Main Article Content
The aim of the study was clinical and laboratory evaluation of the effectiveness of traditional and optimized therapeutic and diagnostic technologies in acute pancreatitis of biliary etiology in diabetic patients with diabetes mellitus. Materials and methods. The article analyzes the results of treatment of 122 diabetic patients with acute biliary pancreatitis. Laboratory analysis was conducted within the monitoring cytopathic hypoxia markers, depending on the morphological forms of acute pancreatitis and effectiveness of optimized and traditional standard therapy. Results. The results indicate that acute pancreatitis of biliary etiology in diabetic patients was accompanied by a consistent pattern of imbalance in the cytopathic hypoxia system, which is determined by the severity of the pancreatic morphological changes. Interstitial form was accompanied by high levels of carbonyl group by 30.7 %, 38.75 % for adenosine deaminase and decreased level of arginine to 18.05 %; localized pancreatic necrosis was characterized by increased endothelial dysfunction markers (nitrates and nitrites to 18.35 %, homocysteine 52 %); diffuse pancreatic necrosis was characterized by increased markers of stimulated catabolism of purine nucleotides (xanthine and hypoxanthine to 85.2 %); subtotal-total pancreatic necrosis — increased levels of relative enzymes (xanthine oxidase and xanthine dehydrogenase) to 44.39 %. Pattern dynamics violations of cytopathic hypoxia markers allows use them as the predictors of functional liver failure and multiple organ failure in diabetic patients with necrotic forms of acute biliary pancreatitis. Conclusions. Standard treatment methods do not allow effectively correct cytopathic hypoxia, endotoxemia and hepatic failure. Proposed optimized complex of conservative therapy allow effectively and timely correction them, namely in the interstitial form on day 4, localized pancreatic necrosis on day 7, diffuse pancreatic necrosis on day 10, subtotal-total form on the 14th day after the medical treatment started. Supplementation of standard treatment regimens for the edematic form of acute pancreatitis with a systemic multifunctional metabolic corrector allow impact the homeostatic disorders caused by enzyme toxemia, in particular metabolic and ischemic-reperfusion mechanisms of hepatic dysfunction formation that, under the condition of destructive forms, requires additional drugs of low molecular weight heparins for the recovery of hemorheological features at at the systemic and intraorgan levels.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Demidov VM, Demidov SM. Expansion of diagnostic arsenal for professionals in the terms of suspicion of acute inflammatory process. Hirurgiya Ukrainy. 2013;4(48):213-20. (in Ukrainian).
Zaporozhchenko BS, Muravyov PT, Gorbunov AA, et al. Metabolic correction approaches in the surgical holiatry of patients with the complicated acute destructive pancreatitis. Medychni perspektyvy. 2012;17(1):73-6. (in Ukrainian).
Miminoshvili OI, Antoniuk OS, Ukrainskiy VV, Yaroshak SV, Nesterenko AF. Prevalence and clinics of disfunction and insufficiency of different organs at acute pancreatitis. Medychni perspektyvy. 2012;17(1):84-7. (in Russian).
Iftodiy AH, Hrebeniuk VI, Bilyk OV, Bilookyj OV, editors. Optimіzacіja dії protimіkrobnih preparatіv u kompleksnomu hіrurgіchnomu lіkuvannі zapal'nih procesіv pozapechіnkovih zhovchnih protok ta pіdshlunkovoї zalozi [Optimization of action of antimicrobial preparations in the surgical holiatry of inflammatory processes of extrahepatic bilious channels and pancreas]. Chernivtsi: Bukrek, 2014. 312 p. (in Ukrainian).
Syplyvyj VO, Robak VI, Yevtushenko DV, et al. Surgical treatment of acute necrotizing pancreatitis: criteria that determine the results of treatment. Visnyk Vinnytskogo natsional’nogo medychnogo universytetu. 2014;18(1):136-9. (in Ukrainian).
van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254-1263. PMID: 21741922. doi: 10.1053/j.gastro.2011.06.073.
Rüttinger D, Kuppinger D, Hölzwimmer M, Zander S, et al. Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions and of the duration of surgical therapy. Am J Surg. 2012;204(1):28-36.
Fitz S, Hackert T, Hartwig W, Rossmanith F, Strobel O, et al. Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg. 2010;200(1):111-7. PMID: 20637344. doi: 10.1016/j.amjsurg.2009.08.019.
Davis P, Hayden J, Springer J, Bailey J, Molinari M, Johnson P. Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery. Can J Surg. 2014;57(2):44-52. PMID: 24666459. doi: 10.1503/cjs.006413.