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: Acute severe pancreatitis is the most severe disease in urgent abdominal surgery In these conditions - diagnosis and treatment of this group of patients remains a high priority issue of urgent surgery and intensive care therapy It is extremely important to estimate severity of local changes and general conditions of patient in order to draw up efficient disease management and forecast the outcome of the disease. It can be done by the use of different scoring systems of severity: J.H.C. Ranson, Glasgow (Imrie), SOFA, APACHE I or II, SAPS, MODS and others. Instrumental methods of investigation are used to examine scale and type of disease of pancreas, retroperitoneum and abdominal: laparoscopy, ultrasonography, computed tomography (CT), magnetic resonance imaging. It is generally recognized that the most informative methods of diagnosis of acute severe pancreatitis and its complications are ultrasound diagnostics and computed tomography In 2008 in Mumbai the Acute Pancreatitis Classification Working Group identified two types of classification - clinical and morphological, the last is based on beam diagnostics. Clinical classification is used during the early stage of disease (within the first week of acute pancreatitis manifestation), morphological classification is applicable to the subsequent stage (usually after the first week of illness). This allows radiologists to describe the «morphology» while clinicians include the results of the examination into the overall clinical picture and draw up the plan of appropriate treatment.
Abstract: Purpose. For basic, purpose was to develop effective methods of exact diagnostics of an acute pancreatitis (AP), to work out classifications of disease, an establishment of patients' condition definitions, and also productive supervision over dynamics of its process by means of application computed tomography (СТ) and magnetic resonance imaging (MRI). Besides, on the base of obtained data, the optimum tactics of treatment was worked out Materials and methods. More than 500 patients with AP were underwent CT and MRI with one-stage contrast agents' injection. During the research we have applied different variations of scanning modes and parameters. Results were analyzed in connection with supervision on patients conditions. Treatment tactics depended on obtained data Results. We have worked out effective methods of AP diagnostics, optimal parameters of research in different clinical currents and we have developed an effective tactics of treatment in patients with severe AP Besides, on the base of obtained data, the optimum tactics of treatment was worked out Conclusions. CT with intravenous contrasting is the best method of diagnostics or supervision in dynamics, which allows to work out the most productive treatment tactics. Using CT in combination with MRI in some cases can be specifying method of diagnostics. References 1. Араблинский А.В., Черняков P.M., Хитрова А.Н., Богданова Е.Г. Лучевая диагностика острого панкреатита. Медицинская визуализация. 2000; 1-14. 2. Прокоп М., Галански М. Спиральная компьютерная томография. 2009. 3. Райан С., МакНиколас М., Юстеис С. Анатомия человека при лучевых исследованиях. 2009. 4. Шабунин А.В., Мумладзе Р.Б., Чеченин Г.М., Тавобилов М.М. Этапное хирургическое лечение острого панкреатита, панкреонекроза алкогольной этиологии. Неотложная и специализированная хирургическая помощь. 1-й конгресс московских хирургов. Тез. док. М. 19-21 мая 2005 г. М.: ГЕОС. 2005; 122. 5. Balthazar E. CT diagnosis and staging of acute pancreatitis. RadiolClin. North. Am. 1989; 27 (1): 19-37. 6. Balthazar E.J., Megibov A.J., Pozzi R. Mucelli Imaging of the pancreas. Medical radiology.2009. 7. Piironen A. et al. Detection of severe acute pancreatitis by contrast enhanced magnetic resonance imaging. European Radiology. 2000; 2: 354. 8. Balthazar E. et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174 (2): 331-336. 9. Bradley E.L. A clinically based classification system for acute pancreatitis. Summary of the international simposium on acute pancreatitis. Atlanta. G., Sept. 11-13. 1992: 586-590. 10. Багненко С.Ф., Рухляда Н.В., Толстой А.Д., Гольцов В.Р. Лечение острого панкреатита на ранней стадии заболевания. НИИ СП им. И.И. Джанелидзе, С.-Пб. 2002; 24. 11. Robinson PJ.A., Sheridan M.B. Pancreatitis computed tomography and magnetic resonance imaging. European Radiology. 2000; 3: 401. 12. Balthazar E.J., Freeny P.C., Sonennberg E. Imaging intervention in acute pancreatitis. Radiology. 1994; 193: 197-306. 13. Balthazar E.J. et al. Acute pancreatitis. Prognostic value of CT. Radiology. 1985; 156:767-772. 14. Isenmann R., Rau B., Beger H.G. Infected necroses and pancreatic abscess. Surgical therapy. Kongressbd Dtsch Ges Chir Kongr. 2001; 118: 282-284. 15. Кармазановский Г.Г., Федоров В.Д. Компьютерная томография поджелудочной
Possibilities of CT in sarcopenia detection in patients with chronic diseases and cancer of pancreas
DOI: https://doi.org/10.25512/DIR.2012.06.1.03
For quoting:
Lyadov L.K., Bulanova E.A., Sinitsyn V.E. "Possibilities of CT in sarcopenia detection in patients with chronic diseases and cancer of pancreas ". Journal Diagnostic & interventional radiology. 2012; 6(1); 13-18.
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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.
Abstract: Acute severe pancreatitis remains one of the actual issue in urgent surgery Forecast of the disease is dependant on spread of purulent necrotic process in pancreas and retroperitoneal tissues. Therefore diagnosis of purulent complications becomes extremely important. The aim of the study was to demonstrate and evaluate features of ultrasonography in diagnosis and treatment strategy definition of purulent necrotic complications of acute severe pancreatitis. Materials and methods. The study included 115 patients with acute destructive pancreatitis aged of 21-81 years The major part of them (50%) were persons at most able-bodied (working) aged 32-59 years. All patients underwent ultrasound diagnostics for determination the spread of pathology and detection of complications of the disease. Ultrasound scanning was carried out as follows: 1. inspection of pancreatic parenchyma; 2. inspection of cellular tissues; 3. detection of free liquid in the abdominal cavity; 4. evaluation of the abdomen and kidneys; 5. inspection of the pleural cavity Results. Examination of the parenchyma revealed that the pancreas was often inlarged, had a fuzzy, uneven contours and heterogeneous structure. However, it should be noted that in some cases, the pancreas was normal size and structure. Infected necrosis, acute liquid accumulation and/or free liquid in the abdominal cavity had occurred in 100% of cases in various combinations during examination of cellular tissues. Regarding the abdominal organs following complications were revealed: obstructive jaundice - in 5(4.3%) cases; portal vein thrombosis - in 1 (0.9%) case; splenic abscess - in 1 (0.9%) case. The presence of liquid in the pleural cavity was determined by leaves dissociation of the parietal and visceral pleura. The volume of the liquid was determined according standard classification. Conclusion. Ultrasound scanning allows to determine the presence and extent of local complications arising at the stage of purulent necrotic complications of acute severe pancreatitis and general complications as a result of systemic pathological effect on the body of the disease. References 1. Охотников О.И. Перкутанная диапевтика в неотложной абдоминальной хирургии органов панкреато-билиарной зоны. Автореф. ... дис. докт. мед. наук. Воронеж. 1998; 39 с. 2. Echenique A.M., Sleeman D., Yrizarry J. et al. Percutaneous catheter-directed debridement of infected pancreatic necrosis in 20 patients. J. Vase. Interv. Radiol. 1998; 9: 565-571. 3. Затевахин И.И., Цициашвили М.Ш., Будурова М.Д. Комплексное ультразвуковое исследование при остром панкреатите. Анналы хирургии. 1999; 3: 36-42. 4. Scaglione M., Casciani E., Pinto A. et al. Imaging Assessment of Acute Pancreatitis. 5. Багненко С.Ф., Курыгин А.А., Синенченко ГИ. Хирургическая панкреатология. Санкт-Петербург: Речь. 2009; 608 с. 6. Loser C., Folsch U.R. Acute pancreatitis: medical and endoscopic treatment. Pancreatic disease. State of the art and future aspects of research. 1998; 12: 66-78. 7. Martines-Noguera A., Mohtserat E., Torruba S. etal. Ultrasound of the pancreas: update and controversies. Eur. Radiol. 2001; 11: 1594-1606. 8. Mortele KJ, Girshman J, Szejnfeld D, et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am. J. Roentgenol. 2009; 192(1): 110-116. 9. Kumar P., Mukhopadhyay S., Sandhu M. et al. Ultrasonography computed tomography and percutaneous intervention in acute pancreatitis: A serial study. Austral. Radiology. 1995; 39(2): 145-152. 10. Balthazar E.J., Freeny P.C., van Sonnenberg E. Imaging and intervention in acute pancreatitis. Radiology. 1994; 193: 297-306. 11. Mortele K.J., Wiesner W., Intriere L. et al. Modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am. J. Roentgenol. 2004; 183(5): 1261-1265. 12. Bharwani N., Patel S., Prabhudesai S. et al. Acute pancreatitis: The role of imaging in diagnosis and management. Clinical Radiology.2011; 66: 164-175. 13. De Waele J.J., Delrue L., Hoste E.A. et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system. SourcePancreas. 2007; 34 (2): 185-190. 14. Биссет Р., Хан А. Дифференциальный диагноз при абдоминальном ультразвуковом исследовании. Пер. с англ. под ред. С.И. Пиманова. М.: Медицинская литература. 2001; 272 с. 15. Бенсман В.М. Облегченные способы статистического анализа в клинической медицине. Краснодар: Издательство КГМА. 2002; 30 с. 16. Кармазановский ГГ, Степанова Ю.А. Классификация острого панкреатита - современное состояние проблемы и нерешенные вопросы. Медицинская визуализация. 2011; 4: 133-137. 17. Сидорова Ю.В., Шабунин А.В., Араблинский А.В., Шиков Д.В., Бедин В.В., Лукин А.Ю. Острый панкреатит: некоторые вопросы диагностики и лечения. Диагностическая и интервенционная радиология. 2011; 5(2): 15-26.
