[Acute pancreatitis (protocols of diagnosis and treatment)].

Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed.

[The concept of abruption of pancreatic necrosis--key to the solution of the problem of destructive pancreatitis].

The main criterion of severity of acute destructive pancreatitis (ADP) is the volume of pancreatonecrosis formed during the first 24 hours of the disease. A prognostic system is developed allowing to urgently detect the "risk group"--patients with the developing massive pancreatonecrosis by means of the assessment of clinical criteria. In the process of intensive therapy of the "risk group" patients there occurs arresting, "abruption" of the destructive process which greatly improves the results of treatment (the frequency of purulent complications decreases from 32% to 14%, lethality from 45% to 19%).

[Pancreatitis predominantly affecting the caudal part of the pancreas].

The characteristics of specific features of acute and chronic processes in the caudal pancreatis and surrounding retroperitoneal fat is given on the basis of an analysis of 273 cases of pancreatitis with the predominant lesion of this portion. It was established that acute caudal pancreonecrosis at an early period had atypical symptoms and more favourable course than that of the proximal parts of the pancreas. Later periods of the development of this variant of the disease are characterized by great frequency and spread of pyo-necrotic lesion of the retroperitoneal fat.

[Pathogenesis and clinical significance of fat necrosis in acute pancreatitis].

An analysis of results of 200 experiments, 100 autopsies after death from acute destructive pancreatitis and clinical observation of 2000 patients with necrotic forms of acute pancreatitis has given data on pathogenesis of fat necrosis, dynamics of its development, its interrelationships with alterations of the pancreas parenchyma. A concept of unity of proteolytic and steatonecrotic components of acute destructive pancreatitis is substantiated. The authors propose a classification of periods of development of fat necrosis, determine the clinical significance of alterations of the fat tissue at early terms of the disease, give recommendations for the surgical and conservative treatment.