O. Yu. Cherkun’s research while affiliated with Poltava State Agrarian University and other places

Introduction. Acute pancreatitis (AP) is among the most prevalent surgical conditions affecting the abdominal cavity, with the incidence steadily rising each year. Despite advancements in diagnosis and treatment, mortality rates remain alarmingly high, particularly among young, working-age patients. Aim. To analyze the diagnostic effectiveness of magnetic resonance imaging (MRI) in identifying local parapancreatic complications in severe acute pancreatitis and its impact on surgical decision-making in these patients. Materials and methods. The study involved 127 patients with moderate and severe acute pancreatitis, divided into two groups. The comparison group consisted of 87 patients who received treatment based on traditional approaches, while the main group included 40 patients who underwent additional magnetic resonance imaging to diagnose local parapancreatic complications. Results. The analysis of the prevalence and nature of local parapancreatic complications revealed no significant differences between the two groups. The initial severity of the condition, assessed using the BISAP scale, was nearly identical: 3.2±0.32 points in the comparison group and 3.1±0.31 points in the main group. Organ dysfunction at the onset of the disease was observed in 67.8% of patients in the comparison group and 65.0% in the main group. All patients who developed local parapancreatic fluid collections underwent diagnostic puncture, followed by drainage if purulent contents were detected. Dynamic ultrasound assessments were used to evaluate the volume of the drained cavity and monitor the patient’s overall condition. In cases where there was no local improvement (reduction of parapancreatic fluid) or systemic improvement (regression of SIRS and/or signs of severe intestinal obstruction), patients in the comparison group underwent traditional "open" surgical intervention, whereas patients in the main group received MRI of the abdominal cavity. Conclusions. MRI is a crucial tool for diagnosing local parapancreatic complications and it plays a significant role in optimizing surgical strategies for patients with severe acute pancreatitis.

b> Introduction: Among the diseases leading to deep neck infection (DNI) and descending necrotizing mediastinitis (DNM), odontogenic causes are the most prevalent, accounting for 40–70% of cases. Tonsillo-pharyngeal causes follow at 16–30%, while other etiologies do not exceed 6%. Materials and methods: A retrospective analysis was conducted, examining the clinical course, diagnostic measures, and treatment strategies of 139 patients with DNI due to oropharyngeal inflammatory diseases. These patients were treated at the Poltava Regional Clinical Hospital from 2012 to 2023. Based on the primary source of infectious/purulent inflammation, patients were divided into two groups. Group I included 25 patients with tonsillo-pharyngeal origin of DNI; Group II consisted of 114 patients with dental origin of DNI. The study assessed the course, diagnosis, and treatment outcomes based on the parameters of gender, age, etiological factor, underlying pathology, disease duration before hospitalization, initiation of antibiotic therapy, type of DNM based on spread pattern, causative agent, severity of condition upon admission, signs of sepsis, type of surgical intervention, postoperative complications, duration of treatment in the intensive care unit, overall hospitalization duration, and mortality. Results: Oropharyngeal infection is the predominant cause of DNI and DNM. Notably, odontogenic DNI is more frequently observed than tonsillopharyngeal DNI (82.0% vs. 18.0%). Its progression is characterized by lower mortality (13.2% vs. 24.0%) and a reduced risk of DNM onset (7.0% vs. 44.0%). However, odontogenic DNM is more often associated with adverse outcomes (50.0% vs. 9.1%). Conclusions: Thus, frequency and severity of DNM in patients with DNI depends on the etiology of the disease, but the adverse consequences of treatment are largely influenced by weak concomitant pathology and sepsis during hospitalization.</br

At present, acute pancreatitis holds the second position in the hierarchy of acute intra-abdominal pathology, with a mortality rate of up to 70% in severe cases. The emergence of reactive hydrothorax at the onset of the disease, as well as during the course of treatment, may signify a severe trajectory of acute pancreatitis, contributing to an elevated fatality rate. The objective of this study is to analyze the progression of reactive hydrothorax in patients experiencing acute severe pancreatitis. Матеріали і методи. У дослідження включено 127 пацієнтів з тяжким та середньо-тяжким перебігом гострого панкреатиту, віком від 22 до 81 року (в середньому 47,9±14,5 роки), які в переважній більшості госпіталізовані до стаціонару не пізніше 48 годин від початку захворювання. Загалом реактивний гідроторакс було виявлено в дебюті захворювання у 23,6% пацієнтів (переважно за рахунок його лівобічної локалізації – 16,5%), відсоток яких на фоні консервативного лікування та пункцій плевральних порожнин зменшувався до розвитку локальних інфекційно септичних ускладнень черевної порожнини та заочеревинного простору на 12-14 добу перебігу захворювання (підвищення останніх з 15,7% до 22,8%). Встановлено міцний кореляційний зв'язок між появою «другої хвилі» органної дисфункції та рецидиву гідротораксів на другому-третьому тижні від початку захворювання у хворих на гострий тяжкий панкреатит. Показанням до дренування плевральної порожнини було об’єм рідини в ній більше 500 мл, або рецидиви останнього на фоні повторних пункцій плевральної порожнини. Materials and methods. The study included 127 patients with severe and moderately severe acute pancreatitis aged from 22 to 81 years (mean 47.9±14.5 years), who were mostly admitted to hospital no later than 48 hours after the onset of the disease. In general, reactive hydrothorax detected at the onset of the disease was found in 23.6% of patients (mainly due to its left-sided localisation in 16.5% of cases), the percentage of which decreased the under conservative treatment and pleural punctures to the development of local infectious and septic complications of the abdominal cavity and retroperitoneal space on day 12-14 of the disease (increase from 15.7% to 22.8%). The study has revealed a strong correlation between the appearance of the "second wave" of organ dysfunction and the recurrence of hydrothorax in the second or third week after the onset of the disease in patients with acute severe pancreatitis. Indications for pleural cavity drainage include fluid volume of more than 500 ml or recurrence of the latter under repeated pleural punctures.

Introduction: Acute pancreatitis has emerged as a leading urgent abdominal condition, with a high mortality rate of up to 70% in cases of purulent-septic complications. The identification of specific causative agents during the infection stage of acute severe pancreatitis is challenging due to the various mechanisms by which pathogens can infiltrate parapancreatic fluid collections. However, early antibiotic prophylaxis is essential in the management of this patient population, considering the potential need for prolonged treatment involving multiple antibiotic rotations. This study aims at analyzing the changes in the microbial species spectrum responsible for purulent-septic complications in acute severe pancreatitis during the course of treatment. Methods: We investigated 174 bacterial cultures obtained from patients diagnosed with acute severe pancreatitis who were treated at the Surgical Department of M.V. Sklifosovsky Poltava Regional Hospital between 2015 and 2018. Among these cultures, 87 were obtained during the initial surgical intervention (39 after initial ultrasound-guided drainage and 38 during the initial open surgical intervention), and 87 were obtained during the course of treatment. Results: Among patients who underwent primary drainage of parapancreatic fluid collections, no aerobic flora was detected in 71.4% of cases, but subsequent bacterial cultures revealed microbial growth in 77.6% of patients. In patients who underwent open surgical intervention, pathological flora was detected in nearly all cases, both during the primary bacterial passage and in subsequent cultures. The species spectrum differed significantly between the primary and repeated bacterial passages. The initial cultures showed a predominance of gram-positive flora (S. epidermidis, Streptococcus spp., Enterococcus spp.), while repeated cultures demonstrated a notable increase in hospital-acquired strains and gram-negative flora (E. coli, Proteus spp., Acinetobacter spp.), along with a nearly three-fold increase in S. aureus. These findings have significant implications for selecting appropriate antibacterial agents throughout the treatment course. Notably, a substantial decrease in the sensitivity of multidrug-resistant strains to reserve antibiotics such as meropenem and trigecycline, by approximately 20%, was observed in subsequent bacterial studies. Conclusion: The microbial spectrum and antibiotic sensitivity of pathogens causing purulent-septic complications in acute severe pancreatitis undergo dynamic changes during the course of treatment. These findings underscore the importance of conducting repeated bacterial cultures and adjusting antibiotic therapy accordingly to optimize treatment outcomes.

This article presents the analysis of a rare clinical case of treatment of a patient with mucinar cystadenoma of the appendix. It has been demonstrated that the clinical course of this disease, as a rule, does not have a clear specific clinical picture, but most often it is clinically similar to chronic appendicitis, ovarian cysts, tumours of the abdominal cavity, and intestinal colic. Despite the progress in the radiological diagnosis of diseases of the abdominal organs, the diagnosis of mucocele of the appendix is extremely rare. The paper presents a case of treatment of a female patient who was admitted to M.V. Sklifosovsky Poltava Regional Clinical Hospital for emergency with suspected acute appendicitis. Following pre-operative examination, the patient was diagnosed as having “Acute appendicitis. Appendicular abscess”, and according to urgent indications the patient was operated on. The extent of surgical operation included appendectomy, drainage of the abdominal cavity. The macroscopic preparation was sent for a histopathological examination, where the diagnosis of "Mucinar cystadenoma of the vermiform appendix" was established. The patient was discharged from the surgical department in satisfactory condition on the 7th day. Considering that in every fifth patient, mucocele of the appendix is combined with synchronous or metachromic cancer of the colon, and in 4-24% of cases with cancer of the ovaries, gallbladder, thyroid and breast, the patient is further subject to strict examination and observation. Therefore, the problem of detecting mucocele of the appendix is relevant and requires additional investigation for diagnosis and differential diagnosis with other cystic formations of the abdominal organs.

One of the most pressing issues of urgent abdominal surgery is acute pancreatitis. The incidence of pancreatitis increases annually by 2.5 - 3.1%, ranging from 15 to 70 cases per 100,000 population in Europe and North America. About 40% of patients die within the first 7 days after hospitalization, most in the first 3 days. Patients with acute severe pancreatitis who are experiencing the first wave of the disease have a high risk of secondary infection of the pancreatic necrosis foci that is an indication for surgical intervention. This article presents the analysis of the treatment results in 22 patients with acute severe pancreatitis, 7 (31.8%) men and 15 (68.2%) women. Age of patients ranged from 22 to 79 years (46,9 ± 1,5 years). 2-7 days was the time from the onset of the disease to hospital admission. Purulent-septic complications developed in 22 (100.0%) patients, the presence of sequestrate was detected in 9 of them (40.9%). The average period of hospital staying for this group of patients was 48.3 ± 4.4 days; the mortality rate was 27.3% (6 patients). Having analyzing the biochemical markers obtained, we can state that the increase in the level of procalcitonin and C-reactive protein indicates the development of purulent-septic complications in patients with acute severe pancreatitis, while the decrease in the free T3 concentration at normal T4 and TSH levels in 6 (27.3%) of patients, suggests the development of their lowT3 syndrome that in turn suggests an unfavourable course of the disease.