DIAGNOSIS OF ACUTE PANCREANTITIS ACCORDING TO THE RESULTS OF STUDY OF EXUDATES

D.Y.SOSNIN, V.A.SAMARTSEV, A.S.OSOKIN

Perm State Medical Academy named after acad. E.A. Vagner, Perm, RUSSIA

Despite obvious successes in the treatment of acute pancreatitis (AP), timely diagnosis of this disease, especially in patients with concomitant surgical pathology remains to be unresolved problem. One of the criteria for the diagnosis of AP is the discovery of high activity of α-amylase in the exudate of the abdominal cavity.

In 274 patients, study the activity of α-amylase was carried out in parallel samples of blood serum and exudates of the abdominal cavity by unified kinetic method. The main group consisted of 163 patients with various forms of AP. The comparative group consisted of 111 patients with surgical diseases of the abdominal cavity.

The enzyme activity in the exudate of the abdominal cavity, obtained during operation in patients with AP, greatly exceeded the activity in blood serum and constituted 4949,0 ± 916,2 E/l and 720,8 ± 527,4 E/l, respectively (p <0,001 .) There were no significant differences in the initial activity of α-amylase in the effusion subject to the form of AP, which constituted 5233,2 ± 1002,4 E/l in edematous pancreatitis, and 3945,3±1213,1 E/l in destructive forms (P> 0,05). In the comparative group the level of enzyme in exudates was lower than in serum and constituted 68,8 ± 23,7 E/l against 107,3 ​​± 22,5 E/l (p <0,001). Advantages of simultaneous determination of amylolytic activity in the exudate and blood serum with the calculation of their ratio were proved by comparing diagnostic sensitivity and specificity of traditional tests (α-amylase and lipase), studied in blood serum and α-amylase studies in exudates. For this index there were determined operating characteristics close to 100%, that is significantly higher the results of traditional laboratory tests.

Comparative assessment of traditional laboratory tests and α-amylase activity in the exudate of the abdominal cavity for the diagnosis of acute pancreatitis.

Thus, the most reliable laboratory diagnostic criteria of AC is identification of α-amylase in parallel samples. Blood serum and exudate of α-amylase_exudate / α-amilase _{blood serum} coefficient greater than 1.0 shows presence of AP.

THE USE OF SUCCINATES IN THERAPY OF TOXIC DAMAGES OF LIVER

D.S. SUKHANOV, A.Y. PETROV, A.L. KOVALENKO, M.G. ROMANTSOV

St. Petersburg State Medical Academy. after I.I. Mechnikov, St. Petersburg, RUSSIA

High frequency of drug-induced liver disease in patients with respiratory tuberculosis is conditioned by a necessity of chemotherapy, which creates a high pharmaceutical load over hepatocytes. In this regard, the search for new drugs with hepatoprotective activity is relevant.

The aim: To evaluate the efficacy of the drug on the basis of methionine and succinate (remaksol) as a means of a pathogenetic therapy of drug-induced liver disease (DLD) in patients with pulmonary tuberculosis. Were observed 133 patients with newly diagnosed pulmonary tuberculosis (infiltrative, disseminated) at the age from 16 to 56 years. The main group (MG) was consisted of 68, the comparison group (CG, placebo) - of 65 patients. The study medication (400 ml) was administered intravenously once a day for 12 days.

Results. The disappearance of clinical manifestations of DLD (detected at 15-27,9% of patients - dyspeptic, astenovegetative syndromes) against the background of remaksol administration was observed on the 3-6th days. Reduction in the activity of ALT and AST in the MG was +

3.4-and 2.5-times, while in the CG - only in 1.7 and 1.6 times (p <0,01). Complete normalization of ALT level was detected at 67.4%, of AST level - at 58.8% of investigated patients of the MG, while in 17.6% of patients their activity did not exceed 2 normal levels. In the CG normal levels of ALT and

AST were lower - 40.0% and 33.0% correspondingly. Concentration of direct fraction of bilirubin in patients of the MG has decreased (-1.13 mmol / l) to 23.4% to the end of therapy (p <0,05). In the therapy, average values of activity of GGT (-21.3 IU / l) have decreased to 24.3% from baseline to the 13 day of treatment. During the study undesirable side reactions (USR) were identified in 4.4% of cases, they were estimated at 1-2 points and most likely were reaction to the compound components of the solution (nicotinamide, riboksin). Adverse effects that were resulted in any complications were not recorded.

Conclusion: remaksol as suktsinatócontaining drug quickly suppresses the clinical symptoms of DLD, inhibits cytolytic and cholestatic syndromes, that justifies its application in patients of this group.

INDUCTION OF SYNTHESIS OF ENDOGENIC S-ADENOSYL-L-METHIONINE (SAM) IN THE CORRECTION OF TOXIC AND DRUG-INDUSED

DAMAGES OF LIVER

D.S. SUKHANOV, A.Y. PETROV, A.L. KOVALENKO, M.G. ROMANTSOV

St. Petersburg State Medical Academy. after I.I. Mechnikov; "NTFF" Polysan ",

St. Petersburg, RUSSIA

The aim. Assessment of the level of endogenous intracellular SAM in liver under the influence of remaksol, reamberin and exogenous SAM on the models of toxic and drug-induced damages of liver.

Materials and methods. The experiments were carried out on 74 white mongrel nonlinear male rats. Toxic hepatitis in rats (n = 44) was induced by single oral administration of 50% oil solution of carbon tetrachloride in a dose of 1 ml per 100 g of body weight. Drug-induced liver damage with anti-TB drugs was modeled by introducing of anti-TB drugs (ATD) in the doses: isoniazid (H) 50 mg / kg, sc + rifampicin (R) 250 mg / kg, per os + pyrazinamide (Z) 45 mg / kg, per os within 14 days. The content of SAM in rat liver was determined by the original method, developed in the Institute of Toxicology.

Results. Acute intoxication of rats with carbon tetrachloride resulted in depletion of cellular reserves of SAM: the content of the latter was close to zero. Remaksol being exogenous SAM, in acute experimental toxic liver damage has markedly activated the endogenous accumulation of SAM in hepatocytes (13,79 ± 1,17 and 17,31 ± 2,87 g / g, respectively). In the chronic experiment (14-day toxicity by anti-TB drugs) remaksol has increased the levels of SAM as compared with intact animals (1.7-times, p <0.01) and with animals treated with Reamberin and exogenous SAM against the background of anti-TB drugs ( 2.3 and 1.9 times respectively, p <0.01). Exogenous SAM and Reamberin didn't significantly increase the level of endogenous SAM.

Conclusion. Remaksol has an inducing effect on the level of endogenous SAM in comparison with exogenous SAM and Reamberin. Its hepatoprotective effect is associated with methionine and succinic acid, comprising the preparation.

ACUTE DESTRUCTIVE PANCREATITIS-RELATED COMPLICATION DEVELOPMENT AND FATAL OUTCOME FORECASTING

Т.А SULTANALIYEV , А.Т. DJUMABEKOV , S.М. ABUOV, S.М. ZHARMENOV,

R.B. KALYMBETOV., A.Z. ARTYKBAYEV

Almaty State Institute of doctors’ advanced training, Almaty, KAZAKHSTAN

The research objective : to determine more important factors of development of complications and fatal outcome when acute destructive pancreatitis (ADP) exists, and to assess the efficiency of the complication development and lethality forecasting method to choose the treatment procedures.

Materials and methods. We have developed methods of forecasting the complication development risk and fatal outcome probability when ADP exists, based on determination of arithmetical mean probability. By carrying out the retrospective analysis of histories of the acute pancreatitis patients, the most important complication development and fatal outcome probability factors such as the procalcitonine level increase, encephalopathy, CDD increase to 26 per a minute, the urea level increase, the pancreas size extension, the free liquid availability in the abdominal cavity, the free liquid availability and liquid formation in the omental bursa were selected. To facilitate the ADP-related complication development and fatal outcome forecasting, “Pancreonecrosis” software performing automatic calculations was developed. To prove the efficiency we have prospectively determined the complication development risk in 111 patients, and the fatal outcome risk in 30 patients. The forecast concurrency was found in 102 (91.9%) patients with complications, and in 30 (91.9%) in patients with fatal outcome.

Conclusions. The acute destructive pancreatitis-related complication development and fatal outcome forecasting methods developed by us are highly effective and enable to approach to the surgical treatment procedures in different way.

Date: 2014-12-28; view: 819