[Laparoscopic operations in patients with chronic renal failure on peritoneal dialysis].

The aim of our study was analysis of efficacy of laparoscopic operations for treatment of complications arising in patients with terminal chronic renal failure (TCRF) on peritoneal dialysis (PH). A total of 86 TCRF patients participated in the trial. The study group consisted of 36 patients who have undergone laparoscopic surgery for correction of dysfunction of the peritoneal catheter, for treatment of acute and progressive chronic diseases of the abdomen. A control group included 50 patients treated with laparotomy. All the patients were on the dialysis for 1-48 months. After laparoscopic operations 7 patients were switched on hemodialysis. In the control group peritoneal dialysis was discontinued in 30% patients, lethality in this group was twice higher. Thus, laparoscopic operations allow prolongation of peritoneal dialysis in dysfunction of peritoneal catheter and in development of acute and progression of chronic surgical diseases of the abdomen.

[Contemporary low-invasive, videoendoscopic and organ-sparing abdominal operations].

The paper presents the results of low-invasive, videosurgical, and organ-sparing operations, developed and performed by the authors. Original low-invasive techniques of external, external-and-internal and internal bile-duct drainage, and bile-duct endoprosthesis replacement have been performed in 25 patients with benign and malignant bile-duct strictures. Transcutaneous puncture drainage operations, including those combined with an original method of transdrainage sclerotherapy with nitric oxide, have been performed in 93 patients with postnecrotic pancreatic cysts. Endoscopic virsungotomy have been performed as part of the complex treatment of 43 patients with external pancreatic fistulas and 14 patients with polycystic head of pancreas. X-ray endovascular embolization has been performed in 7 patients with internal arterio-pancreatic fistulas. Program laparoscopic abdominal cavity sanation by an original method have been performed in 50 patients with diffuse peritonitis. The results of the study demonstrate high effectiveness of the methods, which in most cases can be applied as an alternative to conventional surgical interventions.

[Quamatel in the treatment of acute and chronic pancreatitis]. / Kvamatel v lechenii ostrogo i khronicheskogo pankreatita.

The aim of the study was to assess effects of H2-blocker of the IIId generation famotidine (quamatel) on the progression of acute and chronic pancreatitis and intensity of pain in patients with pancreatitis. 46 patients received standard therapy plus intravenous quamatel. Control patients received only standard treatment. It was found that intravenous quamatel relieves pain primarily within the first treatment week. Quamatel shortens duration of analgetics use, narcotic, in particular. It is thought valid to include quamatel in combined treatment of patients with acute and chronic pancreatitis.

[Diagnosis and treatment of "biliary" complications of laparoscopic cholecystectomy]. / Diagnostika i lechenie "biliarnykh" oslozhnenii laparoskopicheskoi kholetsistéktomii.

Optimal curative and diagnostic policy has been worked up in early "biliary" complications of laparoscopic cholecystectomy. 10 cases with such complications in the course of 1000 operations were analyzed, and the authors came to conclusion, that rational succession and optimal combination of noninvasive and minimally invasive diagnostic and curative measures contribute to upgrading diagnosis of the complications and in some cases to elimination of them by the use of minimally invasive endoscopical methods. The curative and diagnostic algorythm has been devised.

[Radiologic methods in the diagnosis of diseases of the spleen]. / Luchevye metody v diagnostike zabolevanii selezenki'

Ultrasonic and computer-aided tomographic examinations of 2457 patients with suspected diseases of the abdominal cavity organs have revealed splenic involvement in 48. The sensitivity of ultrasonic technique for the detection of splenic diseases has made up 70.8%, that of computer-aided tomography--95.8%. Invasive interventions monitored by these two methods were carried out in 26 patients; in 10 of these transcutaneous puncture drainage was carried out for cysts (2), hematoma (1), and abscesses of the spleen (7). In one patient with multiple abscesses of the spleen the drainage was found insufficient for complete cure and he had to be subjected to splenectomy, in the rest cases surgery did not have to be resorted to. Therefore, ultrasonic and computer-aided tomographic examinations of the spleen, used together with various invasive interventions, result not only in correct diagnosis and differential diagnosis of this organ's disease, but permit various therapeutic measures and help achieve cure without laparotomy.

[Choice of a method of extracorporeal detoxication in pyogenic peritonitis]. / Vybor metoda ékstrakorporal'noi detoksikatsii pri gnoinom peritonite.

An experience of using discrete exchange plasmapheresis (DEP), filtration exchange plasmapheresis (FEP), hemofiltration (HF) and plasmafiltration (PF) in combination with ultraviolet (UV) irradiation of autoblood has been reviewed in 92 patients with pyogenic peritonitis. It has been shown that HF (PF) is an effective and pathogenetically grounded method of detoxication in patients with disseminated pyogenic peritonitis at a stage of polyorgan failure. FEP must be a method of choice during complex therapy at terminal phases of disseminated pyogenic peritonitis. The mechanisms of FEP therapeutic effect are based on elimination of a wide range of toxic substances, correction of severe metabolic disturbances, improvement of central and liver hemodynamics and, in combination with UV irradiation of autoblood, on bacteriocide and antihypoxic effect. The use of DEP is restricted to local pyogenic processes in the abdominal cavity.