[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.

Observation of two-neutrino double-beta decay in 136Xe with the EXO-200 detector.

We report the observation of two-neutrino double-beta decay in (136)Xe with T(1/2) = 2.11 ± 0.04(stat) ± 0.21(syst) × 10(21) yr. This second-order process, predicted by the standard model, has been observed for several nuclei but not for (136)Xe. The observed decay rate provides new input to matrix element calculations and to the search for the more interesting neutrinoless double-beta decay, the most sensitive probe for the existence of Majorana particles and the measurement of the neutrino mass scale.

[Pancreatic pseudocysts in recurrent pancreatitis: traditional and mini-invasive surgery/endotherapy. Problems in the treatment strategy choice].

Introduction of methods of miniinvasive surgery/endotherapy have permitted to widen essentially the possibilities of treatment of complicated recurrent pancreatitis. Miniinvasive interventions on pancreatic gland and neighbor organs, as well as laparotomic interventions, must be regarded not as an alternative, but like interchangeable methods, permitting to improve significantly the treatment outcome in an acute destructive and chronic pancreatitis, including those, which is complicated by a pancreatic pseudocysts formation.

[Papillomatosis of the distal part of the common bile duct associated with adenomatosis of its wall]. / Papillomatoz distal'nogo otdela obshchego zhelchnogo protoka v sochetanii s adenomatozom ego stenki.

A case of papillomatosis of the distal part of the common bile duct in combination with adenomatosis of its wall in a patient aged thirty nine is described. On the basis of data from the literature and their own observations, the authors present different opinions concerning the mechanism of the development of bile duct papillomatosis.

[Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area]. / Osobennosti topograficheskogo vazimootnosheniia golovki podzheludochnoi zhelezy i dvenadtsatiperstnoi kishki i patologiia organov pankreatoduodenal'noi zony.

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.

[Nervous and mental disorders in patients with chronic alcoholic pancreatitis]. / Nervno-psikhicheskie rasstroistva u bol'nykh khronicheskim pankreatitom alkogol'noi étiologii.

Presented are the results of comprehensive CNS examinations in 53 alcoholics with chronic pancreatitis. Related psychopathological and neurological syndromes are specified. Hepatopancreatoduodenal and CNS abnormalities were found directly correlated. The addition of pancreatitis to alcoholism leads to development of encephalomyelopolyradiculoneurotic syndrome.

[Recurrent pancreatitis as a surgical problem]. / Retsidiviruiushchii pankreatit kak khirurgicheskaia problema.

Experience in the treatment of 1498 patients with alcoholic pancreatitis treated with laparotomic and mini-invasive surgeries both in acute and chronic phases of the disease is presented. In 742 patients surgical treatment was multistaged. Re-operations in 17 patients with "chronic purulent pancreatitis", reconstructive surgeries on the pancreas, pancreatic and bile ducts in 84 patients with "head" pancreatitis were most difficult. Percutaneous puncture-catheter procedures for liquid formations in acute phase of pancreatitis were effective as the first stage of treatment to reduce the danger of subsequent laparotomy. Catheterisation of chronic pseudocysts in alcoholic pancreatitis is associated with frequent complications and recurrences and can not be regarded as alternative to internal drainage surgeries. Pancreatic surgeries must guarantee effective correction of intrapancreatic hypertension for prevention of acute pancreatitis recurrences. In acute phase of pancreatitis surgical methods must ensure prevention of symptoms recurrences and pyoseptic complications of pancreatitis.

[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.

[Results of transduodenal papillosphincterotomy and double internal drainage of the common bile duct using the SPP-20 device]. / Rezultaty transduodenalnoi papillosfinkteroplastiki i dvoinogo vnutrennego drenirovaniia obshchego zhelchnogo protoka, vypolnennykh apparatom SPP-20.

The authors discuss the immediate and late results of operations conducted with the [symbol: see text] suturing instrument of their design. It made possible one-stage transduodenal papillosphincteroplasty by application of two rows of tantalum staple sutures with division of the tissue between them--papillosphincterotomy. The authors conducted the operation on 242 patients for benign stenosis of the common bile duct by stones incarcerated in it. In 29 patients the intervention was complemented by the formation of supraduodenal choledochoduodenoanastomosis by means of the same suturing instrument, establishing in this was double internal drainage of the bile ducts. The suturing instrument made the operation easier and atraumatic and provided reliable hemostasis. Immediate postoperative mortality as 1.9%. Transduodenal papillosphincterotomy with the [symbol: see text] suturing instrument produced g od and satisfactory results in 95.2% and poor results in 4.8% of patients; poor late results of double drainage of the choledochus by the authors' method were not registered.

[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.

[Choice of bile-diverting operations in neoplastic obstruction of the distal common bile duct]. / Vybor zhelcheotvodiashchikh operatsii pri opukholevoi neprokhodimosti distal'nogo otdela obshchego zhelchnogo protoka]

Analysis of clinical material of 206 patients with tumor obstruction of the distal part of the common bile duct allowed the conclusion to be made on the expediency of applying endoscopic methods for jaundice correction as the first stage in preparation for the operation (122 patients) and also as the only and final operation (70 patients). Study of the immediate and late-term results of different variants of operations for bile diversion in obstruction of the distal choledochus (203 operations) showed the superiority of the Roux hepaticoejunoanastomosis in which recurrent jaundice due to obstruction of the cystic duct does not occur, as is encountered in creation of a cholecystoejunoanastomosis, and there are no conditions for the development of ascending cholangitis.

[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.

[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.

[Combined internal and external drainage of pancreatic cysts]. / Sochetannoe vnutrennee i naruzhnoe drenirovanie kist podzheludochnoi zhelezy.

The results of combination of the internal and external drainage of pancreatic cysts in 9 patients are presented. Four variants of the external drainage of cysts after cysto-gastrocystojejunostomy are described. A prolonged washing of the cyst in early postoperative period results in the rapid diminishing of the cyst and in prevention of complications and recurrence of the disease.

[Calculous pancreatitis]. / Kal'kuleznyi pankreatit.

On the grounds of 12 observations over calcareous pancreatitis cases (10 of them were operated upon) some problems of etiology and clinical picture of the disease have been considered. The longitudinal pancreatojejunostomy without resection or with distal pancreatic resection, the authors' method included, is accepted as the method of choice. The immediate and late results of this operation are satisfactory.

[Computed tomography in the diagnosis and treatment of surgical diseases of the liver]. / Komp'iuternaia tomografiia v diagnostike i lechenii khirurgicheskikh zabolevanii pecheni.

Surgical diseases of the liver were detected by computed tomography in 110 patients. The aimed percutaneous puncture of focal neoplasms of the liver followed by cytological examination of the aspiration material was performed in 34 patients. The elaboration of puncture techniques of treatment of hepatic cysts and abscesses as well as the preoperative decompression of bile ducts in patients with mechanical jaundice is in progress.

[Clinico-immunologic status and postoperative course of patients with chronic pancreatitis and complicated cholecystitis]. / Kliniko-immunologicheskii status i techenie posleoperatsionnogo perioda u bol'nykh khronicheskim pankreatitom i oslozhnennym kholetsistitom.

Patients with chronic pancreatitis and complicated calculous cholecystitis are known to have considerable disturbances of the immune status of the organism. The complex of preoperative management and postoperative treatment of such patients should include drugs mainly influencing the cell immunity indices.

[Indications for and technic of papillosphincterotomy]. / Pokazaniia i tekhnika papillosfinkterotomii

The authors' experience with 45 papillosphincterotomies, performed for diseases of bile passages and chronic pancreatitis, is reported. The details of the operative technic, employed by the authors, are described. The technic of papillosphincterotomy on a conus-shape sound by means of a "laser scalpel" proved to be the most perfect one. Careful observation of the surgical technic made it possible to gain favourable results--only 1 of 45 operated patients died. Papillosphincterotomy is largely advocated in stenoses and concretions in the large duodenal papilla, strictures of choledocho-duodenoanastomoses, care should be taken not to overwiden indications to the operation concerned.