No abstract

Over the last decade, the issue of treatment of acute necrotizing pancreatitis has been requiring special attention because of the growth of this pathology worldwide and high mortality from it, especially with extended infected types of the disease.The aim of the research was to improve results of treatment of patients with nonbiliary necrotizing pancreatitis by optimizing of the surgical tactics, which depend on the extent of necrosis in the pancreas and peripancreatic fat. Materials and methods.The study analyzed results of treatment of 220 patients with acute nonbiliary necrotizing pancreatitis, who were hospitalized in the clinic from 2014 to 2016. The age of the patients ranged from 18 to 80 years, including patients under the age of 50, who accounted for 54 %. Comparison of qualitative features was carried out through analysis of conjugacy tables, using the χ² Pearson criterion (Pearson Chi-square). For four-field tables (for 1 degree of freedom), the Yates's correction was used. When comparing the groups, the level of statistical significance (P) was calculated. At P < 0.05, the differences were considered statistically significant. Results.The research argues that mortality depends not only on the extent of pancreatic necrosis, but also on the choice of method of surgical intervention. Use of puncture-draining operations under ultrasound control and lumbotomy made it possible to reduce postoperative mortality from lesser sac abscess from 6.5 % to 3.9 %, from retroperitoneal phlegmon -from 31.6 % to 15.8 %, and from their combination -from 60.0 % to 33.3 %. In cases of diffuse purulent peritonitis, mortality from laparostomy combined with the programmed sanitation of the abdominal cavity was 40 %; it included cases when carbapenem antibiotics (imipenem/cilastatin, and meropenem) were used in the complex treatment, accounting for 33.3 %, and cases of implementing laparostomy, sanitation, and drainage of the abdominal cavity, making 50 %. Conclusions.The more extensive use of puncture-draining operations under ultrasound control and lumbotomy, as well as laparostomy in combination with the programmed sanitation of the abdominal cavity, allowed to reduce mortality from 26.1 % to 12.1 %.Порівняльне оцінювання різних способів хірургічного лікування небіліарного некротичного панкреатиту О. В. Розенко, Д. М. Синєпупов, А. М. Сорокін Мета роботи -поліпшити результати лікування хворих на небіліарний некротичний панкреатит шляхом оптимізації хірургічної тактики залежно від поширеності некрозу в підшлунковій залозі та парапанкреальній клітковині.Матеріали та методи. Проаналізували результати лікування 220 пацієнтів із гострим небіліарним некротичним пан-креатитом, які перебували на стаціонарному лікуванні у клініці з 2014 до 2016 року. Вік пацієнтів -від 18 до 80 років, 54 % хворих були віком до 50 років. Якісні ознаки порівнювали за допомогою аналізу таблиць спряженості за допо-могою критерію χ² Пірсона (Pearson Chi-square). Для чотирипільних таблиць (для 1 ступеня свободи) використовували поправку Йейтса (Yates's ...

Background: Subdural migration of epidural catheters is well known and documented. Subdural placement of intrathecal catheters has not been recognized. Two cases of sudural placement of intrathecal catheters are presented. Objective: The possibility of subdural migration of epidural catheters and its manifestations has been well documented. The following 2 cases demonstrate that intrathecal catheters can enter the subdural space upon placement. Case Reports: The first case is a 52-year-old male with multiple sclerosis receiving a pump for intrathecal baclofen. It worked well for 10 years, but after 2 months of inadequate relief despite a 2-fold increase in baclofen, the catheter was imaged. The catheter pierced the arachnoid in the lower thoracic spine and tunneled subdural. It then pierced the arachnoid again, re-entering the cerebrospinal fluid (CSF) in the cephalad portion of the thoracic spine. Over time, the tip became covered with tissue, preventing direct CSF communication and causing subdural drug sequestration. The second case is a 54-year-old male with chronic bilateral lower extremity pain having a pump placed for pain control. Because of inadequate relief after implantation, the catheter was imaged. It pierced the arachnoid at L4-L5 but became subdural at T12-L1. At the time of surgical revision, the catheter was pulled back to L2. Repeat imaging showed it to be entirely subarachnoid, and analgesia was restored. Conclusions: These cases differ from others in the literature because the catheter was apparently subdural at the time of initial implantation. As these 2 cases demonstrate, this placement may manifest immediately, but it may remain undetected for a prolonged period. Initial subdural placement should be considered along with catheter migration into the subdural space in the differential of a malfunctioning pump. Key words: intrathecal catheter, subdural, migration