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Acute necrotic pancreatitis was followed by disorders of intestinal functions in 96.7% of patients and in 68% — its failure was occurred what had directly influenced on frequency of purulent—septic complication and mortality rate. It was proved that citrulline plasma level had been objectively reflected the severity of enteral failure and served as independent lethality criteria in patients with acute necrotic pancreatitis.

Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, was conducted. Content of presepsin, procalcitonin, С—reactive protein and interleukin—6 (ІL—6) in the patients' blood plasma was determined, and bacteriological investiga' tions, contrast—enhanced CT were conducted as well. Positive results of bacteriologi' cal investigations were noted in 43 patients. Level of presepsin and procalcitonin in patients, suffering purulent—septic complications, in 3 — 4 times exceeded such in a sterile pancreonecrosis. Presersin level,exceeding over 632 pg/ml, have permitted to confirm the presence of local and systemic infection with high specificity and sensitivi' ty, and this have exceeded diagnostic possibilities of the procalcitonin content determi' nation. High level of ІL—6 and С—reactive protein is characteristic for the systemic inflammatory response syndrome (SIRS) of infective and noninfective origin.

In 70 patients, suffering an acute necrotic pancreatitis (ANP), and 10 practically healthy persons a content of presepsin in a blood plasm, using immunochemiluminescent method and conducted bacteriological investigations, were analyzed. The infection occurrence is accompanied by plausible upgrading of a presepsin level in a blood plasm, depending on activity and severity of a septic process: in local infection--up to (677 ± 30) pg/ml, sepsis--up to (988 ± 47) pg/ml, severe sepsis--up to 2668 pg/ml; in an ANP without infection it have constituted (332 ± 38) pg/mI at average, in practically healthy persons--(184 ± 16) pg/mI. A presepsin level correlates with a state severity in accordance to APACHE I scale, what permits to estimate the patients state severity objectively, to prognosticate a favorable and unfavorable consequences of treatment, rapidly changing, depending on efficacy of treatment.

In the investigation 70 patients were included, treated for necrotic acute pancreatitis. On the 7th day from an acute pancreatitis occurrence a state of oxidative system was studied in the patients. Raising of the blood serum concentration of malonic dialdehyde higher than 3.68 mcmol/l, reduction of the glutationperoxidase activity lower than 8.49 mcmol NADFН(2) h/mg protein and glutationreductase — lower than 5.18 mcmol NADFН(2) h/mg of protein before 7 days of treatment of an acute pancreatitis was accompanied by raising of the pancreas infectioning risk, what have had demanded the operative intervention performance.

The dynamics of cytopathic hypoxia markers in patients with acute pancreatitis (AP) biliary etiology (BE), depending on the presence of concomitant diabetes mellitus (DM), which is an independent factor of premorbid severity increase and increase in the degree of operational and anesthetic risk. Markers of cytopathic hypoxia use as methods for early diagnosis of acute liver failure (ALF) and monitoring the effectiveness of its correction promising. In terms of cytopathic hypoxia may be at the stage of laboratory diagnostics to distinguish between destructive and non-destructive forms APBE, and for markers of endothelial dysfunction--destructive forms on the area and depth of destruction of the pancreas.

The results of examination of 68 patients, admitted to hospital for an acute pancreatitis during 48 h from its occurrence, were analyzed. In all the patients the cytokines (IL-8, IL-10, TNF-alpha) content was determined in the blood, using immunoenzymal analysis. Algorithm of prognostication of an acute pancreatitis-associated pulmonary injury, basing on determination of the cytokines contents, was elaborated.

Influence of therapeutic plasmapheresis on bowel barrier function and evacuation was investigated in 83 patients with severe acute necrotizing pancreatitis. Except standard therapy patient obtained therapeutic plasmapheresis using "Haemonetics" PCS 2 system. Complex treatment of patients with acute necrotizing pancreatitis and dynamic ileus using plasmapheresis increases contractive and propulsive function of stomach and duodenum and prolongs period of activity of these organs on 32%. Intestinal barrier function associates with restoration of bowel evacuation. Addition of plasmapheresis to standard therapy of necrotizing pancreatitis can be effective prevention of dynamic ileus.

The investigations, concerning detection of the hemostasis system activation, were done in 26 patients, suffering various critical morbid states (an acute pancreatitis). The contents of products of the enzymes lysis of coagulation system and fibrinolytic system constitute one of the most precise indices. Fibrinopeptid A (FpA) is considered one of the most secure indices, confirming intravascular thrombin formation, and D-dimer--of a fibrin formation. In the patients examined a trustworthy increase of a D-dimer and FpA contents was registered, witnessing the hemostasis system activation in an acute pancreatitis as well as an excessive formation and lysis of fibrin. D-dimer and FpA contents in a plasma constitutes an important diagnostic index, its determination secures the possibility of early diagnosis and control of a hemostasis system disorders.

The changes in a system of the blood neutrophils in 65 patients, suffering different forms of an acute pancreatitis, were studied. The trustworthy differences in a neutrophils system structure were determined in patients while their effective conservative treatment, effective surgical treatment, complicated course of postoperative period and exitus lethalis. This data permit to adjust a base for algorithm creation on prognostication, diagnosis and monitoring in patients, suffering an acute pancreatitis.

Estimation of the severity state in patient, suffering an acute pancreatitis, while admitting him into a hospital, constitutes a significant part of diagnosis and complex treatment. Application of a highly accurate scales and markers, which are used to prognosticate the disease course severity and to determine the inflammation grade, may influence the results of complex treatment of the patients. In the investigation a high diagnostic accuracy in prognosis of an acute pancreatitis course severity was noted for APACHE II scale (24 hours) and Ranson scale (48 hours). There was established, that determination of a C-reactive protein content has less diagnostic accuracy, but it may be applied as a less complex and more rapid test for prognostication of an acute pancreatitis course severity after admitting the patient to hospital.

In patients, suffering an acute pancreatitis with purulent-septic complications, there are observed: the blood neutrophils metabolic activity raising in spontaneous NST--test, the reserve index of the blood neutrophils metabolic activity is secured, but the phagocytic number is lowered, raised or normal. In patients, who have died, the blood neutrophils metabolic activity in stimulated NST--test is raised, but preservation reserve of their metabolic activity is lowered, in comparison with such in a control group. Trustworthy raising of the blood neutrophils metabolic activity in stimulated NST--test was observed in patients, suffering infected pancreonecrosis, in comparison with such in aseptic necrosis, the phagocytic number in them was trustworthy reduced. In patients, suffering an acute pancreatitis, who have died, there was established the reversed correlation dependence between the formazanpositive blood neutrophils quantity in spontaneous NST--test and preservation reserve.

Results of investigation of content of activated protein C, Intercellular Adhesion Molecule -1 (ICAM-1) and interleukin (IL)--18 in the patients with an acute pancreatitis were presented. At the hospital attendance the concentration of IL-18, ICAM-1 increase and the activated protein C level lowering were noted. The strict immediate correlation connection between serum blood level of IL-18, ICAM-1 and hematocrit and the reverse one--between these mediators concentration and the activated protein C content--were noted during all period of observation.

In 81.25% patients with an acute necrotic pancreatitis and in 50% of healthy persons the blood neutrophils are sensitive to cerulloplasmin in metabolic activity. In 62.5% of patients the phagocytic index have had reduced in addition of cerulloplasmin. Phagocytic number in addition of cerulloplasmin have constituted over 1,5 conditional units, in 75% of patients, without such addition - in 84%. The conclusion was made about necessity of individual selection of immunomodulators in patients with an acute necrotic pancreatitis.

Immune status in patients with destructive pancreatitis (DP) in long persisting disease and after performance of operative intervention was studied. Signs of secondary combined immunodeficiency were revealed, manifested by decrease of absolute quantity of all lymphocytes populations by 20-70% and concentration of immunoglobulins in blood serum by more than 40%. Conventional therapy did not influence indexes of immunogramm while using immunoglobulin for intravenous injection (IGII), besides saturation of blood by antibodies, the complement activities are increasing as well as indexes of the phagocytes functional state. Application of IGII had promoted the decrease of the patients state severity, normalization of clinico-laboratory data, causing the mortality lowering (P < 0.05), decrease of the treatment duration of survived patients (P < 0.05).

Results of investigation of the calcitonin and calcium level in the blood serum in dynamics in 15 patients with various forms of an acute pancreatitis were analyzed. In oedematous form of an acute pancreatitis the calcitonin content had constituted 4.5 pg/ml at average, promoting the calcium level rising up to 2.97 mmol/l; in necrotic form of an acute pancreatitis the calcitonin concentration had constituted 164.4 pg/ml, calcium--1.74 mmol/l; in purulent--necrotic form--accordingly 288 pg/ml and 1.5 mmol/l.

The fibronectin content dynamics in the blood serum was estimated in patients with various clinical forms of an acute pancreatitis. The fibronectin level lowering may be a predictor of occurrence and diagnostical criterion for infective complications in patients with destructive pancreatitis. Application of clexane had promoted the fibronectin level raising in the blood serum in patients with sterile and infected pancreatic necrosis.

The neutrophils functional state was studied in 101 patients with an acute destructive pancreatitis (DP), complicated by parapancreatitis, in 20 patients with edematic pancreatitis and in 25 healthy persons using cytochemical reactions with determination of the enzymes activity of alkaline phosphatase, myeloperoxidase, and also of lysosomic-cation proteins, phospholipids and glycogen. The enzymatic contents of neutrophils changes in acute period of destructive pancreatitis (DP) are causing their function inhibition, promoting the infection complications occurrence. The neutrophils functional activity indexes may be used in early diagnosis and prognostication of the DP course.

In experiment on 40 male rats of the Wistar line there was investigated the oxygen extraction (O2) and the bacteria translocation in 30 min, 2, 6, 12 and 24 hours after the stimulating operation (control group) and simulation of the ductal-hypertensive form of an acute experimental pancreatitis (AEP)--the main group. The data obtained witness the general extraction of O2 raising by 222% (P < 0.001) at average and lowering of its intestinal extraction in 30 min and 2 hours (by 33 and 31% at average, P < 0.05) and its raising in 24 hours by 138% (P < 0.001) at average also. These disorders had correlated with velocity of the intestinal E. coli reproduction and with the bacteria translocation on the way intestine-->mesenterial lymph nodes in 6 hours after the disease occurrence with preservation of the lymph nodes and the liver barrier function in the AEP duration over 24 hours. The data obtained had permitted to substantiate the necessity of the remedial measures complex application, directed on the frequency of purulent complications lowering.