[Cardiac electrode as a cause of the chronic sternal ostheomyelitis].

Results of the diagnostic concept and treatment of 5 patients with the chronic sternal ostheomyelitis after the open cardiac surgery caused by the "forgotten" cardiac electrodes were analyzed in the article. The radiologic diagnostic criteria and necessity of the computed tomography, in particular, were stated.

[The distal pancreatic resection with spleen preservation: which collaterals can we rely on?].

The spleen preservation by distal pancreatic resection can be performed either with spleen vessels preservation or with the ligation of the least. The experiment evolved ligation of all gastric arteries but the short gastric arteries in 20 cadaveric organocomplexes, followed by ink perfusion through the left gastric and left gastro-epiploic arteries. The study was amplified with the intraoperative dopplerography of portal arteries of the spleen after crossclamping of the left gastro-epiploic and short gastric arteries. Ten patients after distal pancreatic resection with spleen preservation and splenic vessels ligation had the CT-angiography before and after the surgery. All the conducted studies demonstrated the incapability of short gastric arteries to supply the satisfactory spleen perfusion. The left gastro-epiploic artery proved to be the main source of splenic blood supply after splenic vessels ligation.

[Duodenal pancreatic-preserving resections with common bile and pancreatic ducts replantation by cystic form of duodenal dystrophy].

Two patients with cystic dystrophy of duodenum and chronic inflammation of duodenally ectopic pancreatic tissue were successfully operated on. Both cases clinically demonstrated abdominal pain and duodenal obstruction. Absence of substantial tissue changes in "main" pancreas allowed execution of pancreas-preserving operation. Thus, subtotal duodenectomy was performed in the first patient. The second patient had resection of vertical branch of the duodenum with intestinal fragment replacement. Extensive periorganic fibrosis in both cases substantially complicated verification of anatomic structures and dissection.

[Diagnosis and treatment of cystic forms of duodenal dystrophia].

Cystic dystrophy of duodenal wall and duodenal dystrophy (DD)--is a rare disease which is based on chronic inflammation of the pancreas tissue (PT), malrelated in the wall of the duodenum (DU). The principal method of surgical treatment of this disease is Pancreaticoduodenectomy (PRD), although it was presented several reports of successful use sandostatin or endoscopic treatment in some patients. Analysis of demographic, clinical and instrumental data, methods of surgical treatment of DD showed that all patients with persistent or recurrent abdominal pain was noted in all patients, weight loss--51%, vomiting--at 26%, jaundice--in 20% of patients. The most accurate diagnostic methods were CT, endo-ultrasound and MRI. The diagnosis of duodenal dystrophy installed in 35 patients. Operations were performed on 22 patients: Implemented PRD (10), removal of pancreatic head resection with a vertical branch of the PT and duodenoduodenoanastomosis (2), pancreatic head resection with excision of the cyst wall of the first portion of duodenum (2), gastric resection (1), resection of the vertical branch of the duodenum with duodenoduodenoanastomosus (2), duodenectomia (1) and resection of the vertical branch of the duodenum with reconstruction of the intestinal insert (2). Four patients fulfilled draining intervention on pancreatic ductal system--pankreatico and cystoenteroanastomoses. Postoperative and late mortality--0.77% of patients the disappearance of pain and 23%--a decrease in its intensity. In two cases, after the PRD against the background of pronounced chronic pancreatitis observed impaired glucose tolerance. Cystic dystrophy of duodenal wall without the expressed "orthotopic" pancreatitis clearly shows pathogenetic, clinical, diagnostic and therapeutic aspects of this disease, causing the possibility of an effective surgical treatment, only limited intervention by the KDP, without resection of the pancreas.

[Computer--tomographic resecability criteria at cancer head of the pancreas].

UNLABELLED: The aim of the study was to explore the possibilities of CT in evaluating resectability of pancreatic head adenocarcinoma, depending on the tumor. MATERIALS: The results of CT and intraoperative findings in 62 patients with cancer of the head of the pancreas. RESULTS: It was shown that the tumor localized in caudal glands, had higher resectability when compared with tumors of the cranial localization at tumor sizes of 3-4 cm in size tumor less than 3 cm, the probability that radical surgery was highest in patients with central localization of the tumor.

[Features of chronic pancreatitis in the elderly patients].

The aim of this study was to determine the severity of the exocrine and endocrine insufficiency of the pancreas, HC composition and state of homeostasis in the elderly patients. Was obsercved 76 patients with CP (46 females, 30 males), of whom 20 patients diagnosed alcoholic pancreatitis (AP) aged 30 to 55 years. At 26 patients was marked biliary pancreatitis (BP), age of patients was 35-60 years and at 30 was found involutional pancreatitis (IP) from 60 to 74 years, 15 people (with no signs of lesions of the gastrointestinal tract) consisted the control group. The diagnosis of CP was made on the basis of clinical data, laboratory and instrumental investigations. Depending on the etiology of chronic pancreatitis was revealed a different degree of impairment of exocrine and endocrine functions of pancreas. These changes were more pronounced in patients with AP, which depended on the severity of the disease and the presence of complications. In duodenal bile of patients was significantly progressive decrease in the total content of the HC, which depended on the reduction of the total content of the conjugates. Revealed a qualitative change in HC composition may reduce absorption of exogenous cholesterol in the intestine of patients with CP, and is one of the reasons affecting the state of the exocrine pancreas. These changes are especially pronounced in patients with IP. All patients with CP were observed on blood hypercoagulation, which was accompanied by a decrease in the overall constant blood clotting, increasing content of F, an increase in the index of coagulation and clot elasticity. Especially pronounced these changes were in patients with complicated disease and the elderly patients.

[Arterial celiac-mesenterial aberrations: comparative analysis of intraoperative data and CT-angiography].

137 CT-angiograms of arterial celiac-mesenterial vessels were pro- and retrospectively analyzed in 120 patients. Radiological data was compared with intraoperative anatomy during standard and extended pancreatoduodenal resections. The analysis showed a considerable variability in architecture of celiac and superior mesenteric artery branches: hereby, a classical arterial anatomy was found only on 55% of the analyzed CT-scans. Intraoperative revision confirmed CT-data in all cases. CT-angiography is a prompt and reliable method of celiac-mesenterial arterial anatomy determination, making surgical treatment of patients with liver and pancreas diseases safer.

[Autoimmune pancreatitis associated with Shegren syndrome].

In the article presented a clinical case of autoimmune pancreatitis in association with Shegren syndrome.

[The role of neuromediators and cytokines in pathogenesis of chronic pancreatitis of alcohol etiology].

AIM: To determine the role of acetylcholine (AC), serotonine (5-HT) and cytokines in progression and complications of chronic alcohol pancreatitis (CAP). MATERIAL AND METHODS: 50 CAP patients were examined in the exacerbation, remission and complications of CAP (48 males, 2 females) aged 30-50 years. Control group consisted of 15 healthy subjects. IL-1beta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-4 were studied with enzyme immunoassay, 5-HT--with Ch. Sadovanquivad method, AC and activity of cholinesterase (CE) in the blood--by the method of Sh. Hestrin. Pancreatic tissue fibrosis was assessed according to computer tomography findings. RESULTS: Patients with CAP in exacerbation had significant rise of proinflammatory, anti-inflammatory cytokines, AC and 5-HT. In a complicated course of CAP there is a pronounced rise in TNFalpha in normal level of IL-4. CAP patients with destructive changes in the pancreas showed significant rise in the level of AC and 5-HT and lowering of cytokines. CE activity in complicated course of CAP is low this indicating protein-synthetic insufficiency in CAP patients. CONCLUSION: In CAP the action of 5-HT and AC aims at maintenance of secretory activity of the pancreas. In inflammation participation of neuromediators decreases. Stimulation of pancreatic secretory activity switched to autonomic regulation which is prognostically unfavourable.

[Substantiation of the selection of tactics for the surgical treatment of chronic pancreatitis].

177 patients with chronic pancreatitis and the pancreas head affection (CPPHA) were examined and these results were discussed. Option of the pancreatoduodenal resection (PDR) method was performed with due regard the greatest physiology of the operation and rare happening of the poor postoperative results. There are two methods operations of these patients--PDR or isolated resection of pancreas head (IRPH). Variations of IRPH have lesser the nearest unfa variable post operation results. There is no increase of postoperative lethality and complications if the right option and careful performance of IRPH (as Beger operation) was made.

[Impairment of humoral regulation of exocrine pancreatic function in chronic pancreatitis].

AIM: To elicit the role of cholecistokinin (CCK), biogenic amines, bile acids (BA) in development of functional pancreatic insufficiency (PI) in chronic pancreatitis (CP). MATERIAL AND METHODS: Blood concentrations of CCK, serotonin and acetylcholin, fecal concentration of elastase (E-1), BA spectrum in the blood and duodenal content were studied in 46 CP patients (20 patients with alcoholic pancreatitis--AP and 26 patients with biliary pancreatitis--BP) and 15 healthy controls. RESULTS: In AP patients E-1 fell to 78.4 +/- 6.3 mcg/g (severe exocrine PI), while in BP patients E-1 was 170.0 +/- 28.9 mcg/g. CCK in AP and BP decreased to 0.33 +/- 0.03 and 0.45 +/- 0.03 ng/ml, respectively (control--1.60 +/- 0.02 ng/ml, respectively, p < 0.05). AP and BP patients had a rise in the absolute concentration and percentage of the total fraction of the taurodioxicholanic acids to 10.2 +/- 1.6 and 15.0 +/- 2.3%, respectively, (control 9.5 +/- 1.2%) in duodenal bile. The concentration of glycocholic acid fell to 24.1 +/- 1.6 and 23.7 +/- 3.7%, respectively, (control--36.4 +/- 2.4%, p < 0.05). AP patients had more significant decrease of taurocholic acid--to 4.5 +/- 0.7% (control--9.2 +/- 0.7%, p < 0.05). In the peripheral blood of AP patients there was an elevated basal level of serotonin and acetylcholine in the presence of low cholinesterase activity. After meal, acetylcholine concentration lowered in high secretion of serotonin. CONCLUSION: Depending on severity of destructive changes in the pancreas, AP and BP patients had different degree of exocrine insufficiency which may be secondary to the absence of acetylcholine rise in the blood after meal. Alterations in the composition of the conjugates of cholic and taurodioxicholanic BA lead to alterations of CCK blood concentration and, therefore, to changes in exocrine pancreatic secretion. Imbalance between serotonin and acetylcholine levels after meal evidences for defects in conventional regulatory interrelations. Decreased threshold of nociceptors activation in simultaneous enhancement of afferent nociceptive flows may entail pain syndrome in CP.