[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Neuroendocrine "silent" tumors of the pancreas]. / Neiroéndokrinnye "nefunktsioniruiushchie" opukholi podzheludochnoi zhelezy.

Neuroendocrine tumors are the rare pathology. They are characterized by slow growth and favorable prognosis for life. From 1985 to 2000 fifty-two patients with "silent" neuroendocrine tumors were treated. Clinical symptoms in 60% patients were associated with squeezing of the surrounding organs and tissues (gastroduodenal obstruction or cholestasis), in 20% patients tumors were diagnosed within the framework of syndrome of multiple endocrine metaplasia and in 16% cases tumors were revealed accidentally. Fifty-two percent of the tumors located in the head of the pancreas, 23 and 25% - in the corpus and tail of the pancreas respectively. All the patients underwent surgery. Neuroendocrine nature of the tumors was verified during morphologic study. Five-year survival was 51.8, 41.6 and 54.5% when tumor located in the head, corpus and tail of the pancreas, respectively.

[Virtual surgeries based on spiral computed tomography]. / Virtual'nye khirurgicheskie operatsii na osnove ispol'zovaniia spiral'noi komp'iuternoi tomografii.

Experience of spiral computed tomography with bolus contrast enhancement and subsequent 3D-reconstruction of picture for virtual modeling of surgeries is presented. The method was used in 204 patients with tumors and diseases of the liver, pancreas, spleen, kidneys, adrenal glands, parapapillary diverticula of the duodenum, coarctations and aneurysms of aorta, extraorganic tumors of the retroperitoneal cavity and neck. Coincidence of virtual and real types of surgeries reached 75-92.8% depending on the disease and clinical situation. Perspectives of 3D-reconstruction for evaluation of normal and pathologic anatomic features in an individual patient, choice of an optimal surgical variant, prognosis of possible complications and their prophylaxis are demonstrated. Integration of surgeon's and radiologist's thinking is very important for correct diagnosis and surgical policy.

[Pancreatoduodenal resection with preservation of the pylorus]. / Pankreatoduodenal'naia rezektsiia s sokhraneniem privratnika.

Experience with 106 pancreatoduodenal resections (PDR) with pylorus savage for tumors and benign diseases of pancreatic head and periampullar zone is analyzed. Features of mobilization of pancreatoduodenal complex in PDR are shown. They permit to reduce the rate of complications (gastrostasis). Necessity of differential approach to choice of creation of biliodigestive anastomosis is demonstrated. Risk of postoperative pancreatitis is highest in non-dilated pancreatic duct and small-changed pancreatic parenchyma. In these cases terminolateral pancreatojejunostomy with external drainage of pancreatic duct (12 patients) and pancreatogastrostomy (21) are preferable. PDR with pylorus savage permitted to use wider pancreato-, bilio- and duodenoenteroejunoanastomosis on one loop of the jejunum. Gastrostasis was seen in 50% patients after PDR with pylorus savage. Technical features of surgery and also postoperative complications leading to gastrostasis are demonstrated.

[Portal embolization (an experimental-morphological study)]. / Portal'naia émbolizatsiia (éksperimental'no-morfologicheskoe issledovanie).

Results of experimental-morphological study of influence of unilobar portal embolization by biologic occlusive material RABROM on the liver of 6 laboratory animals are presented. It is shown that portal venous embolization leads to focal necrosis of parenchyma of embolized hepatic lobe, it atrophy and formation of portal cirrhosis. In non-embolized hepatic lobe the distinct signs of increased regeneration and hypertrophy of hepatocytes were revealed. RABROM didn't lead to damage and inflammatory changes of vascular wall that testifies to it biologic inertia. It is recommended to use the method of portal venous embolization for preparation of patients with low functional hepatic reserve for extensive resections.

[Assessment of pancreatoduodenal resection completion methods]. / Otsenka metodov zaversheniia pankreatoduodenal'noi rezektsii.

The nearest outcomes of 305 pancreatoduodenal resections (PDR) for malignant and benign diseases of the pancreas head and periampullar zone are presented. Necessity of differential approach to choice of method of pancreatodigestive anastomosis formation is demonstrated. In unectatic main duct of the pancreas and unchanged pancreatic parenchyma there is a high risk of postoperative pancreatitis and lethal outcome which achieved 29.8% in the group of 57 patients. In patients with diameter of main pancreatic duct more than 3 mm and fibrotic changes of its parenchyma, the majority of methods of pancreas inclusion the in digestive canal were characterized by favorable results, lethality was 7.7% among 248 patients. Recently, the increase of rate of PDR with pylorus preservation permits to apply widely pancreato-, bilio-, and duodenoenteroanastomosis on the same jejunal loop.

[Effects of some growth factors and cytokines on ATP synthesis by plasma-membrane-enriched particles isolated from different human tumors]. / Vliianie nekotorykh faktorov rosta i tsitokinov na sintez ATF preparatami obogashchennykh plazmaticheskimi membranami chastits, izolirovannykh iz razlichnykh opukholei cheloveka.

Plasma-membrane-enriched particles isolated from the tissues of malignant tumors of different sites are shown to accumulate ATP under the influence of polypeptide growth factors and cytokines whose receptors have a tyrosine kinase activity. Polypeptide growth factors, such as EGF, FGF, NGF, TNF, insulin, and the cytokine IL-2, were studied on the accumulation of adenosine-5'-triphosphate (ATP) by the preparations of plasma-membrane-enriched particles isolated from the target tissues of human malignant tumors. The tumor (transformed) cell plasma membranes of the lung, bowel, stomach, pancreas, as well as the cells of neurinoma and a retroperitoneal extra-organ malignant tumor (leiomyosarcoma) are demonstrated to be able to synthesize ATP from inorganic phosphate and ADP under aerobic conditions human with the participation of the cyanide-insensitive proton phoric NADH-bound transversely oriented chain. Signal-stimulated accumulation of plasma membranous ATP was found to increase in the tissues in malignant transformation as compared to that in normal tissues. Experiments using selective inhibitors of tyrosine kinases (tyrphostin-25, quercetin) indicated the involvement of plasma membranous signal-transducing ATP in the activation of receptor tyrosine kinase growth factors.

[Thoracoscopic splanchnic sympathectomy in pancreatic diseases]. / Torakoskopicheskaia splankhniksimpat¿ektomiia pri zabolevaniiakh podzheludochnoi zhelezy.

Thoracoscopic splanchnicsympathectomy (TSSE) was performed in 8 patients with inoperable tumors of the corpus and tail of the pancreas and in 3 patients with painful syndrome of chronic pancreatitis. Severe painful syndrome in the upper abdominal region was the main indication for ISSE. Thoracoscopic resection of the lower thoracic sympathetic ganglia and splanchnic nerves was performed. Postoperative complications were detected in 3 patients: in one case it was pneumothorax, in two--pains in the thorax due to the injury of intercostal nerve by thoracoport. There were no lethal outcomes accounted for surgical procedure. The effectiveness of the operation was evaluated by the use of descriptive and visual analogue scales of pain sensitiveness and changes of the amplitude of somatosensor provoked potentials of the brain. Favourable and satisfactory results were obtained in 9 cases.

[Roentgenological examination of stomach after pancreatoduodenectomy]. / Rentgenologicheskoe issledovanie zheludka posle pankreatoduodenal'noi rezektsii.

High frequency of complications after pancreatoduodenal resections dictates the necessity to study causes of their origin. This paper provides the results of roentgenologic examinations in early and late postoperative periods in 24 patients who underwent classic pancreatoduodenal resection by Whipple and in 23 patients after pylorus saving pancreatoduodenal resection--operation by Traverzo-Longmire. Conventional method of roentgenologic examination of the operated stomach was used. In early postoperative period disturbances of motor-evacuatory function of upper parts of gastrointestinal tract were revealed in 50% of patients in any modification of pancreatoduodenal resection. In most cases slowering down of the evacuation up to complete gastrostasis was observed. But in long-term follow-up functional results after pancreatoduodenal resection according to x-ray examination data were much better after operation by Traverzo-Longmire (75% patients) than after classic version by Whipple (37% patients). Thus, the results of roentgenologic examination showed that pylorus saving version of pancreatoduodenal resection provides optimal conditions for normal activities of the saved organ.

[Carbohydrate metabolism in patients after pancreatoduodenal resection]. / Sostoianie uglevodnogo obmena u bolnykh posle pankreatoduodenalnoi rezektsii.

The authors studied carbohydrate metabolism 4 weeks to 12 months after pancreatoduodenal resection (PDR) in 21 patients whose ages ranged from 40 to 55 years. Seven of them had been operated on for carcinoma of the major duodenal papillas and the other patients for carcinoma of the major duodenal papillas and the other patients for carcinoma of tree pancreas. The control group was formed of 10 healthy volunteers of the same age as the patients of the two groups under study; 10 patients who were subjected to PDR with pancreatojejunostomy and 11 patients in whom resection of the pancreatic stump was completed by intraductal occlusion of the formed stump. None of them had disorders of carbohydrate metabolism before the operation. The patients were examined by the oral test for glucose tolerance (OTGT, 75 g of glucose) with glycemia determination and by intravenous glucose tolerance test (i.v. GTT) with determination of glycemia and C-peptide. It was found that the glycemia curves obtained during OTGT did not have a diabetic character according to the WHO criteria. In performing TTG, the coefficient K was diabetic in both groups. Study of the C-peptide level during the i.v. GTT showed that in the group with occluded ducts the level of the C-peptide and the nature of its secretion differed obviously from those in the other groups under study, which testified to disturbances in the homeostai mechanisms.

[Cystic tumors of the pancreas]. / Kistoznye opukholi podzheludochnoi zhelezy.

Thirty-three patients were operated on for cystic tumors of the pancreas at the Vishnevsky Institute of Surgery in 1980-90. Cystadenoma of the pancreas was found in 16 (48.5%) of them and cystadenocarcinoma in 15 (45.5%). Fifteen (45.5%) patients had been previously operated on in different institutions presumably for a "cyst" of the pancreas, 6 of them repeatedly; the tumor recurred rapidly in all of them. In the Institute 30 patients underwent radical operations: 30 distal resection of the pancreas and 5 pancreatoduodenal resection. Diagnostic and palliative manipulations were performed on 3 patients. Postoperative lethality was 9.1% (3 patients). Postoperative follow-up periods lasted from 12 months to 9 years. Dissemination of the tumor occurred in 2 patients two years after the operation. The remaining 25 patients are alive and capable of working.

[Problems in the surgical treatment of pancreatic chronic diseases]. / Problemy khirurgii khronicheskikh zabolevanii podzheludochnoi zhelezy.

The work analyses the results of 999 operations on the pancreas conducted in 861 patients with chronic oncological and nonneoplastic diseases of the gland. Pancreatoduodenal resection (PDR) was performed in 171 patients (for tumors of the pancreaticoduodenal zone in 151 and for chronic pancreatitis of the head of the gland in 20) in 13 of them a modified operation with preservation of the stomach and pylorus was carried out. The late-term results were satisfactory in both groups of patients, the survival of oncological patients was much higher after radical operations then after palliative surgery. Total duodenopancreatectomy has no advantages over PDR and should be undertaken only when there are strict indications. In chronic pancreatitis, complicated also, preference was given to organ-preserving interventions, primarily to draining operations, which preserve more fully pancreatic exocrine and endocrine functions: longitudinal pancreatojejunostomy was conducted in 106 patients, internal drainage of pancreatic cysts in 184, and occlusion of external pancreatic cysts in 70 patients. It is advisable that the most complicated, particularly repeated and reconstructive, operations on the pancreas are carried out at specialized centers in which the problem of surgical diseases of the pancreas is studied more closely.

[Morphological reaction of various tissues and organs on the administration of the occluding material "Rabrom"]. / Morfologicheskaia reaktsiia razlichnykh tkanei i organov na vvedenie okklioziruiushchego materiala "Rabrom".

A new occlusive X-Ray opaque antibacterial substance of biological origin was experimented on rats and dogs. The substance was administered intraperitoneally, intrahepatically and on the soft tissues of the limbs. Morphological studies conducted showed accumulation of macrophages.

[Surgical treatment of patients with chronic calculous pancreatitis]. / Khirurgicheskoe lechenie bol'nykh khronicheskim kal'kuleznym pankreatitom.

The article discusses experience in the examination of 109 patients with chronic calculous pancreatitis (CCP), 102 of them were treated by operation (a total of 130 operations were carried out). Calculous cholecystitis was a consequence of alcohol intake in 102 cases, and was due to other causes in 7 cases. In 71% of cases CCP was attended by the development of indirect signs of pancreatic hypertension and in 45.1% by pancreatic cysts. Operations for internal (h = 49) and external-internal (n = 27) drainage were most pathogenetically justified. The mortality after these operations was 2%. The total postoperative mortality was 6.9%, mortality in the late-term periods was 8.8%. Unfavourable late-term results were encountered in individuals who continued drinking alcohol as well as in inadequate drainage of the pancreatic duct system.

[A method of pancreato-duodenal resection and total duodeno- pancreatectomy]. / Metodika pankreatoduodenal'noi rezektsii i total'noi duodeno- pankreatéktomii.

During 1975-88 the staff of the Vishnevskii+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.

[Occlusive pancreatojejunoanastomosis in pancreatoduodenal resection]. / Okkliuzionnyi pankreatoeiunoanastomoz pri pankteatoduodena'lnoi rezektsii.

A technique for creation of occlusive pancreatojejunoanastomosis (OPJA) in pancreatoduodenal resection was used in 7 patients. Uncomplicated course of the postoperative period was noted in 6 of them. The indications for formation of the OPJA are substantiated by the experience with 32 pancreatoduodenal resections with pancreatojejunoanastomosis formation, and 47--with occlusion of the pancreatic stump.