The given paper describes a case of treating adenocarcinoma of the papilla of Vater diagnosed as the cause after an episode of acute pancreatitis. The etiology of aсute pancreatitis was considered idiopathic until the onset of complaints caused by tumor growth. The volume of radical surgery has changed intraoperatively due to the detection of infected limited necrotic clusters, didn’t diagnosed both laboratory and instrumentally. Pathomorphological conclusion: considering clinical data, low-grade (G3) adenocarcinoma of the major duodenal papilla, which developed from pre-existing tubular villous adenoma of the duodenum or intraampullary papillary neoplasia (IAPN). Predicting the early detection of MNPs after AP episode requires further research by improving imaging techniques, introducing new non-invasive techniques and investigating circulating biomarkers. The scope of surgery for patients with clinically significant complications of tumor growth and identified competing diagnosis at the target site should be individually decided and weighed. Infected pancreatitis in the late stages requires careful diagnosis.

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Objective.To estimate the impact of preoperative biliary decompression inpatients, suffering tumorogenic obturation jaundice, complicated by ascending cholangitis, on development of postoperative complications. Materials and methods. The one-centre retrospective investigation of the treatment results was conducted in 136 patients, suffering tumorogenic obturation jaundice. In 84 patients preoperative biliary decompression was done (Group I). In 52 patients preoperative biliary decompression was not performed (Group II).In all the Group I patients an ascending preoperative cholangitis was diagnosed: in 48 (57.1%) -of the I degree severity, in 36 (42.9%) - of the II degree of severity. In 21 (40.4%) patients of Group II preoperative ascending cholangitis I degree of severity was revealed. Results. Performance of preoperative biliary decompression did not worsen postoperative results, taking into account the postoperative complications structure (p=0.07), but influenced the wound infection development (p=0.01). Additional factors were determined: preoperative ascending cholangitis of I degree (p=0.007) and II degree (p=0.001) of severity; hyperbilirubinemia over 250 mcmol/l (p= 0.03); delay in operative treatment more than by 3 weeks after preoperative biliary decompression (р= 0.02); presence of the antibioticoresistant microflora in a time of preoperative biliary decompression (p=0.009) and at the operation time (p=0.002). Conclusion. Performance of preoperative biliary decompression raises the risk for the wound infection development, but is not the cause for postoperative prognosis worsening, taking into account the postoperative complications structure.

Objective. Determination of impact of combination, consisted of 3% solution of silicon dioxide and antibacterial preparations, on bacterial cultures of S. aureus, P. aeruginosa, E. coli. Materials and methods. Clean cultures of bacteria, kept in Collection of Microorganisms in Department of Microbiology and Immunology of Training–Scientific Centre «Іnstitute of Biology and Medicine» of Taras Shevchenko National University: S. aureus (Rosenbach, 1884), P. aeruginosa (Schröter, 1872; Migula, 1900), E. coli (Migula, 1895; Castellani і Chalmers, 1919) were applied. Action of antibacterial preparations cefoperazon, cefoperazon–sulbactam, ampicillin–sulbactam, amicacin, as well as enterosorbent 3% solution of silicon dioxide, was investigated. In the investigation the impact of antibacterial preparations and silicon dioxide together with antibacterial preparations on test–cultures of bacteria was studied, using broth and agarised medium of Muller–Hinton. Results. The data, obtained in the investigation, trust efficacy of combined application of 3% solution of silicon dioxide, owing sorption capacity, with antibacterial preparations in reduction or elimination of subsequent growth of bacterial test–cultures of S. aureus, P. aeruginosa, E. coli. Combination of 3% solution of silicon dioxide with ampicillin–sulbactam in dilutions 64 and 32 mg/l promotes reduction of the E. coli growth on surface of agarised medium in comparison with the investigation variant without application of 3% solution of silicon dioxide. While polyresistence of P. aeruginosa revealed, 3%solution of silicon dioxide together with cefoperazon–sulbactam in concentrations 8 and 16 mg/l and ceftazidime in concentrations 8, 16, 32, 64 mg/l guarantees bactericidal effect for this microorganism. Growth of P. aeruginosa while application of 3% solution of silicon dioxide in combination with ampicillin–sulbactam in dilutions 8, 16, 32, 64 mg/l was arrested. Application of 3% solution of silicon dioxide in combination with amicacin–sulbactam 16 mg/l inhibits the S. aureus growth, what is observed, when combination of 3% solution of silicon dioxide with amicacin in dilutions 8, 16 mg/l and cefoperazon–sulbactam in dilutions 8, 16 mg/l are exploited. Growth of the microorganism do not evolve in variants of the investigation without 3% solution of silicon dioxide, as well as with him, if amikacin is applied in concentrations 64 and 32 mg/l. Conclusion. The biliary ducts drainage in obturative jaundice of tumoral genesis and subsequent presence of drainage (internal or external) constitute the main risk factors for their colonization by multiresistant microorganisms. At the same time, the biliary ducts drainage in combination with antibioticotherapy is estimated as an urgent method for control of the infection primary focus in an acute cholangitis. Establishing of procedure for application of 3% solution of silicon dioxide in combination with certain groups of antibacterial preparations for microorganisms revealed constitute important measure for bacteriobilia prophylaxis. The further investigations conduction with wider spectrum of antibacterial preparations and 3% solution of silicon dioxide for control of clinically significant species of microorganisms is necessary and perspective.

The aim of the study is to evaluate the clinical characteristics of patients with hypertriglyceride associated acute pancreatitis. A single-center observational study of a series of cases was performed on the basis of the Kyiv Department of Surgery for Liver, Pancreas and Bile Tracts named after V.S. Zemskov in the period from 2018 to 2019. Investigation includes patients with acute pancreatitis and hypertriglyceridemia (the triglycerides level is more than 1.7 mmol/l). Exclusion criteria: patients with acute pancreatitis with normal triglyceride levels, patients with acute pancreatitis with elevated triglycerides, that have not been treated enough. All patients were evaluated by Charlson index of comorbidity, body mass index, alcohol history, relapses and severity of disease. All patients were monitored throughout inpatient treatment, from hospitalization to discharge to home or death. The end point of the study was the discharge of the patient to home after the elimination of the manifestations and complications of acute pancreatitis or death of the patient. The 234 patients who were hospitalized and treated with a diagnosis of acute pancreatitis, 27 patients had hypertriglyceridemia and 3 of them were excluded from the study. The study involved 24 patients. Therefore, the frequency of acute pancreatitis associated with high triglycerides was 11.5% (27/234), with the average level of triglyceridemia was 10.1 ± 2.4 mmol / l (range 5.8 - 13.6 mmol / l) , 75% of patients (18/24) had moderate hypertriglyceridemia (2.3 - 11.2 mmol / l), 25% (6/24) - severe (11.2 - 22.4 mmol / l) . The median age was 32 years (quarterly interval 31.5 - 35 years). There were 18 men (75%) and 6 women (25%). Alcohol-induced pancreatitis was observed in 17 (70.8%) patients with hypertrtiglyceridemia. The median body mass index is 28.9 kg / m 2. Normal weight was 33% (8/24) patients, excessive - 25% (6/24), obesity I stage - 29% (7/24) obesity II stage - 8% (2/24) obesity III stage - 4% (1/24). The Charlson comorbidity index ranged from 0 to 5 points, in 1 patient it was 5 points, in 3 patients - 2 points, in 3 patients - 1 point. Diabetes mellitus were in 25% of patients (6 /24), two of them was diagnosed at first. Recurrent cases of disease were in 58.3% of patients (14 /24), 10 of 14 had a history of two cases of acute pancreatitis. In 71% (17 /24) observed a light stage of the disease, 25% (6 /24) - pancreatitis medium degree of severity and in 4% (1 /24) of the patient severe pancreatitis. Mortality was 4%. Conclusions. The frequency of hypertriglyceride-associated acute pancreatitis is 11.5%. In light, moderate and severe pancreatitis, the average degree of hypertriglyceridemia (blood triglycerides 2.3 -11.2mmol/l) was prevailed. Hypertriglyceride-associated acute pancreatitis has no specific complications, but has a tendency to recurrence. Patients with hypertriglyceridemia need constant laboratory monitoring (determination of triglycerides), pharmacological therapy and follow-up to prevent the development of acute pancreatitis.