Abstract: Aim: was to study possibilities of transabdominal ultrasonography in the diagnostics of the first phase of acute pancreatitis. Material and methods: for the period 2010-2016, 7488 patients which required a differential diagnosis of disease with acute pancreatitis were urgently hospitalized. Transabdominal ultrasonography was made in 100% of patients in first hours and days of after hospitalization. 3519(47%) of patients were hospitalized during first 7 days from the beginning of the disease. Acute pancreatitis was confirmed in 458 patients (13%). Results: new ultrasound signs were discovered and on the basis of them - a new method of transabdominal ultrasonography of acute pancreatitis was developed, which is based on the identification of hypoechoic areas corresponding to the vitreous edema of loose connective tissue, more than Conclusions: the patented new method of transabdominal ultrasonography of acute pancreatitis in the first phase of the disease (patent # 2622611) allows to confirm or reject acute pancreatitis during the direct visualization of the pancreas. The method makes possible to establish an exact diagnosis when it is required to differentiate acute pancreatitis from another urgent pathology ir case of the absence of anamnesis, specific laboratory changes, the inability to apply other visualization methods, with changes in organs caused by concomitant pathology and background diseases, in patients with overweight. References 1. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2): e1-15. 2. Еrmolov AS, Ivanov PA, Blagovestnov DA. i dr. Diagnosis and treatment of acute pancreatitis. M.: Vidar-M. 2013; 384 [In Russ] 3. Baker ME, Nelson RC, Rosen MP et al. ACR Appropriateness Criteria® acute pancreatitis. Ultrasound Q. 2014; 30(4): 267-273. 4. Diagnosis and treatment of acute pancreatitis (Russian clinical guidelines). SPb. 2014 [In Russ]. 5. Fedoruk A.M. Ultrasonography in the diagnosis and treatment of acute pancreatitis. Mn.: 6. Savel'ev VS, Filimonov MI, Burnevich SZ. Pancreatonecrosis. M.: Medicinskoe informacionnoe agentstvo. 2008; 264 [In Russ]. 7. Vinnik YU.S., Dunaevskaya S.S., Antyufrieva D.A. Possibilities of modern methods of visualization of acute severe pancreatitis. Novosti hirurgii. 2014; 22(1): 58-62. [in Russ] 8. Kajsarov VR. Features of the defeat of the retroperitoneal tissue in acute destructive pancreatitis: Cand. Med. sci diss. Sankt-Peterburg, 2005; 106 [In Russ]. 9. Lipatov VA. The severity of parapancreatic fiber, depending on body type. Medicine Online.Ru.- 01.07.2002. URL: http://www.medicina-online.ru/articles/43352/ [In Russ]. 10. Nigaj NG, Borovskij VV. Method for ultrasound diagnosis of acute pancreatitis forms. Patent KZ24337. 2011 [In Russ]. 11. Baranov AI, Еrmolaev YU.D., ZHerlov GK. Method for the diagnosis of acute pancreatitis. Patent RF №2242929. 2004 [In Russ]. 12. Bibik IL, Nikolaev NЕ. Modern algorithm for the diagnosis of acute pancreatitis]. Medicinskij zhurnal. 2006; (2): 23-25 [In Russ]. 13. Block S, Maier W, Bittner R, et al. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut. 1986; 27(9): 10351042. 14. Bertilsson S, Kalaitzakis E. Use of Pancreatitis - Associated Drugs Is Very Common in Patients With Acute. Pancreatitis but Is Not Related to Pancreatitis Etiology, Severity or Recurrence: A 10-Year Population-Based Cohort Study. Gastroenterology. 2014; 146(5): 95. 15. Bertilsson S, Kalaitzakis E. Acute Pancreatitis and Use of Pancreatitis - Associated Drugs: A 10-Year Population-Based Cohort Study. Pancreas. 2015; 44(7): 10961104. 16. Agrawal A, Alagusundarmoorthy SS, Jasdanwala S. Pancreatic Involvement in Critically ill Patients. J Pancreas (Online) 2015; 16(4): 346-355. 17. Rybachkov VV, Dubrovina DЕ, SHvecov RV, Utkin AK. Pancreas injury and post-traumatic pancreatitis. Al'manah Instituta hirurgii imeni A.V. Vishnevskogo. 2007; Suppl 1: 780-781 [In Russ]. 18. Mathur AK, Whitaker A, Kolli H, Nguyen T. Acute Pancreatitis with 19. Ranson JHC. The Role of Surgery in the Management of Acute Pancreatitis. Ann Surg. 1990; 211(4): 382393. 20. Wilson C, Imrie CW, Carter DC. Fatal acute pancreatitis. Gut. 1988; 29(6): 782-788. 21. Kirillova MS, Novikov SV. Ultrasound diagnosis of acute pancreatitis in the first phase of the disease. Patent RF № 2622611. 2017 [In Russ].
Abstract: Background: expansion of tourism business in countries of South and Southeast Asia, Africa, and South America led to the appearance of rare parasitic diseases in Russia, Europe, and the United Kingdom. In our country, more than 1.3 million patients with various parasitosis are officially registered annually, among which there is an increase in the incidence of intestinal protozoa. Aim: was to show features of the diagnosis of acute manifestations of necrotic amebic colitis, which simulated severe intoxication with manifestation of clinics of acute surgical disease and intestinal bleeding Material and methods: using the example of case report of a 70-year-old woman, the possibility of complex diagnostics using abdominal ultrasound, abdominal computed tomography, colonoscopy with biopsy of intestinal ulcers and parasitological research methods is shown. Results: detoxification, anti-inflammatory therapy in a surgical hospital and instrumental examination allowed us to objectively evaluate and conduct targeted therapy avoiding serious complications. Discussion: primary lesions with acutely occurring both local and general body reactions lead to severe intoxication, which does not allow to exclude acute surgical pathology, and in some cases dictate the need for urgent surgical intervention. Differential diagnosis of an amoeba with a colon cancer only on the basis of x-ray symptoms is almost impossible. Specific anti-ameba therapy leads to the disappearance of amoeba. Conclusion: only on the basis of a complex of clinical and epidemiological data, ultrasound, CT, colonoscopy, histological analysis and parasitological methods of research, pathology can be correctly identified. References 1. Bronshtejn A.M., Malyshev N.A., Luchshev V.I. Amebiasis: clinical features, diagnosis, treatment. Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. 2001; 3(3): 215-222 [In Russ.]. 2. Gostishchev V.K., Khrupkin V.I., Afanas'ev A.N., Gorbacheva I.V. The complicated intestinal amebiasis in emergency surgery. Xirurgiya. 2009; (5): 4-9 [In Russ.]. 3. Lisicyn K.M., Revskoj A.K. Urgent abdominal surgery for infectious and parasitic diseases. M: Medicina, 1988: 237-271 [In Russ.]. 4. Petridou C, Al-Badri A, Dua A, et al. Learning points from a case of severe amoebic colitis. Infez Med. 2017; 25(3): 281-284. PMID: 28956549 5. Cook G.C. Parasitic infections of gastrointestinal tract: a worldwide clinical problem. Curr Opin Gastroenterol.1989; 2(Is1): 126-139. 6. Ozereczkovskaya N.N. Organ pathology in the acute stage of tissue helminthiases: the role of blood and tissue eosinophilia, immunoglobulinemia E, G4 and factors that induce an immune response. Medicinskaya parazitologiya iparazitarny'e bolezni. 2000; (3): 3-8 [In Russ.]. 7. Romanenko N.A. Modern tasks of sanitary parasitology. Medicinskaya parazitologiya i parazitarny'e bolezni. 2001; (4): 25-29 [In Russ.]. 8. Sergiev V.P, Filatov N.N. Infectious diseases at the turn of the century: an awareness of the biological threat. Moskva: Nauka, 2006; 572 s [In Russ.]. 9. Kry'lov M.V. The determinant of parasitic protozoa (human, domestic animals and agricultural plants). Sankt-Peterburg: ZIN, 1996; 602 s [In Russ.]. 10. Eryuxin I.A., Xrupkij V.I. (red.) Experience of medical support of troops in Afghanistan 1979-1989 V. 2: Organization and scope of surgical care for the wounded. Moskva, 2002: 379-386 [In Russ.]. 11. Scherbakov I.T., Leonteva N.I., Chebyshev N.V., i dr. Pathomorphology of colonic mucosa in patients with chronic post-parasitic colitis. Aktual'ny'e voprosy' infekcionnojpatologii. 2014; 95(6): 934- 938 [In Russ.]. 12. Ellyson J.K, Bezmalinovic Z., Parks S.N, Lewis F.R. Necrotizing amebic colitis: a frequently fatal complication. Am J Surg. 1986; 152(1): 21-26. PMID: 3728812. 13. Shirley DA, Moonah S. Fulminant amebic colitis after corticosteroid therapy: a systematic review. PLoS Negl Trop Dis. 2016; 10(7): e0004879. 14. Guzeeva T.M. Status the incidence of parasitic diseases in the Russian Federation and tasks in terms of the reorganization of the service. Medicinskaya parazitologiya i parazitarny'e bolezni. 2008; (1): 3-11 [In Russ.]. 15. Weitzel T, Carbera J, Rosas R, et al. Enteric multiplex PCR panels: A new diagnostic tool for amoebic liver abscess? New Microbes New Infect. 2017; 18: 50-53. PMID: 28626584 DOI:10.1016/j.nmni.2017.05.002. 16. Abbas М.А., Mulligan D.C., Ramzan N.N., et al. Colonic perforation in unsuspected amebic colitis. Dig Dis Sci. 2000; 45(9): 1836-1841. PMID: 11052328. 17. Sinharay R., Atkin G.K., Mohamid W., Reay-Jones N. Caecal amoebic colitis mimicking a colorectal cance. J Surg Case Rep. 2011; (11): 1. PMID: 24972391 DOI:10.1093/jscr/2011.11.1. 18. Delabroussea E., Ferreirab F., Badeta N., et al. Coping with the problems of diagnosis of acute colitis. Diagn Intervent Imaging. 2013; 94(7-8): 793—804. PMID: 23751227 DOI:10.1016/j.diii.2013.03.012.
Abstract: Aim: was to identify features of echographic imaging in patients with suspicion on nonocclusive mesenteric blood-flow disorders. Materials and methods: we analyzed ultrasound data of 50 patients with dynamic ileus (DI). Patients with severe bulging of the transverse colon and the presence of free gas in the abdominal cavity were not included into the research. All patients underwent ultrasound examination. We evaluated the functional and morphological state of small intestine and colon, celiac trunk and the superior mesenteric artery (SMA). We also examined intraorganic blood flow in walls of small intestine and colon with the determination of the resistance index (RI) and the linear velocity of blood flow. The ultrasonic data was verified in 34 cases intraoperatively and morphologically, in 12 cases - only morphologically. Colonoscopy was performed in 4 patients whose ultrasound differential diagnosis between nonocclusive blood-flow disorders in colon walls and pseudomembranous colitis. Results: in 3 cases nonocclusive blood-flow disorder was not confirmed. Based on endoscopic and bacteriological data we revealed pseudomembranous colitis (PMC). In 1 patient with ultrasound signs of inflammatory changes in walls of the descending colon at colonoscopy revealed necrotizing ulcerative colitis and suspected circulatory problems in the intestinal wall. It was morphologically identified that 24 patients had nonocclusive blood-flow disorders in walls of the small intestine,10 patients had nonocclusive segmental infarction of small intestine and colon, in 12 patients had nonocclusive segmental infarction of colon. Conclusion: ultrasound study, conducted in dynamics, in patients with DI, reveals inflammatory and ischemic changes in walls of the small intestine and colon, which provides an abillity to choose the optimal method of treatment of these patients, in some cases predicted for the pathological process. Absolute symptoms of nonocclusion ischemia of intestine during ultrasound mode in colour doppler imaging (CDI) are: violation of diameter, lack or absence of blood flow in intraorganic walls of the affected intestine while maintaining its mesentery tissue, in a number of patients - bubbles of gas in the intestinal wall. An indirect sign of circulatory disorders of the small intestine is a complex of ultrasonic signs as an extension of its diameter with liquid contents, wall thickening by submucosal edema, mucosal folds flattening and lack of peristalsis. An indirect sign of circulatory disorders of the colon during US is identification of a fragment of the colon with thick walls layered structure haustrum smoothness, lack of blood flow in the structure of the wall in the presence of it in the mesentery When comparing ultrasound, endoscopic and morphological data, in some cases it is possible to make differential diagnosis between nonocclusive intestinal blood-flow disorder and pseudomembranous colitis.
Abstract: In patients with severe multiple trauma, posttraumatic period is often complicated by the development of polyorgan insufficiency, development of which is connected with morpho-functional changes of the liver parenchyma. Aim: was to identify dynamics of ultrasound signs of morphological and functional changes of liver in patients with multiple trauma. Materials and methods: performed analysis of ultrasound data obtained in dynamics, in 28 patients with severe multiple trauma. From the analysis, we excluded patients with blunt abdominal trauma with injury of liver. In first 2 days, 21 patients underwent surgical operations in treatment of craniocerebral trauma and trauma of musculoskeletal system. All patients underwent ultrasound examination of the abdominal cavity and retroperitoneal space to exclude possibility of appearance of free liquid; also estimated condition of liver, spleen, functional and morphological condition of the gastrointestinal tract. In first days after trauma, ultrasound examination was performed 2-3 times. Color duplex scanning of vessels of liver and spleen was performed once a day or every other day for 2-3 weeks of a traumatic period. Evaluated arterial and venous blood flow of liver by measuring the linear blood flow velocity (LBFV) and resistance index (RI), portal blood flow by measurement of linear and volumetric flow rate. Results: in all patients on admission to hospital, liver and spleen sizes had normal size. On the 3rd day after the injury, was revealed an increase in the cranio-caudal liver size by 2-4 cm and increased length of spleen by 5-8 cm, which lasts for 10-20 days. During dynamical ultrasound, 8 patients with 10-20 days against a background of increasing level of bilirubin and transaminases, in addition to increasing size of liver and spleen, we marked infiltration of tissues along hepatic veins with their narrowing and along branches of the portal vein with thickness from 0,25 to 0,7 cm. We marked LBFV decreasement by portal vein to 10-13 cm/sec and a volume flow to 250-400 ml / min, increased RI by hepatic artery In 3 patients in the liver parenchyma, we revealed avascular tissue regions with decreased echogenicity, indicating the formation of ischemic regions. Conclusion: during dynamical ultrasound in patients with severe multiple trauma, on day 3 after injury, were diagnosed morphological changes in liver parenchyma with violation of its hemodynamics. Further progression of the process observed for 10-20 days from the date of trauma: the growth of intrahepatic portal hypertension, increased peripheral resistance in arteries of liver parenchyma, the appearance of ischemic areas of liver parenchyma. The totality of above ultrasonic signs of hemodynamic disorders of liver, characterize organic hepatocellular insufficiency, which is a poor prognostic sign in the development of polyorgan insufficiency. References 1. Marushhak E.A. Povrezhdenija pecheni i selezenki u bol'nyh s zakrytoj abdominal'noj travmoj [Injury of liver and spleen in patients with blunt abdominal traums]. Avtoreferat Diss. kand. med. nauk. M. 2009; 31 [In Russ]. 2. Abdominal'naja travma: rukovodstvo dlja vrachej (Pod red. A.S. Ermolov M.Sh. Hubutija, M.M. Abakumov) [Abdominal trauma: manual for physicians]M.: Vidar, 2010; 504 [In Russ]. 3. Travmaticheskaja bolezn' i ee oslozhnenija ( Pod red. 4. Gajduk S.V. Kliniko-patofiziologicheskoe obosnovanie rannej diagnostiki sindroma poliorgannoj nedostatochnosti i visceral'nyh oslozhnenij u postradavshih s politravmoj [Clinical-pathophysiological rationale of early diagnostics of polyorgan insufficiency and visceral complications in patients with polytrauma]. Avtoreferat Diss. kand. med. nauk. SPb., 2009; 47 [In Russ]. 5. Gajduk S.V., Sosjukin A.E., Bojarincev V.V. Travmaticheskaja bolezn' i sindrom poliorgannoj disfunkcii - aktual'nye problemy mediciny kriticheskih sostojanij [Traumatic disease and syndrome of polyorgan dysfunction - actual problems of medicine of critical conditions]. Vestnik Rossijskoj Voenno-medicinskoj akademii. 2008; 1(21): 66-70 [In Russ]. 6. Zolotokrylina E. S. Voprosy patogeneza i lechenija poliorgannoj nedostatochnosti u bol'nyh s tjazheloj sochetannoj travmoj, massivnoj krovopoterej v rannem post- reanimacionnom periode [Questions of pathogenesis and treatment of polyorgan insufficiency in patients with severe multiple trauma, massive bloodloss in early postreanimation period]. Anesteziologija i reanimatologija. 1996; 1: 9-13 [In Russ]. 7. Cibuljak G.N. Obshhaja hirurgija povrezhdenij: rukovodstvo [General surgery of trauma: manual]. SPb.: Gippokrat. 2005; 646 [In Russ]. 8. Chastnaja hirurgija mehanicheskih povrezhdenij (Pod redakciej G.N.Cibuljak) [Particularistic surgery of mechanical injury.].SPB.: Gippokrat. 2011; 570 [In Russ]. 9. Saenko V.F. Desjaterik V.I., Perceva T.A., Shapovaljuk V.V. Sepsis i poliorgannaja nedostatochnost [Sepsis and polyorgan insufficiency]'. Krivoj Rog: Mineral. 2005; 441[In Russ]. 10. Tokmakova T.O.,Kameneva E.A., Grigor'ev E.V. Narushenie mikrocirkuljacii kak prichina poliorgannoj nedostatochnosti u postradavshih s tjazheloj cherepno-mozgovoj travmoj[Microcirculatory disorders as a reason of polyorgan insufficiency in patients with severe craniocerebral trauma]. Politravma. 2011; 4: 47-50 [In Russ]. 11. Gel'fand E. B., Gologorskij V.A., Gel'fand B.R. Abdominal'nyj sepsis: integral'naja ocenka tjazhesti sostojanija bol'nyh i poliorgannoj disfunkci [Abdominal sepsis: estimation of severity of condition of patients and polyorgan disfunction]. Anesteziologija i reanimatologija. 2000;3:29-34 [In Russ]. 12. Chappell D., Jacob M., Hofmann-Kiefer K. et al. A rational approach to perioperative fluid management. Anesthesiology. 2008; 109(4): 723-740. 13. Brealey D., SingerM. Multiorgan dysfunction in the critically ill: epidemiology, pathophysiology and management. J. Royal Coll. Physic. Lond. 2000; 34(5): 424-427. 14. Baker S.P, O'Neill B., Haddon W. Jr., Long W.B. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3): 187-196. 15. Trusov O.A. Patologicheskaja anatomija i patogenez poliorgannoj nedostatochnosti pri ostroj arterial'noj neprohodimosti konechnostej i peritonita (na materiale rannih autopsij)[Pathological anatomy and pathogenesis of polyorgan insufficiency in case of acute arterial failure of limb and peritonitis (based on early autopsy)]. Avtoreferat Diss. dokt. med. nauk. M., 2002; 41[In Russ].
