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Clinical-paraclinical peculiarities in diagnosis of different forms of chronic pancreatitis


Author: Liudmila Tofan-Scutaru
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2006
Scientific advisers: Vlada-Tatiana Dumbrava
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 22 February, 2006
Approved by NCAA on the 27 April, 2006

Abstract

Adobe PDF document0.47 Mb / in romanian

Thesis

CZU 616. 37-002. 2-07

Adobe PDF document 2.74 Mb / in romanian
134 pages


Keywords

chronic pancreatitis, test of stimulation, debit enzimes, duodenal content, alpha-amylase, lipase, trypsin, glycemia, insulin, C peptide, lysosomal enzymes, α-1-antitrypsin, α-2-macroglobulina, markers viral, infections HBV and HCV

Summary

It have been invesigated and compared 161 patients with persistent, recurrent and pseudotumoral forms of chronic pancreatitis (CP) with 15 healthy persons – witness group (WG). The research results were showed some diagnostic clinical-paraclinical peculiarities of the disease. The algic syndrome was estimated to be present in 100 per cent of cases, mild persistent pains occurring in persistent chronic pancreatitis (PCP); prolonged intermittent severe pains – in recurrent chronic pancreatitis (RCP) and continuous moderate to severe pains – in pseudotumoral CP (PTCP). An efficient functional method of diagnosing CP: intravenous eufilin-glucose test (IVEGT) has been elaborated. Patients with different clinical forms of CP have been thoroughly examined, the pancreas function being estimated by IVEGT. Pancreas serum enzymes dynamics in IVEGT in the early stages indicates the phenomenon of blood pancreatic enzymes deviation and the decrease of functional reserve capacity of the exocrine pancreas (trypsin – of choice). IVEGT dynamics showed trypsinemia a jeun lacking increase following the stimulation both in PCP and RCP; delayed reaction of serum α-amylase and serum lipase with the apical point 120min after stimulation in PCP and real increase in α-amylase and serum lipase 5min after stimulation without normalization to the end of IVEGT in RCP. In early diagnosis of pancreas exocrine function insufficiency, the study of lipase amount in the duodenal contents is essential; the examination of α-amylase and trypsin being non-informative, in IVEGT dynamics is useful for determining the functional reserves of the exocrine pancreas. For patients with persistent chronic pancreatitis IVEGT dynamics showed a smaller and delayed insulin-secretory reaction, inadequate with glycemia increase – fast indicating endocrine function disturbances in the pancreas in the persistent CP. The study of protease inhibitors in IVEGT dynamics in CP patients shoved a considerable decrease compared WG of α-1-antitrypsin after 5min, persistency in the RCP group after 10min and 60min following stimulation; real decrease of α-2-macroglobulina a jeun in patients with PCP as compared with other groups, this being present through the duration of research unlike the witness group and unlike the RCP patients after 30min and 120min after stimulation, - this indicating an infavorable development of the inflammatory process in PCP. Activity of lysosomal enzymes: arylsulfatase, β-glucosidase, β-glucuronidase is characterized by variability in the IVEGT dynamics but is significantly increased in CP patients, an important fact in estimating the inflammatory process in the pancreas. Concomitant study of viral infections HBV and HCV markers in patients with CP and a more frequent detection of HBV infection markers in the duodenal contents than in the serum suggest the role of virus of hepatitis B infection in the etiopathogenesis of CP.