[Risk factors of fatal outcome in pancreatonecrosis].

The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

[New trends in surgical technologies of soft tissue wound management].

The authors performed an animal model study of postoperative wound complications using 72 white Wistar rats and 36 mongrel dogs with aseptic cut wounds, granulating wounds, and relaparotomic wounds. In the control group the wounds were closed by a conventional method; in the main group a machine stitch was performed. Wound closure in the main group was performed after approximation of wound edges with specially constructed devices. Morphological and microbiological analysis showed that the key role in development of complications is played by morphofunctional wound substrate, which comprises the degree of paravulnar tissue traumatization with suture when a conventional method is used, and paravulnar tissue ischemia in case of microbial dissemination. The authors conclude that machine stitch is preferable.

[Method of suturing of median laparotomic wounds].

New method of suturing of median laparotomic wounds with interrupted twined (IT) suture is developed. Efficacy of IT-suture compared with other methods was evaluated in experiment (68 animals) and clinical study based on following data -- time of elimination of local inflammation in wound area, number and nature of purulent complications, long-term results of treatment (postoperative ventral hernias). Use of IT-suture in clinical practice permitted to reduce number of purulent complications from 23.4 to 6.3% compared with noose sutures and from 15.7 to 6.3% compared with uninterrupted ones. There were no eventrations, postoperative ventral hernias were seen in 2 (4%) patients.

[Diagnosis of chronic duodenal obstruction].

Arteriomesenterial compression (AMC) of a low-horizontal part of the duodenum is one of the causes of chronic duodenal obstruction (CDO). The degree of compression of this part of the duodenum was studied in 82 patients with CDO. It was revealed that distance between the aorta and superior mesenterial artery (SMA) on the level of low-horizontal part of the duodenum was less than 20 mm in the majority of cases. When this distance is 20 mm or less the duodenum is compressed by SMA and looks like sand-glass. If the distance between the aorta and SMA is 10 mm and less, delay of contrast in the middle third of a low-horizontal part of the duodenum during roentgenography is an obligate symptom. In AMC 10-20 mm this phenomenon is diagnosed less frequently. In AMC 20 mm and less endoscopy demonstrates symptoms of CDO in the majority of cases. There were no intraoperative subjective symptoms of AMC.

[Ultrasonic method of monitoring the course of the wound process in the anterior abdominal wall]. / Ul'trazvukovoi metod kontrolia za techeniem ranevogo protsessa v perednei briushnoi stenke.

Method of ultrasonic monitoring of wound process was used in 102 patients with acute surgical abdominal diseases undergone surgery from middle laparotomy. On 7th and 10th day after operation in phase of regeneration patients with uncomplicated wound process demonstrated reduce of hypoechogenic zone with appearance of zones with high echogenic structure, or transformation of hypoechogenic zones in hyperechogenic. Increase of hypoechogenic zone width in. 5-7 days after operation testifies high risk of purulent-necrotic complications in wound.

[Clinical efficacy of using ximedon in surgical practice]. / Klinicheskaia éffektivnost' primeneniia ksimedona v khirurgicheskoi praktike.

Results of clinical trial of the new pyrimidine derivative--ximedone are presented. The drug was administered per os 0.5 g x 4 times a day (0.5 h before meals). Total course dose achieved 60 g. Ximedone implementation for complex treatment of burns, trophic ulcer of lower limbs, different inflammations demonstrated positive results. Prophylaxy administration of the drug in abdominal surgery at acute appendix resulted with lower incidence of postoperative complications. High efficacy and good tolerability of the drug allows to recommend it for wide medical use.

[Optimization of methods and improvement of technical means in combination with the nonspecific reparative regeneration stimulator ximedone in dermatoplasty surgery]. / Optimizatsiia metodov i sovershenstvovanie tekhnicheskikh sredstv v sochetanii s nespetsificheskim stimuliatorom reparativnoi regeneratsii ksimedon v kozhno-plasticheskoi khirurgii.

Treatment of extensive tissue defects should be complex, whose basis is an early free skin plastic repair with obligatory addition of agents that enhance the reparative capacities of tissues. For this, the authors propose a number of original appliances (forceps, variants of dermoperforators, bandage, etc.) and drugs, such as ximedon (tablets, 5-10% aqueous solution, lanolin-vaseline-based ointment, talc-based powder), whose clinical trials in 300 patients have shown their high therapeutical effect. The time of preparation of the wound surface for dermatoplastic interventions became shorter and the frequency of poor outcomes of operations reduced.

[Prophylaxis and treatment of eventration after relaparotomy]. / Profilaktika i lechenie éventratsii posle relaparotomii.

A method of prophylaxis and treatment of eventrations after relaparotomy using apparatus of transtissue fixation was fested clinically. The apparatus was used in 24 patients with acute abdominal surgical disease subjected to relaparotomy. The apparatus of transtissue fixation permits to shorten time of operation, to make easier the work of surgeon and assistants, to minimize damage to sutured inflamed tissues. Lethality was 16.7%. There were no eventrations.