scholarly journals The key role of pancreatic fibrosis severity in the surgical treatment algorithm of patients with chronic pancreatitis

2020 ◽  
Vol 73 (2) ◽  
pp. 235-238
Author(s):  
Oleh E. Kanikovskiy ◽  
Ihor V. Pavlyk ◽  
Iryna V. Oliinyk ◽  
Vasyl V. Mosondz
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Pathological Process ◽  
The Body ◽  
Nutrition Status ◽  
Tissue Pressure ◽  
Surgical Interventions ◽  
Computer Morphometry ◽  
Definition Of

The aim of the work was to improve the results of surgical treatment of complicated forms of chronic pancreatitis. Materials and methods: The results of surgical treatment of 181 patients with complicated forms of chronic pancreatitis have been analyzed. All these patients were treated in surgical clinic of 2 nd medical faculty of National Pyrogov Memorial Medical University in Vinnytsya. Results: It is possible preoperative indirectly assess the severity of fibro- degenerative changes in pancreas, that includes 1 – the definition of pain type; 2 – CT or MRI (Marseilles- Rome classification); 3 – assessment of the stage of chronic pancreatitis (Büchler classification); 4 – patient's nutrition status and preoperative differential diagnosis with pancreatic cancer; 5 – assessment of the fibrosis severity (elastomers). The key point in treatment depended on intraoperative examination: detection of strictures of the main pancreatic duct (pacemaker of chronic pancreatitis); the tissue pressure resistance to the liquid, which is the maximum value> 200 mmHg, in the region of stricture and falls in other parts of the pancreas; pressure in the main pancreas duct, which rises only in 59.5% of patients. The head of the pancreas was involved in the pathological process in 83.8%, in 16.2% it was isolated in the isthmus or the body and tail of the pancreas. In general, the distal pancreas was involved in 37.8%. At computer morphometry of histological samples, the area of connective tissue fields reached 81.4 ± 6.62%, preserved exocrine part in 4.87 ± 1.62%, endocrine – 1.92 ± 0.12%, total area of ducts – 6 , 47 ± 1.12%. Conclusions: The combined Frey-Izbickiy local resection provides a wide excision of the pacemaker (stricture) of chronic pancreatitis. In case of extrapancreatic complications or repeated surgical interventions on the pancreas due to chronic pancreatitis, this effect can be achieved by pancreatoduodenal resection.

scholarly journals ‘A transverse scar on the neck’ – psychosomatic approach in the differential diagnosis and surgical treatment of hyperthyroidism in post-war Finland

2021 ◽  
Vol 65 (2) ◽  
pp. 140-156
Author(s):  
Eve-Riina Hyrkäs
Keyword(s):  
Surgical Treatment ◽  
Psychiatric Patients ◽  
Differential Diagnostics ◽  
Historical Study ◽  
Complex Nature ◽  
Surgical Interventions ◽  
Somatic Illness ◽  
Post War ◽  
Definition Of ◽  
The Mind

AbstractIn the Finnish medical discussion during the middle decades of the twentieth century, the challenging differential diagnostics between hyperthyroidism and various neuroses was perceived to yield a risk of unnecessary surgical interventions of psychiatric patients. In 1963, the Finnish surgeon Erkki Saarenmaa claimed that ‘the most significant mark of a neurotic was a transverse scar on the neck’, a result of an unnecessary thyroid surgery. The utterance was connected to the complex nature of thyroid diseases, which seemed to be to ‘a great extent psychosomatic’. Setting forth from this statement, the article aims to decipher the connection between hyperthyroidism, unnecessary surgical treatment and the psychosomatic approach in Finnish medicine. Utilising a wide variety of published medical research and discussion in specialist journals, the article examines the theoretical debate around troublesome diagnostics of functional complaints. It focuses on the introduction of new medical ideas, namely the concepts of ‘psychosomatics’ and ‘stress’. In the process, the article aims to unveil a definition of psychosomatic illness that places it on a continuum between psychological and somatic illness. That psychosomatic approach creates a space with interpretative potential can be applied to the historiography of psychosomatic phenomena more generally. Further inquiry into the intersections of surgery and psychosomatics would enrich both historiographies. It is also argued that the historical study of psychosomatic syndromes may become skewed, if the term ‘psychosomatic’ is from the outset taken to signify something that is all in the mind.

scholarly journals Modern principles of surgical treatment of chronic pancreatitis

2019 ◽  
pp. 306-312
Author(s):  
Volodymyr Kopchak ◽  
Mykhailo Nychytailo ◽  
Oleksandr Duvalko ◽  
Vasyl Khanenko ◽  
Volodymyr Trachuk ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Pancreatic Duct ◽  
Surgical Techniques ◽  
Surgical Interventions ◽  
Distal Pancreatic Resection ◽  
Initial Surgery ◽  
Beger Procedure ◽  
Repeated Surgery ◽  
Resection Of The Pancreas

We reviewed the charts of 752 patients, who have undergone surgery for various forms of chronic pancreatitis at “Shalimov’s National Institute of Surgery and Transplantation of the NAMS of Ukraine” in the years from 2007 to 2017. The average age of the 591 males (78,6 %) and 161 females (22,4 %) was 43,0 ± 3,2 years. Out of these, 446 (62,4 %) patients with pseudocysts and pancreatic fistula and also with isolated main pancreatic duct lithiasis underwent drainage procedures. The 269 (37.6%) patients were subjected to different types of resection, including the Frey operation, pancreatoenterostomy with artificial pancreatic duct formation, the Berne technique, the Beger procedure, pancreatoduodenectomy, distal-pancreatic resection and other procedures. After pancreatic resections, the patients did not require repeated surgical interventions for chronic pancreatitis. In some cases of chronic pancreatitis, there was an isolated lesion of the pancreas: in such cases (13 patients), we performed distal resection of the pancreas. Among the observed patients here were no fatal cases. Satisfactory results were obtained in 92.6 % of cases at longterm follow-up. Post-operative complications occurred in 27 patients (4.6 %), in 6 (1.03 %) patients there was a need for repeated surgery. Progression of the disease in patients previously operated in our clinic was observed in 32 (5.5 %), and 72 patients, initially operated in other medical institutions. Patients after direct resection of the pancreas did not require repeated surgery for chronic pancreatitis. The main causes of unsatisfactory results of the surgical treatment for chronic pancreatitis have been found to be: false indications for initial surgery, improper primary surgical techniques, insufficient use of drainage procedures, as well as, performing a drainage procedure instead of a resection. Key words: chronic pancreatitis, surgical treatment, resection and drainage procedures. For citation: Usenko OY, Kopchak VM, Nychytailo MY, Duvalko OV, Khanenko VV, Trachuk VI, Khomiak AI. Modern principles of surgical treatment of chronic pancreatitis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):306–12

scholarly journals Carbuncle - the actual problem of modern surgery (Literature review)

2019 ◽  
Vol 21 (4) ◽  
pp. 19-24
Author(s):  
K V Lipatov ◽  
Yu E Cherkasov ◽  
V I Khrupkin ◽  
M V Lysenko ◽  
E I Dekhissi
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Plastic Surgery ◽  
Pathological Process ◽  
Tissue Viability ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Timely Diagnosis ◽  
Results Of Treatment ◽  
Surgical Tactics

Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.

scholarly journals Pathomorphology of cat pancreas under chronic pancreatitis

2021 ◽  
Vol 23 (102) ◽  
pp. 87-92
Author(s):  
O. V. Kovalchuk ◽  
L. P. Goralskyi ◽  
I. M. Sokulskyi
Keyword(s):  
Chronic Pancreatitis ◽  
Endocrine Pancreas ◽  
Abdominal Cavity ◽  
Relative Weight ◽  
Pathological Process ◽  
The Body ◽  
Disease Stage ◽  
Registration Number ◽  
Chronic Pancreatits ◽  
State Registration

The paper deals with studying the pathomorphology of cat pancreas under chronic pancreatitis. This paper is a component of a research mix of the Department of Anatomy and Histology, it goes under the title “The development, morphology and histo-chemistry of animal organs in health and in disease”, (state registration number № 0120U100796). A pancreas is an azygos parenchymatous organ which refers to the endoexocrine glands, includes exocrine and endocrine pancreas, is involved in the processes of digestion and regulation of carbohydrate metabolism, protein metabolism and lipid exchange in tissues. Pancreatic juice, which is rich in enzymes (trypsin, lipase, amylase), is produced in an exocrine pancreas, and hormones (insulin, somatostatin, glucagon (vasoactive intestinal polypeptide), pancreatic polypeptide) are produced in endocrine pancreas. This galand is involved in the process of digestion while producing digestive enzymes, which get into the duodenum and hydrolyze practically all parts of feeds which enter the body. It is located in an abdominal cavity, anatomically connected with a stomach, liver and duedenum. It has been found that pathomorphological changes in pancreas under chronic pancreatits manifest themselves depending on the disease stage and are revealed by insignificant progress of the pathological process. Herewith, morphological parameters of pancreas width and length in cats under chronical pancreatitis did not significantly change, but these indices tended to decrease. Its absolute weight  in cats under chronical pancreatitis, as compared with clinically healthy cats, did not change and equalled 9.12 ± 2.03 g. But pancreas relative weight in sick cats increased by 1.4 (Р ≤ 0.01) and equalled 0.51 ± 0.08 %, as compared with control 0.38 ± 0.06 %. Under histological analysis of pancreas histology specimen stained with hematoxylin Corazzi and eosin, some distortion in a microscopic structure of a pancreas was observed, it manifested itself in thickening of interparticle tissue-connective layers which spread like desmogenous bands. Some destructive changes in acini in exocrinal pancreas, which manifested themselves in losing their characteristic form, were noticed. The cytoplasm of such acinous cells was in a state of plasmorrhexis, the pycnosis was observed.

scholarly journals Comparative evaluation of the effect of different methods of surgical treatment of chronic pancreatitis on the quality of life of patients

2012 ◽  
Vol 93 (1) ◽  
pp. 34-38
Author(s):  
A A Karpachev ◽  
I P Parfenov ◽  
A Yu Khlynin ◽  
A L Yarosh ◽  
A V Soloshenko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Psychological Health ◽  
Comparative Evaluation ◽  
General Health Questionnaire ◽  
Life Quality ◽  
Surgical Interventions ◽  
Physical And Psychological Health

Aim. To conduct a comparative evaluation of the effectiveness of surgical treatment of chronic pancreatitis and define the quality of life of patients depending on the methods of surgical treatment. Methods. The study included 81 of the 165 patients with chronic pancreatitis, who underwent the following operations: endoscopic transmural interventions through the wall of the stomach and duodenum, endoscopic transpapillary surgery, percutaneous interventions for sanitation and drainage of the cystic cavity, laparotomic operations of internal drainage, resection interventions. The quality of life of patients was assessed using the general health questionnaire SF-36. Results. The lowest level of life quality was established in the group of patients after endoscopic transpapillary interventions. Statistically significant differences in the level of physical and psychological health were established when comparing patients after endoscopic transpapillary interventions and after endoscopic transmural surgical interventions, which were carried out through the wall of the stomach and duodenum; differences only in the level of physical health were noted when comparing with the group of resection interventions. Conclusion. The quality of life of patients with chronic pancreatitis depends on the type of surgical intervention, age and sex of the patients.

scholarly journals VIDEOTRACOSCOPIC INTERFERENCE WITH BULLOUS EMPHYSEMA COMPLICATED BY SPONTANEOUS PNEUMOTHORAX

2019 ◽  
pp. 59-63
Author(s):  
V. V. Boyko ◽  
K. L. Gaft ◽  
E. V. Nakonechny ◽  
M. V. Shilina
Keyword(s):  
Surgical Treatment ◽  
Spontaneous Pneumothorax ◽  
Comparison Group ◽  
Pulmonary Tissue ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Integral Component ◽  
Surgical Tactics ◽  
Definition Of

Objective. To study the factors of a large number of relapses of spontaneous pneumothorax in bullous emphysema (BE) of the lungs and to improve the results of treatment of patients with various forms of BE with the help of developed methods. Methods. The study is based on the study of the results of surgical treatment of 423 patients with different forms of BE, which used traditional and developed surgical tactics using patented methods for determining the elastic capacity of pulmonary tissue and autohemoplévoidosis as an integral component of radical surgical interventions. Results. The use of developed surgical tactics using videotrakaskopicheskoy biopsy to further determine the destructive index in patients with different forms of BE has reduced the overall number of relapses from 18.8% in the comparison group to 5.1%. Conclusion. Videotracoscopic biopsy with the definition of a destructive index allows to more objectively distribute FE in forms that allows to choose optimal surgical tactics.

scholarly journals X-RAY-ENDOVASCULAR EMBOLIZATION OF PARAPANCREATIC VESSELS IN THE TREATMENT OF CHRONIC PANCREATITIS COMPLICATIONS

2021 ◽  
pp. 85-90
Author(s):  
K.S. Belyuk ◽  
E.V. Mogilevets ◽  
R.S. Shilo ◽  
L.F. Vasilchuk ◽  
S.P. Antonenko ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Research Methods ◽  
Endovascular Embolization ◽  
Vascular Pathology ◽  
Laboratory Research ◽  
Surgical Interventions ◽  
X Ray ◽  
History Of

Goal. To improve the results of surgical treatment of chronic pancreatitis complicated by vascular pathology of the parapancreatic zone. Materials and methods. On the basis of the "Grodno University Clinic" in the department of X-ray Endovascular Surgery of the period 2010 to April 2020, were performed 16 embolizations of the arteries of the parapancreatic zone due to complications of chronic pancreatitis. Among the patients there were 13 (81.25%) men and 3 (18.75%) women. They had a history of chronic pancreatitis, which was confirmed using instrumental and laboratory research methods. One of the patients (6.25%) had a stationary aneurysm.15 (93.75%) patients had a bleeding clinic, which required urgent surgical interventions. Results. Angioembolization of the parapancreatic arteries was effective in 15 (93.75%) patients, which was confirmed by the results of control angiograms. Conclusions. The use of intraluminal embolization for vascular pathology of the parapancreatic zone in treatment of chronic pancreatitis complications is a minimally invasive and effective method.

scholarly journals A laparoscopic access in the surgical treatment of children with solid pseudopapillary tumors of the pancreas

2020 ◽  
Vol 24 (5) ◽  
pp. 307-311
Author(s):  
Polad A. Kerimov ◽  
A. P. Kazantsev ◽  
D. V. Rybakova ◽  
M. A. Rubansky ◽  
M. V. Rubanskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
The Body ◽  
Pancreatic Tumors ◽  
Surgical Trauma ◽  
Long Term Outcomes ◽  
Surgical Interventions ◽  
Pancreatic Resections ◽  
Radical Removal ◽  
Solid Pseudopapillary Tumors

Introduction. Solid-pseudopapillary tumors (SPT) of the pancreas are rare, not exceeding 1-2% of all exocrine pancreatic tumors. Treatment of patients with this pathology consists of the radical removal of the tumor which has to a favorable prognosis of the disease. If the tumor is localized only in the pancreas tail or in the body with invasion into the tail, distal subtotal splenopreserving or distal splenopreserving pancreatic resections are performed. Objective. To demonstrate potentials of laparoscopic access in the surgical treatment of children with SPT. Material and methods. The article discusses 9 patients with diagnosed SPT who had the abovementioned surgical interventions via laparoscopic access . Discussion. The researchers demonstrated that pancreatic resections can be performed laparoscopically. Conclusions. The laparoscopic access is a priority for distal, distal subtotal pancreatic resections. It reduces surgical time, minimizes surgical trauma, accelerates patients’ rehabilitation , improves cosmetic effects as well as makes hospital stay shorter. In addition, it does not worsen immediate and long-term outcomes of the treatment.

Surgical treatment in patients with chronic pancreatitis in a multidisciplinary hospital

2021 ◽  
Vol 23 (3) ◽  
pp. 55-60
Author(s):  
Rustam K. Aliev ◽  
Pavel N. Romashchenko ◽  
Nicolay A. Maistrenko ◽  
Andrey S. Pryadko ◽  
Arsen K. Aliev
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Morphological Changes ◽  
Specific Patient ◽  
Surgical Decision ◽  
Surgical Interventions

A rational personalized program of surgical treatment of patients with various clinical and morphological forms of chronic pancreatitis is substantiated, integrating modern diagnostic and minimally invasive technologies. Examination results and treatment of 354 patients with chronic pancreatitis were analyzed. Patients were divided into three groups according to the modified Marseille-Rome Classification of Chronic pancreatitis (1988). Calcifying chronic pancreatitis was detected in 119 patients, obstructive in 81, and inflammatory in 154. Modern methods of diagnosis and treatment of chronic pancreatitis allowed the modification of the classification by allocating subgroups for each disease form. The justified use of the entire range of modern surgical technologies, taking into account the morphological changes of the pancreas, allows the maximum correction of complications of chronic pancreatitis with minimal complications and good quality of life in the long-term. The choice of surgical aid in patients with chronic pancreatitis is established to primarily depend on the form and variant of the disease course. The main criteria for choosing a surgical aid should be the state of the pancreatic ductal system, the degree and nature of changes in its parenchyma, and the presence of a cystic or inflammatory component during the surgical decision making. Important adjustments in the stage of surgical interventions are made due to mechanical jaundice, portal hypertension, decompensated duodenal stenosis, and concomitant somatic pathology in patients. Subgroups of patients with identified main chronic pancreatitis form, according to its modified classification, allows the determination of the surgical intervention volume, type, and access for each specific patient.

scholarly journals Indications for various options of foot deformities orthopedic correction in diabetic neuroosteoarthropathy

2020 ◽  
Vol 23 (4) ◽  
pp. 374-385
Author(s):  
Petr S. Bardiugov ◽  
Mikhail V. Parshikov ◽  
Gagik R. Galstyan ◽  
Nikolaj V. Yarygin
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Clinical Course ◽  
Pathological Process ◽  
Foot Deformities ◽  
Orthopedic Treatment ◽  
Surgical Interventions ◽  
Prevention Of Relapse ◽  
Diabetic Neuroosteoarthropathy ◽  
Single Approach

Diabetic osteoarthropathy is one of the most difficult complication of diabetes mellitus, requiring the cooperation of a many of specialitys, including traumatologists - orthopedists. However, there is no single approach to the choice of orthopedic treatment tactics for this group of patients. From 2015 to 2018 inclusive, there were 35 patients with diabetic osteoarthropathy that received conservative or surgical orthopedic treatment. 11 patients received conservative orthopedic treatment; 24 patients received surgical treatment. A total of 26 surgical interventions were performed. Two types of surgical interventions were performed: 1) resection of the protruding fragment of one or another bone of the tarsus - 12 operations 2) reconstructive surgery aimed at correcting gross deformation of the middle and / or hindfoot - 14 operations. Along with general clinical examination, all patients underwent orthopedic examination, determining the degree of blood supply disturbance. A differentiated approach to choosing the method of orthopedic treatment of the presented group of patients allowed to restore limb supportability, ensure stability in the ankle joint and joints of the middle foot, create conditions for healing and prevention of relapse of the ulcer. The experience gained allowed us to offer indications for a particular method of orthopedic treatment of foot deformities in diabetic osteoarthropathy, depending on the stage of the pathological process, its location, the severity of the deformation, and the clinical course of this pathology.

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