Сравнительный анализ результатов различных способов резекции головки поджелудочной железы при хроническом панкреатите

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.Актуальность Более чем в половине наблюдений хронического панкреатита (ХП) диагностируется увеличение головки поджелудочной железы (ПЖ) с наличием осложнений, которые служат показанием к резекции органа. Разработка оптимального способа хирургического лечения ХП с поражением головки поджелудочной железы (ГПЖ) является одной из задач хирургической панкреатологии.Цель Провести сравнительную оценку непосредственных и отдаленных результатов различных способов резекции ГПЖ при ХП.Материал и методы Выполнено проспективное контролируемое исследование со сравнительным анализом результатов хирургического лечения 131 пациента с ХП с увеличением размеров ГПЖ. В 29% (n=38) наблюдений у больных присутствовали осложнения воспалительного характера, в 86,3% (n=113) они были связаны с компрессией соседних органов, в том числе диагностированы механическая желтуха (n=60), непроходимость на уровне двенадцатиперстной кишки (ДПК) (n=43), и региональная портальная гипертензия (n=10). Проведено 47 панкреатодуоденальных, 58 субтотальных и 26 частичных резекций ГПЖ.Результаты При дуоденосохраняющих резекциях ГПЖ получены статистически значимо лучшие непосредственные результаты по сравнению с панкреатодуоденальными резекциями. Субтотальная резекция ГПЖ в бернском варианте превосходила все остальные дуоденосохраняющие резекции по показателям средней продолжительности операции, послеоперационного стационарного лечения, интраоперационной кровопотери. Частота релапаротомий по поводу внутрибрюшных осложнений геморрагического характера при этом составила 8,2% (n=4). Частота неблагоприятного эффекта по параметру сохранения боли через 5 лет после дуоденосохраняющих резекций ГПЖ составила 0,125, а после панкреатодуоденальной резекции — 0,357 при статистически значимой величине относительного риска (RR), равной 0,350 (ДИ 95%=0,13–0,98). По остальным показателям клинических отдаленных результатов хирургического лечения в зависимости от различных способов резекции ГПЖ статистически значимых различий получено не было (p>0,05). Качество жизни больных через 5 лет после операции, согласно анкете EORTC QLQ-C30, статистически значимым  (р=0,0228) получено только по двум показателям: одышка (DY:8,3) и бессонница (SL:16,67;27,4) с более высокими значениями после операций Beger и бернского варианта субтотальной резекции ГПЖ соответственно

Непосредственные и отдаленные результаты оригинальных способов продольной панкреатоеюностомии с расширением площади анастомозирования панкреатоеюнального соустья

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.АКТУАЛЬНОСТЬ. Зависимость результатов дренирующих операций от эффективности дренирования протоковой системы поджелудочной железы (ПЖ) и адекватности оттока панкреатического сока через анастомоз не вызывает сомнений, в связи с чем разработка новых способов продольной панкреатоеюностомии (ППЕС), расширяющих площадь панкреатоеюнального соустья, является актуальной задачей.ЦЕЛЬ ИССЛЕДОВАНИЯ. Сравнить непосредственные и отдаленные результаты ППЕС с расширением площади панкреатоеюнального соустья у больных хроническим панкреатитом (ХП).МАТЕРИАЛ И МЕТОДЫ. Проведен анализ непосредственных и отдаленных результатов лечения 58 больных ХП с нарушением проходимости главного панкреатического протока (ГПП) на всем протяжении без увеличения головки поджелудочной железы (ГПЖ), оперированных в объеме ППЕС. Все больные были распределены на две группы: сравнения (n=26, оперированные до 2008 г.) и основную (n=32, оперированные после 2008 г. с использованием новых способов ППЕС: с включением в единое панкреатоеюнальное соустье дистальной и проксимальной культей при диастазе ГПП и задней поверхности ПЖ (n=3), с иссечением передней поверхности ПЖ в виде фрагментов треугольной формы (n=11), с циркуляцией петли тонкой кишки на восстановитель- ном этапе операции (n=19).РЕЗУЛЬТАТЫ. Применение оригинальных способов ППЕС в основной группе больных не удлинило среднюю продолжительность операции (160 [135; 185]) и интраоперационную кровопотерю (265 [175; 340]). В основной группе больных не было послеоперационных осложнений и летальности, но средняя продолжительность послеоперационного стационарного лечения (18 суток [16; 20,5]) превысила данные некоторых зарубежных и отечественных авторов. Купирование боли через 5 лет после операции у больных основной группы превысило на 26,6%, а развитие диарейного синдрома с зависимостью от приема ферментных препаратов оказалось вдвое ниже, чем у больных группы сравнения. По данным анкетирования EORTC QLQ-C30, через 5 лет после операции установлены статистически значимые межгрупповые различия по показателям шкал CF, NV, DY (р=0,03; р=0,02; р=0,006 соответственно), что указывает на преимущество вмешательства, примененного в основной группе.ВЫВОДЫ. 1. Показанием к продольной панкреатоеюностомии при хроническом панкреатите является нарушение проходимости главного панкреатического протока при отсутствии увеличения и воспалительной массы в головке поджелудочной железы.2. Ширина главного панкреатического протока менее 5 мм и наличие диастаза между его прок- симальной и дистальной культями при сохраненной задней поверхности поджелудочной железы не являются поводом для отказа от продольной панкреатоеюностомии в пользу резекционного метода.3. Расширение площади панкреатоеюнального соустья при выполнении продольной панкреатоеюностомии позволяет улучшить непосредственные и отдаленные результаты хирургического лечения хронического панкреатита

Functional relations for the six vertex model with domain wall boundary conditions

In this work we demonstrate that the Yang-Baxter algebra can also be employed in order to derive a functional relation for the partition function of the six vertex model with domain wall boundary conditions. The homogeneous limit is studied for small lattices and the properties determining the partition function are also discussed.Comment: 19 pages, v2: typos corrected, new section and appendix added. v3: minor corrections, to appear in J. Stat. Mech

A Case of Exacerbation of Chronic Pancreatitis Against the Background of COVID-19 Complicated by Pancreaticopleural Fistula with Enzymatic Pleurisy

Аim: to draw attention to the diagnosis and treatment of a rare complication of chronic pancreatitis — pancreaticopleural fistula with subtotal enzymatic exudative pleurisy, as well as the possible connection between exacerbation of chronic pancreatitis and pneumonia caused by SARS-CoV-2.Key points. In primary chronic pancreatitis, pancreaticopleural fistulas develop extremely rarely, while abdominal symptoms may not be expressed, and pleural effusion syndrome comes first in the clinical picture, so it is difficult to establish the true cause of exudative pleurisy in such a situation. The causative agent of COVID-19 has a high affinity for angiotensin-converting enzyme 2 receptors, which are present in large numbers on acinar, ductal, and secretory cells of the pancreas. Obviously, this infection can influence the course of the inflammatory process in chronic pancreatitis.This clinical observation presents a rare case of exacerbation of chronic pancreatitis with the formation of a pancreaticopleural fistula with subtotal enzymatic pleurisy on the left, which was preceded by pneumonia caused by SARS-CoV-2 in a 47-year-old man who abused alcohol. The study of exudate for amylase content helped to identify the enzymatic cause of pleurisy. Multislice computed tomography of the abdominal organs with bolus enhancement revealed a mass formation in the head of the pancreas with ectasia of the Wirsung duct and common bile duct. It was possible to restore the normal passage of bile and pancreatic secretions, as well as to stop the functioning of the pancreaticopleural fistula using pancreatoduodenal resection. A morphological examination of the macroscopic specimen revealed a diagnosis of pseudotumorous capitate chronic pancreatitis in the acute stage. After surgical treatment, according to ultrasound control, pleurisy was cured. The patient was examined a year later; his condition was consistent with the surgery. There were no clinical, physical, or instrumental data for left-sided pancreaticogenic pleurisy, hypertension of the extrahepatic and pancreatic ducts.Conclusion. Recurrent exudative pleurisy in chronic pancreatitis with rapid accumulation of exudate in a large volume with a high amylase content is a sign of pancreaticopleural fistula. The development of exacerbation of chronic pancreatitis was influenced by a combination of factors, including coronavirus infection, which suggests further accumulation of clinical material with this combination of pathological processes

On the partition function of the six-vertex model with domain wall boundary conditions

The six-vertex model on an $N\times N$ square lattice with domain wall boundary conditions is considered. A Fredholm determinant representation for the partition function of the model is given. The kernel of the corresponding integral operator is of the so-called integrable type, and involves classical orthogonal polynomials. From this representation, a ``reconstruction'' formula is proposed, which expresses the partition function as the trace of a suitably chosen quantum operator, in the spirit of corner transfer matrix and vertex operator approaches to integrable spin models.Comment: typos correcte

Noisy Monte Carlo: Convergence of Markov chains with approximate transition kernels

Monte Carlo algorithms often aim to draw from a distribution $\pi$ by simulating a Markov chain with transition kernel $P$ such that $\pi$ is invariant under $P$. However, there are many situations for which it is impractical or impossible to draw from the transition kernel $P$. For instance, this is the case with massive datasets, where is it prohibitively expensive to calculate the likelihood and is also the case for intractable likelihood models arising from, for example, Gibbs random fields, such as those found in spatial statistics and network analysis. A natural approach in these cases is to replace $P$ by an approximation $\hat{P}$. Using theory from the stability of Markov chains we explore a variety of situations where it is possible to quantify how 'close' the chain given by the transition kernel $\hat{P}$ is to the chain given by $P$. We apply these results to several examples from spatial statistics and network analysis.Comment: This version: results extended to non-uniformly ergodic Markov chain

Criminal narrative experience: relating emotions to offence narrative roles during crime commission

A neglected area of research within criminality has been that of the experience of the offence for the offender. The present study investigates the emotions and narrative roles that are experienced by an offender while committing a broad range of crimes and proposes a model of Criminal Narrative Experience (CNE). Hypotheses were derived from the Circumplex of Emotions (Russell, 1997), Frye (1957), Narrative Theory (McAdams, 1988) and its link with Investigative Psychology (Canter, 1994). The analysis was based on 120 cases. Convicted for a variety of crimes, incarcerated criminals were interviewed and the data were subjected to Smallest Space Analysis (SSA). Four themes of Criminal Narrative Experience (CNE) were identified: Elated Hero, Calm Professional, Distressed Revenger and Depressed Victim in line with the recent theoretical framework posited for Narrative Offence Roles (Youngs & Canter, 2012). The theoretical implications for understanding crime on the basis of the Criminal Narrative Experience (CNE) as well as practical implications are discussed

Bayesian Parameter Estimation for Latent Markov Random Fields and Social Networks

Undirected graphical models are widely used in statistics, physics and machine vision. However Bayesian parameter estimation for undirected models is extremely challenging, since evaluation of the posterior typically involves the calculation of an intractable normalising constant. This problem has received much attention, but very little of this has focussed on the important practical case where the data consists of noisy or incomplete observations of the underlying hidden structure. This paper specifically addresses this problem, comparing two alternative methodologies. In the first of these approaches particle Markov chain Monte Carlo (Andrieu et al., 2010) is used to efficiently explore the parameter space, combined with the exchange algorithm (Murray et al., 2006) for avoiding the calculation of the intractable normalising constant (a proof showing that this combination targets the correct distribution in found in a supplementary appendix online). This approach is compared with approximate Bayesian computation (Pritchard et al., 1999). Applications to estimating the parameters of Ising models and exponential random graphs from noisy data are presented. Each algorithm used in the paper targets an approximation to the true posterior due to the use of MCMC to simulate from the latent graphical model, in lieu of being able to do this exactly in general. The supplementary appendix also describes the nature of the resulting approximation.Comment: 26 pages, 2 figures, accepted in Journal of Computational and Graphical Statistics (http://www.amstat.org/publications/jcgs.cfm

Fluctuations of the one-dimensional asymmetric exclusion process using random matrix techniques

The studies of fluctuations of the one-dimensional Kardar-Parisi-Zhang universality class using the techniques from random matrix theory are reviewed from the point of view of the asymmetric simple exclusion process. We explain the basics of random matrix techniques, the connections to the polynuclear growth models and a method using the Green's function.Comment: 41 pages, 10 figures, minor corrections, references adde

The arctic curve of the domain-wall six-vertex model

The problem of the form of the `arctic' curve of the six-vertex model with domain wall boundary conditions in its disordered regime is addressed. It is well-known that in the scaling limit the model exhibits phase-separation, with regions of order and disorder sharply separated by a smooth curve, called the arctic curve. To find this curve, we study a multiple integral representation for the emptiness formation probability, a correlation function devised to detect spatial transition from order to disorder. We conjecture that the arctic curve, for arbitrary choice of the vertex weights, can be characterized by the condition of condensation of almost all roots of the corresponding saddle-point equations at the same, known, value. In explicit calculations we restrict to the disordered regime for which we have been able to compute the scaling limit of certain generating function entering the saddle-point equations. The arctic curve is obtained in parametric form and appears to be a non-algebraic curve in general; it turns into an algebraic one in the so-called root-of-unity cases. The arctic curve is also discussed in application to the limit shape of $q$-enumerated (with $0<q\leq 4$) large alternating sign matrices. In particular, as $q\to 0$ the limit shape tends to a nontrivial limiting curve, given by a relatively simple equation.Comment: 39 pages, 2 figures; minor correction