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POSSIBLE OF ADDITIONAL DIAGNOSTICAL CRITERIA AND TREATMENT OF PANCREATOPATHY

 

I.FIZDEL, M.FRADIN , J.KRASILNIKOVA

Latvian Scientific-practical Centre of treatment Dietology; Riga,LATVIA

Pancreatopathy is an illness characterised more by additional diagnostical criteria: higher ehogenity of pancreas in ultrasonoscopy, decreasing of enzyme production,elevation of glucose periodical. The aetiology of pancreatopathy is the same as chronic pancreatitits. Its known now, that this pathology is the result of the accumulation of cellular and tissue damage caused by insufficient repair mechanism. Directly effects of nutrition on pancreatic gland dysfunction can not be understood without a profound understanding of how nutrients act at a molecular and genetic level. So, very important becasue pancreatopathy is precoursor of chronic pancreatitis or sign of metabolic syndrome and possible developing to sugar diabetes II, detection of in early diagnostic all details, effective correction and treatment.

Methods and material: We observed 51 females 25-35 y.o. with diagnosis primary pancreatopathy and BMI (body mass index) > 15% in Latvian Scientific-practical Centre of treatment Dietology during 10 days. We measured by routine biochemical tests glucose, HbA1C, insulin, amylase, lipase; from antioxidant defences system we tested total antioxidant status (TAS) and superoxiddismutase (SOD), amount of Mg, Ca, Zn, Fe in blood in first and last day of treatment course in Rigas Stradina University Eurocertificated Biochemical Laboratory. We documented also weight, ultrasonoscopy, electrocardiogramm of patients. Treatment course included standart low-calorie diet, herbal tea, hyperoxigenation, special aerobic gymnastic, plastic massage of body, detox-therapy and etc.

Results: We proved primary pancreatopathy in 12 females( group N1) and in 39 – pancreatopathy with metabolic syndrome (MS), group N 2. All patients before treatment had similar normal level of insulin, Hb1C, low margine of TAS, but differency was detected in follow: SOD in erythrocytes higher than norm in patients without MS 1801+137 U/gHb, with MS –normal ranges; lipase 150+ 21U/L (norm) in group N 1, in group N 2 two time more. Amylase was low in group N 1 (42,3+3,1), in patients with MS three time more. Zinc stands in high line of norm: 17,5 µmol/L. After low-calorie diet all parametres returned to norm, but ehogenity of pancreas and low level of amylase does not change.

Conclusion: Dysbalance between amylase/lipase, changes of SOD within glucosemia may be able as additional diagnostical biochemical criteria for early diagnostic of pancreatopathy and risk factor of developing of metabolic syndrome,for prevention of progressive disorders and markers of adequate treatment.

 

 

ENDOSCOPIC STENTING IN THE TREATMENT OF BENIGN BILE FLOW VIOLATIONS

 

Y.I. GALLINGER, M.V. KHRUSTALEVA, M.A. AMELINA, D.G. SHATVERAN

Russian Scientific Center of Surgery after acad. B. Petrovsky, Moscow, RUSSİA

 

Endoscopic stenting of bile ducts with plastic endoprostheses were undertaken in 192 patients with impaired bile flow of non-tumor etiology between 1988 and 2010. Causes of violation of bile flow were as following: choledocholithiasis in 116 (60.4%), cicatrical strictures of hepaticocholedoch - in 62 (32.3%), stenosis of the distal part of choledoch in chronic pancreatitis - in 6 (3.1%), primary sclerosing cholangitis - in 8 (4 2%) cases. In patients with cicatrical and inflammatory strictures in 12 cases stenosis was located in the lower third, in 31 cases - in the middle and in 33 cases - in the upper third of hepaticocholedoch. Indications for stenting in patients with choledocholithiasis in 55 cases were high bilirubinemia and the risk of hemorrhagic complications during endoscopic papillosphinkterotomy (EPST); in 40 patients - the impossibility of single-stage sanitation of biliary tract in choledocholithiasis. In 6 patients with resected by Billroth-II stomach and 15 patients with parapapillar diverticuls stenting was carried out for reduction of perforation risk of EPST. Of 192 attempts endoscopic transduodenal biliary stenting was successful in 171 (89.1%) patients. Failure of stenting in 21 (10.9%) cases was associated with the presence of high and extended cicatric damages of hepaticocholedoch or its severe deformity in patients with strictures of hepatico-choledochoanasthomosis after liver transplantation. Of the total number of patients with established transpapilar drainage 53 (31.0%) patients were operated in a planned manner after relief of jaundice. In 63 patients with choledocholithiasis was performed endoscopic choledochal sanation (in 18 - mechanical lithotripsy). In 33 patients with cicatric strictures and 22 patients with choledocholithiasis transpapillar stenting was the definitive treatment option. The term of functioning of stents on the average has made 4.5 months. The course of endoscopic treatment of cicatricial stenosis has lasted for 12-18 months.



Our experience indicates an efficacy of endoscopic transpapillar stenting of hepaticocholedoch in patients with impaired bile flow of non-tumor etiology; it allows to improve the results of the treatment of this category of patients, and in many cases is an alternative to surgical treatment of choledocholithiasis and benign stenosis of bile ducts.

 

ASSESSMENT OF THE SEVERITY AND RISK OF PROGRESSION OF HEPATIC ENCEPHALOPATHY IN PATIENTS WITH HEPATIC CIRRHOSIS IN THE RICU

 

N.R. GIZATULINA, R.A. IBADOV, A.H. BABAJANOV, N.A. STRIJKOV

 

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

 

Purpose: To introduce modern methods of assessment of the degree of hepatic encephalopathy in patients with hepatic cirrhosis (HC) at the stages of portosystemic shunting.

Materials and methods: Results of identification of the severity of hepatic encephalopathy, obtained by HEPAtonormTM - Analyzer (MERZ) device served as criterion for the assessment of the risk of surgical treatment. 55 patients with HC treated in the RSCS named after V.Vahidov within the period from 2004 to 2005. Age of the patients ranged between 23-62 years and constituted average of 39.1 ± 5.3 years.

Results: The scientific principles underlying the methodology, are defined with 100% sensitivity and specificity of the HEPA-tonormTM device, inducing critical flicker frequency (CFF), a threshold of which is in direct relation with the progression of hepatic encephalopathy.

Definition of CFF showed that in the group of examined patients average indicator constituted - 38,8 ± 2,1 Hz (with allowable level above 40 Hz). It should be noted that the clinical manifestations of hepatic encephalopathy at the initial examination, corresponding to the 1st stage acc. to H.O.Conn (1979), were found only in 11 patients, CFF indicator constituted 36.8 ± 0.9 Hz. In the group of patients in which hepatic encephalopathy was not clinically revealed (20 cases) CFF constituted – 38.2 ± 0.7 Hz, that shows, the latent stage, in other cases (14 patients) – 41.9 ± 0.8 Hz. Biochemical indicators in patients constituted average of: AlAT 289.1 ± 49.7 nmol /s.l.; total bil. – 27.9 ± 3.6 mcM/l. Different versions of portosystemic shunting were performed in 34 patients (distal splenorenal anastomosis (CPA) - 21; proximal CPA - 6; CPA with –H- insertion - 4; splenosuprarenal anastomosis - 6; latero-lateral CPA - 3).

In the early postoperative period, acute hepatic failure (AHF) was observed in 9 cases (16.3%) with mortality in two cases. Signs of hepatic encephalopathy were clinically determined in 15 (27.2%) patients. Biochemical parameters constituted: AlAT 347.4 ± 56.9 nmol/s.l.; total bil. – 46.4±9.2 mcM/l. Analysis of the results of preoperative examination in this group of patients revealed that CFF indicators reduced to 37.1 ± 1.1 Hz, after the operation to 35.3 ± 1.2 Hz (p <0.01). In the group of patients without clinical manifestations of encephalopathy average indicator of FCC the nearest postoperative period constituted 38.6 ± 1.1 Hz (p> 0.05). In its turn, indicators of AlAT and total bilirubin were not significantly different in treatment groups (p> 0.05).

Conclusion: Identification of the threshold of critical flicker frequency with HEPAtonormTM - Analyzer device allows objective assessment of the severity and risk of progression of hepatic encephalopathy in patients with hepatic cirrhosis at the stages of portosystemic shunting.

 

TREATMENT OPTIMIZATION OF PATIENTS WITH CHRONIC ACALCULOUS CHOLECYSTITIS IN COMBINATION WITH FUNCTIONAL CONSTIPATION IN THE BACKGROUND OF ABDOMINAL ISCHEMIC SYNDROME

 

N.B. GUBERGRITS, K.A. VORONIN

 

National Medical University n.a. M.Gorky, Donetsk, UKRAINE

 

Purpose: To evaluate the effectiveness of pathogenetically substantiated drug combinations to treat patients with chronic acalculous cholecystitis (CAC) in combination with functional constipation (FL) in the presence of abdominal ischemic syndrome (AIS). Materials and methods: We included 60 patients CAC, combined with the presence of FL and AIS. The diagnosis of AIS was verified by Doppler ultrasound of the abdominal aorta and its unpaired branches based on an assessment of blood lipid fractions. CAC diagnosis was based on the presence of clinical manifestations, detection of characteristic changes of the gallbladder and the violation of its contractile capacity by ultrasound, multiphase chromatic duodenal probing. Organic nature of constipation was excluded by means of special methods of investigation of the colon (irrigography, colonoscopy). Examination of patients ranged in age from 50 to 83 years. They were divided into two groups of 30 people. Patients with a comparison group received basic treatment (diet number 5, antiseptic). The main group but this combination was administered pathogenetically substantiated drug consisting of tribudat to 200mg three times a day, 100 ml of tivortin intravenously, Choliver 2 tablets 3 times a day and on mukofalk 5g 3 times a day for 18-20 days. Before and after treatment were assessed severity of clinical manifestations, including with an indicator of moderate severity, assessed the dynamics of blood lipid spectrum, the contractile function of the gallbladder. Results. By the end of treatment indicated a marked reduction of pain, frequency, elimination of constipation, the degree of reduction of total lipids, cholesterol, triglycerides, blood, increase in α-blood cholesterol and decrease its atherogenicity index, the normalization of contractile function of the gall bladder in the main group of patients than in the comparison group. Conclusions: The use of pathogenetically validate complex consisting of tivortin, tribudat, Choliver and mukofalk and optimizes the treatment of patients with FL CAC on the background of AIS.

 


Date: 2014-12-28; view: 829


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HOW THE TRADITIONAL OR SINGLE PORT CHOLECYSTECTOMY CAN BE JUSTIFIED IN PATIENTS WITH THE PREVIOUS SURGERY OF ABDOMINAL CAVITY | CHRONIC BILIARY PANCREATITIS: ETIOLOGY, PATHOGENESIS, CLINICS, TREATMENT
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