[Clinical significance of the procalcitonin test in differential diagnosis of systemic inflammatory reaction in pancreatonecrosis]. / Klinicheskaia znachimost' prokal'tsitoninovogo testa v differentsial'noi diagnostike sistemnoi vospalitel'noi reaktsii pri pankreatonekroze.

The significance of procalcitonin test (PCT) in the differential diagnosis of sterile and infectious pancreonecrosis was evaluated. Twenty-four patients with destructive pancreatitis were examined. Plasma procalcitonin concentrations were increased in the patients with infectious pancreonecrosis and correlated with the clinical status of patients evaluated by APACHE II and SOFA scores. The sensitivity and specificity of this test in the diagnosis of infectious pancreonecrosis were 84.4 and 83.3%, respectively, its prognostic significance being as high as 93.1%. Plasma concentrations of procalcitonin in sterile pancreonecrosis were normal or slightly increased. These results indicate that measurement of procalcitonin concentrations is an optimal laboratory test for differential diagnosis of sterile and infectious pancreonecrosis. PCT helps determine the treatment strategy in patients with various forms of destructive pancreatitis.

[Efficacy of pefoxacin (abactal) in the complex treatment of patients with pancreonecrosis]. / Effektivnost' pefloksatsina (abaktala) v kompleksnom lechenii bol'nykh s pankreonekrozom.

The efficacy of pefloxacin in the complex treatment of 28 patients with pancreatonecrosis of various etiology was estimated in a prospective trial. The diagnosis of pancreatonecrosis was verified by the data of the disease clinical progress, laboratory findings and instrumental examination. Pefloxacin (Abactal; LEK) was administered intravenously in a dose of 400 mg every 8 hours (1200 mg) in combination with metronidazole in a dose of 1.5-2.0 g a day intravenously. When indicated 3 days after the start of the pefloxacin therapy, the treatment was switched to the oral use of the drug in the same dosage. The positive clinical effect (cure and improvement) at the end of the treatment with pefloxacin was stated in 78 per cent of the patients in spite of the initial severity state of above 15 APACHE II. It was shown that in the treatment of patients with pancreatonecrosis when the severity state was not above 12 APACHE II the antibacterial therapy with pefloxacin in combination with metronidazole was optimal.

[Evaluation of the effectiveness of various protocols of antibiotic prophylaxis and therapy in pancreatic necrosis]. / Otsenka éffektivnosti razlichnykh rezhimov antibakterial'noi profilaktiki i terapii pri pankreonekkroze.

The efficiency of various protocols of antibiotic prophylaxis and therapy (APT) used in 63 patients with pancreonecrosis is analyzed. Early treatment with carbapenemes is the most effective in disseminated infectious pancreonecrosis requiring obligatory surgical treatment. Drug efficiency is the key factor in choosing APT for intensive care of patients with destructive pancreatitis.

[The role of antibacterial prophylaxis and therapy in pancreonecrosis]. / Rol' antibakterial'noi profilaktiki i terapii pri pankreonekroze.

The research of efficiency of different antibacterial prophylactic and therapy procedures among 89 patients suffering destructive pancreatitis is presented in the article. Determined that optimized tactics of antibacterial prophylactic and therapy with using of such medicines like carbapenems have the important value in cardinal improvement of the results of multi-stage surgical and intensive treatment of the patients suffering pancreonecrosis.

[Inflammatory reaction and sepsis in pancreatic necrosis]. / Sistemnaia vospalitel'naia reaktsiia i sepsis pri pankreonekroze.

Analysis of clinical data, results of treatment, and the development of systemic inflammatory reaction (SIR) in 100 patients with sterile or infective pancreonecrosis and pancreatogenic necrosis demonstrated a phase-wise pattern in the development of inflammatory and septic process in pancreonecrosis. The development of inflammation and sepsis in such patients is determined by the extent of involvement, infection of necrotic zone, and disease duration. SIR, shock, and polyorgan failure are the cardinal components in the pathogenesis of various phases of pancreonecrosis. Detection of signs of SIR and sepsis are needed for individual and urgent evaluation of patient's state. The scale for evaluating the severity of patient's physiological condition and index of involvement of abdominal and retroperitoneal organs are the most accurate, sensitive, and quantitative characteristics for evaluating the patient's condition and the course and outcome in pancreonecrosis.

[Blood fibronectin and liver phagocytic function in peritonitis patients]. / Fibronektin krovi i fagotsitarnaia funktsiia pecheni u bol'nykh peritonitom.

The concentration of blood fibronectin and the state of the phagocytic function in the liver was studied in 19 patients with an emergency pathology of the abdominal cavity complicated by the infective-toxin shock and polyorganic insufficiency. Patients with severe abdominal pathology had a considerably decreased level of circulating fibronectin, disturbed phagocytic function of the liver and development of the hypercatabolic state. Hypofibronectinemia was accompanied by polyorganic disorders, systemic bacteriotoxemia and disseminated intravascular coagulation. Causes of hypofibronectinemia and its role in pathogenesis of systemic complications in patients with emergency abdominal pathology are discussed.

[Effect of intestinal decompression with intubation on portal and systemic bacteremia in patients with peritonitis]. / Vliianie zondovoi dekompressii kishechnika na portal'nuiu i sistemnuiu bakteremiiu u bol'nykh s peritonitom.

Examination of 55 patients, who underwent operation for generalized peritonitis of various etiology, included comparative appraisal of the degree of portal and systemic bacteremia and the leukocytic index of intoxication in patients with and those without nasointestinal intubation. It was found that the microflora of a paretic intestine was one of the most important factors of intoxication in patients with peritonitis in the postoperative period. Nasointestinal intubation in this case proved to be an effective method for reducing the degree of portal and systemic bacteremia and ensured a significant decrease of the degree of intoxication as compared to that in the control group.

[THe role of portal bacteremia and endotoxinemia in the pathogenesis of multiple organ failure in peritonitis]. / Rol' portal'noi bakteriemii i éndotoksinemii v patogeneze poliorgannoi nedostatochnosti pri peritonite.

The indices of portal bacteremia and endotoxinemia, parameters of metabolism, hepatic hemodynamics, the phagocytic function of the liver and leukocyte reaction were studied in 13 patients with diffuse peritonitis of different etiology. Close interconnections of the level of portal toxemia is shown with the degree of activation of the phagocytic function of the liver, changes in hepatic hemodynamics, degree of metabolic disturbances playing an important role in pathogenesis of polyorganic insufficiency as well as the role of leukocytic reaction in microendocrinous regulation of metabolism in peritonitis.

[Metabolic disorders in peritonitis: hemodynamic or cellular disorders?]. / Narusheniia metabolizma pri peritonite: gemodinamika ili kletka?

Systemic and hepatic hemodynamics, gas exchange, acid-base balance in blood from the artery, portal, hepatic and peripheral veins were examined in 113 patients with diffuse peritonitis varying etiologically. In view of adequate tissue perfusion and oxygen transport revealed it is suggested that causes of metabolic derangement arising in peritonitis and responsible for multiple organ insufficiency should be searched into at the level of intracellular metabolism.