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 2 mm thickness and more than 5 mm length. When identifying these signs at least in one of fixed parapancreatic areas - we diagnose acute pancreatitis.

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.: Belarus'. 2005; 126 [In Russ].

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 Normal Serum Lipase and Amylase: A Rare Presentation. J Pancreas (Online). 2016; 17(1): 98101.

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:

Purpose. Define the role of ultrasound diagnostics in preoperative evaluation, surgical approach, and postsurgical assessment in patients with cystous lesions of pancreas underwent various types of pancreatic distal resection (PDR).

Material and methods. Since 1995 till 2008 in Vishnevsky Institute of Surgery (Moscow) 54 patients with distal cystous lesions of pancreas received a course of treatment. Mean age was 50,6+1,2 years, 37 patients (68.5%) were women. Complex pre- and postoperative ultrasound study was performed in all the cases. Morphologically there were true cysts (2 cases), lymphocysts (1 case), postnecrotic cysts (21 patients), serous cystadenoma (9 cases), mucinous cystadenoma (16 cases), and mucinous cystadenocarcinoma (5 cases).

Results. After laparotomy and abdominal revision the following operations were performed:

1. Spleen-preserving distal pancreatic resection;

2. Distal pancreatic resection with splenectomy.

Pancreatic stump assessment revealed 2 possible complications: external pancreatic fistula and sub. phrenic abscess. Spleen-preserving interventions were shown to associate with fewer complication rate, than those with splenectomy.

Conclusions. The cardinal problem is that the PDR associates with repeatedly high complication rate, and the most common complications are external pancreatic fistulas and subphrenic abscesses. As far as the complication rate has the tendency to decrease in spleen-preserving interventions, it is advisable to avoid splenectomy in cases of benign pancreatic lesions.   

References

1.        Fahy B.N., Frey C.F., Ho H.S. et al. Morbidity, mortality and technical factors of distal pancreatectomy. Am. J. Surg. 2002; 183 (3): 237–241.

2.        Andren-Sandberg A., Wagner M., Tihanyi T. et al. Technical Aspects of Left-Sided Pancreatic Resection for Cancer. Dig. Surg. 1999; 16 (4): 305–312.

3.        Шалимов А.А. Хирургия поджелудочной железы. М.: Медицина. 1964.

4.        Mayo W.J. The Surgery of the Pancreas: I. Injuries to the Pancreas in the Course of Operations on the Stomach. II. Injuries to the Pancreas in the Course of Operations on the Spleen. III. Resection of Half the Pancreas for Tumor. Ann. Surg. 1913; 58 (2): 145–150.

5.        Алимов А.Н., Исаев А.Ф., Сафронов Э.П. и др. Обоснование безопасности органосохраняющего метода лечения разрыва селезенки в хирургии изолированной и сочетанной травмы живота. Хирургия. 2005; 10: 55–60.

6.        Lee S.Y., Goh B.K., Tan Y.M. et al. Spleen-preserving distal pancreatectomy. Singapore Maed. J. 2008; 49 (11): 883–885.

7.        Warshaw A.L. Conservation of the spleen with distal pancreatectomy. Arch. Surg. 1988; 123 (5): 550–553.

8         Буриев И.М., Икрамов Р.З. Дистальная резекция поджелудочной железы. Анналы хирургической гепатологии. 1997; 2: 136–138.

9.        Kimura W., Fuse A., Hirai I., Suto K. Spleen-preserving distal pancreatectomy for intraductal papillary-mucinoustumor. Hepatogastroenterology. 2004; 51 (55): 86–90.

10.      Edwin B., Mala T., Mathisen O. et al. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg. Endosc. 2004; 18 (3): 407–411.

11.      Vezakis A., Davides M., Larvin M., McMahon M.J. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg. Endosc. 1999; 13 (1): 26–29.

Abstract:

Aim. Was to analyze possibilities of CT diagnostics of patients with chronic diseases and cancer of pancreas.

Materials and methods. We have analyzed 42 patients with cancer of pancreas and chronic pancreatitis. 20 patients had verified cancer (10 male and 10 female aged 47-82 yrs) and 22 patients with chronic pancreatitis (16 male and 6 female aged 29-63 yrs). All the patients underwent CT for diagnosis specification, estimation of pancreas condition and stage of disease.

Results. Sarcopenia was detected in 14 patients (70%) with pancreas cancer (9 of 10 male, 5 of 10 female). There was no significant difference in postoperative complications. Complications were marked in 11 of 20 pts (55%), including 8 of 14 patients (57%) with sarcopenia. Postoperative morbidity marked in 3 cases sarcopenia was detected in 15 patients (68%) with chronic pancreatitis (13 of 16 male, 2 of 6 female). There was no postoperative morbidity or complications in this groups of patients.

Results. CT in good for standard diagnostics of pancreas diseases and can estimate sarcopenia degree. Due to obtained data the level of carcopenia in surgically treated patients with pancreas cancer and chronic pancreatitis reaches 70%. Application of CT gives new possibilities in diagnostics of metabolic disorders in patients with severe chronic pancreatitis and pancreas cancer.
 

References 

1.    Заводчиков А.А., Башкина А.С., Лаврухина А.А. и др. Пути противодействия саркопении. Лечебная физкультура и спортивная медицина. 2011; 50-59.

2.    Morley J.E., Thomas D.R., Wilson M.M. Cachexia: pathophysiology and clinical relevance. Am. J. Clin. Nutr. 2006; 83: 735-743.

3.    Tan B.H., Fearon K.C. Cachexia. Prevalence and impact in medicine. Curr. Opin. Clin. Nutr. Metab. 2008; 11: 400-407.

4.    Klaude M. et al. Proteasome proteolytic activity in skeletal muscle is increased in patients with sepsis. London. Clin. Sci. 2007; 112: 499-450.

5.    Dodson S. et al. Muscle wasting in cancer cachexia. Clinical implications, diagnosis and emerging treatment strategies. Annu. Rev. Med. 2010; 62 (8): 1-15.

6.    Prado C.M. et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts. A population-based study. Lancet. Oncol. 2008; 9: 629-635.

7.    Baumgartner R.N. et al: Epidemiology of sarcopenia among the elderly in New Mexico. Am. J. Epidemiol. 1998; 147: 755-763.

8.    Janssen I., Heymsfield S.B., Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J. Am. Geriatr. Soc. 2002; 50: 889-896.

9.    Pichard C. et al. Nutritional assessment. Lean body mass depletion at hospital admission is associated with an increased length of stay. Am. J. Clin. Nutr. 2004; 79: 613-618.

10.  Cosqueric G. et al: Sarcopenia is predictive of nosocomial infection in care of the elderly. Br. J. Nutr. 2006; 96: 895-901.

11.  Metter E.J. et al. Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J. Gerontol. a Biol. Sci. Med. Sci. 2002; 57: 359-365.

12.  Prado C.M. et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Cli. Cancer. Res. 2007; 13: 3264-3268.

13.  Heymsfield S.B. et al. Human body composition. Advances in models and methods. Ann. Rev. Nutr. 1997; 17: 527-558.

14.  Witt H. et al. Chronic Pancreatitis. Challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. 2007; 132 (4): 1557-1573.

15.  Uomo G., Gallucci F., Rabitti P.G. Anorexia-cachexia syndrome in pancreatic cancer: recent development in research and management. JOP. 2006; 7: 157-162.

16.  Zamboni M. et al. Sarcopenic obesity. A new category of obesity in the elderly. Nutr. Metab. Cardiovasc. Dis. 2008; 18: 388-395.

17.  Roubenoff R. Sarcopenic obesity. Does muscle loss cause fat gain? Lessons from rheumatoid arthritis and osteoarthritis. Ann. N.-Y. Acad. Sci. 2000; 904: 553-557.

18.  Cruz-Jentoft A.J. et al. Sarcopenia. European consensus on definition and diagnosis. Age and Aging. 2010; 39: 412-423.

19.  Baracos V.E. et al. Body composition in patients with non-small cell lung cancer. A contemporary view of cancer cachexia with the use of computed tomography image analysis. Am. J. Clin. Nutr. 2010; 91: 1133-1137.

20.  Antoun S. et al. Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann. of Oncology. 2010; 21: 1594-1598.

21.  Mitsiopoulos N. et al. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J. Appl. Physiol. 1998; 85: 115-22.

22.  Shen W. et al. Visceral adipose tissue. Relations between single-slice areas and total volume. Am. J. Clin. Nutr. 2004; 80: 271-278.

23.  Shen W. et al. Total body skeletal muscle and adipose tissue volumes. Estimation from a single abdominal cross-sectional image. J. Appl. Physiol. 2004; 7: 2333-2338.

24.  Mourtzakis M. et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl. Physiol. Nutr. Metab. 2008; 33: 997-1006.

25.  Eisenhauer E.A. et al. New response evaluation  criteria  in  solid  tumours.   Revised RECIST guideline (version 1.1). Europ. J.of Cancer. 2009, 45: 228-247.

26.  Bozzetti F. Screening the nutritional status in oncology. A preliminary report on 1,000 out-patients.   Support  Care  Cancer.   2009;   17:279-284.

27.  Bachmann J. et al. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J. Gastrointest. Surg. 2008; 12: 1193-1201.

28.  Tan B.H.L. et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin. Cancer. Res. 2009; 15 (22): 6973-6979.

29.  Beger H.G. et al. Treatment of pancreatic cancer. Challenge of the facts. World. J. Surg. 2003; 27: 1075-1084.

30.  Beger H.G. et al. Diseases of the pancreas. Current surgical therapy. Berlin. Springer-Verlag Heidelberg. 2008; 301-311.