Endoscopic Ultrasound versus Conventional Ultrasonography as A Diagnostic Tool for Patients with Obstructive Jaundice

Background Patient presented with jaundice, initial evaluation should be ultrasonography for evaluation of liver parenchymal changes, cirrhosis and assessment of hepatic vascularity and evaluation of intrahepatic, extrahepatic biliary system. Aim of the Work to compare between the Conventional US and Endoscopic Ultrasound in diagnosis of obstructive jaundice and other diagnostic modality including CT/MRI, ERCP for diagnosis and evaluation of the cause of OJ. Patients and Methods This study was conducted on 60 patients with obstructed jaundice as evident by ultrasonography in the form of dilated CBD with IHBRDs, with visualization of Gall bladder content and pancreas if can be well visualized, all patients had clinically apparent jaundice with disturbance of liver biochemical profile, all patient underwent EUS and compare finding with US including CBD diameter and IHBRDs degree. Results EUS provide better visualization of CBD and IHBRDs with diagnosis of pathological lesion including stones, malignancy. EUS also has better visualization of pancreatic pathology including inflammation and malignancy and extent of the tumor including local extent, lymphatic spread with vascular invasion. Conclusion EUS is better than US and other modality CT&MRI and ERCP in diagnosis of distal CBD stricture including malignant obstruction especially in cases of early malignancy and small tumors, and calculary distal obstruction. CT is insensitive in diagnosis of periampullary cancer, EUS provide early diagnosis of Pancreaticobiliary malignancy and give better advandage for early resectability .

Spilled enzymatic peritonitis as a complication of destructive cholecystopancreatitis in the 3rd trimester of pregnancy and labor in a woman with obesity III degree

Purpose. Study of the course of labor of a pregnant woman with pancreatic necrosis, parapancreatitis and serous-fibrinous diffuse enzymatic peritonitis. Materials and methods. The article presents a clinical case that describes the course of pregnancy with pancreatic pathology. Surgical delivery and surgical treatment of pathologies detected intraoperatively are described. The peculiarities of drug therapy are shown. The article is intended for obstetricians-gynecologists, gastroenterologists and surgeons.

DIFFERENTIAL DIAGNOSIS OF PANCREATIC PATHOLOGY ACCORDING TO ENDOSCOPIC ULTRASONOGRAPHY BASED ON FUZZY MATHEMATICAL MODELS

Эндоскопическая ультрасонография, являясь высокоинформативным и уточняющим методом диагностики патологии поджелудочной железы остается в значительной мере субъективным и операторзависимым исследованием. Целью работы явилось повышение качества дифференциальной диагностики очаговой патологии поджелудочной железы на основе анализа эталонных эндосонограмм за счет использования гибридных нечетких математических моделей, при синтезе которых формальные процедуры строятся с использованием клинического опыта высококвалифицированных специалистов ультразвуковой диагностики. В отделении эндоскопии Курской областной клинической больницы эндоскопическая ультрасонография выполнена у 729 пациентов. Опухоли поджелудочной железы выявлены у 139 (19,1%) пациентов, различные формы хронического панкреатита диагностированы у 141 (19,3%) больного. По результатам исследований выделены 6 типов эталонных эндосонограмм, соответствующих дифференцируемой патологии, на основании которых, с использованием гибридных нечетких математических решающих правил, разработанных в Юго-Западном государственном университете, получена нечеткая гибридная модель дифференциальной диагностики хронического очагового панкреатита и протоковой аденокарциномы поджелудочной железы. По результатам математического моделирования и статистических испытаний на репрезентативных контрольных выборках было показано, что полученная модель дифференциальной диагностики, использующая только эталонные эндосонограммы, обеспечивает уверенность в искомом диагнозе на уровне 0,6. Дополнительная информация, получаемая при анализе эндосонограмм, повышает диагностическую уверенность до величины 0,9. Таким образом, полученная модель дифференциальной диагностики хронического очагового панкреатита и протоковой аденокарциномы поджелудочной железы обеспечивает приемлемое для клинической практики качество принимаемых решений Endoscopic ultrasonography is a highly informative and clarifying method for diagnosing pancreatic pathology. At the same time, it remains to a large extent subjective and operator-dependent research. The aim of this work is to improve the quality of differential diagnosis of focal pancreatic pathology based on the analysis of reference endosonograms through the use of hybrid fuzzy mathematical models. When synthesizing these models, formal procedures are built using the clinical experience of highly qualified specialists in ultrasound diagnostics. In the endoscopy department of the Kursk Regional Clinical Hospital, endoscopic ultrasonography was performed in 729 patients. Pancreatic tumors were detected in 139 (19.1%) patients, various forms of chronic pancreatitis were diagnosed in 141 (19.3%) patients. Based on the research results, 6 types of reference endosonograms corresponding to differentiable pathology were identified. On the basis of endosonograms, using hybrid fuzzy mathematical decision rules developed at Southwestern State University, a fuzzy hybrid model of differential diagnosis of chronic focal pancreatitis and ductal adenocarcinoma of the pancreas was obtained. Based on the results of mathematical modeling and statistical tests on representative control samples, it was shown that the resulting model of differential diagnosis, using only reference endosonograms, provides confidence in the desired diagnosis at the level of 0.6. Additional information obtained from the analysis of endosonograms increases the diagnostic confidence to a value of 0.9. Thus, the model obtained for the differential diagnosis of chronic focal pancreatitis and ductal adenocarcinoma of the pancreas provides an acceptable quality of decisions for clinical practice

Familial Gullo’s Syndrome: a clinical case report

This case report describes a male patient born in 1953 presenting an occasional increase in serum amylase and lipase forty years ago. The monitoring of enzymes was accompanied by radiological investigations, which did not reveal pancreatic pathology. In his family, including 10 siblings, half were carriers of this isolated anomaly; multiple cysts in pancreas, kidneys, and liver were present in some family members, in addition to a pancreatic neoplasia in a sister who did not carry the enzymatic abnormality. Our patient developed colon adenocarcinoma at the age of 67.Here we examine the characteristics of non-pathological chronic pancreatic hyperenzymemia defined as such by the main Italian pioneer Professor Gullo.

Pancreatic lesion in children with nephrotic syndrome

Nephrotic syndrome occupies one of the leading places among kidney diseases in children. Scientific studies indicate that edema syndrome, arterial hypertension, disorders on the microcirculatory level occurring in case of nephrotic syndrome contribute to the slowing and reduction of blood flow in the pancreas, which leads to the development of hypoxia and metabolic disorders. Under conditions of metabolic and microcirculatory disorders, as well as against the background of the therapy used in children with nephrotic syndrome the risk of secondary pancreas lesion increases significantly. Pathogenetic treatment of nephrotic syndrome involves the administration of glucocorticosteroid and cytostatic therapy. The study of autopsy materials of the pancreas in children who died of glomerulonephritis revealed histomorphological changes in 35.7% of children in the form of acute interstitial pancreatitis and pancreonecrosis. At the same time there are still few works in the scientific literature, devoted to the study of functional state of the pancreas in children with kidney diseases. The data on pancreatitis prevalence in children are extremely inconsistent. Significant variation in the frequency of pancreatic lesion in children (from 5 to 25%) is most often associated with diagnostic difficulties. Ultrasound examination after a meal (postprandial test) allows to diagnose pancreatic pathology (indirect signs of chronic pancreatitis, reactive pancreatic changes) with higher accuracy (by 23%) than traditional examination. Late diagnosis of pancreatic lesion and lack of correction can significantly affect patients’ health and quality of life. There is a need to study functional state of pancreas in children with nephrotic syndrome to improve understanding of pathogenesis of possible involvement in pathological process and optimization of preventive and therapeutic tactics.

ASSESSMENT OF HOMEOSTASIS IN PATIENTS WITH SECONDARY DESTRUCTIVE PAROTITES

Subject. It is important to develop methods for the diagnosis and treatment of secondary destructive parotitis (SDP) depending on the form of the disease. A working classification of SDP is proposed. The aim of the study is to improve the diagnosis of SDP by developing a program for early detection and differential diagnosis of forms of diseases. Methodology. The basis of this work was the examination and treatment of 287 patients with various forms of destructive parotitis. Results. In 103 patients with SDP, the disease occurred as a monoabsccess and with the formation of multiple small-focal abscesses. Changes in indicators of metabolic processes, hemostasis and immunity did not exceed the limits of possible physiological fluctuations. In 62 patients with phlegmonous form of SDP, a significant decrease in total serum protein was observed (by 8%). When combined with SDP and pancreatic pathology, the level of amylase increased 3 to 4 times. Of the 122 patients with SDP 14% were dominated by alterations in the local inflammatory response and the development of general complications in the form of sepsis. There are two main states of life support systems: unstable compensation and decompensation. Conclusions. Clinical and laboratory manifestations of SDP dictate the expediency of identifying the main forms of the course of the disease which are characterized by certain clinical and laboratory data. Given the real threat of the spread of acute inflammatory process, the development of local and general complications, treatment of SDP should be performed only in a specialized maxillofacial hospital.