Acute Destructive Pancreatitis Research Articles

Pathogenetic Factors Contributing to the Development of Delayed Complications of Acute Destructive Pancreatitis

Purpose. To evaluate pathogenic factors contributing to the development of delayed complications of newly diagnosed acute destructive pancreatitis (ADP). Materials and methods. A comprehensive examination, treatment and 5-year follow%up of 83 patients who underwent the first attack of ADP have been conducted. The day of admission to the hospital, 24 hours from the beginning of the intensive care, and Days 3 and 5 after the attack were selected as the timepoints of the study. Complete diagnostic procedures were performed once every six months after hospitalization for five years. The patients were followed%up every month. Depending on the further progression of ADP, the patients were divided into four groups. Group I included 27 patients with acute pancreatitis which evolved into pancreatic pseudocysts. Group II (n=43) was comprized of the patients with chronic pancreatitis; group III (n=8) included the patients who presented no pathological processes associated with structural and functional pancreatic changes over the next 5 years; and group IV (n=5) included the patients with pancreatogenic diabetes mellitus. Results. The study confirmed the role of autoimmune mechanisms and abnormal foci localization in pancreas in the development of pancreatogenic diabetes mellitus, contribution of inflammation to formation of post-necrotic pancreatic pseudocysts, as well as the significance of the patient compliance for development of chronic pancreatitis with extensive pancreatic lesions. Conclusion. Statistical analysis of the long-term monitoring of patients allowed to set the odds ratio evolution acute pancreatitis depending on its initial characteristics. At the same time we take into account the parameters and interpretation of the study which is possible in the first few days hospitalization.

Disorders in structural-functional properties of erythrocytes in experimental acute destructive pancreatitis of alcohol etiology and their correction

The effects of various combinations of pharmacological agents on parameters characterizing red blood cell (RBC) membrane proteins and lipids have been investigated in RBC isolated from Wistar male rats with acute destructive pancreatitis induced under conditions of forced alcoholization for 60 days. Administration of a combination of Hepon, Hypoxenum, and Phosphogliv normalized 22.5% of parameters altered change during development of acute destructive pancreatitis under conditions of chronic alcoholization of parameters, corrected towards normal values 42.5% of parameters (35% of parameters remained unchanged). Administration of Glutoxim, Mexidol and Heptral, was more effective: this combination normalized 50.0% of parameters studied, corrected towards normal values 37.5% of parameters, leaving unchanged only 12.5% of parameters studied.

PREDICTORS OF SEPSIS IN PATIENTS WITH URGENT CONDITIONS

Background. Given that the imbalance in pro- and anti-inflammatory cytokines plays an important role in the pathogenesis of sepsis, estimation of its prognostic value in patients in the early stages from the disease onset or injury is of concern. Aim of study. To study changes in concentrations of biomarkers for inflammation on day 1–2 in patients with a high risk for sepsis. Materials and methods. On day 1-2 from the admission, blood tests were performed in 48 patients with a high risk of sepsis: 9 — with mediastinitis, 6 — with widespread purulent peritonitis, 24 — with severe concomitant injury, 9 — with acute destructive pancreatitis. Sepsis occurred in 28 patients of group 1. Group 2 consisted of 20 patients without sepsis. We investigated concentration of procalcitonin, C-reactive protein, interleukine-6 and -10, lipopolysaccharide-bindidng protein and soluble receptor for interleukine-2. Result. Significant differences in concentrations of groups were identified on day 1-2 in CRP (P=0.00009), IL-2R (P=0.0005) LBP (P=0.00002) and IL-6 (P=0.0192). Conclusion. Hyper LBP and CRP on the background of high IL-2R, IL-6, increase the risk of sepsis.

Our experience in treating children with acute destructive pancreatitis

Our experience in treating children with acute destructive pancreatitis

CLINICAL VALUE OF MEASURMENT OF INTRA- ABDOMINAL PRESSURE AND ITS MONITORING IN EMERGENCY SURGERY

The article presents an analysis of modern methods of the measurement, including classical and original methods and devices developed by the authors. The results of examination and treatment were analyzed in 397 patients with acute obturation intestinal obstruction and acute destructive pancreatitis, who had the abdominal compartment syndrome from I to IV degree. The authors showed that on-time decompressive laparotomy allowed the decrease of lethality from 25% to 15-17,8%.

СОСТОЯНИЕ ПОРТО-ПЕЧЁНОЧНОЙ ГЕМОДИНАМИКИ ПРИ ПЕЧЁНОЧНОЙ НЕДОСТАТОЧНОСТИ У БОЛЬНЫХ ДЕСТРУКТИВНЫМ ПАНКРЕАТИТОМ

Extraorgan complications of acute destructive pancreatitis are registered in 60–95% of patients. Liver failure is regis-tered in one of the four patients with pancreatic necrosis. We analyzed the results of surgical treatment of 122patients with acute destructive pancreatitis. We studied clinical indicators of liver failure in 103(84.4%) patients with acute pancreatitis. The development of portal hypertension with decrease in hepatic volume perfusion is an important ele-ment in the pathogenesis of acute pancreatitis and associated liver function abnormalities. In patients with severe and moderate liver failure, the reduction of blood flow in portal vein was registered. It was caused by reduce of portal vein diameter and decrease in linear blood flow velocity. Destructive pancreatitis is accompanied by liver failure with hyperbilirubinemia, increased activity of cytolytic enzymes, incoordination in protein and carbohydrate metabolism as its common manifestations. An important factor in the pathogenesis of liver failure is a reduction of porto-hepatic hemodynamics and as a consequence – hepatic hypoperfusion.

MINIINVASIVE TECHNIQUES OF ACUTE DESTRUCTIVE PANCREATITIS DIAGNOSTIC AND TREATMENT

In the article the modern controlled miniinvasive techniques of acute destructive pancreatitis diagnostic and treatment and its complications are discussed. Perspective miniinvasive techniques as many-frequent bioimpedancemetry and crystallography are described. Different controlled miniinvasive interventions were used in the particular sequence in dependence on clinico-morphological form of pathological process. Endocavital ultrasound research is the perspective area in the development of miniinvasive techniques at the destructive pancreatitis.

ЕКСТРАКОРПОРАЛЬНА ДЕТОКСИКАЦІЯ В ЛІКУВАННІ ХВОРИХ НА ГОСТРИЙ ПАНКРЕАТИТ

<p>РЕЗЮМЕ. За період з 2007 по 2012 р. обстежено 115 хворих на гострий панкреатит різного ступеня тяжкості<br />віком від 28 до 72 років. У обстежених пацієнтів виявлено зміни клітинного і гуморального імунітету, порівняно із<br />здоровими: у крові зменшувалася відносна кількість основних класів клітин клітинної ланки імунітету. Обстежені<br />пацієнти були поділені на 2 групи: пацієнти з гострим панкреатитом, набряковою формою – 23 хворих; пацієнти<br />з гострим деструктивним панкреатитом – 92 пацієнти. В основну групу спостереження увійшли 42 пацієнти<br />(36,8 %), у яких позитивних результатів досягнуто за допомогою інтенсивної консервативної терапії, оперативного<br />лікування, а також застосування екстракорпоральної детоксикації. Застосування еферентних методів в лікуванні<br />гострого деструктивного панкреатиту дозволило зменшити кількість гнійно-септичних ускладнень та летальних<br />наслідків.</p><p><br />КЛЮЧОВІ СЛОВА: панкреатит, екстракорпоральна детоксикація.</p>

Pathogenesis of Cardiac Depression in Acute Destructive Pancreatitis

Objective is to identify the pathogenic factors for progression of pancreatogenic cardiac failure in the nearest and remote periods. Materials and methods. The study was carried out on 130 male Wistar rats (292±4.0 g) divided into 4 groups. The animals were anesthetized with ethyl ether. Acute destructive pancreatitis was simulated in three experimental groups by infusion of bile (0.15 ml/kg body weight) taken from the bile duct into the pancreatic tissue. The isolated isovolumically contracting rat heart (according to E. L. Fallen et al) was simulated 24 hours, 7 days and 1 month after the bile infusion. The pressure in the left ventricle was measured by electric manometer BMT and registered along with the first derivative at the device N3384P calculating the systolic and diastolic blood pressure, and the speed of contraction and relaxation. At the same time the perfusate samples passed through the coronary arteries were har vested, and aspartate aminotransferase (AST) and glucose were determined by standard methods. To identify the cardiac depression, the high contraction rhythm and hypercalcemic and hypoxic perfusion were applied. Results. It was found that in acute destructive pancreatitis the power and speed parameters of the heart con tractile function were altered that led to lowering the systolic blood pressure and velocity of contraction and relax ation of the left ventricular myocardium and increased diastolic blood pressure as an indicator of cardyomyocyte contracture rate. These abnormalities were evidently manifested in increased heartbits, including hypercalcemic and hypoxic perfusion of the isolated hearts. Glucose consumption was raised per each mmHg generated by the ventricular pressure. Conclusion. the most significant pathogenetic factors of pancreatogenic heart failure include hypoxia, car diomyocyte membrane destruction, inhibition of sarcolemma Capump, sarcoplasmic reticulum, and mitochondrial dysfunction. The maximum depression of myocardial contractility of the left ventricle is detecting during the first day and in a month after simulated pancreatic necrosis.

Systemic disorders management in patients with acute pancreatic necrosis

To study the effectiveness of sulodexide for systemic disorders correction in patients with acute pancreatic necrosis. The study included 60 patients with acute pancreatic necrosis who were divided into main and control groups by 30 patients. Their age varied from 27 to 79. Standard combined therapy with prevention of disseminated intravascular coagulation and thrombotic complications was recommended in all patients. In the control group enoxaparin therapy in prophylactic doses (4,000 IU (40 mg) per day) was used. Mean duration of treatment was 6±0.9 days. Sulodexide was used in the main group. Sulodexide was administered since the 1st hospital day 600 LE per day intravenously for 5-10 days. The duration of treatment was determined according to clinical course and «capillary leak» that was measured by serum proteins loss. Mean duration was 8.8±0.3 days. Hospital-stay was significantly lower in study group than in control group for about 5±2.2 days (p<0.03). Overall mortality was lower by 10%. In both groups unfavorable outcomes were caused by severe multiple organ failure. There were no deaths in case of SOFA score less than 6. In the main group mortality of patients with severe multiple organ failure was 2.4 times lower than in the control group (14% vs. 33%). Correction of microcirculation and tissue perfusion improves the severity of systemic manifestations of acute destructive pancreatitis. Mortality and hospital-stay were decreased due to reduced incidence, severity and duration of multiple organ failure and frequency of complications.

Use of somatostatin analogues in the pancreonecrosis therapy (kliniko-experimental research)

Experimentalmodel of acute destructive pancreatitis onrats of Wistar line with weight of 300±30 gwas reproduced.There were 5 animal groups (one control group and four experimental groups). Experimental animals received oktreotidin different doses. In 2 days there were estimated the blood biochemistryand histopathologic features of liver and pancreas of operated animals. In clinical part there were formed two groups of patients out of selected case histories by a principle of similarity of complex therapy differing in oktreotid doses, namely: 1) pancreatonecrosis patients estimated of 3 to 8 points by Ranson scale in whose treatment regimen oktreotid 300 mkg/day (n=70) dose was included; 2) pancreatonecrosispatients estimated of 3 to 8 points by Ransonin whose treatment regimenoktreoid1200 mkg/day (n=38) was included. There were compared indices of lethal outcomes, average bed-days, and dynamics of laboratory findings, number and volume of surgical procedures. Dose-related effect of a synthetic analogue of somatostatin, acetateoktreotid, was proved. Introduction in complex therapy of pancreatonecrosisthe highest possible authorized doses of oktreotid (1200 mkg/day) is conducive to more favorable course of illness, dynamic reduction of amilazemia, decrease of lethal outcomes and total bed-day, and also, reduction of initial and repeated operative procedures.

Features of pathological changes in patients with different types of pancreatic pseudocyst.

Background. A growing number of patients with pancreatic pseudocyst on the background of acute or chronic pancreatitis or due to injury of the pancreas encourages scientists to study the etiology and pathogenesis of this disease. Objective. Тo study morphological features of various types of wall structure and adjacent parenchyma of pseudocyst using histochemical techniques. Methods. Resected pancreatic specimens taken intraoperative from 47 patients were used as a material. Results. Patients of the first group with forming acute pseudocyst on the background of acute destructive pancreatitis, characterized by severe circulatory disorders in pancreas, destructive changes of all structural components of the gland with subsequent development of reactive inflammatory response to injury in the form of diffuse or focal leukocyte infiltration of the stroma and the parenchyma and signs of original reparative process. In all patients of the second group with postnecrotic chronic pseudocyst the wall of pseudocyst was represented by granulation tissue and fibrous layer. In the surrounding pancreatic tissues it was revealed morphological signs of chronic pancreatitis with fibrotic stromal changes and chronic inflammatory infiltration, parenchymal atrophy and restructuring of false acinar lobules, metaplasia of their cell. All patients of the third group demonstrated a pronounced fibrosis of the stroma with atrophy of parenchyma and restructuring of all components of the pancreas: the formation of false acinar lobules, compensatory hypertrophy of islet apparatus, restructuring of ductal system of pancreas, formation of retention pseudocyst with a fibrous wall lined with epithelium with signs of hyperplasia and metaplasia. Conclusion. Morphological changes that occur during formation of pseudocyst lead to organ dysfunction and should be considered as an adverse pathological process that requires surgical correction.

Comparison of the Methods for Classification of Observations in Predicting Complications in Critically ILL Patients

We compare cluster analysis, Wald's sequential analysis, and the method of coordinate system rotation for the classification of patients with acute destructive pancreatitis and patients with acute combined radiation damage for early detection of complications. In the first case, the Wald analysis is efficient. In the second case, k-means cluster analysis and coordinate rotation method are proposed

CHANGES OF IMMUNE STATUS IN ACUTE PANCREATITIS AND ITS CORRECTION

Changes of immune status were studied in patients with acute pancreatitis. The presence of expressed secondary immunodeficiency was determined in patients with acute destructive pancreatitis. The Ronkoleykin immunomodulator was used to correct the immune status. The authors obtained the posi- tive results. An application of Ronkoleykin immunomodulator allowed decrease of the postoperative lethality with a high degree of reliability (p < 0.01).

Choice of surgical treatment in patients with acute destructive pancreatitis

Medical and diagnostic algorithm in patients with pancreatic necrosis is developed. It takes into consideration features and expansion of necrotic process in retroperitoneal space, objective severity of patients' condition according to SAPS scale and inflammatory process according to serum procalcitonin concentration. Comparative analysis revealed that the use of developed algorithm improves results of treatment.

Dynamics of hematogenous dissemination of intestinal microflora in experimental acute destructive pancreatitis

The results of microbiological examination of haematogenous dissemination of intestinal microflora in the dynamics of experimental acute destructive pancreatitis are presented in the article. The species composition and population levels of contaminants have been determined. Based on the experimental study, contamination of portal blood within 24-48 hours of opportunistic enterobacteria and staphylococci in high and low systemic blood at the population level has been established.

Optimizing antibacterial treatment in acute pancreatitis (experimental and clinical research)

Aim. To examine the effectiveness of interstitial electrophoresis in antibacterial treatment in animals with experimental pancreatitis and in patients with acute pancreatitis. Methods. Cefotaxime concentration was studied by highly effective chromatography at different routes of administration in 40 rats of both gender with body weight of 150-250 g at the department of surgery of Kazan State Medical Academy and department of pharmacology of Kazan State Medical University. The clinical part of the research compared treatment results in group of patients (n=27) in whom interstitial electroforesis was performed together with antibacterial treatment with group of patients (n=26) who were treated conventionally. Results. Antibiotic introduction using galvanizing in experimental pancreatitis is more effective compared with traditional antibiotic introduction 24 hours after acute pancreatitis modulation. In the clinical part of the research in the main group complications were registered in 14.8% of cases, localized forms of infection (3 effusions, 1 retroperitoneal abscess) were the most common. In control group complications were seen in 34.6% of cases, generalized infections were the most common type (omental and retroperitoneal abscess - in 15.4% of cases, retroperitoneal pyogenic cellulitis - in 19.2% of cases). So, in the basic group less invasive procedures were more common compared with laparotomy, marsupialization, lumbotomy being more common in control group. Mortality rate was 11.1% in the main group and 15.4 in control group (р 0.05). Conclusion. Using interstitial electrophoresis in antibacterial treatment decreases the frequency of purulent complications, with localized forms of the infection being more prevalent, and allows to decrease the mortality rate in patients with acute destructive pancreatitis.

Методы нутритивного обеспечения при проведении интенсивной терапии у пациентов с острым панкреатитом

The influence of different variants of parenteral nutrition (PN) for patients with necrotizing pancreatitis and edematous form of acute pancreatitis are analyzed. It is shown that the best method of parenteral nutrition for most patients is the use of a mixture of “three in one” (if there are contraindications to the use of fat emulsion should apply “two in one”). Using a mixture of “three in one” reduced the number of septic complications, faster stabilize hemodynamics and laboratory parameters in patients with acute destructive pancreatitis. We can recommend to reach the target energy requirements at 25–30 kcal/kg ideal body weight per day for patients with acute pancreatitis. In the presence of persistent hyperglycemia (more than 6.6 mmol/l) it is advisable to use enteral nutrition of diabetes type. You should give preference to enteral nutrition with the lowest hyperglycemic index, dietary fibers and low osmolarity.

MORPHOLOGICAL FEATURES OF EXTRAPANCREATIC LESION OF INTERNAL ORGANS IN ACUTE ENZYMATIC PARAPANCREATITIS

The article analyzes the causes of fatal outcomes and structure of postoperative complications in patients who died of acute destructive pancreatitis. The analysis of morphological changes of internal organs has shown that the cause of early fatal outcomes is massive enzymatic noncorrected intoxication, and late lethal outcomes are caused by the intoxication associated with resorbtion of toxic substances from necrotically changed parapancreatic cellular tissue. The special attention is given to the features of anatomic interrelation of the destructively changed pancreas and the affected parapancreatic cellular tissue. An obligate lesion of the parapancreatic cellular tissue was found in the necrosis centres in the pancreas parenchyma. The article studies morphological changes in the wall of the small intestine that cause enteral insufficiency in acute destructive pancreatitis. It was shown that according to the autopsy data, the real number of observations of total pancreatonecrosis was not adequate if to compare with that that was supposed according to the data of clinical and intraoperative inspections. The analysis of operative interventions showed that purulent-necrotizing parapancreatitis is an object of surgical intervention.

MODERN CONTROLLED MINIINVASIVE TECHNIQUES OF ACUTE DESTRUCTIVE PANCREATITIS DIAGNOSTIC AND TREATMENT

In the article the modern controlled miniinvasive techniques of acute destructive pancreatitis diagnostic and treatment and its complications are discussed. Perspective miniinvasive techniques as many-frequent bioimpedancometry and crystallography are described. Different controlled mini- invasive interventions were used in the particular sequence in dependence on clinico-morphological form of pathological process. Endocavital ultrasound research is considered as perspective area in the development of miniinvasive techniques of destructive pancreatitis treatment.