Pancreas In Children Research Articles

Laparoscopic surgery for solid pseudopapillary tumors of the pancreas in children

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Представить опыт применения лапароскопических операций у детей с солидной псевдопапиллярной опухолью (СПО) поджелудочной железы. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В Морозовской ДГКБ за период с 2012 г. по 2021 г. лапароскопические операции по поводу СПО поджелудочной железы были проведены 16 пациентам. У 12 пациентов опухоль располагалась в области хвоста поджелудочной железы, у 4 пациентов — в теле поджелудочной железы. Было выполнено 12 дистальных и 4 центральных резекций поджелудочной железы. <h3>РЕЗУЛЬТАТЫ</h3> Длительность операции варьировала от 80 до 200 мин (в среднем 95 мин). Во всех случаях интраоперационная кровопотеря не превышала 100 мл и не требовала гемотрансфузии ни в одном случае. У 1 (6,25%) пациента, которому выполнялась лапароскопическая центральная резекция поджелудочной железы, в ходе оперативного вмешательства была выполнена конверсия в лапаротомию. Общие сроки послеоперационного пребывания в стационаре составили 10—14 сут (в среднем 12 дней). Катамнез прослежен у всех пациентов в сроки от 3 мес до 5 лет. Во всех случаях проводили плановое циклическое обследование (ультразвуковой скрининг, компьютерная томография с внутривенным контрастированием), при котором ни в одном случае не выявлено рецидива заболевания. <h3>ЗАКЛЮЧЕНИЕ</h3> Лапароскопические операции у детей с СПО в области хвоста и тела поджелудочной железы выполнимы при условии наличия в клинике достаточного опыта малоинвазивной и панкреатической хирургии. В руках опытного хирурга лапароскопическая дистальная резекция поджелудочной железы может стать предпочтительным методом лечения СПО у детей.

Pancreatic Masses in Children and Young Adults: Multimodality Review with Pathologic Correlation.

Masses and masslike lesions of the pancreas are uncommon in the pediatric population. However, owing to overlapping clinical and imaging features, it can be challenging to differentiate the various causes of pediatric pancreatic masses at initial patient presentation. Clinical data such as patient age, signs and symptoms at presentation, laboratory test results, and potential underlying cancer predisposition syndrome can be helpful when formulating a differential diagnosis. US may be the first imaging study to depict a pancreatic mass in a child, as this examination is frequently performed in children with nonspecific abdominal signs and symptoms because of its wide availability and relatively low cost and the lack of a need for sedation or anesthesia. CT or MRI is typically required for more thorough characterization of the mass and surgical planning. Complete characterization of pancreatic masses includes assessment of vascular involvement, local invasion, and extrapancreatic spread of tumor. The authors provide an up-to-date comprehensive review of the clinical manifestations, histopathologic features, and imaging findings of primary and secondary tumors of the pancreas in children and young adults. Advances in imaging, current prognostic information, and treatment paradigms also are highlighted. Finally, nontumorous masslike lesions of the pediatric pancreas, including vascular malformations, cystic disorders (eg, von Hippel-Lindau syndrome, cystic fibrosis), intrapancreatic accessory spleen, and autoimmune pancreatitis, are discussed. Online supplemental material is available for this article. ©RSNA, 2021.

До питання корекції зовнішньосекреторної недостатності підшлункової залози у дітей з функціональними та органічними гастродуоденальними захворюваннями

Стаття присвячена обґрунтуванню та оцінці ефективності включення мікротаблетованого ферментного препарату Ерміталь 10 000 в комплексну терапію дітей з функціональними та органічними гастродуоденальними захворюваннями. Наведено результати власних досліджень функціонального стану підшлункової залози у дітей з поєднаною патологією органів травлення. Отримані нами дані свідчать про ефективність і високий рівень безпеки та переносимості препарату Ерміталь 10 000 як замісної ферментної терапії при відносній панкреатичній недостатності у дітей.

Стеатометрія й еластометрія як методи неінвазивної діагностики стеатозу та фіброзу підшлункової залози у дітей

Актуальність. Ожиріння асоційовано з ектопічним накопиченням жиру з відкладенням жиру у паренхіматозних органах, у тому числі у підшлунковій залозі (ПЗ) з формуванням її стеатозу. Тривалий перебіг стеатозу підшлункової залози здатний призводити до хронічного запалення та фіброзу органу. Обмеженість проведення інвазивних досліджень у дітей обумовлює потребу у розробці та впровадженні в практику охорони здоров’я новітніх неінвазивних методів обстеження підшлункової залози. Мета: вивчити можливість ультразвукової діагностики стеатозу та фіброзу підшлункової залози у дітей з використанням методу стеатометрії (оцінка швидкості згасання ультразвуку) та еластометрії. Матеріали та методи. Було обстежено 60 дітей, які знаходились на стаціонарному лікуванні у відділенні дитячої гастроентерології ДУ «Інститут гастроентерології НАМН України». Розподіл за групами відбувся на основі наявності ожиріння й надмірної маси тіла: 1-шу групу становили 44 пацієнти з ожирінням і надмірною масою тіла, 2-гу групу — 16 дітей з нормальною масою тіла. Сонологічне дослідження, еластометрія та стеатометрія проводились на апараті Ultima PA Expert («Радмір», Україна). Наявність та ступінь стеатозу підшлункової залози визначались при попарному порівнянні ехогенності ПЗ з ехогенністю нирок та заочеревинного жиру. Результати. Було виявлено, що серед пацієнтів 1-ї групи 25 дітей (56,8 %) мали сонологічні ознаки стеатозу підшлункової залози, третина хворих мала ехографічні ознаки неспецифічних запальних зміни паренхіми залози. Аналіз даних стеатометрії ПЗ виявив, що середня величина коефіцієнту затухання ультразвуку у представників 1-ї групи була вірогідно вище за відповідний показник 2-ї групи (р &lt; 0,05) і становила (2,45 ± 0,39) дБ/см у представників 1-ї групи та (1,80 ± 0,23) дБ/см у представників 2-ї групи. Середній показник жорсткості паренхіми ПЗ у дітей із нормальною масою тіла був вище за аналогічний показник пацієнтів з ожирінням і надмірною масою тіла, але вірогідність відмінностей не була достатньою. У представників 1-ї групи середнє значення жорсткості паренхіми ПЗ становило (3,69 ± 0,78) кПа та (3,78 ± 0,27) кПа — у 2-й групі. Висновки. Встановлено, що середній показник коефіцієнту затухання ультразвуку під час сонографії підшлункової залози у дітей з ожирінням і надмірною масою тіла є вірогідно вищим порівняно з пацієнтами, які мають нормальну масу тіла, що свідчить на користь наявності стеатозу підшлункової залози у дітей з ожирінням/надмірною масою тіла. Проведене дослідження свідчить про можливість використання стеатометрії та еластометрії як методів діагностики стеатозу й фіброзу підшлункової залози у дітей.

Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children.

Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.

Lumbar Contusion: A Rare Cause of Voluminous Pseudocyst Pancreas in Children

Lumbar Contusion: A Rare Cause of Voluminous Pseudocyst Pancreas in Children

Pancreatic lesion in children with nephrotic syndrome

Nephrotic syndrome occupies one of the leading places among kidney diseases in children. Scientific studies indicate that edema syndrome, arterial hypertension, disorders on the microcirculatory level occurring in case of nephrotic syndrome contribute to the slowing and reduction of blood flow in the pancreas, which leads to the development of hypoxia and metabolic disorders. Under conditions of metabolic and microcirculatory disorders, as well as against the background of the therapy used in children with nephrotic syndrome the risk of secondary pancreas lesion increases significantly. Pathogenetic treatment of nephrotic syndrome involves the administration of glucocorticosteroid and cytostatic therapy. The study of autopsy materials of the pancreas in children who died of glomerulonephritis revealed histomorphological changes in 35.7% of children in the form of acute interstitial pancreatitis and pancreonecrosis. At the same time there are still few works in the scientific literature, devoted to the study of functional state of the pancreas in children with kidney diseases. The data on pancreatitis prevalence in children are extremely inconsistent. Significant variation in the frequency of pancreatic lesion in children (from 5 to 25%) is most often associated with diagnostic difficulties. Ultrasound examination after a meal (postprandial test) allows to diagnose pancreatic pathology (indirect signs of chronic pancreatitis, reactive pancreatic changes) with higher accuracy (by 23%) than traditional examination. Late diagnosis of pancreatic lesion and lack of correction can significantly affect patients’ health and quality of life. There is a need to study functional state of pancreas in children with nephrotic syndrome to improve understanding of pathogenesis of possible involvement in pathological process and optimization of preventive and therapeutic tactics.

Experience in surgical treatment of diseases of the pancreas in children

The article is devoted to the experience of surgical treatment of pathology of the pancreas at the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Children’s City Clinical Hospital No. 13 named after NF Filatova: annular pancreas, acute and chronic pancreatitis, tumors and cysts of the pancreas. From 2016 to 2020, more than 267 reconstructive interventions on the pancreas were performed, including longitudinal and transverse pancreatojejunoanastamosis, pancreatoduodenal resection, cystoenteroanastamosis, sectoral and total resection of the pancreas. In the postoperative period, the most severe complication in this category of patients was arrosive bleeding, which is the main cause of all deaths after surgery.

Clinical and morphological differential diagnosis of congenital hyperinsulinism before the stage of immunohistochemical study of paraffin-embedded specimens of pancreas in children

Introduction.Differential diagnosis of various forms of congenital hyperinsulinism (CH) is required at the stage of urgent histological examination, but the difference between the exo- and endocrine parts of the pancreas in frozen sections is visualized very poorly.The objective was to search for differential diagnostic criteria of focal and diffuse forms of CH, suitable for urgent histological examination.Methods and materials. Pancreatic surgery material from 25 children with CH, of which 15 cases of focal form (FCH) and 10 cases of diffuse (DСH), and autopsy material from 10 children without CH (K). Frozen and paraffin sections stained with hematoxylin-eosin and histochemical stains were made from the tissue of the pancreas. The number of endocrinocytes with large nuclei was estimated in 10 fields of view for each case.Results. The average proportion of endocrinocytes with large nuclei was significantly (p &lt;0.01) higher compared to the control both with FCH (in the affected area) and DCH (FCH – (1.82±0.50) %, DCH – (4.68±1.66) %, K – (0.34±0.21) %). We found a tendency to detect a higher absolute number of cells with large nuclei in DCH ((4.95±1.24) DCH and (3.71±1.56) FCH). Staining with azure-eosin, picro Mallory and the PAS reaction gave unstable result, and staining with toluidine blue and May-Grunwald did not allow differentiating exo- and endocrine parts of the pancreas.Conclusion. An increase in the size of the endocrinocyte nuclei was the unsuitable criterion for the differential diagnosis of CH forms, and histochemical stains did not give a stable qualitative result. For urgent biopsy examination, new immunohistochemical methods are needed.

Solid pseudopapillary neoplasms of the pancreas in children

Solid pseudopapillary neoplasms of the pancreas in children

Деякі аспекти розвитку та корекції вторинної екзокринної недостатності підшлункової залози у дітей

Based on the analysis of literature sources, the main causes and mechanisms of the secondary exocrine pancreatic insufficiency in children are highlighted. The main mechanisms of regulation and peculiarities of functional activity of the pancreas in children are discussed. The importance of pancreatic enzymes for physiological digestion of food nutrients as well as for ensuring satisfactory nutritional status of a child is noted. It is shown that the main reason for the development of secondary exocrine insufficiency of the pancreas in children is a violation of the pancreatic enzymes activity in the duodenum. Factors that adversely affect the effectiveness of pancreatic enzymes by disrupting their activation or inactivation in the duodenum have been listed. They include: 1) motility disorders of the gastrointestinal tract; 2) bile acid deficiency; 3) violation of entero-pancreatic regulation of the pancreas; 4) hyperacidic conditions of the stomach and duodenum; 5) intestinal dysbacteriosis; 6) violation of the outflow of pancreatic juice into the duodenum. The mechanisms of negative influence of these factors on the activity of pancreatic enzymes are also revealed. It is noted that the increase in the prevalence of secondary exocrine pancreatic insufficiency is due to the peculiarities of diseases of the digestive system, namely, the combined nature of the lesions of different parts of the gastrointestinal tract. The effective properties of the mini-tablet enzyme preparation, as well as indications for its use are analyzed; the dosage of enzyme preparations for children in accordance with domestic and foreign recommendations was discussed. The list of pathological conditions in which it is advisable to use enzyme preparations, as well as the requirements that must be met when using enzyme preparations to achieve maximum effectiveness during enzyme replacement therapy. The author declares no conflict of interest. Key words: children, exocrine insufficiency of the pancreas, enzyme preparations.

Ectopia of the pancreas in the loop of the small intestine in an 8-y-o child

Ectopia of the pancreas in children is a rare congenital malformation in which normal pancreatic tissue develops in other organs, without communication with the main gland in the wall of the stomach, intestines, liver, gallbladder, Meckel's diverticulum, and the spleen. In this article, the authors cite a rare case of ectopia of the pancreas in the loop of the small intestine, which led to the development of intestinal obstruction. Girl B., eight years old, was admitted to the hospital on an emergency basis with paroxysmal abdominal pain. There was no nausea or vomiting. A contrast study of the gastrointestinal tract with barium sulfate was performed, which revealed a violation of the evacuation of the contrast medium. A laparoscopy was performed with the clinic for low intestinal obstruction. Revision of the intestine revealed a tumor-like formation measuring 6 4 cm at 60 cm from the ileocecal angle. A minilaporotomy was performed, a 10 cm section of the ileum was resected, bearing a tumor-like formation with an end-to-end anastomosis. The postoperative period is favorable. The girl was discharged from the hospital on the eighth postoperative day. On histological examination, pancreatic tissue was found in the wall of the small intestine, with duct ectasia. At the follow-up examination after one year. the patient had no complaints with normal growth and development. This clinical observation demonstrates the nonspecificity of the clinical picture and the difficulty of diagnosing pancreatic ectopia, and the advantages of minimally invasive interventions that allow diagnosing a rare pathology and its timely adequate correction.

Laparoscopic resections of the pancreas in children with hyperinsulinism

Introduction. Congenital hyperinsulinism (CHI) is an inherited disease characterized by severe persistent hypoglycemia in the neonatal period due to insulin hypersecretion and rapid development of neurologic and systemic disorders. There are two main CHI forms: a diffuse one when hyper functioning of beta-cells affect the whole pancreas, and a focal one, characterized by an area of intact parenchyma. Currently, surgery is an acknowledged approach in focal forms, while in diffuse CHI forms surgical treatment is prescribed only in severe pharmacoresistant cases.Material and methods. A total of 11 patents with CHI, aged 1.5 - 26 months, had laparoscopic pancreatic resections at the department of pediatric surgery of Russian Medical Academy of Continuous Professional Education. All patients were examined , treated and prepared for surgery at the Endocrinology Research Centre ( Moscow). The focal CHI form was diagnosed in 3 children; the diffuse one - in 8 patients. In the focal CHI form, a focal resection was done: laparoscopic corpocaudal resection of the pancreas – 2 patients; resection of the pancreatic head with Roux–en-Y pancreaticojejunostomosis - 1 child. All children with diffused disease had laparoscopic near-total (98%) pancreatectomy.Results. In all cases, there were no intraoperative complications. Stenosis of the distal common bile duct developed in one child after the resection of pancreatic head which required a laparoscopic cholecystoduodenoanastomosis. There were no other complications. Two children with focal CHI were reported to recover completely; one patient suffered of hypoglycemia attacks not related to the increased insulin production. In diffuse cases, a stable euglycemia was achieved in 2 patients; 3 children had recurrent hypoglycemia attacks which required Somatostatin analogue therapy. One patient developed diabetes mellitus. In this case, follow-up period lasted for 2 months which is too short to assess the endocrinological outcome.Conclusion. The article presents the first Russian experience of laparoscopic pancreas resection in children with CHI. The laparoscopic approachcan be successfully applied in the surgical treatment of children with CHI.

Gastric duplication cyst with localization in the pancreas in children

Introduction. Gastric duplication cyst is a rare clinical observation. More often, these cysts are localized in the fundus or body of the stomach and have a common muscle layers and blood supply. Even more rarely, duplication cysts are not anatomically connected to the stomach and are located in other parts of the abdominal cavity or in the retroperitoneal space. Cystic duplication of the gastrointestinal tract, which are localized in the pancreas, is extremely rare.&#x0D; The aim of the study is to demonstrate the possibility of using laparoscopy for this disease.&#x0D; Materials and methods. The paper describes three rare clinical observations of gastric duplication cyst topographically associated with the pancreas. In the first clinical observation, gastric duplication cyst was combined with mediastinal duplication cysts, an esophageal bronchial fistula, and extralobar pulmonary sequestrations. In the second observation, a duplication cyst had communication with the pancreatic duct system and was clinically manifested by recurrent bleeding. In the third case, a duplication cyst is diagnosed behind the body and tail of the pancreas.&#x0D; Results. In all cases, surgical treatment was carried out by the laparoscopic method, leading to complete recovery. Histological examination in all the described observations confirmed the gastric type of epithelium of the mucous membrane of the cysts. The article provides a review of the literature.&#x0D; Conclusion. Thus, the efficiency of laparoscopic interventions in children with gastric duplications topographically associated with the pancreas was demonstrated. The described rare clinical manifestations, a combination of defects, as well as the possible presence of heterotopy of the mucous membrane of the duplication cyst confirm the need for surgical correction of the disease.

当科における小児膵Solid pseudopapillary neoplasmに対する手術成績の検討

当科における小児膵Solid pseudopapillary neoplasmに対する手術成績の検討

Differential diagnosis of pancreatoblastoma (PB) and solid pseudopapillary neoplasms (SPNs) in children by CT and MR imaging.

To determine whether features on computed tomographic and/or magnetic resonance imaging can differentiate pancreatoblastoma (PB) from solid pseudopapillary neoplasms (SPNs) of the pancreas in children. Clinical and imaging data for 20 cases of SPNs and 14 cases of PB confirmed by surgery or biopsy were retrospectively analysed. The size, border, calcification, haemorrhage, solid/cystic component proportion, intratumoural vessels, tumour capsulation, pancreatic duct dilatation, peripancreatic vessel invasion, distant metastasis status and apparent diffusion coefficient (ADC) values of the two groups were examined, and key diagnostic features were identified. Statistical analysis was performed using the chi-square test and Student's t test. Sensitivity and specificity values were calculated when a single criterion was used. Age ≤ 5 years, elevated serum α-fetoprotein (AFP), larger size, ill-defined border, calcification, absence of haemorrhage, intratumoural vessel, peripancreatic vessel invasion and distant metastasis differentiated PB from SPN (p < 0.05). ADC values of SPN were higher than those of PB (p = 0.001). There were no significant differences regarding tumour capsule (p = 0.435), pancreatic duct dilatation (p = 1.000) or cystic degeneration area over 50% of the tumour volume (p = 1.000) between the two groups. The following features are helpful for differentiating PB from SPN: age ≤ 5 years, elevated serum AFP, larger size, ill-defined border, calcification, haemorrhage absence, intratumoural vessel, peripancreatic vessel invasion, distant metastasis and lower ADC value. • CT and MRI are helpful to differentiate pancreatoblastoma (PB) from solid pseudopapillary neoplasms (SPNs) of the pancreas in children. • The following features are helpful to differentiate PB from SPN: age ≤ 5 years, elevated serum AFP, larger size, ill-defined border, calcification, absence of haemorrhage, intratumoural vessel, peripancreatic vessel invasion, distant metastasis and lower ADC value.

Determination of the level of pancreatic elastase as the “gold standard” for assessing the state of the pancreas in pediatric practice

The purpose of the studywas to assess the state of the pancreas in children, taking into account the indicators of pancreatic elastase of blood serum and feces.Materials and methods.A study of pancreatic elastase was carried out in 115 children aged 7-15 years with combined gastroduodenal and biliary pathology.Results.In a comprehensive assessment of the structural and functional state of the pancreas, it was found that in 26.5% of cases there were functional and 45.2% structural changes: chronic pancreatitis - 9.6% of patients, recurrent pancreatitis - 9.9%, reactive pancreatitis - 25.7% of children, dysfunctional disorders - 26.5% of patients. Findings. The studied method has 100% sensitivity and 98% specificity in the differential diagnosis of functional and structural changes in the pancreas. The coprological test allows a quantitative determination of the elastase-1 level, reflecting the degree of pancreatic insufficiency.Conclusion.Using this test for quantitative determination in serum provides an opportunity to assess the level of enzymemia in reactive pancreatitis. In accordance with modern concepts, pancreatic elastase can be considered as the “gold standard” for diagnosing chronic pancreatitis, a marker for the exocrine function of the pancreatic gland (scatological test) and as an indicator of reactive pancreatitis (definition of serum elastase-1).

Can Point Shear Wave Elastography Be Used as an Early Indicator of Involvement?: Evaluation of the Pancreas and Liver in Children With Cystic Fibrosis.

The aim of this study was to determine the effect of cystic fibrosis (CF) on pancreas and liver elasticity in young children using point shear wave elastography and to determine the relationship with clinical findings. Twenty-two patients with genetically proven CF, who were admitted to our pediatric gastroenterology clinic, and 22 healthy control participants were enrolled in the study. The shear wave velocity (SWV) of the liver and pancreas were measured with point shear wave elastography. The 22 patients with CF included 45.5% girls with a mean age ± SD of 35 ± 35.8 months (range, 5-123 months). The 22 healthy control participants included 41.2% girls with a mean age of 58.9 ± 44.4 months (range, 2-159 months). The mean SWV of the pancreas in the patients with CF (1.06 ± 0.26 m/s) was significantly higher than that of the healthy control participants (0.85 ± 0.23 m/s; P = .01). The mean SWV of the liver in the patients with CF (1.46 ± 0.24 m/s) was significantly higher than that of the healthy control participants (1.12 ± 0.21 m/s; P = .001). The SWV of the pancreas and liver did not show any significant differences depending on ursodeoxycholic acid use, malnutrition status, and the presence of the F508 deletion mutation. This study showed an increased SWV of the pancreas in children with CF, contrary to the literature. We also found an increased liver SWV even in the absence of CF-related liver disease. Ultrasound elastography may be a useful method of evaluating early changes in the pancreas and liver before the obvious clinical, laboratory, and B-mode ultrasound signs of CF-related involvement.

Exocrine pancreatic dysfunction in children with obesity: characteristics of clinical picture and diagnostics

Introduction. During the last twenty-five years the occurrence of obesity in children and teenagers has increased significantly. Materials and methods. 110 adolescents of 12–17 years old, with alimentary-constitutional obesity and involvement of pancreas and without its injury, as compared to the 30 healthy children of control group, were examined. The research provided determination of the sizes and elasticity of pancreas. The detection of the total cholesterol, high density lipoproteins and leptin level was carried out. Intensity of clinical symptoms (spastic pain in epigastrium and left subcostal arc; abdominal pain without localization, vomit without relief, general weakness) have been made accordingly to sum of points (from 0 to 3 points). If sum of points makes from 0 to 2 – intensive character of abdominal pain is low, from 3 to 5 points – it is high, from 5 to 10 points – it is very high. Normal level of amylase in a blood serum (Karavey’s method) is 12–32 g/(hour l), аnd diastase in urine – 20–160 g/(hour l). We made a screening test for elastase-I level by ELISA test. Normal activity of this enzyme in feces is 200 мkg/g. We have used sonographic method for detection of pancreatic diseases in obese children due to echo-structure of parotid gland. The analysis and statistical data processing were made by computer program "Statistica 7.0" and MS Excel XP. Research data. Physical inspection of our patients confirms prevalence of І degree over II degree obesity (52.7 % and 47.3 %, respectively; Р &lt; 0.05). We have confirmed valid risk factor of pancreatic lesion in obese children – presence of diabetes mellitus type I in close relatives (80 % and 65 %, χ2 = 2,05; Р &lt; 0.05). The changes of exocrine function of the pancreas in children with the stage II obesity were established. Echographic signs of the pancreas lesion in teenagers with obesity indicate the presence of functional changes: edema of head or entire edema, partial increase of parenchymal echogenicity, insufficient enlargement of the duct of Wirsung.

Growing Academic Physiatry: The Impact of the Baruch's Grants on Harvard Medical School and Columbia College of Physicians and Surgeons. Part II.

Growing Academic Physiatry: The Impact of the Baruch's Grants on Harvard Medical School and Columbia College of Physicians and Surgeons. Part II.