Exacerbation Of Chronic Pancreatitis Research Articles

ОСОБЕННОСТИ ДИАГНОСТИКИ И ВЕДЕНИЯ ПАЦИЕНТКИ С СИНДРОМОМ ФРЕДЕРИКА (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

Description of a clinical case. The article presents a clinical observation of a 77-year-old patient with newly diag-nosed Frederick’s syndrome, which is a combination of a permanent form of atrial fibrillation and complete atrioven-tricular block. An exacerbation of chronic pancreatitis was the reason for hospitalization of the patient. The patient had no complaints of bradycardia or syncope, but treatment of the underlying disease was difficult due to the development of acute kidney injury against the background of chronic kidney disease and uncompensated chronic heart failure. The cause of the development of Frederick’s syndrome was pronounced myocardium remodeling due to diseases that make up the classic complex of metabolic syndrome – coronary heart disease, arterial hypertension, type 2 dia-betes mellitus and obesity. Conclusion. The analysis of a few domestic and foreign literature sources showed that the development of Frederick’s syndrome is associated with a worsening prognosis and the development of various complications, which is usually underestimated by attending physicians. Taking into account the difficulties of diagnosis and management of patients with this pathology, it is necessary to be wary of the development of Frederick’s syndrome, especially in comorbid elderly and senile patients. Timely medical correction and referral of the patient for surgical treatment will improve the prognosis and reduce mortality in patients with atrial fibrillation.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Optimization of the complex treatment of chronic pancreatitis in elderly patients using systemic enzyme therapy

In the last few years, the number of young people with pancreatic pathology has increased. However, exacerbation of chronic pancreatitis (CP) in “favorable conditions” occurs at any age, leading to extremely unfavorable consequences.
 The aim is to study clinical and etiological factors of CP in elderly patients and optimize the complex treatment of this category of patients by including a systemic enzyme therapy agent.
 Materials and methods. The study included 98 CP patients, with a mean age of 71.3±1.4 years, who were randomized into two groups. All patients received the standard conventional treatment complex (CTC): pantoprazole 40 mg on an empty stomach on demand; prolonged enzyme replacement therapy with pure pancreatin at an adequate dose with each meal; prokinetics and/or antispasmodics as needed for 6 weeks. The study group was randomized into two groups: group I (CTC) — 20 patients got only CTC; group II (CTC+W) — 78 patients received Wobenzym in addition to CTC, 5 tablets three times per day.
 Results and discussion. It has been proven that CP in elderly patients occurs against the background of mixed etiopathogenetic factors: ischemic (87.7%), gastroduodenal (84.7%), and dyslipid (70.4%). Clinically, asthenic and dyspeptic syndromes predominate (92.8% and 77.5%, respectively). According to the anthropometric examination, body weight deficiency is observed in 64.3% of the examined, with endocrine pancreatic insufficiency in 29.6% in terms of fasting glucose and exocrine pancreatic insufficiency in 70.4% in terms of FαE. The use of CTC contributed to the reduction of dyspeptic and painful abdominal syndromes (p˂0.05), a decrease in body weight deficit by 4.3% in terms of body mass index, and a tendency to normalize pancreatic function.
 Conclusions. The addition of CTC with Wobenzym resulted in a decrease in the clinical manifestations of the disease (p<0.03–p<0.05), an improvement in carbohydrate imbalance in terms of postprandial glycemia (p<0.05), and a trend towards a decrease in the level of glycated hemoglobin by an average of 0.2%. The administration of Wobenzym in the complex treatment of CP in elderly patients contributed to an increase in the level of FαE by 42.6% compared to this index before treatment (p<0.001) and a decrease in nutrient deficiency due to the elevated body mass index of this category of patients by 7.0%.

Ultrasound histography in assessing the degree of pancreatic fibrosis in chronic pancreatitis

Aim: to analyze the clinical and pathogenetic significance of ultrasound histography in pancreatic fibrosis in patients with chronic pancreatitis (CP).
 Materials and methods. One hundred and eighty-six patients with CP were examined. Complete blood count, urinalysis, biochemical blood and urine tests, duodenal intubation test, coproscopy, enzyme immunoassay, and radioimmune assay were performed. The levels of blood transforming growth factor β1 (TGFβ1) and fecal elastase 1 were measured. Ultrasonography and ultrasound histography of the pancreas and liver, Doppler sound study of the abdominal aorta, celiac trunk, and superior mesenteric artery were carried out.
 Results. There were correlations suggesting decreased exocrine pancreatic function as its fibrosis progressed, which was indirectly reflected in the increased L index of an ultrasound histogram. The positive correlation between L index and TGFβ1 also showed increased L index in more severe pancreatic fibrosis. CP exacerbation was accompanied by decreased Kgst and N, which were confirmed by evident hyperenzymemia (the blood enzyme deviation) with the decrease of those indices. The clinical signs of CP, especially the rise in the number of dyspeptic complaints that show decreased pancreatic exocrine secretion, revealed pancreatic fibrosis. This was also shown by the fact that the debit hour of lipase and the activity of fecal elastase 1 decreased as the L index increased. There were signs that decreased blood flow in the pancreas made the fibrosis and insufficiency of the organ worse. Furthermore, ultrasound histographic findings reflected a positive correlation between pancreatic and hepatic fibrosis.
 Conclusion. An examination of pancreatic ultrasound histographic correlations led to the conclusion that this technique could be used to estimate the degree of pancreatic fibrosis and CP exacerbation indirectly.

Characteristics of the pancreas and liver state in chronic pancreatitis on the background of treated chronic viral hepatitis C depending on the international CAGE questionnaire testing results

Background. It was found that in 35–56% of patients, hepatobiliary diseases are considered to be a factor causing the formation or exacerbation of chronic pancreatitis (CP) while reducing the share of pancreatitis of alcoholic etiology, as it was previously believed. However, the role of the alcohol factor and its consideration in the treatment strategy for CP and comorbidity with chronic viral hepatitis C (HCV) also needs to be clarified, because it is known that excessive alcohol consumption and smoking increases the risk of developing pancreatitis by 8–17 times. The purpose is to conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis associated with chronic viral hepatitis C treated etiotropically, depending on the results of testing according to the international CAGE questionnaire. Materials and methods. We have examined 100 ambulatory patients with CP and concomitant HCV, treated etiotropically. All patients were examined according to generally accepted algorithms. To clarify the effect of alcohol on the formation of CP and the state of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study on the density of the liver parenchyma and the pancreas was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous shear wave elastography on the Ultima PA scanning ultrasound device with the further measurement of the median of the parameters in kilopascals. Determination of the presence and depth of exocrine pancreatic insufficiency was carried out by the content of fecal elastase-1 evaluated using the enzyme immunoassay method. Results. Screening-testing of patients with CP on the background of HCV treated etiotropically using the CAGE scale made it possible to state that 65.0% of them had a latent craving for alcohol, and 21.0% of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group with CAGE ≥ 2.0, functional and structural changes in the liver and pancreas were significantly more severe (deepening of the exocrine pancreatic insufficiency with a decrease in fecal α-elastase by 13.01%, an increase in the total index of the coprogram by 15.11% and the total ultrasound indicator of the pancreatic structure by 28.06%, and the total ultrasound indicator of the liver structure by 40.68% (р<0.05)) and corresponded to the average degree of severity of the process in the pancreas according to the criteria of the Marseille-Cambridge classification, and in the group with CAGE<2.0— only to a mild degree. Conclusions. The negative effect of the factor of increased alcohol use according to the CAGE was proven by increased density of pancreatic echotexture by 5.73% (p<0.05), and of the hepatic echotexture by 5.16% (p<0.05). According to the results of the correlation analysis on the dependence of the structural state of the liver and pancreas on the CAGE score, which were R=0.713, p<0.05, and R=0.686, p<0.05, respectively, there was found a strong direct dependence of the structural state of the liver and pancreas on the CAGE score, which proved an independent, reliably significant role of alcohol consumption for patients with a comorbid course of CP and HCV.

Effectiveness of Intestinal Lavage for the Inflammatory, Pro- and Antioxidant Processes Correction in the Treatment of Chronic Pancreatitis Therapeutic Exacerbation

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas with periods of exacerbation and remission. Frequent long-term exacerbations lead to the destruction of the soft tissue and a decrease in its functional properties. CP is manifested by an activation of inflammation, severe pain that reduces the quality of life, the development of exocrine and endocrine insufficiency and the development of polynutrient trophologic insufficiency (PTI), which requires adequate correction. The objective: to study the dynamics of inflammatory, pro- and antioxidant parameters under the influence of the use of the intestinal lavage method in patients with the therapeutic exacerbation of CP that occurred after acute pancreatitis (AP). Materials and methods. The study included 60 patients with CP after a history of AP. Patients were divided into two groups. I group included 38 patients who received a generally accepted complex of CP treatment. II group included 22 patients, whose treatment complex included a course of modified intestinal lavage in addition to the drug therapy. The effectiveness and duration of the procedures were determined by laboratory, anthropometric and instrumental parameters of CP and PTI in the patients with CP after AP history. The processes of pro- and antioxidant disorders were studied with the determination of the content of malonaldehyde, superoxide dismutase, catalase, and SH-groups. Results. The proposed method of intestinal lavage demonstrated that its use makes possible to increase the time of intestinal lavage due to the “pulsating” supply of liquid, provides a gentle effect of washing on the intestinal mucous membrane, and prevents additional traumatization of the intestine in case of the need to administer drugs. The use of a double circuit allows to administer drugs immediately after lavage without the probe removement, and in such way to prevent the mixing and possible side effects when using several drugs at the same time. Conclusions. The study demonstrated that the higher level of effectiveness of the proposed treatment complex with the inclusion of a course of intestinal lavage compared to the protocol complex for the management of patients with a therapeutic exacerbation of chronic pancreatitis (CP) after a history of acute pancreatitis (AP) was proved. The analysis of the level of C-reactive protein proved that this parameter can be a marker of the depth of intoxication and the severity of inflammation. The use of a course of intestinal lavage procedures in the generally accepted treatment of patients with CP after the history of AP led to a decrease in pain syndrome, improvement of anthropometric parameters, coprogram indicators and normalization of pro- and antioxidant changes.

Chronic pancreatitis: about some complications and features of their pathogenesis and course

The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idiopathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.

Can Empirical Segmental Angioembolization of Splenic Artery Salvage Pancreatic Intraluminal Bleed?

Background Postpancreatectomy hemorrhage (PPH) and Hemosuccus Pancreaticus (HP) may present with slow but significant intraluminal bleed which may not be evident on imaging. We evaluated the efficacy of empirical segmental-angioembolization of splenic artery in intraluminal PPH and HP. Result This is a cross-sectional study done by analyzing all consecutive patients with PPH and HP who underwent empirical coil embolization of splenic artery. There were total of 137 pancreaticoduodenectomies (PD), 68 distal pancreatectomies (DP), 11 patients with median pancreatectomies (MP) and 134 admissions for acute pancreatitis and exacerbation of chronic pancreatitis during the study period. Eleven (5.1%) patients had PPH, of which two were managed surgically. Among nine patients, 4/9 (44.4%) with pseudoaneurysm on computed tomography angiography (CTA) were excluded. Among pancreatitis, 7 (5.2%) had HP, and 5/7 (71.4%) patients with pseudoaneurysm on CTA were excluded. Hence, seven patients, PPH—5 and HP—2, were included. Both HP patients were managed successfully with empirical segmental coil embolization of splenic artery. Among PPH, one patient required laparotomy for failed embolization. Overall, 6/7 (85.7%) had successful coil embolization. No reintervention, continued bleed, or blood transfusions were required postprocedure, and no splenic infarct or abscess was seen in any of the seven patients postembolization. The 72-hour rebleed rate was 1/7 (14.3%), which was managed surgically. Conclusion Empirical segmental coil embolization of splenic artery in intraluminal pancreatic bleed holds promise as a salvage life-saving procedure even when no blush or pseudoaneurysm is evident.

Wernicke encephalopathy after chronic pancreatitis exacerbation. Case report

Wernicke encephalopathy (WE), is an emergency acute neuropsychiatric condition, which develops secondary to thiamine deficiency. According to data of multiple investigations, this disorder is greatly underdiagnosed. WE classically connected to chronic alcohol abuse, but also diagnosed in non‑alcoholic patients with different risk factors including severe vomiting, chronic malnutrition, systemic infections, malignancies, chemotherapy, HIV/AIDS, gastrointestinal surgeries or disease, and renal problems.
 We present a case of a 33‑year‑old woman with history of chronic pancreatitis exacerbation with prolonged vomiting, present to the neurological department with neurological symptoms consistent with WE. WE was suspected according to triad of symptoms, such as altered mental state, oculomotor disturbances and ataxia. Brain magnetic resonance imaging (MRI) and thiamine blood level aid us to confirm WE diagnosis. The patient was given thiamine, at the dosage of 200 mg 3 times per day intravenously for seven days, followed by oral thiamine. Gaze paresis disappeared at day 10, truncal ataxia noticeably improved after two weeks. The patient was left with some signs of anterograde amnesia, gaze‑provoked nystagmus at the two month follow‑up.
 Physicians should be familiar with clinical presentation of WE in non‑alcoholic patients with appropriate history and risk factors, like prolonged emesis, unbalanced diet, malignancies, etc. Presence of classic triad of clinical symptoms and pathological findings on brain MRI are the most important diagnostic tool, while the blood thiamine level may be within the normal range. Early diagnosis and therapy onset are crucial for patients to prevent further irreversible complications or death.

Treatment of Microcirculatory Disturbances in Acute Pancreatitis: Where Are We Now?

Acute pancreatitis is a serious inflammatory condition. Research has shown an increase in the number of pancreatitis-associated hospitalizations, with a marked decline in the mortality rates down to 0.79% in patients with acute pancreatitis and 0.26% in patients with exacerbation of chronic pancreatitis. Up to one-third of patients develop pancreatic tissue necrosis, with a mortality rate of 30%. One of the mechanisms is the disturbances in pancreatic microcirculation due to the release of endothelin, a long-acting vasoconstrictor. The development of pancreatitis causes the release of other inflammatory mediators, which reduce blood flow in the microcirculation. The activation of intracellular trypsinogen initiates a cascade of mechanisms in pancreatitis. There is no specific treatment for acute pancreatitis. Protease inhibitors are not effective in treating severe acute pancreatitis. There is an important role of low-molecular-weight heparin in attenuating necrosis and restoring perfusion of the pancreas. Other drugs used are endothelin receptor antagonists, antagonist of interleukin-1 and interleukin-6 receptors, α-tocopherol, tumor necrosis factor-α and platelet-activating factor inhibitors, acetylsalicylic acid, and local intra-arterial injection of lidocaine. The prophylactic use of antibiotics is not recommended. The treatment outcome of acute pancreatitis is still unsatisfactory.

Experience of performing pancreatoduodenal resection in children

Introduction. The article is devoted to the experience of treating children with pancreatic tumors who underwent pancreatoduodenal resection (PDR) at the Department of Pediatric Surgery, Faculty of Pediatrics, N. I. Pirogov Russian National Research Medical University and at the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the N. F. Filatov Children’s City Clinical Hospital. This type of operation was performed in children with tumors of the head of the pancreas, with the spread of fibroinflammatory changes to nearby organs in chronic pancreatitis and with complicated forms of chronic duodenal obstruction. Materials and methods. For the period from 2010 to 2021 9 PDEs were performed in patients aged 1 to 16 years. The results of treatment in this category of patients were assessed as satisfactory. It is noted that the postoperative period has a number of features: prolonged restoration of gastric motility and passage through the gastrointestinal tract (100% of patients), exacerbation of chronic pancreatitis (100% of patients). Against the background of conservative therapy in all children (100% of patients), the symptoms of pancreatitis were stopped in the period from 26 to 41 postoperative days, the evacuation function of the stomach was fully restored within 2-4 weeks after the operation. Discussion and conclusions. Among the postoperative complications, there were: stenosis of biliary and pancreatic-digestive anastomoses (22% and 11% of those studied, respectively), adhesive intestinal obstruction (11% of cases), intra-abdominal bleeding (11% of patients). One patient had a lethal outcome after repeated surgical interventions for pancreatic head limphangioma complicated by intra-abdominal bleeding and biliary peritonitis. The prognosis in this category of patients is favorable - in the follow-up after surgical treatment in all children (100% of patients), the passage through the gastrointestinal tract is not disturbed, the endo- and exocrine function of the pancreas is preserved (100% of patients), there were no indications for prescribing enzyme therapy and insulin preparations …

Confusion with the definition and diagnostic criteria for acute on chronic pancreatitis: review and recommendations

Objectives Chronic pancreatitis (CP) is a fibroinflammatory disease complicated by episodes of acute inflammation (acute on chronic pancreatitis (ACP)). This entity is common, variably defined and can reflect different pathological mechanisms that requires different interventions. The aim of this study is to conduct a systematic review of how ACP is described, defined and diagnosed in the literature. Methods A systematic search was conducted from January 1993 to June 2020. All articles that used a term to describe ACP in adults were reviewed and definitions and diagnostic criteria were sought. Results After reviewing 2271 abstracts, 848 articles included a term to describe ACP. The most common descriptions were ‘acute on/in CP’ (374), ‘acute exacerbation of CP’ (345) and ‘flare(-up) of CP’ (43). Among the 848 articles, 14 included a pragmatic definition of ACP, and only 2 papers stated diagnostic criteria. These covered both acute inflammation and acute exacerbation of chronic abdominal pain. Conclusion There is no universally accepted term, definition or diagnostic criteria for ACP. A consensus definition is needed to improve quality and comparability of future articles as well as clinical management.

Optimization of laparoscopic ureteral repair with a buccal graft in case of its extended strictures and obliterations

Purpose of the study. Currently, laparoscopic technique has become widely used in the treatment of extended strictures and obliterations of the ureter. The use of minimally invasive approaches will also be relevant for such a relatively new operation as buccal ureteroplasty. In the literature, there are isolated publications devoted to this technique. The aim of this study was to study the results of our own experience of laparoscopic ureteral reconstruction using a buccal graft.Patients and methods. We observed 5 patients – 2 men and 3 women, at the age of 30–62 years. All patients have already been operated on the urinary tract, of these, in four patients, the urinary tract was drained with a nephrostomy or internal ureteral stent. Two patients underwent replacement ureteroplasty with tubularized buccal graft, and three patients underwent augmentation ureteroplasty with buccal graft using the onlay method.Results. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the ClavienDindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The follow-up period was 1–15 months; one woman developed unextended ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients are spared from permanent urinary drains, they do not have upper urinary tract obstruction. Conclusion. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the Clavien-Dindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The observation period for the patients was 1–15 months, one woman developed short ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients do not have permanent urinary drains, violations of the urodynamics of the upper urinary tract were not revealed in them.

Systemic lupus erythematous presenting with hemorrhagic shock caused by gastric penetration of pancreatic pseudocyst: a case report

BackgroundSystemic lupus erythematous that causes various organ damage is rarely associated with pancreatic lesion. To the best of our knowledge, no cases presenting with hemorrhage shock caused by gastric penetration of pancreatic pseudocyst due to lupus pancreatitis have been reported. Herein, we report a case of hemorrhage shock caused by gastric penetration of pancreatic pseudocyst due to lupus pancreatitis.Case presentationA 53-year-old Japanese man with a history of systemic lupus erythematous, pancreatic pseudocyst, and chronic pancreatitis complained of epigastric pain and had hematemesis. He visited our emergency room and was admitted in our hospital. Upper endoscopy showed that hemostasis was obtained; however, computed tomography scan was performed since he was suspected to have gastric penetration into hollow viscera. The computed tomography revealed accumulation of fluid around the pancreas and gastric penetration of pancreatic cyst. Blood test showed increased serum amylase level. These results suggest that the exacerbation of chronic pancreatitis causes the penetration. Surgery was considered; however, we took a wait-and-see approach since hemostasis was obtained. After that, he was in stable condition, although he suffered from fever and accumulation of left pleural effusion was observed by computed tomography. However, he had massive hematemesis and melena 9 days after hospitalization and died in spite of several treatments including blood transfusion. Autopsy revealed that he actually had pleural thickening, which is not caused by accumulation of left pleural effusion but by severe pleural inflammation. We therefore performed additional blood and urinary tests on the same day. The test results showed that he had a high titer of anti-double-stranded deoxyribonucleic acid (DNA) antibody, hypocomplementemia, and erythrocyturia, indicating that he had systemic lupus erythematous with high disease activity considering his fever and pleural inflammation.ConclusionsPatients who have systemic lupus erythematous with high disease activity have the potential to develop fatal complications due to pancreatitis, so appropriate treatments are required for such patients.

The relationship between IBS-like syndrome and exacerbation of chronic pancreatitis

The relationship between IBS-like syndrome and exacerbation of chronic pancreatitis

Оцінка кальцій-фосфорного обміну та рівня вітаміну D у пацієнтів з хронічним панкреатитом та хронічним обструктивним захворюванням легень

Our attention was drawn to the comorbidity of chronic pancreatitis and chronic obstructive pulmonary disease, namely the features of clinical and pathogenetic links. The article examines metabolism of vitamin D, parathyroid hormone and calcium-phosphorus metabolism in patients with this comorbidity and considering exocrine insufficiency. The results of our own research in this direction are presented. The purpose of the study was to determine the nature of the exocrine pancreatic insufficiency effect on the metabolism of vitamin D, parathyroid hormone and calcium-phosphorus metabolism. Material and methods. The study included 30 patients with exacerbation of chronic pancreatitis and 50 patients with a diagnosis of chronic pancreatitis in the acute stage and chronic obstructive pulmonary disease aged 47-55 years (average age – 52.36±1.83 years). All patients had chronic pancreatitis for more than 10 years. Inclusion criteria was the presence of exocrine pancreatic insufficiency and changes of vitamin D in patients’ metabolism. Patients were hospitalized in the gastroenterology department of the Regional Clinical Hospital, Chernivtsi, Ukraine in connection with exacerbation of chronic pancreatitis. Chronic obstructive pulmonary disease was in stable or unstable remission. Respondents were informed about the study and gave their consent. The control group consisted of 20 healthy individuals. Results and discussion. We revealed a complication of the clinical course in patients with chronic pancreatitis and chronic obstructive pulmonary disease on the background of exocrine pancreatic insufficiency. One of the manifestations was a violation of the metabolism of vitamin D, parathyroid hormone and calcium-phosphorus metabolism. Correlation analysis revealed a positive relationship between levels of exocrine pancreatic insufficiency and serum vitamin D concentration (p <0.05, r = 0.71). There was a strong inverse correlation between the levels of parathyroid hormone and vitamin D (p <0.05, r = - 0.87), and the content of calcium in the serum (p <0.05, r = - 0.74). Conclusion. Comorbidity of chronic pancreatitis and chronic obstructive pulmonary disease causes severe disorders of mineral metabolism and metabolism of vitamin D

Assessment of bioelectrical impedance analysis in patients with chronic pancreatitis and chronic obstructive pulmonary disease considering exocrine pancreatic insufficiency

The article describes and analyzes the results of bioelectrical impedance analysis in patients with chronic pancreatitis and chronic obstructive pulmonary disease considering the level of fecal elastase-1.The aim of our study was to investigate the features of Bioelectrical impedance analysis in patients with chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD) considering the level of fecal elastase-1.Materials and methods. We examined 84 patients: 30 patients with CP and 54 patients with comorbid pathology - CP and COPD aged 30-65 years (52.36 ± 1.83 years). Patients were hospitalized in the gastroenterology department of theRegionalClinicalHospital,Chernivtsy,Ukraine with exacerbation of CP. COPD was in stable or unstable remission. Fecal elastase-1 level was determined by using the Pancreatic Elastase ELISA (BIOSERV Diagnostics). Biometric measurements were performed with a body composition analyzer BC-601 (TANITA,Japan). All examined patients were divided into groups depending on the exocrine pancreatic insufficiency (EPI): severe (n=9), moderate (n=34), mild (n=23) and normal (n=18).Results. The group of patients with severe EPI was characterized by weight loss. It can be explained by the appearance of absorption disorders of nutrients (malabsorption and maldigestion syndromes). In the groups of moderate and mild EPI fat and cell mass were significantly lower than normal rate in control group. There is a positive correlation between fecal elastase-1 and the level of patients’ metabolism (p<0,05).Conclusions. Bioelectrical impedance analysis (percentage of fat mass, visceral fat level and muscle mass) correlates with the level of fecal elastase-1, which can be used as an additional criteria for the severity of CP and for the control of the effectiveness of substitution therapy.

Empirical coil embolization of splenic artery as a salvage life saving procedure in post pancreatectomy hemorrhage and hemosuccus pancreaticus

Introduction: Computerised Tomography Angiogram (CTA) is the diagnostic modality in Post pancreatectomy Haemorrhage (PPH) and Hemosuccus Pancreaticus (HP). However, occasionally, the offending aneurysm or the source of bleed may not be evident by CTA or conventional angiography. Intraluminal bleeds, especially after Dunking Pancreaticojejunostomy, may be from small pseudoaneurysms in the territory of splenic artery or from cut end of pancreas that are difficult to pick up by CTA. We evaluated the efficacy of empirical segmental Coil embolisation of pancreatic segment of splenic artery in the setting of intraluminal PPH as well as HP following Acute /Chronic pancreatitis. Methods: A cross sectional study was done by analysing the prospectively held pancreatic database from January 2009-december 2018. All consecutive patients with PPH following any type of Pancreatectomy as well as Hemosuccus Pancreaticus (in Acute and chronic pancreatitis) who underwent empirical coil embolization of splenic artery were included. Those who showed blush on CTA or conventional angiography and those who were managed primarily with surgery for PPH were excluded. The rebleeding and mortality rates were assessed at 72-hour and 30-days respectively. Results: There were 137 Pancreaticoduodenectomies, 68 Distal Pancreatectomies, 11 median pancreatectomies and 134 admissions for Acute pancreatitis/ exacerbation of Chronic pancreatitis during the period. Overall, 6/7 (85.7%) with negative CTA had successful coil embolization. No re-intervention/ continued bleed/ splenic infarcts/ no requirement of transfusion or abscess were seen in any of these six patients. Conclusion: Empirical coil embolization of splenic artery in pancreatic bleed holds promise as a salvage life-saving procedure.

The Analysis of Intestinal Lavage Method Efficiency in Patients with Chronic Pancreatitis Exacerbation

The clinical picture in patients with chronic pancreatitis (CP) which develops due to acute pancreatitis (AP) (in month after attack of AP) is characterized by intestinal insufficiency syndrome (IIS). The multifactorial mechanism of IIS in CP as a result of AP requires direct attention of the physician on the elimination of the pathological symptoms, which are the main cause of malabsorption, trophological insufficiency, abdominal discomfort and pain, and as consequence, reduced quality of life and social adaptation.The objective: to investigate the dynamic of the clinical signs, anthropometric parameters and pro- and antioxidant status indicators after treatment by proposed treatment with the intestinal lavage course in patients with chronic pancreatitis which is as result of acute pancreatitis.Materials and methods. The results of investigation and outpatient treatment of 34 patients with CP (complicated by IIS) as a result of AP were analyzed.Results. It was established the effectiveness of the optimized treatment complex at the level of MA – 39,55 %, CM254 – 8,85 %, CM280 – 7,09 %, SOD – 7,75 %, SH-groups – 5,18 %, catalase – 17,78 %. The effectiveness of the optimized treatment complex by the level of PSA was 41,15 %, ferritin – 18,61 %, albumin – 15,13 %. The implementation of the proposed treatment course in the standart treatment of patients with chronic pancreatitis which developed due to acute pancreatitis has led to a significant more effective reduction of pain, improved coprogram results and normalization of endogenous intoxication indicators and positive changes antioxidant system.Conclusion. The conducted analysis of results showed that the parameters of C-reactive protein, albumin and ferritin can be used as markers of the intoxication expresion, severity of inflammation and nutrient deficiency, as well as determining the number of intestinal lavage procedures: when the content of CRP 3,0–7,0 mg/l, ferritin – 100,0–150,0 ng/ml, albumin – 35,0–32,0 g/l one lavage procedure was performed; with content of CRP – 7,0–30,0 mg/l, ferritin – 50,0–100,0 ng/ml, albumin – 32,0–29,0 g/l – 3 procedures were perfomed, with a CRP content of 30,0–50,0 mg/l, ferritin – 20,0–50,0 ng/ml, albumin ≤29,0 g/l 5 procedures of intestinal lavage were performed.

CLINICAL EFFECTIVENESS OF ANTRAL IN PATIENTS WITH CHRONIC PANCREATITIS

The studies on the pathogenesis of chronic pancreatitis (CP) have proven the important role of systemic inflammation, factors of proteinase-inhibitory system with increasing damaging effects of systemic proteolysis, disturbance of oxidant-antioxidant homeostasis, changes in blood lipid and protein spectroscopic processes that collectively contribute to inhibition of reparative processes and the activation of pancreatic fibrosis processes. The aim of this study was to determine the effectiveness of applying Antral medicine in the treatment of CP in the exacerbation phase on the basis of a comprehensive assessment of clinical course of CP and structural and functional disorders of the pancreas. Material and methods. 52 patients with CP of mixed aetiology were examined in the exacerbation phase of moderate severity. The first group (group 1, control) included 24 people, who received standard treatment within 30 days. The main group (group 2) involved 28 people, who in addition to the standard therapy took Antral (Pharmak OAO, Kyiv) in a dose of 1 tablet (200 mg) 3 times a day for 30 days. The comparison group consisted of 30 healthy individuals of the same age and sex. Results. In 4 weeks since the beginning of the therapy, the astheno-vegetative syndrome was found as significantly less manifested in only 2 people (7.1%) of the 2 groups, whereas in the 1 group it remained in 17 patients. At the same time in all patients of group 2 (100.0%) the pain and feeling of heaviness in the epigastric region, pain in the left and right subcostal area were disappeared, they did not complain of nausea.
 The restoration of physical performance in 100.0% of patients in the 2 group can be regarded as a positive manifestation of the therapy efficacy. Analyzing the indicators, which characterize the phase of CP exacerbation, it is necessary to note the patients of the 2 group demonstrated higher efficacy of their treatment program. Thus, dynamic indicators of blood α-amylase activity against the background of hyperfermentemia diagnosed prior the treatment and in the phase of CP exacerbation significantly decreased in both groups of observation on the 30th day of the therapy; the syndrome of enzyme rejection in the blood was eliminated in 100% of patients of the 2 groups; whereas in group 1 this was observed only in 58.3% of the patients. The dynamic of indicators of the inflammation syndrome in patients with CP (by blood C-reactive protein content) indicates its complete elimination in 96.4% of the patients in group 2 vs. 29.2% of the patients in group 1. Analysis of the dynamic indicators of elastase-1 content in the faeces of the patients with CP on the 30th day of the therapy indicates a significant increase in this indicator in only group 2. Restoration of the secretory capacity of the pancreas was observed in 78.6% of patients in group 2 vs. 20.8% of the patients in group 1. Conclusions. Complex therapy of patients with chronic pancreatitis with applying Antral in addition to the integrated therapy has led to faster, when compared with only standard therapy, achieving clinical remission of chronic pancreatitis, elimination of inflammatory pancreatic oedema, hyperfermentemia and inflammation, restoration of the external secretion of the pancreas.