[Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis].

AIM: To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014. MATERIAL AND METHODS: Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively. RESULTS: Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

[Mini-invasive technologies in treatment of acute cholecystitis in patients with high operational and anesthetic risk].

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

[State of succinate dehydrogenase in the organism--"unbalanced" or hyperactive].

Through the use of the original cytobiochemical method to study oxidation in mitochondria, preserving their native organization in network within cells in a blood smear, we revealed hyperactive state of succinate dehydrogenase, which is realized in the organism under physiological stress. It is consistent with the view of the non-equilibrium state of enzymes during activity. The mechanism of the succinate dehydrogenase hyperactivity moderation is based on the full functioning of alpha-ketoglutarate dehydrogenase, supported by oxidation of isocitric acid.

[The single-stage surgical treatment of the complicated colon cancer].

The results of the single-stage surgical treatment of 54 patients with the complicated forms of colon cancer were analyzed. All patients had radical operations with the formation of primary intestinal anastomosis. For the improvement of the results we have optimized the algorithm of the diagnostics and treatment of such patients, including the endoscopic colon decompression with its recanalization and colic stasis liquidation. The approach to the colon cancer, complicated with the intestinal bleeding was also optimized by the use of intensive hemostatic and substitutional therapy. The optimal use of the described above methods allowed the single-stage radical endosurgical treatment of the patients.

[The videolaparoscopic splenectomy by spleen injuries].

The results of 9 videolaparoscopic splenectomies were analyzed. Indications and contraindications to the procedure were formulated, as well as the operative technique. The videolaparoscopic splenectomy proved to be more safe and effective in comparison with the traditional method.

[Laparoscopy for the diagnostic and treatment of the acute appendicitis].

Results of diagnostics and treatment of patients with acute appendicitis, operated on laparoscopically during 2007-2009, were analyzed. Indications and contraindications for the use of laparoscopic method, as well as indications to conversion to traditional open access, were defined. Operative technique for different forms of appendicitis and clinical situations was described. Postoperative complications were analyzed with the use of clinical cases. Ways of decreasing its rate were suggested.

[Laparoscopy in urgent abdominal surgery].

The use of videolaparoscopic methods for the treatment of penetrating stomach and duodenal ulcers, acute cholecystitis, acute pancreatitis, acute appendicitis, intestinal obstruction, acute gynecological diseases and abdominal trauma is analyzed. Laparoscopic methods at urgent abdominal surgery improves the quality of diagnosis and treatment, decrease the rate of postoperative complications and lethality, reduce the hospital stay.

[Hepatobiliscintigraphy in the diagnosis of obstructive jaundice].

The authors show the role of hepatobiliscintigraphy (HBSG) in cholelithiasis as a screening technique in evaluating the patency of the common bile duct, which allows cholecystectomy to be performed if there are normal values, without resorting to additional studies. They have reprospectively analyzed the results of clinical and instrumental studies in 101 patients with cholelithiasis and obstructive jaundice of various etiology in whom the diagnosis was verified by endoscopic cholangiopancreatography (ERCPG). The sensitivity, specificity, and diagnostic efficiency of the scintigraphic technique were 96.5, 36.3, and 86.1%, respectively. It is recommended that invasive diagnostic techniques, such as ERCPG and other direst X-ray contrasting methods, should be used after having a positive result of two techniques: ultrasonography and HBSG (in the above order).

[Esophagogastroimpedancemanometry in diagnosis of gastroesophageal reflux in patients with chemical burns of the stomach].

Esophagogastroimpedancemanometry conducted in 40 patients with chemical bums of the stomach (CBS) in acute and early postburn periods has revealed that CBS affect motor function of the cardia in 95% patients. This motor cardial dysfunction results in erosive and erosive-ulcerous reflux-esophagitis in 22.5% patients. Motor dysfunction of the cardia and esophagitis depends both on CBS severity and time since the trauma. Gastroesophageal reflux in CBS patients is triggered by intragastric hypertension accompanied with lowering of the esophageal-gastric pressure gradient provoking motor dysfunction of the esophagus and reduction of the esophageal clearance.

[Video-thoracoscopy in the treatment of patients with penetrating wound of the thorax].

Thoracoscopic surgical procedures were used in the treatment of 79 patients with penetrating wound of the thorax complicated by hemothorax. Small hemothorax was diagnosed in 72.1% patients; 56.1% had injuries of thoracic organs, 26.3% -- injuries of diaphragm. Thoracoscopic hemostasis and correction of intrathoracic injuries were performed in 84,6% patients. Conversion to video-assisted minimally-invasive thoracotomy (because of injuries of the diaphragm as a rule) occurred in 15,8% patients, conversion to typical thoracotomy -- in 3.5%. In medium hemothorax (16.4% patients) injuries of thoracic organs and anatomic structures were diagnosed in 76.9% cases. Hemostasis and correction of intrathoracic injuries through thoracoscopic approach were performed in 43.8% patients, conversion to typical thoracotomy was necessary in 7% cases. Big hemothorax was diagnosed in 11.4% patients, 55.6% of them had injuries of thoracic organs and anatomic structures. Complete thoracoscopic procedure was performed in 44.4% cases; 33.3 patients required conversion to thoracotomy. Thoracoscopy is an effective method of surgical treatment of thoracic injuries in patients who don't require urgent thoracotomy. This procedure permits repair of intrathoracic injuries in 73.4% cases. Postoperative complications were seen in 15% cases, postoperative lethality was 1.4%.

[Impaired gastric acid secretion in patients poisoned by cauterizing liquids].

Intragatric pH-metry made in 80 patients with chemical gastric burn (CGB) in the acute and early postburn periods revealed that in 17% of the victims, gastric acid secretion remains normal, 51.2% of cases showed its increase (hyperacidity) whose maximum rates (100%) are detected in patients with extensive CGB of the third degree and whose minimum rates (20%) were found in those with fourth-grade CGB. Hypoacidicity was diagnosed in 31.2% of the patients. A significant (1.7-6-fold) enhancement of acid secretion was observed during stimulation, which suggests the compensated hyperfunction of intact gastric mucosal portions and supports the fact that the values of basal acidicity are leveled by bile reflux duodenogastritis. The latter was diagnosed by pH-metry data in 63.8% and by esophagogastroduodenoscopy (EGDS) in 87.5% of cases. The detection rate of reflux gastroesophagitis (RGE) was also higher by EGDS than that by pH-metry: 42.5 and 26.3% of cases, respectively. The lowest detection rate of RGE was noted in patients with fourth-degree CGB whereas the endoscopic signs of reflex esophagitis (RE) were most pronounced: erosive and ulcerative RE was diagnosed in 28% of cases.

[Thoracoscopy in surgery of thoracic wounds]. / Rol' torakoskopii v khirurgii ranenii grudi.

One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. Injuries uncorrectable by endosurgically were diagnosed during thoracoscopy in 2.9% patients. Indications for urgent thoracoscopy in thoracic injuries are the following: 1) middle and small hemothorax or hemopneumothorax; 2) suspicion for heart wound; 3) suspicion for diaphragm injury; 4) tense pneumothorax. Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.

[Treatment of patients with perforated pyloroduodenal ulcers]. / Lechenie bol'nykh s perforativnymi piloroduodenal'nymi iazvami.

Results of treatment of 206 patients with perforated gastroduodenal ulcers were analyzed. Atypical clinical picture of perforated ulcer in some patients led to diagnostic mistakes. Diagnostic algorithm including videolaparoscopy in difficult cases is proposed. The study group included 183 patients who have undergone open suturing of perforated ulcer, in 17 patients videolaparoscopic suturing was performed. Combination of perforation with other complications of ulcer disease required extended surgery in 6 patients. Diagnostic algorithm after surgery for correct antiulcer therapy is developed.

[Influence of gastroesophageal reflux on the reparative process in burn of the esophagus]. / Vliianie zheludochno-pishchevodnogo refliuksa na techenie reparativnykh protsessov pri ozhoge pishchevoda.

Experience in endoscopic examination and treatment of 282 patients with isolated and combined chemical burn of the esophagus (CBE) of different severity is presented. Endoscopic treatment, performed in combination with chemotherapy, consisted in irradiation of burn surface with low-energy laser 'Mustang' through the canal of the endoscope. The procedure was performed 3 times a week up to complete epithelization of burn ulcers. Both in primary esophagogastroduodenoscopy and in repeated examinations sphincter function of the cardia, presence and sizes of axial hiatal hernia, changes of esophageal mucosa and presence of gastroesophageal reflux were analyzed. It is demonstrated that CBE was associated with dysfunction of the cardia in more than 90% cases. Rate of erosive and ulcerous reflux-esophagitis was 24.6-34%; cicatrix stricture of the esophagus - 6.3-12.2% in isolated and combined CBE, respectively. Severity of reflux-esophagitis and its complications was determined by severity of chemical burn.

[Videolaparoscopy in surgical treatment of perforated duodenal ulcers]. / Videolaparoskopiia v khirurgicheskom lechenii perforativnykh iazv dvenadtsatiperstnoi kishki.

A perforation of duodenal ulcer is a serious complication of ulcer making up 10-15% in the structure of complications and serving as an absolute indication for operation. According to the information of the Moscow Committee for Public Health, lethality in the group of non-operated patients with perforated stomach and duodenal ulcers made up 100% for the period of 1991-2000.

[Obliteration of gallbladder lumen in patients with high operation risk]. / Obliteratsiia prosveta zhelchnogo puzyria u bol'nykh s vysokim operatsionnym riskom.

The paper presents pilot results of clinical application of developed experimintally method of treatment for acute cholecystitis based on demucosation of the gall-bladder followed by obliteration of its lumen. Two modifications of the method-treatment of mucous membrane of the gall-bladder by phenol emulsion (16 patients) and electrocoagulation of the mucosa (49 patients)--were used with good clinical results in patients with high operation risk. Follow-up results are available for up to 3.5 years.

[Hepato-bilio scintigraphy in the examination of patients with acute cholecystitis before laparoscopic cholecystectomy]. / Gepatobilistsintigrafiia v obsledovanii bol'nykh ostrym kholetsistitom pered laparoskopicheskoi kholetsistéktomiei.

The role of hepato-bilio scintigraphy in examination of 47 patients with acute cholecystitis was evaluated. Laparoscopic cholecystectomy was performed in all the patients. The existence of a functionally "dead" gallbladder in most cases presupposes the existence of marked inflammatory and infiltrative alterations of the neck of the gallbladder, a chronic decline of liver function in patients with calculous cholecystitis complicated with mechanical jaundice and pancreatitis. The effectiveness of hepato-bilio scintigraphy in detection of extra liver biliary tracts obstruction is proved. Hepato-bilio scintigraphy is a highly informative method of diagnosis in acute cholecystitis that makes it possible to evaluate functional status of the liver, gallbladder, cystic duct, extra liver biliary tracts.

[Acute phase response and plasma proteins in acute cholecystitis]. / Ostrofaznyi otvet i belki plasmy krovi pri ostrom kholetsistite.

Changes in the levels of plasma proteins albumin, transtiretine, transferrin, C-reactive protein, orosomucoid, and alpha 1-antitrypsin were followed up in patients with acute cholecystitis. Acute-phase response develops in acute cholecystitis; its development is most accurately characterized by the concentrations of C-reactive protein. The content of this protein together with the concentrations of transtiretine, orosomucoid, and alpha 1-antitrypsin can be regarded as an indicator of the severity of inflammation of the gallbladder and helps predict the disease course and define the terms of an intervention by the least invasive methods of treatment.

[Chemical mucolysis and obliteration of the gallbladder lumen in high surgical risk patients (experimental study)]. / Khimicheskaia mukoklaziia i obliteratsiia prosveta zhelchnogo puzyria u bolnykh s vysokim operatsionnym riskom (éksperimentalnoe issledovanie).

A method for obliteration of the gallbladder, based on its mucoclasis with phenol preparations, was developed in experiments on unbred dogs. The safety of using preparations based on phenol for chemical demucosation of the gallbladder is demonstrated. The suggested method may serve as a prototype for the development of similar interventions in clinical practice in acute cholecystitis and cholelithiasis after endoscopic cholecystostomy and cholecystolithoextraction. The method was used in clinical practice in 3 patients with acute calculous cholecystitis and severe concomitant pathology and a high operative-anesthesiological risk.