Etiological differences in demographics, clinical course and consequences of acute pancreatitis: a retrospective study.

OBJECTIVE: Aim: The study is intended to consider acute pancreatitis from the point of view of its etiological structure, as well as demographic description, features of the clinical course, distribution of morphological forms, severity and consequences of the disease in different etiological variants. PATIENTS AND METHODS: Materials and Methods: The work was based on a retrospective analysis of the medical records of 677 patients with acute pancreatitis who underwent inpatient treatment from 2017 to 2022 in an emergency hospital and a tertiary regional hospital in Vinnytsia, Ukraine. RESULTS: Results: The etiological structure of the general sample was as follows: the alimentary factors - 37,5% of cases, biliary - 18,6%, alcohol - 14,0% and postoperative - 7,8%, respectively. The oldest patients were observed in the group with biliary AP (age [median, interquartile range] 61 [46-72] years), the youngest - in the group with alcoholic AP (age [median, interquartile range] 40 [35-47] years). Men significantly predominated in the groups with alimentary and alcoholic AP. A significant predominance of women was observed in the group with biliary AP (62,7% vs. 37,3%, p=0,0003). The highest mortality was in the alcoholic AP group (22,1%), also here was a significantly lower rate of inpatient bed days (6,0). Edematous AP was dominant in all etiological variants. While infected necrotic pancreatitis was significantly more often found in patients with alcoholic genesis (7,4%). CONCLUSION: Conclusions: The etiologic variations of acute pancreatitis differ by demographic and clinical indicators and require more detailed study to understand its prognosis, management, and development of effective prevention and treatment strategies.

TREATMENT OF COMBAT GUNSHOT SHRAPNEL TRAUMA OF LARGE DEFECTS OF THE SOFT TISSUES OF THE LOWER EXTREMITIES WITH PLASTIC SURGERY IN COMBINATION WITH VACUUM ASSISTED WOUND CLOSURE (VAC).

OBJECTIVE: The aim: To evaluate efficacy of the tissue defect closure techniques in combination with VAC in the treatment of battle casualities of the lower extremities. PATIENTS AND METHODS: Materials and methods: The results of wound healing until complete wound closure, of 62 patients with shrapnel defects of the lower extremities where assessed. RESULTS: Results: Treatment of patients with soft tissue defects of the lower extremities using rotational flaps on the vascular pedicle and VAC significantly reduces the incidence of infectious complications (18.75% in the main group vs. 30% in the control group (p<0.05)), reduces the intensity of pain according to the VAS scale during the first week of treatment in the main group to 5±0.5 versus 7±0.8 in the control group (p<0.05) and reduces the length of hospital stay by 7 days. CONCLUSION: Conclusions: The use of rotational flaps on the vascular pedicle and local tissue closure techniques in combination with VAC is an effective method of treating patients with combat gunshot wounds of the soft tissues of the lower extremities.

DUNBAR SYNDROME: CLINICAL MANIFESTATION IN ADULTS, DIAGNOSTIC PROBLEMS (CASE REPORT).

In this case we used CBC and biochemical tests, ECG, ultrasound of the abdominal cavity and heart, CT scan with and without IV contrast. Women with complains on recurrent severe abdominal pain in epigastric region and right part of the abdomen radiating to the back, nausea, vomiting. Making laboratory and instrumental tests for confirmation of the diagnosis. Surgical treatment of DS was performed and after one year of the follow up there were no complications. DS may mimic other medical conditions such as gallbladder diseases, gastritis/peptic ulcer, appendicitis, colorectal malignancy, hepatitis, atherosclerotic diseases etc. That is why DS is a diagnosis of exclusion. This case illustrates pathway to find correct diagnosis and improve management tactic.

ASSOCIATION OF CLINICAL AND EARLY ROUTINE LABORATORY FINDINGS WITH SEVERITY OF ACUTE PANCREATITIS.

OBJECTIVE: The aim: To identify the association of clinical and simple laboratory data determined during hospitalization of the patient with severity of acute pancreatitis. PATIENTS AND METHODS: Materials and methods: Clinical and laboratory parameters of 229 patients with acute pancreatitis were analyzed. All patients were divided into two groups depending on the severity of acute pancreatitis: in the group with mild AP were 130 (56.8%) patients and the group, which included moderately severe and severe degree of AP consisted of 99 (43.2%) patients. RESULTS: Results: The association of the age group of 61-70 years with the severity of acute pancreatitis was revealed (p 0.05). We did not find an association between the causes of acute pancreatitis and its severity. In the group with moderate-severe acute pancreatitis, the frequency of concomitant pathology was significantly higher than in the group with mild acute pancreatitis - 92.9% (92) and 78.5% (102) cases (p<0.05). The association between the severity of acute pancreatitis and the following laboratory parameters: blood sugar, leukocyte levels, the level of stabs, lymphocytes, total protein, serum amylase, urinary diastase, creatinine, ALT, AST, prothrombin index, neutrophil-lymphocyte ratio was revealed (p<0.05). CONCLUSION: Conclusions: The study did not reveal a significant difference between compared groups in the time of hospitalization; found no association between the causes of acute pancreatitis and its severity. Instead, the association between female sex, the presence of concomitant pathology and some routine laboratory findings with the severity of acute pancreatitis was proved.

SURGICAL TREATMENT OF ECHINOCOCCOSIS OF THE LIVER AND ITS COMPLICATIONS.

OBJECTIVE: The aim: To analyze the frequency of complications of echinococcal cysts of the liver, the causes of recurrence and the results of surgical treatment of patients with echinococcal liver disease. PATIENTS AND METHODS: Materials and methods: The results of surgical treatment of 79 patients who were hospitalized from January 2011 to JANUARY 2022 with liver echinococcosis and its complications were analyzed. Among them there were 11 men (13,9%) and 68 women (86,1%), with average age 47,5 ± 2,3 years. Complications of echinococcal cysts developed in 17 (21,5%) patients. RESULTS: Results: The choice of surgical intervention method was determined individually, taking into account the location of echinococcal cysts, their size, depth, proximity of important anatomical structures. 53 (67,1%) patients underwent total or subtotal pericystectomy, 8 (10,1%) patients underwent liver segment resection, 5 (6,3%) patients underwent cyst dissection with removal and treatment its cavity, PAIR method was applied in 1 (1,3%) patient. Echinococcectomy was performed laparoscopically in 12 (15,2%) patients. The use of laparoscopic surgery for echinococcosis of the liver reduced intraoperative blood loss, duration of operation, hospital stay. We did not have recurrences of the disease after radical surgery. After palliative surgery, recurrence occurred in 2 (2,63%) patients. CONCLUSION: Conclusions: Surgical interventions for urgent indications in patients with complicated echinococcal cysts of the liver increase the risk of recurrence of the disease. Pericystectomy was performed in 53 (67,1%) patients, is a radical and efficient operation for complete recovery and does not lead to recurrence of the disease. The efficiency of laparoscopic echinococcectomy has been demonstrated.

PERCUTANEOUS ULTRASOUND-GUIDED PUNCTURE AND CATHETER DRAINAGE METHODS IN THE TREATMENT OF FLUID COLLECTIONS FOLLOWING ACUTE PANCREATITIS.

OBJECTIVE: The aim: Improve the treatment outcomes of patients with fl uid collections following acute pancreatitis using an ultrasound-guided puncture and catheter drainage methods. PATIENTS AND METHODS: Materials and methods: 67 patients with acute pancreatitis complicated by fl uid collections were divided into two groups. The fi rst group (comparison group) consisted of 32 patients who underwent percutaneous ultrasound-guided puncture and catheter drainage interventions in addition to conservative therapy. The second group (control group) consisted of 35 patients receiving conservative therapy. The age of patients was from 18 to 77 years. In the comparison group among 32 patients there were 19 women and 13 men, the average age consisted 48.2 ± 2.2 years. In the control group among 35 patients there were 21 women and 14 men, the average age of patients consisted 47.1 ± 2.3 years. RESULTS: Results: The mortality rate in the comparison group was 2 (6.2%) cases, in the control group - 4 (11.4%) cases (p <0.05). Infection of fl uid collections developed in 2 (6.2%) patients of the comparison group and in 5 (14.3%) patients of the control group. The average length of stay in the hospital of patients in the comparison group was 24.13 ± 2.17 days, in the control group 28.11 ± 1.05 days (p <0.05). Also in the comparison group there was a faster normalization of clinical and laboratory indicators (level of leukocytes, serum amylase, C-reactive protein) (p <0,05). CONCLUSION: Conclusions: the use of percutaneous ultrasound-guided puncture and catheter drainage methods has reduced mortality and improved treatment outcomes in patients with acute pancreatitis complicated by fluid collections.