Chronic Pancreatitis Pancreas Research Articles

ЛАПАРОСКОПИЧЕСКАЯ ПАНКРЕАТОЦИСТОЕЮНОСТОМИЯ

Background. Pancreatic pseudocyst formation is known to be one of the most common complications of chronic pancreatitis. Despite the widespread use of the laparoscopy, it is still relatively rarely employed in pancreatic surgery. Objective. To analyze the outcomes of laparoscopic Roux-en-Y pancreatocytojejunostomy as well as to present a brief literature review. Material and methods. Data from diagnostic examinations, laboratory tests, as well as the outcomes of surgical treatment of a female patient for a pancreatic cyst are presented. It is worth noting that a laparoscopic Roux-en-Y pancreatocystojejunostomy was used for pancreatic cyst treatment in this case. Results. Successfully performed laparoscopic surgery enabled to preserve as much of the pancreas as possible and to avoid postoperative complications. Conclusions. The described case, along with the reviewed publications, indicate that laparoscopic internal drainage may be regarded as a feasible method for the treatment of encapsulated cysts of the body and tail of the pancreas in chronic pancreatitis. This is due to the fact that this surgical option doesn’t involve pancreatic parenchyma volume reduction and has a lower risk of relapse as compared with external drainage methods. Based on the above mentioned, the choice of this method is associated with relatively minimal surgical trauma, fewer complications and a short-term postoperative period. To perform such operations successfully, special tools and skills are required. The presence of domestically produced endoscopic staplers contributes to the further implementation of this type of intervention into practice.

Retrospective quantification of clinical abdominal DCE-MRI using pharmacokinetics-informed deep learning: a proof-of-concept study.

Dynamic contrast-enhanced (DCE) MRI has important clinical value for early detection, accurate staging, and therapeutic monitoring of cancers. However, conventional multi-phasic abdominal DCE-MRI has limited temporal resolution and provides qualitative or semi-quantitative assessments of tissue vascularity. In this study, the feasibility of retrospectively quantifying multi-phasic abdominal DCE-MRI by using pharmacokinetics-informed deep learning to improve temporal resolution was investigated. Forty-five subjects consisting of healthy controls, pancreatic ductal adenocarcinoma (PDAC), and chronic pancreatitis (CP) were imaged with a 2-s temporal-resolution quantitative DCE sequence, from which 30-s temporal-resolution multi-phasic DCE-MRI was synthesized based on clinical protocol. A pharmacokinetics-informed neural network was trained to improve the temporal resolution of the multi-phasic DCE before the quantification of pharmacokinetic parameters. Through ten-fold cross-validation, the agreement between pharmacokinetic parameters estimated from synthesized multi-phasic DCE after deep learning inference was assessed against reference parameters from the corresponding quantitative DCE-MRI images. The ability of the deep learning estimated parameters to differentiate abnormal from normal tissues was assessed as well. The pharmacokinetic parameters estimated after deep learning have a high level of agreement with the reference values. In the cross-validation, all three pharmacokinetic parameters (transfer constant , fractional extravascular extracellular volume , and rate constant ) achieved intraclass correlation coefficient and R2 between 0.84-0.94, and low coefficients of variation (10.1%, 12.3%, and 5.6%, respectively) relative to the reference values. Significant differences were found between healthy pancreas, PDAC tumor and non-tumor, and CP pancreas. Retrospective quantification (RoQ) of clinical multi-phasic DCE-MRI is possible by deep learning. This technique has the potential to derive quantitative pharmacokinetic parameters from clinical multi-phasic DCE data for a more objective and precise assessment of cancer.

Effect of autonomic dysfunction on the exocrine function of the pancreas in chronic pancreatitis

Background. The article evaluates the impact of autonomic dysfunction according to the heart rate variability data and the Spielberger-Khanin questionnaire on the exocrine function of the pancreas in chronic pancreatitis (CP). The aim is to evaluate the exocrine function of the pancreas depending on the heart rate variability and survey using the Spielberger-Khanin questionnaire. Materials and methods. One hundred outpatients with a diagnosis of CP who were treated in Ternopil healthcare institutions were examined. The presence of exocrine pancreatic insufficiency was determined by the level of fecal α-elastase. The psycho-emotional state was assessed using the Spielberger-Khanin questionnaire. Statistical and spectral indicators of heart rate variability were analyzed: the range of variation, the amplitude of the mode, stress index, indicator of activity of regulatory systems, total spectrum power, absolute and percentage values of very low frequency (VLF), low frequency (LF), high frequency power (HF), the LF/HF ratio. A correlation analysis was performed of the obtained heart rate variability data, the Spielberger-Khanin questionnaire data with the degree of exocrine pancreatic insufficiency in terms of the level of fecal α-elastase. Results. The average value of reactive anxiety on the Spielberger-Khanin questionnaire is 44.33±0.89, personal anxiety is 43.19±0.82, which corresponds to the upper limit of the moderate level. A negative correlation was found between these parameters and the level of fecal α-elastase (r=–0.482, p<0.01, and r=–0.555, p<0.01, respectively). Based on the heart rate variability of patients with CP, a tendency among them to sympathicotonia was detected, which was accompanied by a significant increase in the amplitude of the mode, stress index, the LF/HF ratio and a decrease in the range of variation compared to the control group. In contrast to the healthy individuals, the humoral-metabolic effect of heart rhythm regulation prevailed in those with CP (VLF— (48.66±1.21)%) and the share of the nervous component (LF— (31.69±0.67)%, HF— (19.65±0.75)%) decreased, there was a significant decrease in the total power of the spectrum compared to the control group (1546.25±44.18 versus 3155.65±211.38). The indicator of the activity of regulatory systems in patients with CP (6.91±0.12) was at the upper limit of the intense load of regulatory systems, which reflects a significant impairment of adaptation among them and reliably differs from the control level (3.90±0.31). A significant correlation was found between the total power of the spectrum, indicator of the activity of regulatory systems and the level of fecal α-elastase (r=0.511, p<0.01, and r=–0.398, p<0.01, respectively). Conclusions. During the study, it was found that with a deterioration in the psycho-emotional state (according to the data of the Spielberger-Khanin questionnaire), exocrine insufficiency of the pancreas in patients with CP increased: there was a correlation between the content of fecal α-elastase and the level of reactive and personal anxiety. Positive statistically significant correlations between the amplitude of the mode, stress index with the duration of the course of CP indicate compensatory activation of the sympathetic division of the autonomic nervous system. It was also proved that exocrine insufficiency (according to the content of fecal α-elastase) worsened with an increase in sympathicotonia (according to the stress index). Adecrease in the functional reserve in patients with СР was revealed: a significant decrease in the total power of the spectrum was found compared to that of the control group; against this background, there was a decrease in the adaptive potential, deterioration in the psycho-emotional state, which resulted in an increase in exocrine pancreatic insufficiency. The obtained data motivate to improve the generally accepted comprehensive therapy of patients with chronic pancreatitis with the additional inclusion in it of agents to stabilize the autonomic nervous system.

Multitasking dynamic contrast enhanced magnetic resonance imaging can accurately differentiate chronic pancreatitis from pancreatic ductal adenocarcinoma.

Accurate differentiation of chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) is an area of unmet clinical need. In this study, a novel Multitasking dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) technique was used to quantitatively evaluate the microcirculation properties of pancreas in CP and PDAC and differentiate between them. The Multitasking DCE technique was able to acquire one 3D image per second during the passage of MRI contrast agent, allowing the quantitative estimation of microcirculation properties of tissue, including blood flow Fp, plasma volume fraction vp, transfer constant Ktrans, and extravascular extracellular volume fraction ve. Receiver operating characteristic (ROC) analysis was performed to differentiate the CP pancreas, PDAC pancreas, normal control pancreas, PDAC tumor, PDAC upstream, and PDAC downstream. ROCs from quantitative analysis and conventional analysis were compared. Fourteen PDAC patients, 8 CP patients and 20 healthy subjects were prospectively recruited. The combination of Fp, vp, Ktrans, and ve can differentiate CP versus PDAC pancreas with good AUC (AUC [95% CI] = 0.821 [0.654 - 0.988]), CP versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), PDAC pancreas versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC tumor with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC downstream with excellent AUC (0.917 [0.795 - 1.000]), and CP versus PDAC upstream with fair AUC (0.722 [0.465 - 0.980]). This quantitative analysis outperformed conventional analysis in differentiation of each pair. Multitasking DCE MRI is a promising clinical tool that is capable of unbiased quantitative differentiation between CP from PDAC.

Surgical tactics of bleeding during clearing of the pancreatic intestinal anastomosis after duodenum-sparing resections of the pancreas for chronic pancreatitis

Surgical tactics of bleeding during clearing of the pancreatic intestinal anastomosis after duodenum-sparing resections of the pancreas for chronic pancreatitis

Спектр короткоцепочечных жирных кислот при хроническом панкреатите

The aim was to evaluate the metabolic activity of the colonic microbiota in patients with chronic pancreatitis (CP) as a marker of changes in the functional state of the pancreas. Material and methods. 40 patients (20 men and 20 women) aged 35 to 74 years (50.6 ± 9.4 years) were examined, 26 patients of which had external secretory pancreatic insufficiency (ESPI), which was confirmed by the data of the elastase test, and 14 patients had no ESPI. The diagnosis of CP was established on the basis of instrumental data. Patients with proven ESPI received enzyme replacement therapy (ERT) in accordance with international and Russian recommendations. The concentration and spectrum of short-chain fatty acids were evaluated by gas-liquid chromatography. The control group consisted of 22 healthy volunteers (13 women and nine men aged 43.4± 6.2 years). Results. As a result of the analysis of the profiles of short-chain fatty acids (SCFAs), a significant change in the content of propionic acid was revealed in patients with CP without GNP when compared with a group of healthy volunteers, no differences were found between the groups of patients with CP. These studies indicate a decrease in the activity of certain types of colon microbiota that produce C3 (propionic acid) in patients with CP without ESPI and, accordingly, who did not receive ERT. This, apparently, is due to the violation of the fermentation of individual substrates entering the lumen of the colon. Conclusion. Indicators of the concentration and spectrum of SCFAs can serve as additional tools for detecting changes in the metabolic activity of the colonic microbiota as a marker of the functional state of the pancreas in CP.

The Complex Rehabilitation Effectiveness of Patients with Chronic Pancreatitis and Chronic Viral Hepatitis C

Aim: To investigate the parameters of the functional state of the pancreas in chronic pancreatitis in the background of chronic viral hepatitis C, as well as their dynamics under the influence of complex therapy with the inclusion of complex bioregulatory drugs. Materials and Methods: 106 patients were examined: patients with CP in remission, patients with CP in remission in combination with HCV in remission, and after antiviral therapy. Patients with CP and concomitant HCV were divided into two groups according to correction programs. Group I (36 patients) received only conventional treatment: antispasmodics and/or prokinetics, enzyme preparations, proton pump inhibitors, hepatoprotectors in the mode “on-demand”. Group II (36 patients), in addition to conventional treatment, received additional complex bioregulatory drugs. Results: After treatment, there was an improvement in coprogram results and an increase in fecal elastase-1 levels. Positive dynamics was observed in both groups, but in patients of group I it was statistically insignificant (p>0.05), while in the group of patients who additionally received complex of bioregulatory drugs, the changes were more pronounced: in group II the level of fecal elastase-1 increased by 52.79% (p<0.05). Conclusions: This indicates a statistically significant effect of treatment using a complex bioregulatory corrector of exocrine insufficiency (Momordica Compositum: 1 ampoule 2.2 ml intramuscularly 3 times a week №10) and a complex bioregulatory hepatotropic drug (Hepeel: 1 tab. sublingually 3 times a day 15-20 minutes before meals or 1 hour after meals for 1 month).

Functional Features of the Pancreas during Chronic Pancreatitis

Aim of study: to identify functional status of pancreas in patients with chronic pancreatitis depending on the stage of fibrotic transformation and activity of parenchymal inflammation. Materials and methods. The preoperative laboratory results and the data of morphological study performed on biopsies obtained during surgery in 88 patients with complications of chronic pancreatitis (CP) were compared. According to morphological study of pancreatic biopsies, the early pancreatic parenchymal fibrosis (I–II degree) has been diagnosed in 31 cases (35.2 %), late fibrosis (III–IV degree) — in 57 (64.8 %) cases. Results. Active parenchymal inflammation at early and late stages of pancreatic fibrosis are associated with changes in pancreatic secretion and intracellular activation of pancreatic enzymes, leading to autodigestion and release of these enzymes from acinar cells into the blood, which has been confirmed by an increase of trypsin and amylase activity in blood compared with inactive inflammation. At late stages of fibrosis reduction of fecal elastase‑1 (161.7 ± 4.8) mg/g was observed in 73.9 % of patients. Reverse correlation has been found between fibrotic transformation of pancreatic parenchyma and the level of fecal elastase‑1 (r = –0.46; p = 0.05), i.e. progressing fibrotic transformation of pancreas leads to reduced exocrine function. Correlation analysis showed that the progression of fibrotic transformation violates carbohydrate metabolism — a direct correlation with glycosylated hemoglobin (r = 0.496; p = 0.05), namely, the endocrine secretion deficiency. Novelty in science. The pancreas functioning was studied depending on the inflammation activity and stage of fibrosis transformation of its parenchyma at chronic pancreatitis. The active inflammation of the pancreas was found to be accompanied by significant activation of pancreatic enzymes (significant increase in blood amylase and trypsin activity), which causes the progression of fibrotic transformation of pancreas in CP. Conclusions. Progression of fibrotic transformation of the pancreatic parenchyma in CP leads to deterioration of the exocrine pancreatic function, as defined by a decrease in the level of fecal elastase‑1 in case of late fibrosis of the pancreas and to the deterioration of endocrine pancreatic function, as manifested by impaired fasting glucose metabolism both at early and late stages of fibrosis, the development of pancreatogenic type II diabetes at the early stages of pancreatic fibrotic transformation, insulin resistance and type I diabetes at later stages of pancreatic fibrotic transformation.

Abstract 1756: The roles of Regnase-1 in pancreatic cancer development and progression

Abstract Background: Regnase-1 is a RNA-degrading enzyme that plays an important role in the regulation of inflammation by degrading mRNA of inflammation-related genes. Although inflammation is known to promote pancreatic carcinogenesis, involvement of Regnase-1 in this process has never been studied. In this study, we thus investigated the role of Regnase-1 in pancreatic cancer development and progression. Methods: We examined the expression levels of Regnase-1 in the pancreas of chronic pancreatitis by repeated administration of caerullein in mice. We sought for a regulator of the Regnase-1 expression in Panc-1 pancreatic cancer cell line. We assessed the biological phenotypes caused by siRNA-mediated Regnase-1 inhibition in multiple pancreatic cancer cell lines, including cell proliferation, migration, apoptosis and cytokine expressions. We generated pancreas-specific Kras-activated and Regnase-1-deficient (PDX1-Cre; Kras G12D KI Regnase-1 fl/fl) mice (PKR mice) and examined these phenotypes. We assessed the relationship between the expression levels of Regnase-1 in pancreatic tumor tissue and prognosis in 39 pancreatic cancer patients who underwent curative surgical resection. Results: The expression levels of Regnase-1 significantly decreased in the murine pancreas of chronic pancreatitis together with the increase in IL-1β. The expression levels of Regnase-1 was downregulated by IL-1β administration in Panc-1 cells. siRNA-mediated Rengase-1 Inhibition significantly promoted cell proliferation, migration and inhibited apoptosis with Bcl-xL upregulation in Panc-1 cells. Rengase-1 Inhibition also upregulated a variety of chemokines involved in the recruitment and activation of myeloid-derived suppressor cells (MDSCs) including CXCL1, CXCL2, CXCL8, CSF2 and CSF3 in Panc1cells. All PKR mice developed pancreatic tumors and became moribund by 3 months of age. We observed massive infiltration of CD11b+Ly6g+Ly6c- PMN-MDSCs and significant upregulation of Arg1, Nos2, Nox2, and S100a8/9 mRNA levels, which are suppressors of anti-tumor immunity known to be secreted from MDSCs. Surgically-resected pancreatic cancer patients with low levels of intra-tumor Regnase-1 expression had significantly shorter recurrence-free and overall survival than those with high levels of Regnase-1. Intratumor Regnase-1 expression levels were negatively correlated with the number of CD11b+ cell infiltration. Conclusion: Inflammation-mediated downregulation of Regnase-1 may contribute to pancreatic cancer development and progression in cell-autonomous and -heteronomous manners. Citation Format: Junya Okabe, Takahiro Kodama, Tetsuo Takehara. The roles of Regnase-1 in pancreatic cancer development and progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1756.

МОЖЛИВОСТІ БІОРЕГУЛЯЦІЇ У КОМПЛЕКСНІЙ ТЕРАПІЇ ХРОНІЧНОГО ПАНКРЕАТИТУ У КОМОРБІДНОСТІ З ХРОНІЧНИМ ВІРУСНИМ ГЕПАТИТОМ С

Key words: chronicpancreatitis, chronicviralhepatitis C, bioregulatorydrugs, Momordica compositum, Hepel, functional and structuralstate of the pancreas. Topicality. Insufficient development of primary and secondary prevention of chronic pancreatitis (CP), which occurs on the background of chronic viral hepatitis C (CVHC), requires a deeper study of the mechanism of its development and the establishment of clinical and pathogenetic features, which should be taken into account rehabilitation. One of such approaches to complex treatment of CP on the background of CVHC is the inclusion of drugs of bioregulatory therapy, which motivated thestudy. The aim is to investigate the parameters of the functional and structural state of the pancreas in chronic pancreatitis on the background of chronic viral hepatitis C, as well as their dynamics under the influence of complex therapy with the inclusion of bioregulatory drugs (BRD). Materials and methods. 106 patients with CP without exacerbation in combinationwith CVHC in the remission phase and without it were examined. The main group of the study included 72 patients with CP in the phase of unstable remission with concomitant CVHC in the latent stage. Patients with CP and concomitant CVHC were divided into two groups according to correction programs. It should be noted that patients in the study contingent of etiological antiviral therapy for CVHC infection for various reasons were not treated (refusal of antiviral treatment due to allergic history, personal intolerance, financial insolvency, etc.). Group I (36 patients) received only conventional treatment (CT). Group II (36 patients), in addition to CT, received additional BRD Momordica compositum for 1 amp. in / m 3 times a week for one month) and Hepel 1 tab. sublingually 3 times a day for 15-20 minutes before meals or after 1 hour after meals for one month. Results. After treatment an improvement in the structure of the pancreas and liver was observed, as evidenced by a decrease in the severity of Echoelastography and ultrasound. The score of ultrasound soft ware in the first group decreased by 28.6 %, and in the second group – decreased by 57.1 %; the rate of Echoelastography of the pancreas by 4.8% and 26.1 %, respectively, and the Echoelastography of the liver – by 15.3 % and 30.7 %, respectively. They also noted an improvement in the results of the coprogram and an increase in the level of fecal elastase-1: inthefirst group – by 23.8 %, and in the secondgroup – by 52.7 %. Discussion. Positive dynamics wasobserved in both groups, but in patients of group I after treatment it was less significant thaningroup II, where additionally a patient with CP on the background of CVHC received complex BRD (p <0.05). This proved a statistically significant higher efficacy of treatment using a complex bioregulatory corrector ofexocrine insufficiency (Momordica Compositum) and a complex bioregulatory hepatotropic drug (Hepeel) for one month. Conclusions: 1. Concomitant CVHC in the latent stage worsened the structural and functional state of the pancreas in CP, as well as the structural state of the liver according to EHR (p<0,05); 2. The use of complex bioregulatory therapy in addition to the conventional treatment of CP on the background of latent CVHC contributed to a statistically significant increase in its effectiveness in relation to conventional treatment: the level of fecal elastase-1 increased by 52.7% (p <0.05) compared to 23.8 %, pancreatic rigidity decreased by 26.1 % vs. 4.8 % (p <0.05), liver rigidity decreased by 30.7 % vs. 15.3 % (p <0.05).

Magnetic resonance imaging with radiomics texture analysis of the pancreas in chronic pancreatitis

Magnetic resonance imaging with radiomics texture analysis of the pancreas in chronic pancreatitis

INFLUENCE OF EXOCRINE PANCREATIC INSUFFICIENCY ON THE COURSE OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH PRIMARY OSTEOARTHRITIS

The study of the functional capacity of the pancreas in chronic pancreatitis (CP) in comorbidity with type 2 diabetes mellitus (DM2) and primary osteoarthritis (OA) is also relevant given that patients with this combination are associated with the presence of metabolic syndrome. The aim of the study was to investigate the state of functional capacity of the pancreas in patients with comorbid chronic pancreatitis and type 2 diabetes mellitus with osteoarthritis. Material and methods. 117 patients with CP with OA with concomitant DM2 and without it were studied. The main group consisted of 92 outpatients with CP with OA in combination with diabetes in the phase of stable or unstable remission, the comparison group – 25 patients with isolated CP with primary OA, and the control group – 30 healthy individuals. Diagnoses of OA, CP and DM2 were established according to generally accepted criteria and protocols Results. Analysis of the data showed that on average in the contingent of studied patients with comorbid OA, CP and DM2 excretory insufficiency of pancreas was significantly more severe than in the group of patients with isolated CP with OA. Conclusions. In the combined course of CP and DM2 with OA, the correlation between fecal α-elastase-1 and glycosylated hemoglobin was statistically significantly stronger than in the group of patients with isolated CP, indicating a mutually aggravating effect of CP and DM2.

Histological Structure of Pancreas in Chronic Pancreatitis and The Role of Pancreatic Stellate Cells

Background: Chronic pancreatitis is a progressive inflammatory disease that causes damage and fibrosis of the parenchyma of pancreas, thus leads to endocrine and exocrine dysfunction. Objective: The goals of this review were to analyze morphological alterations in pancreatic tissue during chronic pancreatitis and this analysis addresses the effect of pancreatic stellate cells (PSCs), on chronic pancreatitis, and collagen fiber deposition. Results: This review also discussed the different immunohistochemical markers for PSCs. Alpha smooth muscle actin (α-SMA) is an excellent marker for activated PSCs. Transforming growth factor beta (TGFβ) is an important profibrogenic cytokine that appears to act by stimulating collagen production by PSCs. Conclusion: It was concluded that chronic pancreatitis caused a significant and progressive serious effects on the acinar cells, duct system, and islets of Langerhans in the form of intracellular vacuolations, decreased zymogen granules, pyknotic nuclei and thickening of the duct wall, and extensive fibrosis. It is hypothesised that during pancreatic injury, PSCs are activated and proliferated exhibiting positive staining for the cytoskeletal protein α- SMA, and synthesising amounts of extracellular matrix proteins, particularly collagen.

Criteria for the Selection of Diagnostic Signs of Chronic Pancreatitis with Obstruction of the Main Pancreatic Duct

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patients intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

Pancreas Proapoptotic Proteases in Patients with Chronic Pancreatitis

Aim. To study features of localization of the DNA-ase I and endonuclease-G proapoptotic proteases in the pancreas in chronic pancreatitis (CP). Materials and methods. Histological pancreas preparations from 60 patients with various CP forms were studied: group I — 10 patients with obstructive CP; group II — 21 patients with calcific CP; group III — 13 patients with fibroparenchymal CP; group IV — 16 patients with CP complicated by pseudocyst. Pancreas biopsies were obtained during planned organ operations, as well as using a fine-needle biopsy under ultrasound control. Tissue material was fixed in Bowen medium. Microscopic tissue sections were prepared and subsequently stained with hematoxylin-eosin and by Mallory-Slinchenko. Immunohistochemical typing of proapoptotic proteases was performed according to the indirect avidin-streptavidin-peroxidase reaction (“Elite”, USA) using rabbit antibodies to DNA-I and endonuclease-G (“Chemicon”, USA, 1: 500 dilution — 1: 2000, incubation 12:00, + 4 °С).Results. Patients in all the groups demonstrated signs of chronic inflammation, with 31.7 % of cases showing signs of its exacerbation. Atrophic changes were found in most patients (96.7 %). No significant differences were observed with regard to the severity and frequency of fibrosis of various degrees in the groups: mild, moderate, severe and full fibrosis was detected in 6.7 %, 20.0 %, 16.7 % and 56.6 %, respectively. The study of the localization of proapoptotic nucleases in the structures of the pancreas showed proapoptotic nucleases of DNA-ase I to be exclusively located in the cytoplasm of pancreatic acinar cells. At all stages of CP fibrosis, single acinar cells with translocation of the nuclease from the cytoplasm into the cell nucleus were found in the lobes of the pancreas. Endonuclease-G was found in large numbers in the cytoplasm of pancreatic islets, with it lower number being detected in the cytoplasm of the epithelial cells of the ducts. Conclusions. In CP, proapoptotic proteases of DNase I and endonuclease G are expressed in the cytoplasm of cells located in different pancreas zones. Thus, DNase I is expressed in the cytoplasm of acinar cells, while endonuclease G is most typical for insular cells and those in the epithelium of the ducts. This proves the existence of various apoptosis mechanisms in the exo- and endocrine portions of the pancreas.

The Results of Duodenum-Preserving Resections of the Pancreas in Chronic Pancreatitis Using the Technology of Sealing the Pancreatic-Intestinal Anastomosis

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

Good Agreement Between Transabdominal and Endoscopic Ultrasound of the Pancreas in Chronic Pancreatitis.

We aimed to evaluate the agreement of single criteria and dedicated scores from transabdominal ultrasound ofthe pancreas (US) compared to standards by endoscopic ultrasound (EUS) and computed tomography (CT). In this observational cohort study performed in a tertiary care center, US and EUS were performed in 110 patients referred for suspected CP. Based on the Mayo score, 52 patients were diagnosed with CP. The sonographic findings obtained by both methods were registered. The number of criteria was counted and scored according to the Rosemont score. Agreement between the number of detected US and EUS criteria was substantial (ICC = 0.74 [0.61-0.83]. Adding Rosemont weighting improved the agreement (ICC = 0.88 [0.81-0.92]). Regarding individual criteria, the agreement was substantial for the detection of calcifications (κ = 0.86) and moderate for cysts and irregular or dilated pancreatic duct (κ = 0.42-0.58). Agreement for the other criteria was poorer (κ≤ 0.40). The diagnostic performance indices [95 % CI] of US for diagnosing CP (using Mayo score as reference standard) were for the unweighted score: Sensitivity: 0.65 [0.51-0.78], specificity: 0.97 [0.87-1.00]; and for Rosemont score: Sensitivity: 0.75 [0.61-0.86], specificity: 0.95 [0.83-0.99]. The agreement between US and EUS for the unweighted and weighted scores was substantial. For the features calcifications, cysts and main pancreatic duct (MPD) changes, agreement was moderate to substantial. For the other detected US criteria, the agreement with EUS was too poor to be clinically relevant.

Technical Modifications to Improve Islet Yield from Chronic Pancreatitis Pancreas (CPP) for Islet Auto-Transplantation (IAT)

Surgical removal of the pancreas in patients with intractable chronic pancreatitis will potentially mitigate the long standing suffering of abdominal pain and improve the quality of life. Nonetheless, the induction of iatrogenic diabetes from surgery becomes irrevocable as the insulin producing islet cells are removed. This novel process of islet isolation (both auto- and allo-) involves specific procurement and packaging of the pancreas which is then transported to a specialized clean-room where islets are isolated. The isolation involves distending the pancreas with dissociation enzymes that help in digesting the extracellular matrix and freeing the islets. The cells are then collected as pellets and purified if necessary by density gradient and later packed in the transplant bag for intra-portal infusion back to the patient. The expectant metabolic outcome following the procedure is solely dependent on the total islet mass transplanted. Despite incorporating the most standardized isolation techniques, the overall islet yields available from the diseased pancreas are still very low. Factors such as donor characteristics, pancreatic fibrosis and cellular atrophy further reduce the yield highlighting the need for effective islet isolation techniques.

The results of resection of the pancreas in chronic pancreatitis

The results of resection of the pancreas in chronic pancreatitis

Fibrosis of pancreas in chronic pancreatitis

Fibrosis of pancreas in chronic pancreatitis