[Cholelithiasis: complications and rehabilitation].

The results of laparoscopic cholecystectomy, conducted in 71 patients, suffering cholelithiasis, were analyzed. In early postoperative period an acute cholangitis have occurred in 2 (2.8%) patients, an acute pancreatitis--in 1 (1.4%), postoperative infiltrate--in 14(19.7%), suppuration of postoperative cicatrix--in 6 (8.4%); late compli- cations as a kind of postcholecystectomy syndrome was observed in 29 (40.8%) patients, and abdominal hernia--in 3 (4.2%).

A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis.

OBJECTIVES: To compare transnasal endoscopy with fluoroscopy for the placement of nasojejunal feeding tubes (NJTs) in patients with severe acute pancreatitis. METHODS: 100 patients were randomised to receive NJTs by transnasal endoscopy or fluoroscopy. Successful placement was confirmed by abdominal radiograph. RESULTS: The success rate was 96% using transnasal endoscopy and 94% using fluoroscopy (p>0.05). The mean (SEM) time to perform a successful procedure was 12.7 (5.1) min for transnasal endoscopy and 7.9 (5.9) min for fluoroscopy (p<0.05). No complications were reported using fluoroscopy, whereas there was one case of tachypnoea and four cases of abdominal distension related to transnasal endoscopy (p<0.05). For transnasal endoscopy, the mean (SEM) visual analogue scale comfort score was 3.2 (1.3) before, 8.7 (1.5) during, and 3.6 (1.3) after a successful procedure. The corresponding values for fluoroscopy were 3.1 (1.2), 5.4 (1.6) and 3.7 (1.4). The difference in scores during the procedure was significant (p<0.05). CONCLUSIONS: Transnasal endoscopic and fluoroscopic placement of NJTs can safely and accurately be performed in patients with severe acute pancreatitis. The results of this study show no significant difference in success and complication rates between the two procedures. However, the procedure time for fluoroscopic placement was shorter than for transnasal endoscopic placement, and patients experienced less discomfort.

Painless pancreatitis after implantation of a biventricular assistive device.

This young cardiac transplant patient developed painless acute pancreatitis within 10 days of implantation of a biventricular assist device (BIVAD). Historical, physical, laboratory, and imaging data allowed conservative management leading to a favorable outcome. Acute pancreatitis after cardiac transplantation is common with a significant mortality rate. Immunosuppression may play an important role in this process as well as infectious and pancreaticobiliary etiologies. Whereas acute pancreatitis is a well-documented complication of cardiac transplantation, this event has not previously been reported in patients who have received a BIVAD. The mechanism by which BIVAD placement may result in pancreatitis is unknown.

[Health education for chronic liver and pancreatic diseases: Discussion groups "chronic liver disease" (CL), "chronic pancreatic disease" (CP)]. / Schulung bei Leber- und Pankreaserkrankungen: Gesprächsgruppe "Chronische Lebererkrankungen" (CL) /"Chronische Pankreaserkrankungen" (CP).

The article deals with our experience in the educational programs for patients with chronic liver diseases and chronic pancreatic diseases.The structure of our educational programs is modular, the main event is the discussion group "Chronic Liver Diseases" (CL) (2 meetings are headed by physicians, 1 by psychologists, duration in all 3,6 hours) respectively the discussion group "Chronic Pancreatic Diseases" (CP) (2 meetings headed by physicians, 1 by nutrition consultants, duration in all 2,6 hours). As needed, additional modules can be added, for example specific seminars in case of alcohol abuse or educational programs for diabetics. The average number of participants is between 7 - 15 persons in the discussion group CL, respectively 11 - 20 in the discussion group CP. An overhead projector is used to address the various topics, the patients are encouraged to actively participate in the discussion. The contents can be found in a structured curriculum and focus on anatomical basics, diagnostic and therapeutic aspects, physical fitness and performance in professional life.

[Chronic pancreatitis: weight loss and poor physical performance - experience from a specialized rehabilitation centre]. / Chronische Pankreatitis: Gewichtsverlust und Leistungsschwäche - Erfahrungen aus einer spezialisierten Rehabilitationsklinik.

There are various potential explanations for weight-loss and poor physical performance in patients with chronic pancreatitis: In severe chronic pancreatitis the decline in enzyme secretion is an important cause for the malassimilation syndrome frequently seen in these patients. Occasionally, difficulties may arise in establishing this decline and in quantifying the secretory capacity of the gland. Many patients limit their food intake because of the pain caused by eating. In untreated patients with diabetes, glucosuria may contribute to their malnutrition. Insufficient funds for food due to alcoholism and anorexia may also be of some significance. Concomitant gastrointestinal diseases and malabsorption following gastrointestinal surgery are frequently found in patients with chronic pancreatitis. Neurological complications and traumatic lesions after accidents - often in connection to the underlying alcoholism - are joined by physical inactivity and thus contribute to the development of muscular atrophy and decreased physical performance. Consequently, rehabilitation of patients with chronic pancreatitis is challenging: They not only need expert medical treatment of both the symptoms of chronic pancreatitis and the concomitant disorders. Therapy must also include dietary support, careful physical training, and - in cases caused by alcoholism - psycho-social support. So far, the multi-professional competence required for these purposes can only be expected in a specialized rehabilitation centre.

[Electrophoresis of biologically active substances in the treatment of chronic pancreatitis]. / Elektroforez biologicheski aktivnykh veshchestv v lechenii bol'nykh khronicheskim pankreatitom.

177 patients with chronic pancreatitis were entered in the study comparing placebo with electrophoresis of biologically active substances (sodium oxybutirate, alpha-tocopherol, dimexide). Sodium oxybutirate eletrophoresis produced the best effect. This was evident from stronger attenuation of clinical symptoms and the activity of the pathological process as indicated by laboratory examination of kallikrein, protease-inhibitory and immune systems.

[Lipid metabolism disorders in acute pancreatitis]. / Zaburzenia metabolizmu lipidów w ostrym zapaleniu trzustki.

On the course of acute pancreatitis which occurred in 30 patients treated in our clinic changes in cholesterol, triglycerides and phospholipids levels were monitored during 7 days of hospitalization taking into account the severity and aetiology of disease. The decrease of cholesterol and phospholipids levels were observed in 3-rd and 7-th day of hospitalization. TGs concentrations however showed variability regarding aetiology and severity of acute pancreatitis lack of mentioned above lipid levels changes before the disease onset as well as their rapid normalization with healing suggest, that they are rather a consequence not a cause of acute pancreatitis.

[The efficacy of physiotherapeutic methods in the treatment of chronic pancreatitis taking into account the season of the year]. / Efektyvnist' fizioterapevtychnykh metodiv u likuvanni khronichnoho pankreatytu z urakhuvanniam sezonu roku.

Overall thirty patients with chronic pancreatitis were studied for expediency of differentiated employment of physiotherapeutic procedures with season of the year being taken into consideration. Shown during the course of treatment was a high clinical efficiency of inhibition of the lipid peroxidation processes and activation of glutathione link of the antioxidant system of defence. Combined use of CMC and phonophoresis with solcoseril ointment and 10% methyluracil ointment makes for enhancement of general bodily resistance, promoting more prolonged remission.

Nuevas Estrategias en el Manejo de la Pancreatitis Aguda

La pancreatitis aguda es un proceso inflamatorio del páncreas con repercusión local y sistémica. La nueva clasificación de la pancreatitis la divide en moderada cuando tiene menos de tres criterios de Ranson y menos de nueve puntos de Apache II y severa cuando tiene más de tres criterios de Ranson y más de nueve puntos de Apache II. La mortalidad en pancreatitis aguda severa oscila del 10 al 60 por ciento según los diferentes reportes. A todo paciente con pancretitis se le realiza ecografía de la vesícula para probar si su origen es biliar, que es la primera causa etiológica y a toda pancreatitis severa se le toma una escanografía dinámica, se mide el grado de necrosis de la glándula y se realiza una punción de las colecciones líquidas o del tejido necrótico para comprobar infección o demostrar que el proceso es estéril. Al paciente con pancreatitis severa asociada a colangitis o ictericia se le realiza colangiopancreatografía endoscópica retrógrada más papiloatomíoa en las primeras 48 a 72 h con mejoría de la sobrevida. La pancreatitis severa es manejada en la unidad de cuidado intensivo por un equipo multidisciplinario, con soporte hemodinámico, ventilatorio, nutricional, antibióticos, somatostanina y/o octreotide. Si requiere cirugía se realiza con la técnica del abdomen abierto con necrosectomia y lavados de la cavidad abdominal a través de una malla. La pancreatitis severa continua siendo un reto para los cirujanos y médicos que se ven enfrentados a esta catástrofe intraabdominal

[Principles of the differentiated use of the natural and preformed therapeutic factors of a health resort in patients with chronic pancreatitis]. / Printsipy differentsirovannogo primeneniia prirodnykh i preformirovannykh lechebnykh faktorov kurorta u bol'nykh khronicheskim pankreatitom.

With the purpose of enhancing efficacy of health-resort treatment of chronic pancreatitis, patients with relevant clinical form and stage of the disease course, early revealed distinguishing features of disturbances in the exocrine function of pancrease should be referred to those health resorts having adequate mineral waters. 75 patients with chronic pancreatitis presenting with various type pancreatic secretion derived benefit from differentiated use of mineral water and physiotherapeutic procedures.

[The clinico-pathogenetic validation of rehabilitative-stage treatment in chronic pancreatitis]. / Kliniko-patohenetychne obhruntuvannia reabilitatsiino-etapnoho likuvannia khronichnoho pankreatytu.

A total of 252 patients were examined. It has been shown that forms of chronic pancreatitis (ChP) have some distinguishing features of the clinical course of the disease and depend on morphofunctional state of pancreas, its ecbolic activity, degree of microcirculatory disorders, state of lipid peroxidation (LPO), that of the antioxidant system of defence as well as psychophysiologic status of the personality, circadian and seasonal variability of functional activity of pancreas in patients with chronic pancreatitis. Substantiated in the paper is rehabilitative staged treatment of ChP patients, depending on ChP forms with due regard to the above-mentioned mechanisms of its relapse, most important of which is LPO status, that of antioxidant system of defence and microcirculation.

[Physiotherapeutic methods in the postoperative period in acute pancreatitis patients]. / Fizioterapevticheskie metody v posleoperatsionnom periode u bol'nykh ostrym pankreatitom.

60 patients surgically treated for acute pancreatitis received postoperative physiotherapy which combined transcutaneous electroneurostimulation with exposure to low-energy laser. The results support the effectiveness of combined physiotherapeutic methods of general and reflex action in severe forms of acute pancreatitis because such physiotherapy early after severe forms of acute pancreatitis because such physiotherapy early after severe pancreatitis surgery promotes the decline of pathological symptoms.

Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas.

Chronic pancreatitis frequently generates complications through involvement of adjacent organs. Distal common bile duct stenosis and segmental duodenal stenosis, the most frequent complications, are usually treated by resection or bypass procedures. This study presents experience with duodenum-preserving resection of the head of the pancreas in the treatment of patients with chronic pancreatitis with predominant involvement of the pancreatic head and coexisting complications involving adjacent organs. This procedure preserves the structure and function of the bile duct and duodenum. Sixty-six patients with severe chronic pancreatitis underwent duodenum-preserving resection of the head of the pancreas. Thirty-eight had associated complications of neighbouring organs: 37 had distal common bile duct stenosis, seven had duodenal stenosis, ten had evidence of segmental portal hypertension and one suffered from a pancreatopleural fistula. Details of all patients were documented prospectively; mean follow-up was 4.2 years. The complications of adjacent organs were permanently eradicated in 36 of 38 patients. Two patients required endoscopic stenting for persisting bile duct obstruction. There was substantial or complete relief of all symptoms in 35 patients. Duodenum-preserving resection of the head of the pancreas is effective in the treatment of severe chronic pancreatitis with predominant involvement of the pancreatic head and provides definitive management of associated complications of adjacent organs.

[The efficacy of the combined use of 5-fluorouracil electrophoresis and magnetotherapy in experimental pancreatitis]. / Effektivnost' sochetannogo primeneniia élektroforeza 5-ftoruratsila i magnitnoterapii pri éksperimental'nom pankreatite.

As shown on the experimental model of rat acute pancreatitis, an intensive 5-fluorouracil electrophoresis course in combination with magnetotherapy significantly reduces the activity of blood trypsin, amylase, lipase and corticosterone. The treatment is thought effective in experimental pancreatitis.

Microheterogeneity of serum glycoproteins in alcoholics: is desialo-transferrin the marker of chronic alcohol drinking or alcoholic liver injury?

The appearance of desialo-transferrin (De-TF) in serum has been reported to be a biochemical marker of chronic alcoholism. However, conclusive evidence of whether De-TF is a marker for chronic alcohol drinking or for alcoholic liver disease (ALD) has not yet been obtained. Glycoproteins can be divided into two groups, a transferrin (TF) group and an alpha 1-acid glycoprotein (A1-AG) group, based on the characteristics of microheterogeneity (M-HTG) of each protein. In the present study, the appearance of M-HTG in serum TF and A1-AG in alcohol drinkers was compared. In 96 patients with ALD, M-HTG of TF was found in 66 patients (68.8%), and M-HTG of A1-AG was found in 61 patients (63.5%). In 20 patients with alcoholic pancreatitis, the detection rate of M-HTG of A1-AG was significantly higher than that of TF. In six patients with pancreatitis but not liver disease, M-HTG of TF was not detected. In 14 alcoholics without liver or pancreas disease, M-HTG of TF was not detected, whereas M-HTG of A1-AG was detected in 6 cases--a significant difference. The amount of alcohol consumed was not different in patients with and without liver disease. In non-ALD, M-HTG of both proteins was detected only in patients with decompensated liver cirrhosis. The detection rate of M-HTG in TF was significantly higher than in A1-AG. These results suggest that M-HTG of serum TF is a marker of ALD and that of serum A1-AG is a marker of chronic alcohol drinking.

Relationship between ethanol-related diseases and nutritional status in chronically alcoholic men.

Two-hundred and fifty chronically alcoholic men (mean age, 41 +/- 11 years) entering an alcoholism treatment program were studied. Detailed clinical history, nutritional assessment and measurement of muscle strength by electronic myometer were performed in each case. In addition, hepatic ultrasonography and liver biopsy, echocardiography and radionuclide cardiac scanning, and electrophysiologica testing of peripheral nerves were performed when there was clinical evidence of liver disease, cardiomyopathy or neuropathy, respectively. Alcoholic cirrhosis was diagnosed in 20 cases, skeletal myopathy in 117, dilated cardiomyopathy in 20 and peripheral neuropathy in 41 cases. No patients with chronic myopathy or cardiomyopathy showed either clinical or laboratory evidence of malnutrition. Patients with cirrhosis showed a significantly lower lean body mass than controls (P = 0.03) and significantly lower nutritional protein levels than those alcoholics without cirrhosis. Alcoholics with peripheral neuropathy had significantly lower anthropometric parameters and nutrition protein levels than their counterparts (P < 0.001). However, in the multivariate analysis, the only independent factor for developing these complications of alcoholism was the total lifetime dose of ethanol (P < 0.001). We conclude that alcohol-related diseases are common in asymptomatic alcoholic men and these diseases appear to be due to an accumulative toxic effect of ethanol. Age and nutritional status do not seem to play a part in the development of such diseases.

Nutritional status in chronically alcoholic men from the middle socioeconomic class and its relation to ethanol intake.

To determine the relationship between nutritional status and ethanol consumption, 250 chronically alcoholic men (mean age 41 +/- 11 years) entering an alcoholism treatment program were studied. A control group of 100 male volunteers (mean age 40 +/- 10 years) was also evaluated. Detailed clinical history, laboratory analysis and nutritional status assessment were carried out in each case and control. In addition, ethanol-related diseases such as liver disease, chronic pancreatitis, cardiomyopathy, myopathy and peripheral neuropathy were ruled out in all patients. The mean daily ethanol consumption of the alcoholics was 235 +/- 62 g over an average of 19 years. All of them belong to a very stable, middle-class working group of men. Only 25 (10%) alcoholics showed evidence of energy malnutrition, 15 (6%), of protein malnutrition, and 6 (2%) of both. In the multivariate analysis, the only independent factors for the development of malnutrition were the total lifetime dose of ethanol and calorie intake (ethanol excluded) (P < 0.01; both), as well as cirrhosis (P < 0.01) when protein malnutrition was considered. Alcoholic cirrhosis was diagnosed in 20 cases, skeletal myopathy in 117, dilated cardiomyopathy in 20 and peripheral neuropathy in 41. When patients with ethanol-related diseases were excluded, no significant differences in nutritional parameters were observed between chronic alcoholics and controls. We conclude that malnutrition is not as frequent as previously thought in middle socioeconomic class male alcoholics and its existence may be considered as another consequence of ethanol intake or secondary to the alcohol-related diseases.