[Acute phase proteins in acute pancreatitis]. / Proteini akutne faze u akutnom pankreatitisu.

INTRODUCTION: Most attacks of acute pancreatitis are self-limiting, but in 10-20% of cases, however, severe diseases with systemic complications develop. During the last few years, it has been recognized that acute phase proteins have an important role in the pathophysiology of acute pancreatitis. The present study examines the value of C-reactive protein, alpha-1-antitrypsin and orosomucoid in the assessment of severity of acute pancreatitis. MATERIAL AND METHODS: 150 adult patients suffering from acute pancreatitis by Mayer's clinical criteria (10) were divided in two groups. The first one (n = 50) consisted of patients with severe form of the disease and the second (n = 100) of patients with a mild form of acute pancreatitis. Acute phase proteins (C-reactive protein, alpha-lantitrypsin and orosomucoid) were determined quantitatively in both groups on the 1, 2, 3, 7 and 14th day of the disease onset. RESULTS: Increase in C-reactive protein values was observed in both groups. There was statistically significant greater increase in C-reactive protein in patients with severe acute pancreatitis than in those with mild form of the disease. C-reactive protein values fell slowly in all patients. Serum alpha-1 antitrypsin values were less increased than C-reactive protein values. There was a greater increase in patients with severe form of disease. The increase of orosomucoid was seen only after the third day of the disease onset and there was not a significant difference in values between the two groups. DISCUSSION: One of the most important problems in treating patients with acute pancreatitis is to detect patients with a severe form of the disease as early as possible, so that adequate treatment can be started immediately. The severity of acute pancreatitis is graded by Ranson and Imrie scores, but they request 48 hours for prognosis to be defined. Despite intensive research, no single laboratory test or pathophysiologic parameters have been found to accomplish early diagnosis. Recent studies suggest that single biologic markers such as acute phase proteins may soon allow a simple and early assessment of the prognosis. CONCLUSION: This study suggests that a C-reactive protein is a good early marker for the severity of acute pancreatitis. The high increased levels at the beginning point to serious course of disease in future. The increase of alpha-1-antitrypsin is of a similar importance, while the increased orosomucoid, appearing only after the third day, is of no importance in relation to the prognosis of the disease.

[Total abdominal colectomy in treatment of acute malignant obstruction of the left colon]. / Totalna abdominalna kolektomija u lecenju akutnih malignih opstrukcija levog kolona.

This paper deals with an experience of a total abdominal colectomy in acute malignant obstruction of the left sided colon. Ten patients were treated with total abdominal colectomy during 1991 with a high frequency of synchronous carcinoma (in two patients) and precancerous lesions (a big polyp in one patient) in total 30%. One patient died after the treatment (10%) and a complete dehiscence of the ileo-rectal anastomosis and reoperation on the ninth postoperative day. One patient had had an infection of the wound. Total abdominal colectomy is an operation which can have an important role in decreasing malignant reoccurrence, avoiding stoma in the postoperative period of one month in most patients. Absolute indication for total abdominal colectomy in patients with acute malignant obstruction of the left sided colon is the "closed loop" obstruction with a decompensated colon, as well as the factor of heredity in close relatives and the absence of locally spread tumors and metasthases disregarding the age of the patient and the competence of the ileocecal valvula.

[10 years' experience with the use of endoscopy in the intraoperative diagnosis of extrahepatic biliary tract diseases]. / Desetogodisnje iskustvo sa primenom endoskopije u intraoperativnoj dijagnostici oboljenja ekstraheparnih zucnih puteva.

In the last ten years 375 patients were operated on biliary tract examined with intraoperative choledochoscopy. Sensitivity of choledochoscopy in our investigation was 72% and negative predictive value was 85% while specificity and positive predictive value for flexible choledochoscopy was 100%. There were no false positive results. After the instrumental exploration of the common bile duct, unsuspected stones were found in 9.19% of patients recorded with choledochoscopy and 3.44% of retained stones confirmed by postoperative cholangiography. Choledochoscopy was successful in determination of the level of obstruction by tumors in all patients (100%), but of limited value in determination of tumor extension through the bile duct wall in 66.66% of patients. Interventional procedures through the work channel of the instrument showed little success. Extraction of impacted stones was recorded in one patient (3.70%) while the biopsies were completely unsuccessful. We recommend choledochoscopy for each patient with open common bile duct, especially with proved multiple common bile duct stones.

[Chilaiditi syndrome]. / Chilaiditijev sindrom.

The paper deals with a patient who was admitted through the surgical emergency service under the suspicion of subphrenic abscess. From the moment of admittance the patient was carefully followed. Laboratory tests were repeated several times. The following examinations were performed within a very short period of time: a posteroanterior X-ray of the chest and both subphrenic spaces, an ultrasonogram of the upper abdomen, a CT scan of the upper abdomen, roenthgenography of the gastroduodenum with gastrografin, an esophagogastroduodenoscopy and irrigography. Apart from the interposition of the colon between the liver and the diaphragm, no other pathological changes were found. Clinical follow-ups of the lungs and the abdomen were normal. The patient was discharged in a good general condition.

[Personal experience with segmental corporo-caudal allotransplantation of the pancreas in an experiment on dogs]. / Nasa iskustva segmentalne korporokaudalne alotransplantacije pankreasa u eksperimentu na psima.

In the Institute for Surgery, its Experimental Centre, has already several years an experimental transplantations of pancreas been carried out with the aim of learning surgery technique and performing a clinical transplantation of that organ. In our work we have used a technique of corporacaudal allotransplatation of pancreas with vascular anastomosis. As the blood vessels of the graft we have used the arteria and vena lienalis with parts of aorta and portal vein, which have been anastomosed with a. and v. iliaca communis of the pancretotomized recipient. We have used techniques of the open pancreatic duct, ligated pancreatic duct, our own technique of permanent bleeding of the pancreatic graft during the transplantation pancreaticojejunostomy and pancreatico-vesicular anastomosis. As the parameters of function of allograft we are using: glycaemia, i.v. GT test, K constant, insulinaemia, amylasaemia, length of survival of animals and pathohistological finding. The average term of survival of experimental animals was 28 days. During the function of alograft the experimental animals shown some signs of laboratory subclinical diabetes. Refusal of transplant was followed by sudden increase of glycaemia, without any clinical or laboratory sign of anticipation of the refusal.

[Partial heterotopic and total orthotopic transplantation of the liver in dogs]. / Parcijalna heterotopna i totalna ortotopna transplantacija jetre u pasa.

From 1983 to 1988 on the Department for Experimental Surgery 20 preservations of the liver has been done, with ice cold Euro- Collins and Ringer solutions, either with in situ or with on banch technique after fast expantation. On five dogs standard 55% left hepatectomy has been done and the right side preserved in situ. Partial heterotopic liver transplantation to the right iliac fossa was performed on five dogs. Total vascular exclusion of the liver and extracorporal inierior vena cava and jugular vein by pass with assisted circulation was performed on one dog, without assistance on four dogs. Total orthotopic liver transplantation was performed on two dogs. The surgical team practiced the technique of liver transplantation in experiment and liver resection with in situ technique and on banch technique.

[Anesthesia in peritoneovenous shunt placement]. / Anestezija za ugradnju peritoneojugularnog santa.

Since 1984 the peritoneovenous shunt has been installed in 33 patients because of resistant ascites. The aim of this study was to find the optimal type of anesthesia in our conditions on our own clinical-patient material. All patients were classified by the ASA, Goldman, Child and Child-Puigh score. The patient, surgeon and anesthesiologist were polled about the quality of anesthesia, and all observed complications were followed, like after different premedications as well as in the course and after different types of neuroleptic anesthesia. General neuroleptic anesthesia was applied in 23 patients (69.7%), one was operated on in ketamine anesthesia (3.0%) and 9 (27.3%) in local anesthesia with 2% Xylocaine. After premedication with Thalamonal in all patients there came to a fall in arterial pressure for more than 20% of initial values and the feeling of uneasiness and fear was present. All patients with local anesthesia absolutely needed additional application of sedation or analgesia, especially during the formation of the subcutaneous tunnel, and neither patient nor surgeon were satisfied with the achieved comfort. During the course of neuroleptic anesthesia with Thalamonal hypotension developed, in 17/20 patients an in 2/20 the presence of prolonged apnea demanded additional artificial ventilation. In the patient operated on in ketamine anesthesia, an acute psychotic reaction developed, followed by visual and acustic hallucinations without signs of metabolic encephalopathy. On the basis of our own experience, we conclude that general neuroleptic anesthesia with the use of Flormidal as an anesthetic and Fentanil as an analgetic, is the method of choice, and that local anesthesia can be recommended only on one operative site (except the subcutaneous tunnel).

[20 years' experience in the treatment of abdominal echinococcosis (1966-1987)]. / Dvadesetogodisnje iskustvo u lecenju ehinokokusa abdominalne lokalizacije (1966-1987).

Primary echinococcus of abdominal localization at Clinic of Abdominal and Endocrine Surgery in Novi Sad in twenty years period is rare disease, without decreasing tendency. Mostly, there is general and local manifestations on which, one can suspect on disease, and almost in all cases prove it by US and CT. These diagnostical procedures contributed to earlier and better surgical treatment. The most common localization of the cyst is liver. Choice of operative procedure is termed by pathomorphological particularity of the cyst, type of complication and recidive prevention. Intraoperative exploration of biliary tract has an important place in prevention of biliary fistulas. Authors underlined controversy about uncomplicated cyst treatment and emphasized that they are often today grateful to noninvasive diagnostics methods.