The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. Methods: 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical examination, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Ас), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se-98,10%), for estimation of organ failure-MODS 2 (Sp-100%, PPV-100%) and APACHE II (Sp-100%, PPV-100%), for detection of pancreatonecrosis sings-CTSI (Sp-100%, NPV-100%), for estimation of need for intensive care-MODS 2 (Sp-100%,
58 Ю.С. ВИННИК, С.С. ДУНАЕВСКАЯ, Д.А. АНТЮФРИЕВА ВОЗМОЖНОСТИ СОВРЕМЕННЫХ МЕТОДОВ ВИЗУАЛИЗАЦИИ ОСТРОГО ТЯЖЕЛОГО ПАНКРЕАТИТАГБОУ ВПО «Красноярский государственный медицинский университет им. проф. В.Ф. Войно-Ясенецкого», Российская ФедерацияЦель. Определить эффективность применения УЗИ, КТ-ангиографии и МРТ в диагностике острого тяжелого панкреатита в ферментативную фазу заболевания.Материал и методы. Обследовано 30 пациентов с диагнозом тяжелый острый панкреатит в фермента-тивную фазу заболевания. Возраст обследованных варьировал от 23 до 76 лет. Пациентам выполнялись УЗИ органов брюшной полости, КТ-ангиография с болюсным контрастированием и МРТ с контрастированием в сроки от 24 до 48 часов от момента госпитализации. УЗИ органов брюшной полости проводилось при по-мощи аппарата Aloka SSD 3500 трансдюсером с частотой 3,5 МГц. Особенностью проведения КТ-ангографии являлось проведение трех сканирований в нативную (бесконтрастную) фазу, в артериальную фазу, в веноз-ную фазу. Задержка начала сканирования для получения артериальной фазы определялась автоматически по программе Bolus tracking. При МРТ и МР-холангиографии выполнялась серия изображений в корональных и аксиальных плоскостях в Т1ВИ и Т2ВИ. Использовали контраст «Магневист» в дозе 0,2 мл/кг.Для оценки эффективности использования диагностических методов рассчитывали показатели: чув-ствительность, специфичность, точность, прогностическая значимость положительного результата (ПЗПР), прогностическая значимость отрицательного результата (ПЗОР).Результаты. При определении эффективности методов визуализации при тяжелом остром панкре-атите, чувствительность УЗИ составила -50,0%, специфичность -20,0%, точность -37,1% , ПЗПР -45,5%, ПЗОР -23,1%. При оценке эффективности МРТ чувствительность метода составила 86,9%, спец-ифичность -100%, точность -90%, ПЗПР -100%, ПЗОР -70%.Заключение. КТ-ангиография и МРТ не имеют достоверных различий по диагностической ценности. Преимуществом МРТ с контрастированием является более четкая визуализация участков инфильтрации и жидкостных скоплений. УЗ-исследование не позволяет четко визуализировать объем поражения, однако, сохраняет актуальность как скрининговый метод. Ключевые слова: острый панкреатит, диагностика, визуализация, тяжелое течениеObjectives. To determine effectiveness of application of ultrasonography (US), CT-angiography and magnetic resonance imaging (MRI) in diagnosis of severe acute pancreatitis in the enzymatic stage of the disease.Methods. 30 patients with diagnosis of a severe acute pancreatitis in the enzymatic stage of the disease have been studied. The age of patients varied between 23 and 76 years. The patients were carried out US of the abdominal cavity organs, CT-angiography with contrast bolus and MRI with contrast in the period between 24 and 48 hour after hospitalization. All patients (abdominal organs) were scanned by B-mode Ultrasonography with Aloka product (model SSD-3500) Ultrasound diagnostic system equipped with 3,5 MHz transducer. As the peculiarity of the conduction of CT-angiography is the performan...
Background: Acute pancreatitis is one of the most common surgical abdominal diseases. The development of trypsin autoaggression which provokes hemostasis disorders play significant role for pathogenesis of severe acute pancreatitis. The study of biochemical hemostasis-related markers and general homocysteine as a marker of endothelium damage at acute pancreatitis and their influence on development of heavy complications of the I phase of a disease is actual and relevant task. These complications are the reason for about 40% of lethal outcomes.Aims: To study hemostasis disorders and homocysteine as marker of damage of endothelial cells in patients with acute pancreatitis during the initial period of a disease depending on disease severity, the volume of injury of a pancreas, and development of complications.Materials and methods: 127 patients who were divided into two groups: with severe AP and not severe AP. We investigated variables and indicators of hemostasis system: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR) fibrinogen, and homocysteine.Results: The most expressed hemostasis disorders and level of the general homocysteine were registered on 3rd day from the disease onset. On the 7th day, the tendency to decrease in indexes of a coagulative link of a hemostasis and decrease in level of the general homocysteine was registered in patients with severe acute pancreatitis. There were correlative communications of high and average degree between the volume of a pancreatonecrosis and violation of a hemostasis on 3rd day from the disease onset, and the level of the general homocysteine rS=0.94 (p1=0.001). In patients with severe pancreatitis, systemic complications of different degree of expressiveness were observed in 69.57% of cases. There were average and high correlations between violation of system of a hemostasis on the 3rd day and systemic complications development, as well as high direct correlation between increase in level of the general homocysteine and systemic complications development rS=0.77, p1=0.001.Conclusions: Hemostasis disorders and the level of general homocysteine correlated with volume of pancreas and retroperitoneal cellular tissue affection and system complications development at the 1-th phase of severe acute pancreatitis.
Abstract:The problems related to studying predictors of atherosclerosis obliterans (ASO) of the lower extremities are quite relevant due to high disability and lethality rate of patients belonging to this group. This study aimed to evaluate the values of lipid profile, general homocysteine and hemostasis in relation to the clinical course of ASO. Material and Methods -55 patients with ASO of the lower extremities were divided into two groups: 30 patients with no progressive clinical course, 25 patients with progressive clinical course. The group division was based on the anamnesis (duration of the disease, decrease of painless walking distance during the year, the length of effect lasting from conservative treatment). Data presented as median with lower and upper quartiles -Me (LQ, UQ). Results -As a result of research, there was a registration of moderate hyperhomocysteinemia -23.6 (20.1, 26.4) mkmol/l, as well as high values of triglycerides -2.10 (1.72, 2.51) mmol/l and low-density lipoproteins -4.48 (3.95, 6.44) mmol/l, against low values of high-density lipoproteins -1.14 (0.72, 1.40) mmol/l in lipid profile. Development of hypercoagulability and susceptibility to thrombosis in patients is manifestation of endothelial dysfunction, which plays a key role in progression of ASO of the lower extremities. Keywords: atherosclerosis obliterans, progressive course, hemostasis, lipid profile, homocysteineCite as Dunaevskaya SS, Antufrieva DA. The condition of lipid metabolism, hemostasis and general homocysteine level as a manifestation of endothelial dysfunction at progressing course of atherosclerosis obliterans of the lower extremities.
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