Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique).

PURPOSE: The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids. MATERIALS AND METHODS: Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction. RESULTS: No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization. CONCLUSION: Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies.

DIAGNOSTIC VALUE OF THE INTEGRAL HEMATOLOGICAL INDEXES AND CHEMILUMINESCENCE OF NEUTROPHILS IN SEVERE ACUTE PANCREATITIS.

Research aim is estimation of dependence between integral hematological indexes and chemiluminescence of neutrophils at severe acute pancreatitis. MATERIALS AND METHODS: The 70 patients with acute pancreatitis were examined, severity of disease were reviled based on integral score Ranson, results of clinical and laboratories examinations, diagnosis was confirmed by instrumentals methods of diagnostics. Patients were divided into two clinical groups: 35 patients with no severe acute pancreatitis and 35 patients with severe acute pancreatitis. Integral hematological indexes were calculated based on results of clinical blood test. Functional activity of neutrophils were estimated by chemiluminescence analysis, activator of reaction was luminal. RESULTS: Severe acute pancreatitis was characterized by lowering of intensity chemiluminescence with prevalence hypoxic type of active oxygen's generation 94,28% patients. High negative correlations between integral indexes of inflammatory reaction and degree of endotoxicosis (Kaif - Kalif's leukocytal index of intoxication, index of correlation between neutrophils and lymphocytes, G.D. Dashnayahtsa nuclear index and reactive response of neutrophils) and indexes of chemiluminescence reaction, which show type of active oxygen's generation (intensity of reaction and peak reaction time) were revealed. It allowed talking about high degree of oxidative stress at expressed inflammatory and necrotic process in pancreatic tissue. Decrease of antioxidant resources against a background expressed pathologic process at severe acute pancreatitis was confirmed by High negative correlations between N index of correlation between neutrophils and square under curve of chemiluminescence reaction (-0,62, p=0,001 at spontaneous reaction and -0,72, p=0,001 activated).

[Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition].

OBJECTIVE: 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 exami- nation, 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 (Ac), 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%, PPV--100%, NPV--96.29%) and APACHE II (Sp--100%, PPV--100%, NPV--97.21%), for prediction of lethality--MODS 2 (Se-- 100%, Sp--98.14%, NPV--100%) and APACHE II (Se--95.00%, NPV-.99.86%). CONCLUSION: Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow and BISAP Scoring systems MODS 2, APACHE I high specificity and positive predictive value allow using it at clinical practice.