Chronic pancreatitis: about some complications and features of their pathogenesis and course

The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idio­pathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.

Surgical treatment of unilateral nodular goiter with compression syndrome in patients with autoimmune thyroiditis

Aim — todetermine indications for the choice of the surgery scope in patients with unilateral nodular goiter with compression syndrome against the background of autoimmune thyroiditis (AIT) and possibility of prognosis of the long-term results of surgical treatment.Materials and methods. The analysis has been performed for the long-term results of hemithyroidectomy in 101 femalepatients aged 23 to 72 years with unilateral nodular goiter against the background of AIT (NGAIT) with compression syndrome. The pre-operational levels of the following parameters, definingsatisfactory and unsatisfactory treatment results, have been analyzed: volume of the lobe of the gland, blood levels of thyroid stimulating hormone, free thyroxine and triiodothyronine, antibodies to thyroid peroxidase, indices of apoptosisand proliferation, variants ofechostructure.Results. Satisfactory results have been established in 75 patients based on the following results of examinations 3 years after hemithyroidectomy: no violations of thyroid gland functional state, andno progression of preoperative AIT signs or progression without hypothyroidism and changesin ultrasound picture in the parenchymaof the remaining lobe of the gland according to the data of ultrasound investigation.Unsatisfactory results were definedin 26 subjects: an increase in the volume of the remaining thyroid gland and the progression of autoimmune process with the development of hypothyroidism. A satisfactory result of hemithyroidectomy in the treatment of patients with NGAIT with compression syndrome can be expected in cases where at the time of surgery the volume of the lobe was not more than 12.7 cm3, its echostructure corresponded to hypoechoic and heterogeneous and pseudomicronodular variants, and the following blood levels were established: thyroid stimulating hormone < 2.85 IU/L, free thyroxine > 16.7 pmol/l, free triiodothyronine > 5.3 pmol/l, antibodies to thyroid peroxidase < 137 IU/ml.Conclusions. One of the possible options for surgical treatment of patients with unilateral nodular goiter against the background of AIT with compression syndrome may be hemithyroidectomy in conditions of preserved hormonal function of the gland with moderately pronounced processes of proliferation and apoptosis, structural changes in the parenchyma at the level of hypoechoic and heterogeneous and pseudomicro-nodal echostructural variants. The use of hemithyroidectomy is contraindicatedin cases of pseudo-large-nodular and more severe variants of the echostructure of the thyroid parenchyma, regardless of the indicators of hormone-producing function, antibodies to thyroid peroxi­dase, proliferation and apoptosis.

Partial upper median sternotomy for anterior aortopexy for innominate artery compression syndrome: Our preferred technique.

Objectives: Innominate artery compression syndrome (IAS) is caused by an anterior compression of the trachea by an abnormally originating innominate artery. One option to relieve such a compression is an anterior aortopexy (AA). In this paper we describe our technique of an AA via a partial upper median sternotomy. Methods: A retrospective review of a prospectively maintained database of patients with IAS (July 2017 to November 2020) treated with AA via a partial upper median sternotomy at University teaching hospitals in the US was done. Results: Nine consecutive patients underwent AA for IAS during the study period. The median age was 9 months (IQR 3- 16.5). The male to female ratio was 1.25. All patients had > 70% compression by flexible bronchoscopy. 2 patients had previous surgeries. The follow-up was a median of 6 (IQR 4- 8.5) months. The indications for the operation were: reflex apnea (4/9 patients), recurrent intubation (4/9 patients), and severe stridor (1/9). IAS was a technical success (defined as ≤ 20 % residual stenosis) in 78 % (7/9) of the patients. Complete symptom resolution after an AA was seen in 71% (5/7) of the patients. 2 patients had an unsuccessful AA, requiring a tracheal resection and an innominate artery reimplantation, respectively. Conclusion: An upper partial sternotomy approach provides a very versatile approach to an AA for IAS. Besides facilitating an adequate AA, it provides options for direct tracheal surgery or an innominate artery reimplantation in case an optimal result is not obtained by an AA.

A Unilateral Variation in Triceps Brachii Muscle Demonstrating a Fourth Head

Introduction Triceps brachii muscle is the only muscle of posterior compartment of arm, consisting of three heads—long, lateral, and medial. Radial nerve and profunda brachii artery run in the radial groove that separate lateral and medial head. Evolutionarily, triceps has many subheads which either fused or disappeared. Therefore, the knowledge of muscle is essential anthropologically and clinically, and this study aims to study the anatomical variations of triceps brachii muscle. Case Report In the present case, during routine dissections of undergraduate MBBS students, a fourth head of origin of triceps brachii muscle was seen in a male cadaver in the right arm. The variation was seen only unilaterally in cadaver. The origin was tendinous arising from the posteromedial aspect of upper part of the shaft of the humerus close to the surgical neck above the radial groove. This tendon was arching over the neurovascular bundle containing radial nerve and profunda brachii artery. Discussion and Conclusion The variations of triceps brachii muscles are mentioned in literature but are uncommon and if tendinous fourth head is present over the neurovascular bundles, it may lead to compression syndrome. Hence, these variations are of great importance to the radiologists, surgeons, and orthopaedicians while dealing with posterior compartment of arm.

INTENSIVE CARE OF LIFE-THREATENING CONDITIONS IN PEDIATRIC ONCOHEMATOLOGY

Malignant neoplasms of the blood system in children are represented by highly aggressive variants, which at the stage of diagnosis and program chemotherapy can be complicated by the development of life-threatening conditions. Understanding the risk of possible complications allows you to effectively carry out preventive and therapeutic measures, to minimize adverse outcomes. This article presents modern approaches to the diagnosis and treatment of the most common life-threatening conditions in pediatric oncohematology: acute tumor lysis syndrome, typhlitis and neutropenic enterocolitis, superior vena cava syndrome, malignant airway compression syndrome, acute impairment of consciousness, spinal cord compression syndrome, thrombosis, methemoglobinemia.