Apolipoproteins as predictors of cardiovascular risk in patients with chronic pancreatitis.

OBJECTIVE: Patients with pancreatic diseases are at increased risk of cardiovascular events. Investigating various apolipoprotein forms as important atherogenesis components may improve cardiovascular risk (CVR) prediction. This study aimed to investigate CVR factors in patients with chronic pancreatitis. PATIENTS AND METHODS: The study enrolled 70 patients (40 males and 30 females, mean age 55.2 years) with chronic pancreatitis and treated pancreatic exocrine insufficiency. We assessed CVR by apolipoproteins A-I, A-II, B, and C-III, lipid profile; score systems [SCORE risk chart and Framingham Risk Score (FRS)], diabetes mellitus; chronic pancreatitis by M-ANNHEIM classification. Statistics were performed via SPSS v. 22. RESULTS: Low apolipoprotein A-I and high apolipoprotein B levels with increased atherogenic potential were observed in 37 and 26 patients. 45.71% demonstrated a high risk of myocardial infarction with high apolipoprotein B/apolipoprotein A-I ratio. Men are at higher CVR risk. Apolipoproteins A-I and A-II correlated with the cardioprotective high-density lipoprotein (HDL) in contrast to apolipoproteins B and C-III, which correlated strongly with low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG). Increased CVR assessed by FRS correlated with significantly lower apolipoprotein A-I and higher apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. With the increase in chronic pancreatitis severity, we observed decreased apolipoproteins and increased apolipoprotein B/apolipoprotein A-I ratio. CONCLUSIONS: Apolipoproteins are valuable CVR indicators. Further studies are required to establish a CVR screening panel in this population.

Screening for Helicobacter pylori infection and Clarithromycin resistance using Real-Time Polymerase Chain Reaction.

OBJECTIVE: Helicobacter pylori (H. pylori) infection is spread worldwide and affects at least half of the world's population. Infected people are at increased risk of several diseases' development, including gastric adenocarcinoma. The aim of this study was to screen patients with dyspeptic symptoms for H. pylori infection and assess Clarithromycin resistance prevalence among the infected patients. PATIENTS AND METHODS: Screening for H. pylori infection was performed in all patients using molecular test based on Real-Time Polymerase Chain Reaction (RT-PCR) in feces after RNA-DNA extraction. Stool samples from all participants were collected 1 to 3 days after patients' hospitalization. The positive results were furthermore assessed for confirmation by breath test and stool antigen test. By point mutations detection in 23S rRNA gene was possible to detect Clarithromycin resistance. Statistical analysis was performed via SPSS 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: This study enrolled 50 patients (18 males) at mean age 46.46±15.10 years. Using molecular test based on RT-PCR in feces we identified H. pylori infection in 24 patients (48.00%). Clarithromycin resistance was observed in 7 of them (29.17%). None of those patients was eradicated before. There was no significant difference by age and gender between infected and non-infected patients. Gastrointestinal symptoms were more often reported in infected patients (p<0.05). The molecular test showed 85.71% sensitivity and 100% specificity, with a diagnostic accuracy of 92.00%. CONCLUSIONS: H. pylori screening by molecular test based on RT-PCR in feces might be beneficial as the test's accuracy is high and include Clarithromycin resistance assessment, which could improve the outcome of eradication therapy.

Macroscopic and microscopic fluorescence spectroscopy of colorectal benign and malignant lesions - diagnostically important features.

Fluorescence spectroscopy is a sensitive, fast and non-invasive tool for a diagnostics of cancerous gastrointestinal lesions. It could be applied for in situ detection of tumours during primary endoscopic observations or as add-on measurement modality during microscopic observations of tissue histology slides for their initial or retrospective diagnosis. Therefore, we are looking for diagnostically important features of normal and cancerous tissue areas in a broad spectral range for gastrointestinal tissues ex vivo using two steady-state macroscopic fluorescent spectroscopic modalities and by confocal fluorescent microscopic detection. Results obtained from autofluorescence spectroscopy of benign and malignant lower part gastrointestinal tract (GIT) lesions from freshly excised tissues during surgical removal of the lesions in 18 patients (22 lesions), were compared with the spectral measurements obtained during confocal fluorescent microscopy observations of unstained tissue slides using 405 nm excitation. Excitation-emission matrices (EEMs) were used for ex vivo measurements with applied excitation in 280-440 nm spectral region and emission observed between 300 and 700 nm. Synchronous fluorescence spectroscopy (SFS) approach was also applied to improve the spectral resolution of the observed complex emission spectra. Specific fluorescent features observed, related to presence of structural proteins, co-enzymes and endogenous porphyrins in the tissues investigated, allow discriminating normal mucosa from benign polyps and malignant carcinoma lesions with diagnostic accuracy up to 94.4%.

Comparison of three urease tests for detection of Helicobacter pylori in gastric biopsy specimens.

OBJECTIVE: To propose two modified urease tests for the detection of Helicobacter pylori in gastric biopsy specimens. PATIENTS AND METHODS: The presence of H. pylori infection was determined in 237 patients undergoing upper gastrointestinal endoscopy. Three media were used for the urease tests: Christensen's 2% urea broth and two urea agar media, modified by increasing the concentration of urea (to 4% and 10%) and phenol red and omitting the nutrients. RESULTS: The modified tests had good sensitivity (> 78%), specificity (96%) and accuracy (> or = 86%) at 2 h using small amounts (15%) of biopsy homogenates. They were statistically more sensitive and accurate than Christensen's broth. CONCLUSION: Both the modified 4% and 10% urea agar tests are simple, sensitive and specific and can be performed with small amounts of sample.

Quantitative assessment of severity of biliary tract infection.

BACKGROUND/AIMS: It is very important for physicians to evaluate the severity of the biliary infection. At the moment, there is no useful quantitative system. In this study, we propose a scoring system for assessing the severity of biliary infections and evaluation of the efficacy of antibacterial and endoscopic treatments. MATERIALS AND METHODS: We created a biliary tract infection score (BTIS) including local physical and ultrasound findings, signs of inflammation and hepatobiliary involvement. The BTIS was calculated in 317 patients: group I-155 pts with cholecystitis and cholangitis, treated only by antibiotics and group II-162 pts with acute cholangitis treated by endoscopic procedures. RESULTS: The BTIS allowed the differentiation of the severity of biliary infections: 15.50 +/- 0.52 in acute cholangitis group and 5.77 +/- 2.79 in group I (p < 0.001). The BTIS significantly decreased after antibacterial therapy (excluding only the cefotiam subgroup) and in endoscopicaly treated patients. CONCLUSIONS: The BTIS is a combination of simple, reliable, acceptable and low cost parameters, reflecting the principal pathological processes and degree of abnormalities. A BTIS facilitated the assessment of severity of biliary infection and comparison of the results of various methods of treatment.

[The dynamics of psychologic distress in patients with maxillofacial and laryngeal malignancies]. / Dinamika narushenii psikhicheskogo statusa u bol'nykh so zlokachestvennymi novoobrazovaniiami cheliustno-litsevoi oblasti i gortani.

The study of psychological dynamics involved in malignancies of the maxillofacial area and larynx included 38 male patients (tumors in maxillofacial area--26; neoplasia of larynx--12). Patients were given different regimens of radiation and radiotherapy; 11 were operated on. Psycho-disorders induced by tumor disease and admission to cancer ward were reported in 35 (92%). With time, such disorders were progressively overshadowed by somato-psychic changes, with asthenic syndrome prevailing, and subsequently psychopath-like features developed. Psycho-organic syndrome was registered in 16 patients as they were approaching terminal stage.

[X-ray generator model URP-125/1000 for the Roentgen-50-2 and Roentgen-100T diagnostic systems]. / Rentgenovskii generator URP-125/1000 dlia diagnosticheskikh kompleksov "Rentgen-50-2" i "Rentgen-100T".

Basic specifications of a power supply model URP-125/1000 are as follows: automatic operation, asynchronous switching, operation of the main circuit following external characteristics, contactless regulation of the anode current, stabilization of the anode voltage while taking roentgenogram. These features allow automatic examination, improved diagnostic accuracy, and simplified design of the units. Stringent requirements are imposed upon reliable and accurate control of the filament voltage.

[Surgical methods of preventing aorto(prosthesis)intestinal erosions and fistulae in surgery of the abdominal aorta and its branches]. / Khirurgicheskie sposoby profilaktiki aorto(protezno)-kishechnykh érozii i fistul pri operatsiiakh na briushnoi aorte i ee vetviakh.

An analysis of 72 reconstructive operations on the abdominal aorta (in 5 cases shunts of the celiac trunk and superior mesenteric arteries were performed) fulfilled by the authors has shown that in order to prevent the development of the aorto(prosthetic)-intestinal erosions and fistulas and possible extension of the inflammatory process to the synthetic prostheses from the adjacent organs it is necessary to use the corresponding technical means and the following methods of protection of anastomoses and vascular transplants: protection of the prosthesis by local tissues or greater omentum flaps, selection of the corresponding diameter and length of the prosthesis.

Intraperitoneal perfusion chemotherapy with hyperthermia in some malignant ascites.

Intraperitoneal administration of chemotherapeutic drugs with hyperthermia (HIPEC) increases their local effect on malignant peritoneal diseases and reduces systemic cytotoxicity. The most commonly used are cisplatin, doxorubicin, and mitomycin C. A major disadvantage of intraperitoneal chemotherapy is limited penetration of the drug in the tumor lesion depth (1-3 mm). Extended exposure and increased pressure in the abdominal cavity solution increases penetration of the agent into the tumor and hyperthermia has synergy with cytostatic agent on the permeability of cell membranes and metabolism of the drug. Real clinical hyperthermia is achieved at 41 degrees C. Of greatest importance is the concentration of the drug, but crucial for the prognosis is complete cytoreductive surgery. A major disadvantage of the closed technique is the uneven distribution of the perfusion solution in the peritoneal cavity, and the main advantage is better control of the perfusion, keeping of constant hyperthermia of the solution and regular repetition of manipulation, like intravenous chemotherapy. Laparoscopy determines the stage of the tumor process, refines the indications and preoperative selection for HIPEC, monitors the effects of treatment and determines locations for introducing catheters. In the review the results of the inraperitoneal chemotherapy with hyperthermia in gastric, colorectal, ovarian and other cancers are discussed as well as in diffuse malignant peritoneal mesothelioma and others.

Open core control software for surgical robots.

OBJECT: In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge "intelligent surgical robot" will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are "home-made" in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. MATERIALS AND METHODS: In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a "force guide" for supporting operators to perform precise manipulation by using a master-slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. RESULTS: The Open Core Control software was implemented on a surgical master-slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a "force guide" on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. CONCLUSION: In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement "General Principles of Software Validation" or IEC62304. For following these regulations, it is important to develop a self-test environment. Therefore, a test environment is now under development to test various interference in operation room such as a noise of electric knife by considering safety and test environment regulations such as ISO13849 and IEC60508. The Open Core Control software is currently being developed software in open-source manner and available on the Internet. A communization of software interface is becoming a major trend in this field. Based on this perspective, the Open Core Control software can be expected to bring contributions in this field.

The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions.

The aim of this study was to examine if cessation of smoking after surgical excision of oral potentially malignant lesions in smokers reduced the risk of recurrences, development of new lesions or malignancies. 51 patients with oral leukoplakia or erythroplakia were included. They were daily smokers at the time of diagnosis and were treated surgically. Patients were advised to quit smoking at each visit. The change of smoking habits and occurrence of unfavorable events were noted during follow-up. Descriptive statistics, Fischer's exact test, Kaplan-Meier curves with log-rank test, and Cox proportional hazards model were used for analysis. 16 patients (31%) quit smoking during the observation period. Only one quitter (6%) developed recurrence compared with 11 continuing smokers (33%) (p<0.05). There were no new lesions and no malignancies among quitters compared with 8 new lesions (p<0.05) and 5 carcinomas (p>0.05) in continuing smokers. Multivariate analysis showed continuing smoking to be the most significant factor for occurrence of unfavorable events, OR 23.7. In conclusion, cessation of smoking significantly reduced the risk of unfavorable events after surgical treatment of oral potentially malignant lesions in smokers.

[The endoscopic treatment of large calculi in the choledochus. The preliminary results with intracorporeal electrohydraulic shock-wave lithotripsy]. / Endoskopsko lechenie na golemi kamuni v kholedokha. Predvaritelni rezultati s intrakorporalna elektrokhidravlichna shokovovulnova litotripsiia.

Results are reported of endoscopic treatment of: 236 patients with common bile duct calculi treated by endoscopic sphincterotomy with or without hydrostatic balloon extraction and extraction of the calculi, mechanical lithotripsy and endoprosthesis; preliminary results in 12 patients treated by intracorporeal electrohydraulic lithotripsy. Complete removal of calculi from the common bile duct was achieved in 171 of 236 sphincterotomized patients (72 per cent). Complications were observed in 11 per cent of the patients. Mechanical cracking of common bile duct calculi was realized in 60 of 65 patients (92 per cent) with complications observed in 3 per cent. Thus, with the use of mechanical lithotripsy the success of endoscopic treatment rose to 98 per cent, without increase in the incidence of complications. Seven patients had endoprostheses placed because of failure to extract the calculi. Intracorporeal electrohydraulic lithotripsy was performed in 12 patients with common bile duct lithiasis (4 with single and 8 with numerous stones with diameter 20-40 mm. In one patient transient acute pancreatitis was observed. A rise in serum amylase content was recorded in 9 patients. The stones in the common bile duct were effectively broken to pieces and removed in 8 patients. Lithotripsy was unsuccessful in 4 patients, two of whom had solid calcium depositions. In the common bile duct of the other two MTBE gas applied. The patients were subjected to repeated lithotripsy with positive effect. It is pointed out in conclusion that crushing stones in the common bile duct allows real improvement of the results of endoscopic sphincterotomy in common bile duct calculosis. Endoscopic treatment of larger calculi became also feasible which until a few years ago were contraindication for endoscopic treatment.

[Atypical anatomical variants and anomalies of the biliary tract in patients with biliary tract and pancreatic diseases. II. Endoscopic treatment]. / Atipichni anatomichni varianti i anomalii na zhuchnite putishta pri bolni sus zaboliavaniia na zhluchnite putishta i pankreasa. II. Endoskopsko lechenie.

Results are reported of endoscopic treatment of 79 patients with atypical anatomical variants and anomalies of the bile ducts: common bile duct calculosis (54), stenosing papillo-odditis (8), indurative pancreatitis (2) and bile duct cancer (15). The following endoscopic manipulations have been performed: endoscopic sphincterotomy (72); hydrostatic balloon extraction of calculi (27); hydrostatic balloon dilatation of constricted segments (29); mechanical lithotripsy (15); nasolabial drainage (17) and endoprosthesis (15). Much more difficult was the extraction of calculi from the common bile in the event of atypical anatomical variants and anomalies of the distal portion of the common bile duct (chi 2 = 14.55; p less than 0.001). Treatment resulted in significant reduction of the bilirubin levels (t = 4.13; p less than 0.001), of AP (t = 4.47; p less than 0.001), GGTP (t = 4.07; p less than 0.001); AcAT (t = 5.75; p less than 0.001) and AlAT (t = 5.63; p less than 0.001). Complications occurred in 6 per cent of the patients (acute pancreatitis, cholangitis, hemorrhage). Mortality from endoscopic treatment was 1.3 per cent. Endoscopic methods for treatment are advised as alternative to operative treatment for patients in advanced age and high operative risk.

[The relationship between duodenal diverticula, biliary tract and pancreatic diseases and their endoscopic treatment]. / Vruzka mezhdu duodenalnite divertikuli, zaboliavaniiata na zhluchnite putishta, pankreasa i tiakhnoto endoskopsko lechenie.

Of 570 ERHP performed in patients with biliary tract and pancreas diseases, duodenal diverticuli were found in 67 (11.8 per cent). Diverticuli were more frequently diagnosed in patients beyond 60 years of age (67.2 per cent). In 83.6 per cent the diverticuli were single, mostly measuring 15-30 mm and localized in the peripapillary area (70 per cent). ERHP was successful in 85 per cent. Diverticuli were most frequently accompanied by stenosing papillo-odditis (82 per cent), cholecystitis (67 per cent), common bile duct calculosis (58 per cent), followed by pancreatitis (37 per cent) and cancer of the bile ducts (4.5 per cent). Endoscopic treatment was conducted in 46 cases: endoscopic sphincterotomy, hydrostatic balloon dilation of narrowed segments, hydrostatic balloon extraction of calculi, mechanical lithotripsy, nasolabial drainage and endoprosthesis. Significantly lower was the technical success of endoscopic sphincterotomy (78 per cent) when compared with its performance in patients without diverticuli (99 per cent). In spite of this, complex endoscopic treatment resulted in significant fall of bilirubin level (t = 6.58; p less than 0.0001), of AP (t = 8.15; p less than 0.001), of GGJP (t = 6.99; p less than 0.0001), of AcAT (t = 7.14; p less than 0.01). The incidence of complications (6.5 per cent) was not higher than the one observed in patients without diverticuli. In conclusion, endoscopic treatment of bile duct diseases is recommended to be performed also in patients with diverticuli, especially in adult patients and in those exposed to increased operative risk.

[Endoscopic treatment of cholangitis via an external nasobiliary drain]. / Endoscopsko lechenie na kholangita chrez vunshen nazobiliaren drenazh.

The acute suppurative cholangitis is an acute emergency condition requiring quick decompression of the obstructed bile pathways. The authors present their experience in the treatment of 51 patients by endoscopic sphincterotomy with or without mechanical lithotripsy and extraction of the stones and a nasobiliary drainage for 5 up to 15 days. Technically the manipulation was 100% successful and its therapeutic efficacy was 94.2% including II patients to whom it was performed as a preoperative procedure. In 6 patients (11.8%) a transitory amylase elevation was registered and one patient (2%) developed acute pancreatitis. The treatment was unsuccessful in 6% of the patients--these were patients with severe liver impairment (biliary cirrhosis) and long term cholangitis. The authors recommend the biliary drainage as an emergency and temporary treatment of the acute suppurative cholangitis.

[Transendoscopic mechanical lithotripsy in choledocholithiasis]. / Transendoskopska mekhanichna litotripsiia pri kholedokholitiaza.

When there are large stones in the common bile duct or constrictions of the bile ducts the stones very often cannot pas spontaneously or after an endoscopically performed sphincterotomy. In 54 patients after an unsuccessful attempt to extract the stone with the Dormia-basket endoscopic mechanical lithotripsy was performed followed by balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and securing a bilionasal drainage for prophylaxis of cholangitis. The mechanical lithotripsy was successful in 50 of the patients (92.4%). The jaundice and the cholestasis decreased up to the 10-th day and the cytolytic enzymes became normal. Complications occurred in 2 patients (4%)--hemorrhage up to the 12-th hour after the manipulation. The author recommends, in cases of unsuccessful stone extraction by endoscopic sphincterotomy, the mechanical lithotripsy in combination with balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and nasobiliary drainage for washing the bile ducts, prevention of bile duct occlusion and treatment of cholangitis in cases of unsuccessful extraction by endoscopic sphincterotomy.