CLINICAL APPLICATION OF FIBRIN ADHESIVE IN THE TREATMENT OF BILIARY AND PANCREATIC FISTULAS

A.F. CHERNOUSOV, T.V. KHOROBRIKH, G.KH. MUSAYEV, G.G. TOMAYEV

First Moscow State Medical University named after I.M. Sechenov, Moscow, RUSSIA

Introduction: Bile and pancreatic fistulas after various operations on the organs of hepatopancreatobiliary area significantly complicate the postoperative course, by extending the period of hospital treatment and significantly deteriorate the quality of life of a patient. Often, such complications require repeated surgery in both the near and late postoperative period.

Purpose: Improvement of the results of treatment of patients with external and internal fistulas in the surgical treatment of diseases of liver and pancreas.

Materials and methods: The study included 90 patients with biliary fistulas and 45 patients with pancreatic fistulas emerging after operations on liver, bile ducts and pancreas, treated in the clinic within the period from 1991 to 2010.

In case of detection of biliary and pancreatic fistulas in postoperative period, in addition to the complex conservative therapy the treatment included percutaneous coronary intervention under US-control (drainage of fluid collection) and if necessary, endoscopic manipulations (choledochoduodenostomy, cytogastrostomy, nasobiliary drainage, etc.).

Before 2005 different sclerosants were used to close fistulas, and in recent years, the mainly used means was fibrin adhesive.

Results: The use of other sclerosants (ethyl alcohol, Lipiodol, kuriozin) did not always allow adequate closure of fistulas and significantly extended the time of hospital treatment. Average length of stay of patients with biliary fistulas was 18,2 ± 1,8 days; with pancreatic fistulas - 27 ± 6,4 days. Introduction of fibrin adhesive into clinical practice lead to express enhancement of reparative processes in the area of sinus tract. With the rapid growth of young granulation tissue of the walls of the sinus tract, a rapid closure of the fistula (within average of 5-10 days after the start of application of fibrin adhesive) was observed. Average length of hospital stay of patients with biliary fistulas was 10,3 ± 2,1 days, with pancreatic fistula - 18,3 ± 3,4 days. Repeated interventions were not applied in observations.

Conclusion: A comparative analysis of different sclerosants and fibrin adhesive in the closure of bile and pancreatic fistulas showed significant effectiveness of the latter, and in all cases allowed to achieve occlusion of the fistulas in a short period as compared to previously used sclerosants.

PROGNOSTIC SIGNIFICANCE OF IL-6 GENE POLIMORPHISM IN ACUTE PANCREATITIS

B. COLAK, T. KARAKAN, M. ARHAN, M. IBİS, M. CİNDORUK, S. DUMLU, A.GORGUL, S.UNAL

Gazi University, Ankara, TURKEY

Aim There are three key factors for patient with acute pancreatitis: diagnosis, disease severity and cause of the disease. We aimed to investigate the effect of IL-6 gene -174 G>C and -572 G>C polymorphisms on Ranson score, Balthazar score, serum IL-6 level, CRP level and white blood cell count.

Methods Thirty six patients diagnosed with acute pancreatitis and 50 healthy control subjects were studied. Ranson and Balthazar scores were determined. Both patient and control groups, erytrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum IL-6 level, IL-6 gene -174 G>C and -572 G>C polymorphisms were examined

Results The -174 G>C and -572 G>C polymorphisms were not correlated with Ranson and Balthazar scores. Serum IL-6 level was correlated with Ranson and Balthazar scores. Also serum IL-6 level was correlated with ESR,CRP and white blood cell count.

Conclusion IL-6 gene -174 G>C and -572 G>C polymorphisms,no significant correlation with Ranson and Balthazar scores, suggest that there is no effect on severity of acute pancreatitis. However, the -174 G>C polymorphism DD genotype and the -572 G>C polymorphism GG,GC genotypes that result in high serum levels of IL-6, supporting indirect effect on prognosis of acute pancreatitis.

RISK FACTORS FOR HEPATOCELLULAR CARCINOMA: THE EXPERIENCE OF A SINGLE CENTER IN ISTANBUL, TURKEY

M. COSKUN (1), S. OZDEMIR (2), B. BAYSAL (2), I. HATEMI (2),

A. DOBRUCALI (2) , K. BAL (2), A. SONSUZ (2), M. TUNCER (2), H. SENTURK (2), G. OZBAY (3), I. YURDAKUL (2).

(1)Balikesir University, Department of Internal Medicine, Faculty of Medicine, Division of Gastroenterology, Balikesir, TURKEY; (2) Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, (3) Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pathology, Istanbul, TURKEY.

Background / Aims: Hepatocellular carcinoma (HCC) is one of the important health problems in Turkey. In this study we retrospectively investigated demographic, biochemical, serological and radiological characteristics of the patients with HCC.

Methodology: Research data were obtained from 79 patients hospitalized (59 male, 20 female) (mean age: 61.2±10.5 yr, range: 34-80 yr). Patient demographics, hepatitis B (HBV), hepatitis C (HCV) and Delta virus markers, routine liver tests, alpha-fetoprotein (AFP) level, imaging methods and liver biopsy were reviewed retrospectively.

Results: Demographic analysis showed that HCC was more common in males and in the elderly population. HBsAg, anti-delta, and anti-HCV were found positive in the patients with the ratio of 65.8%, 6.3%, and 25.3%, respectively. Serum alkaline phosphatase and gamma glutamil transpeptidaz levels were higher than upper normal limits in 72.7% and 72.9% of the patients, respectively. In 85.9% of the patients, AFP levels were higher than upper normal limits. Cirrhosis was present in 88.6% of the cases. The main imaging method for diagnosis of HCC was ultrasonography (USG).

Conclusions: HBV is the most common etiologic cause with the ratio 65.8% of the 79 patients and HCV was also a significant etiologic factor with a 25.3% ratio. HCC developed on cirrhosis basis in most patients. Most patients also had elevated AFP levels. USG, BT and MRI are equivalent radiological methods that complete each other depending on the tumor size.

Date: 2014-12-28; view: 747