[Hepatic dysfunction correction in patients with obturation jaundice].

Comparative analysis of results of examination and treatment of 54 patients, suffering obturation jaundice syndrome, is presented. The presence and severity of hepatic dysfunction was determined in accordance to indices of cytolysis and cholestasis syndromes, and its severity--in accordance to V. P. Zinevich criteria (1986). There was established, that timely elimination of obturation jaundice, using miniinvasive interventions and subsequent conduction of complex hepatotropic therapy, using L-ornitin L-aspartate, permits to correct hepatic dysfunction effectively.

[Criteria of diagnosis and principles of treatment of obturation jaundice and its complicated forms--an acute cholangitis and biliary sepsis].

Analysis of the examination and treatment results was conducted in 92 patients, suffering the obturation jaundice syndrome. There was elaborated a diagnostic program, in which the existing diagnostic standard for obturation jaundice and its complicated forms, an acute cholangitis and biliary sepsis, was added by determination of the blood procalcitonin level, microbiological investigation of the blood and bile, the bile microscopy, the analysis of the system inflammatory response syndrome signs and the organs dysfunction (according to SOFA scale). The program introduction have permitted to perform differential diagnosis of uncomplicated--in 30 (32.6%) patients, and complicated--in 42 (45.7%) obturation jaundice in an acute cholangitis and in 20 (21.7%)--in biliary sepsis. The treatment program is characterized by differentiated approach, depending on the disease kind, and includes the conduction of urgent decompression and sanation of biliary ducts. The method and volume of complex conservative therapy have differed essentially in patients, suffering obturation jaundice, an acute cholangitis and biliary sepsis.

[Surgical sepsis. Diagnostic criterions].

Possibilities of timely diagnosis of sepsis were discussed. Informativity of its clinical symptoms, laboratory and instrumental data was studied. Diagnostic criteria were formulated, the programme of complex diagnosis of sepsis was suggested.

[Sepsis. The fundamentals of the therapeutic program development]. / Sepsis. Osnovy formirovaniia lecheniia lechebnoi programmy.

The more than ten-year experience of treatment of 287 patients with sepsis, caused by severe surgical disease of the soft tissues, was summarized. Algorithm of therapeutic program was proposed. Necessity of specialized hospitals organization was substantiated. Was paid attention on importance of early diagnosis of sepsis, full value treatment of primary focus of infection and conduction of therapy, based on principles of evidence-based medicine.

[Surgical treatment of purulent necrotic complications in patients with diabetic foot syndrome]. / Khirurgicheskoe lechenie gnoino-nekroticheskikh oslozhnenii u bol'nykh s sindromom diabeticheskoi stopy.

Results of treatment of 207 patients with purulent-necrotic complications of the diabetic foot syndrome (DFS) were analyzed. Tactics of treatment was determined considering the DFS form presented, stage of the extremity ischemia, character and severity of purulent-inflammatory affection and the patient's homeostasis state. Urgent operation was performed in 79 (38.1%) patients, in 38 (48.1%) of them--amputation of extremity. In late follow-up period 98 (47.3%) patients were operated on, in 76 (75.5%) of them necrectomy or small amputation was performed, allowing to preserve the extremity. Conservative treatment was conducted in 30 (14.5%) patients with trophic ulcers. Application of elaborated program of treatment had permitted to increase the preservation frequency of supporting function of foot from 28.9 to 56.3% and to reduce general lethality from 18.3 to 13.5%.

[The diagnosis of the severity of blood loss and general principles for the combined treatment of hemorrhage in relation to its severity]. / Diagnostike tiazhesti krovopoteria i obshchie printsipy kompleksnogo lecheniia krovotecheniia v zavisimosti ot ego tiazhesti.

The method of the blood loss severity estimation, basing on electrochemically registered globular volume deficiency (ECRGVD) was proposed. Classification of an acute blood loss severity accordingly to ECRGVD value was elaborated, general principles of complex treatment of hemorrhage were proposed.

[Preparation of the large intestine for the surgical treatment of intestinal obstruction]. / Podgotovka tolstoi kishki k operatsii pri kishechnoi neprokhodimosti.

Obstruction of the large intestine of tumorous origin was treated by the traditional methods in 191 patients: an emergency operation in peritonitis or nonoperative management of the obstruction by cleansing enema, purgatives, and infusion-transfusion therapy. In another group of 341 patients emergency colonoscopy and ultrasonic diagnosis were resorted to and the "obstruction index" (Deltz et al. 1989) was used for objectification of the indications for an emergency operation. The method of fractional oral treatment with 30% solution of polyethelyne oxide-400 and 1% chloramphenicol was applied in this group. Traditional treatment caused resolution of the obstruction in 22.8% of patients in the control and in 28.3% of patients in the experimental group. Postoperative mortality was 24.1% and 16.4%, respectively. The obstruction index allowed correct evaluation of the indications for operation in 97% of cases, the number of forced operation reduced from 52.2% to 14.1%.

[The efficacy of the clinical use of the preparation Cifran in treating surgical infection]. / Effektivnost' klinicheskogo primeneniia preparata "Tsifran" v lechenii khirurgicheskoi infektsii.

The results of the use of antibacterial preparation "Cifran" in patients with purulent-inflammatory processes of different genesis and location were studied. A good tolerance of the patients to the preparation was established. High chemotherapeutic effectiveness of the preparation in detection of gram-positive, gram-negative and anaerobic microflora was noted.

[Use of multicomponent ointments on a hydrophilic base in the treatment of suppurative wounds]. / Primenenie mnogokomponentnykh mazei na gidrofil'noi osnove pri lechenii gnoinykh ran.

The results of experimental and clinical studies on the development of multicomponent ointments on a hydrophilic base for local treatment of wounds at phase I of the inflammatory process have been analyzed. A pronounced therapeutic effect of the use of the remedies suggested (levosin, levomecol, dioxycole, sulphamecole, iodmetroxide) resulting from simultaneous dehydrating, antimicrobial, necrolytic and anesthetic effect, 2-fold shortening of the period of wound treatment and improvement of the results of treatment of the patients with different types of purulent surgical infection were noted.

[Prevention of peritonitis after surgery of the stomach and large intestine]. / Profilaktika peritonita posle operatsii na zheludke i tolstoi kishke.

We have used the combined preparation of foamy aerosol Gyposol-A and nitasol for the prophylaxis of postoperative peritonitis, originated due to gastrojejunal and colo-colonic anastomoses insufficiency. The introduction of preparation via the colonic tube ensures the physical hermetic control of anastomosis and allows to optimize the reparative processes by means of local antimicrobial, antiinflammatory, and stimulant action. Method was used in 76 patients. The frequency of postoperative peritonitis occurrence decreased from 20 to 2.3%.

[Protegentin--a combined preparation for the local treatment of suppurative infection]. / "Protégentin"--kombinirovannyi preparat dlia mestnogo lecheniia gnoinoi infektsii.

Protegentin is a formulation in the form of an ointment for local application. Its high efficacy was demonstrated in the treatment of wounds in the 1st phase of the process, extended decubitus, trophic ulcers, wounds of various genesis not healing for prolonged periods, urogenital infections, abscesses, maxillofacial phlegmon and abscessing parodontosis. The ointment showed good draining, proteolytic and bactericidal effects. The tolerance was good. The positive results were observed in 97 per cent of the cases.

[The morphofunctional characteristics of the normal duodenojejunal flexure and in pathology of the extrahepatic bile ducts]. / Morfofunktsional'naia kharakteristika dvenadtsatiperstno-toshchekishechnogo izgiba v norme i pri patologii vnepechenochnykh zhelchnykh putei.

Results of complex experimental and clinical (146 patients) investigations of the morphofunctional state of the duodeno-intestinal flexure (DIF) are presented. It was established that patients with the pathology of extrahepatic bile ducts had limited mobility of DIF which was responsible for higher intraduodenal pressure and appearance of duodeno-gastric reflux. Mobilization of DIF improves the evacuation of the intestinal contents from the duodenum in patients with the pathology of extrahepatic bile ducts and is thought to be a prophylactic measure against the development of chronic duodenal obstruction after cholecystectomy.

[Methods to optimize local treatment of chronic non-healing wounds and trophic ulcers]. / Puti optimizatsii mestnogo lecheniia dlitelno ne zazhivaiushchikh ran i troficheskikh iazv.

The results of experimental and clinical studies of the effectiveness of the use of algipore saturated with 1% dioxidine solution and 3 % tiotriasaline solution in local treatment of sluggish wounds and trophic ulcer are present.