EFFICACY OF THE ALGORITHMIC STEP-UP APPROACH OF INTERVENTIONAL TREATMENT OF PATIENTS WITH ACUTE NECROTIZING PANCREATITIS.

Aim - to estimate the efficacy of the algorithmic step-up approach of interventional treatment of acute necrotizing pancreatitis (ANP).; We performed a prospective observational cohort study of the efficacy of the developed approach of surgical treatment of 317 patients with different morphological forms of ANP. The following parameters were collected for each episode: length of hospital stay, mortality rate, occurrence of organ failure and local complications.; Transcutaneous punction/drainages were applied as the first step in 37 patients with acute necrotic collections. In the presence of walled-off pancreatic necrosis (WOPN) endoscopic procedures were preferred in case their close localization to the stomach or duodenum in 65 observations. Initial surgical treatment was not effective in 18.8% and video-assisted retroperitoneal debridement in patients with ANP or necrosectomies under endoscopic control in cases of WOPN were performed. Involuntary laparotomic necrosectomies were conducted in 14.5% of patients as a final step of the suggested algorithmic approach. During postoperative period complications occurred in 28.3% of patients. They included 7 new episodes of organ failure, 4 cases of arosive hemorrhage, and 5 cases of pancreatic and duodenal fistulas. Overall mortality rate was 3.3%, after laparotomic surgical treatment - 6.5%.; Surgical treatment in patients with ANP based on the developed algorithmic step-up approach is followed by acceptable complication and mortality level.

[Improved method of dermatoplasty]. / Usovershenstvovannaia metodika dermoplastiki.

For restoration of dermal integument on hands, feet, major joints, face and neck in 104 patients special device was used which provided creation of split dermal flaps of new types--with fenestrated gaping perforations or entire flaps with areas of various thickness which enabled to preserve islands of full thickness skin at donor's sites or superficial dermal layers. The thickness of the transplants made up 0.4-0.6 mm in adults and 0.25-0.5 mm in children. Perforated flaps were transplanted in 128 cases, the flaps of variable thickness--in 31. 151 operations (95.0%) resulted in complete recovering of the transplants, all wounds at donor's sites have closed spontaneously. Through 3-17 years after the operation the scars at perforations' sites looked hardly out of the ordinary, the areas of smaller thickness are unnoticeable, skin-grafts are soft and loading-proofed. The decrease in complications' rate and improvement of functional and aesthetic results of treatment after the application of the device were stated.

[Modern methods of urinalysis]. / Moderní zpusoby analýzy moci.

The author describes work with two apparatuses, Urilux and Miditron, which evaluate by means of reflex photometry as many as ten parameters on diagnostic strips dipped in the examined urine sample. The first apparatus is suitable for doctors' surgeries or in-patient departments, the second larger one for diagnostic laboratories.

[Foreign bodies of the stomach and intestines]. / Inorodnye tela zheludka i kishechnika.

The experience with surgical treatment of foreign bodies of the stomach and intestine in 127 patients is summarized. In presence of acute foreign bodies, the use of drugs increasing intestinal peristalsis, or causing vomiting is not recommended.

[Biochemical values in erythrocytes before freezing and after freezing at low temperatures]. / Nekteré biochemické hodnoty u erytrocytu pred zmrazením a po zmrazení za nízkých teplot.

The authors tested three ways of freezing red cell concentrates with glycerin. At -30 degrees C in a deep freezer; on a Planer at the rate of 1 degree C per minute and by immersion into liquid nitrogen to -196 degrees C, stored in cryo-containers in liquid nitrogen. In samples processed in all three ways, incl. the follow-up of glycolysis in red cell concentrates in acid-citrate-dextrose solution, the levels of the following enzymes were assessed: glucose-6-phosphate dehydrogenase, glutathione reductase, pyruvate kinase. In addition also the levels of sodium, potassium, pH and glucose were assessed. The enzyme estimations of all three mentioned enzymes after triple rinsing with saline in the samples immersed in liquid nitrogen at -196 degrees C had the most acceptable values and smallest losses after rinsing.

[The protective action of the organic substances in naftusia water on erosive-ulcerative lesions of the gastric mucosa in rats undergoing immobilization-cold stress]. / Zashchitnoe deistvie organicheskikh veshchestv vody naftusi na érozivno-iazvennye povrezhdeniia slizistoi obolochki zheludka u krys pri immobilizatsionno-kholodovom stresse.

It is shown that 7-11-day long consumption (by rats) of water naftusia or organic matters isolated from it which contain carbonic acids and catecholamines possessing paramagnetic activity exerts a preventive effect on stress injuries of the mucous membrane of the stomach. Gastric protective action of naftusia goes with hyperplasia and hypertrophy of argyrophil endocrinocytes and antral mucosa, with an increase of gastrin content in it as well as in blood serum, shortening of the nembutal sleep duration.

[Hypercalcemia in bronchogenic carcinoma]. / Hyperkalcémie u bronchogenního karcinomu.

In a population of 621 patients with morphologically proven bronchogenic carcinoma the rate of hypercalcaemia in particular morphologic types of bronchogenic carcinoma was ascertained during the establishment of diagnosis. Regardless of type, there were 10.3% of hypercalcaemic patients in the whole population. Hypercalcaemia was found most frequently in epidermoid carcinoma (10.98%), followed by adenocarcinoma (10.51%), small cell carcinoma (10.11%) and undifferentiated carcinoma (9.72%). In the group of 19 large cell carcinomas the hypercalcaemia was not established. Except large cell carcinoma, the differences among the groups were not statistically significant.

Complete sequence and structure of the gene for human adenosine deaminase.

The nucleotide sequence of the human adenosine deaminase gene was determined. The gene was isolated in a series of overlapping lambda phage clones containing human germ line DNA. A total of 36,741 base pairs were sequenced, including 32,040 base pairs from the transcription initiation site to the polyadenylation site, 3935 base pairs of 5'-flanking DNA, and 766 base pairs of 3'-flanking DNA. The gene contains 12 exons separated by 11 introns. The exons range in size from 62 to 325 base pairs while the introns are 76-15 166 base pairs in size. The area sequenced contains 23 copies of Alu repetitive DNA and a single copy of an "O" family repeat. All but one of these repeat sequences are located in the first three introns or the 5'-flanking region. The apparent promoter region of the gene lacks the "TATA" and "CAAT" sequences often found in eucaryotic promoters and is extremely G/C rich. Contained within this region are areas homologous to other G/C-rich promoters, including six decanucleotide sequences that are highly homologous to sequences identified as functional binding sites for transcription factor Sp1.