RESUMO
It was analyzed the features of different forms of acute pancreatitis in 1001 patients including 324 cases with pancreatonecrosis and 245 patients with middle severity of disease. It was shown that monitoring of patients' condition and destructive process in pancreas by using of modified SOFA-scale and evaluation of sonographic signs of inflammation are advisable. Flow indicators including resistance index and the maximum flow velocity in celiac trunk and superior mesenteric artery represented severity of gland's destruction. Sonographic investigation revealed small-focal pancreonecrosis. It allows to differentiate medical tactics. Surgical treatment was performed in 582 patients. Efficiency of surgical treatment is determined by diagnostic methods, timely sanation of destructive focuses of pancreas, abdominal cavity, retroperitoneal fiber, adequate drainage and mini-invasive techniques using in case of purulent complications. The main prognostic factors of development of complications and adverse outcomes are determined.
Assuntos
Pâncreas , Pancreatectomia , Pancreatite Necrosante Aguda , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artéria Celíaca/fisiopatologia , Drenagem/métodos , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Pâncreas/irrigação sanguínea , Pâncreas/diagnóstico por imagem , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/fisiopatologia , Pancreatite Necrosante Aguda/cirurgia , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento , UltrassonografiaRESUMO
Use of trending analysis of multiple organ failure points in 40 patients with widespread peritonitis allowed to determine the features of its formation and regression. It was detected 4 stages of multiple organ failure. The first stage is origin and development. The second stage is slowdown of development. The third stage is regression. And the fourth stage is final. The definition of multiple organ failure stage and number of stab neutrophiles allows to determine the indications for relaparotomy timely. Sensitivity of such method was 0.9, specificity was 0.8. So, it was obtained a tool for determination of the indications for relaparotomy "on demand". It was able to identify need for surgery on the early stages objectively.
Assuntos
Cavidade Abdominal/cirurgia , Insuficiência de Múltiplos Órgãos , Neutrófilos , Peritonite/complicações , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Insuficiência de Múltiplos Órgãos/cirurgia , Escores de Disfunção Orgânica , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Reoperação/efeitos adversos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Concentrations of defensins-alpha, lipoprotein(α), C-reactive protein, proBNP, VII- coagulation factor and von Wilebrandt factor were measured in supernatants of 3-day leukocyte cultures enriched with neutrophils in order to estimate their synthesis in patients with stable angina and atherosclerosis of lower extremities. In addition, in vitro tumor necrosis factor-alpha test was performed. Simultaneously, concentrations of serum interleukine-6, -8, defensins-alpha, C-reactive protein, proBNP, VII-coagulation factor were determined. Neutrophil protein synthesis was impaired in the patients with stable angina. The same was true of defensins-alpha synthesis whereas production of lipoproteins, pro-BNP, C-reactive proteins, IL-8, and von Wilebrandt factor increased. Pathogenetic role of TNF-alpha was demonstrated.
