and discussion. In group A patients on day 7–9 while clinical and laboratory parameters of acute pancreatitis was decreased we noticed that the number of desquamated endothelial cells was decreased in the field of vision from 8 to 4,7. In group B the increasement of the parameters of the scales of criteria for acute pancreatitis and leukocyte intoxication has the same result – number of cells in the field of vision were decreased from 195 to 50. This patterns of the dynamics of the intensity of coloring of desquamated endothelial cells in both groups are reflected in the coloring coefficient, that was made by our study group. We found that in group A the color coefficient decreases from 1,5 to 0,2 (hyperchromically colored cells prevail), and in group B the coefficient increases from 0,8 to 1,2 (hypochromically colored cells increased). Conclusion. The study of the degree of endotheliocyte staining, reflecting the compensatory possibilities of the organism and treatment efficacy, is of great importance in the assessment of the severity and prognosis of acute pancreatitis treatment. An increasment of the color coefficient of desquamated endothelial cells by 0,4 may indicate that it’s time for surgical methods of treatment.

Derivatives of 3-Hydroxypyridine in The Correction of Disorders in The Structural and Functional Properties of Erythrocytes in Experimental Acute Destructive Pancreatitis Due to Chronic Ethanol Intoxication

At present, acute pancreatitis only in some areas is a rather well-studied disease of the abdominal organs, however, the destructive forms of this disease have various developmental patterns, complications and, often unfavorable outcomes. The aim of the research is to establish the possibilities to correct the disorders in the functional and structural features of erythrocytes by 3-hydroxypyridine derivatives in experimental acute destructive pancreatitis due to chronic ethanol intoxication. In experimental acute destructive pancreatitis due to a 60-day ethanol intoxication there was a decrease in the content of proteins (a - ? ß -spectrin, ankyrin, anion transport protein, actin, gyceraldehyde-3-phosphate dehydrogenase, glutation-S transferase) and lipids (phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, glycerophospholipids, sphingomyelin, phospholipids, triacylglycerol, sum of mono- and diacylglycerol), an elevated level of band 4.1 and 4.5 proteins, pallidin, dematin, tropomyosin and lipids (lysophosphatidylcholine, cholesterol, it’s esters, non-esterified fatty acids), a disorder in intrinsic cellular metabolism of erythrocytes (an increased concentration of lipid peroxidation products, a decreased activity of catalase, superoxide dismutase, degree of stable metabolites of nitrogen oxide and sorption indicators of membrane) in the erythrocyte membrane. The study has revealed that the greatest efficiency in correction of disorders in the functional and structural feutures of erythrocytes from among the derivatives of 3-hydroxypyridine has a compound ß - hydroxynicotinoylhydrazon 2-methyl-3-hydroxy-4-formyl-5-oxymethylpyrydine dihydrochloride, and the least one - 2-ethyl-6- methyl-3-hydroxypyrydine malate (etoxydol), the administration of 2-ethyl-6-methyl-3-hydroxypyrydine succinate (mexidol) has shown an intermediate result.

Diagnosis of infectious complications in patients with acute pancreatitis

BACKGROUND: Up to 30% of patients with acute pancreatitis suffer from the severe form of the disease, of which 30% of cases are lethal, significantly rising to 80% at the development of infectious complications.
 AIM: To improve treatment results of patients with acute pancreatitis due to early diagnostics of infectious complications.
 MATERIALS AND METHODS: Expression of CD64 antigen on neutrophil membrane (DC64 index of neutrophils) was studied using a flow cytometer Cytomics FC500 (Beckman Coulter, USA) using 3-color combination of direct monoclonal antibodies Beckman Coulter: СD14FITC/CD64PE/CD45PC5. Material was whole blood.
 RESULTS: A direct correlation of moderate strength with the development of sepsis was found for both the procalcitonin value and C-reactive protein concentration at this period of illness. However, no relations of endogenous intoxication markers with the development of infectious complications were found (correlation coefficients less than 0.4). Thus, it should be noted that the difference in the indices of the studied parameters of the CD64 antigen expression in the groups began to increase exactly during the 23rd week of the disease.
 CONCLUSION: Based on the literature data, we formulated a working hypothesis, which states that the degree of CD64 receptor expression on peripheral blood neutrophils is an early marker of infectious complications of acute pancreatitis. The value of average fluorescence intensity index of molecules CD64 equal to 10 conventional units was accepted as a threshold value with regard to the development of IE, and the value of 15 conventional unitsas a threshold value with regard to sepsis. The study was conducted in a prospective group of 28 patients. In accordance with the provision of the working hypothesis, the patients were divided into 3 groups depending on the level of average fluorescence intensity index of molecules CD64. Expression of the CD64 receptor on peripheral blood granulocytes as an early laboratory marker of infectious complications of the disease was studied for the first time. We determined sensitivity and specificity, optimal terms of the given research, detected regularities of CD64 expression changes in the course of acute pancreatitis, correlations with other clinical and laboratory indexes, including prospective markers of infection (procalcitonin, C-reactive protein), with the integral scales of severity estimation of patients with acute destructive pancreatitis. Determination of the level of the receptor CD64 expression on the peripheral blood neutrophils showed that this marker reflects the dynamics of the disease course and gives the possibility of the early diagnostics of the infectious complications of acute pancreatitis. The use of this method provides additional information about the development of the surgical infection. It is important that the changes of CD64 antigen expression in dynamics outrun other markers of systemic inflammatory response and sepsis. CD64 antigen expression data on peripheral blood neutrophils is an additional factor in determining differentiated surgical tactics in phase I of the diseases development with regard to acute fluid collections in patients with acute pancreatitis.

Nutritional status of patient with complicated course of cholelithiasis and pancreatitis

Objective. To study the nutritional status of a patient with a complicated course of cholelithiasis and pancreatitis. Materials and methods. A clinical case of a complicated course of cholelithiasis. Methods: clinical, laboratory and instrumental (biochemical blood analysis, ultrasound examination of abdominal organs, esophagogastroduodenoscopy, endoscopic ultrasound, computed tomography of abdominal organs). Results. Based on the data of the clinic, laboratory and instrumental studies, surgical complications of the course of cholelithiasis in the patient were identified (choledocholithiasis, acute destructive pancreatitis with the development of an abscess of the subhepatic space on its background, destructive cholecystitis). Conclusions. Lifestyle modification and timely cholecystectomy would help to avoid the development and complicated course of cholelithiasis.

Оптимизация хирургического лечения острого деструктивного панкреатита

Objective. To improve the results of endovideosurgical treatment of patients with acute destructive pancreatitis. Material and methods. The research was carried out at the bases of the Nur-Sultan Multifunctional City Hospital №2 and the Nur-Sultan Multifunctional City Hospital №1. Statistical analysis of the results was carried out using the methods of variation statistics with the calculation of M ± SD. Differences between comparison groups were analyzed using the Wilcoxon-Man-Whitney test and were considered statistically significant at p≤ 0.05. From 2017-2021, 64 patients with acute destructive pancreatitis were treated according to the developed and implemented treatment algorithm: Of these: AP without organ failure and local or systemic complications -10 people. AP of moderate and severe form -54 people. Lethal outcomes-1; The average length of stay in the hospital is 20.8±1.2 days; The mean age was 43 ± 1.3 years. The control group - treatment of patients with moderate and severe acute biliary pancreatitis without the use of ulinostatin (hereinafter US) was n = 122; Lethal outcomes-8. An algorithm for the use of US was developed and implemented depending on the severity of the course of destructive pancreatitis in the complex treatment of patients with AP. Results. 10 patients were treated conservatively. 54 - surgical treatment was combined with the appointment of US according to the developed scheme. Endoscopic surgery was performed in 51 patients; 3 patients were operated on by laparotomy. The average duration of hospital stay in the main group was 3.5±0.34 days less than in the control group. Conclusion. The research results showed the high efficiency of the developed algorithm for endovideosurgical treatment of AP in combination with the use of the US. Received AC №14704 dated January 27, 2021 (www.kazpatent.kz).

Features of diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism

Aim: To identify a connection between acute and chronic pancreatitis and primary hyperparathyroidism on the base of clinical cases. To consider the features of the diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism.Materials and methods: Over the past 10 years, there have been observed 3 cases of pancreatitis with primary hyperparathyroidism. Two patients were diagnosed with chronic pancreatitis, one patient was diagnosed with acute destructive pancreatitis. Patients were undergoing surgery, parathyroidectomy was performed.Results: Primary hyperparathyroidism is rarely associated with the occurrence of acute or chronic pancreatitis, but hypercalcemia plays an important role in the pathogenesis of these diseases. Pancreatitis usually occurs in the late stage of hyperparathyroidism, which explains the low prevalence of this association in developed countries, where primary hyperparathyroidism is diagnosed at an early stage of the disease.Conclusion: These clinical cases of radical surgical treatment of parathyroid adenoma associated with severe concomitant pathology testifies to the effectiveness of the surgical method in some cases. It is necessary to take into account severe concomitant pathology and diagnose and correct it in time.