[Safety and efficacy of laparoscopic approach for widespread appendicular peritonitis]. / Vozmozhnosti laparoskopicheskogo metoda v lechenii rasprostranennogo appendikulyarnogo peritonita.

OBJECTIVE: To analyze treatment outcomes in patients with acute appendicitis complicated by widespread peritonitis. MATERIAL AND METHODS: The study included 165 patients acute appendicitis complicated by widespread peritonitis. Inclusion criteria: acute appendicitis complicated by widespread peritonitis MIP grade 1-2 in reactive or toxic phase (grading system by Simonyan K.S.), abdominal cavity index ≤16. Exclusion criteria: MIP grade 3, terminal phase, abdominal cavity index ≥17. RESULTS: Analysis of postoperative data revealed no correlation between surgical approach and incidence of postoperative intra-abdominal abscesses and infiltrates. In the main group, intra-abdominal abscesses occurred in 4.9% of patients (n=5), infiltrates - 12.8% (n=13). In the control group, these parameters were 4.6% (n=2) and 18.2% (n=8), respectively. We have developed and introduced into clinical practice a differentiated approach to surgical treatment of widespread appendicular peritonitis based on laparoscopic data. Abdominal cavity was intraoperatively assessed. The proposed method included 5 criteria with establishment of appropriate points (min 3, max 14). In case of total score 3-8, laparoscopic approach was preferred. Overall score 9-11 required laparoscopic surgery with subsequent elective repeated laparoscopy, ≥12 scores - intraoperative conversion and open surgery. Thus, subject to the rules of surgical intervention, the number of intra-abdominal complications between laparoscopic and open methods is equalized. CONCLUSION: The developed differentiated surgical strategy for patients with appendicular peritonitis is effective and reduces the incidence of wound infection, extra-abdominal complications, and hospital-stay, as well as contributes to early rehabilitation of patients.

[Comparative characteristics of using isoflurane, sevoflurane and target concentration of propofol during reconstructive operations on the carotid arteries].

GOAL OF THE STUDY: To compare effects of isoflurane, sevoflurane and target concentration of propofol on the systemic hemodynamics, cerebral blood flow and cerebral oximetry of the brain during the carotid endarterectomy. MATERIALS AND METHODS: We studied 95 patients. The patients were divided into 3 groups. Group I included 26 patients who received isoflurane (under I MAC), Group II--40 patients who received sevoflurane (under I MAC), Group III--29 patients who received target concentration of propofol (under 4 mkg/ml) according to the method of Schneider Studied parameters were defined at the stages: before the operation (I), after the induction (II), after the intubation (III), during the separation of the carotid artery (IV), after the crossclamping of the carotid artery (V), before starting the bloodstream (VI), after starting of the bloodstream (VII), after the end of the operation (VIII). RESULTS: At the first stages of the operation, the using of isoflurane, sevoflurane and propofol was accompanied with moderate dose-dependent lowering of indicators ofcirculatory dynamics. The linear blood flow velocity (LBFV) in the middle cerebral artery on the affected side in the groups of isoflurane and propofol did not depend on the indicators ofcirculatory dynamics; in the sevoflurane group the correlation was traced During the breakoff of the blood circulation in the reconstructed carotid arteries while using the anesthesia of isoflurane, sevoflurane and propofol hemodynamics was stable. LBFV and cerebral oximetry (CO) in the groups of isoflurane and propofol did not depend on the systemic hemodynamics; in the sevoflurane group--they depended After the reinitiating of the bloodstream in the conditions of the isoflurane andpropofol anesthesia the reperfusion of the brain was moderate; in the conditions of the sevoflurane anesthesia the risk of reperfusion damage of the brain during the uncontrolled hypertension remained. At the stage of finishing the operation LBFV and CO did not depend on the systemic hemodynamics in the isoflurane and propofol groups, in the sevoflurane group the dependence was indicated. Consequently, at all the stages of the operation we indicated the disorder of the mechanisms of the brain blood supply autoregulation in the sevoflurane group.

[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.

[The endoscopic and morphological diagnostics of gastroesophageal reflux]. / Endoskopicheskaia i morfologicheskaia diagnostika gastroézofageal'nogo refliuksa.

The experiences with endoscopic examinations of 140 patients with gastroesophageal reflux followed by the development of reflux-esophagitis (RE) of different degree are presented. The authors describe the complicated and uncomplicated forms of RE. The uncomplicated forms include RE with unimpaired integrity of the epithelium, erosive RE, erosive-ulcerous RE. The complicated forms include peptic ulcer of the esophagus, peptic stricture and Barrett esophagus. The degree of RE was found to depend on the character and degree of impairment of the obturating function of the cardia. The morphological examination of the esophagus mucosa was performed in 35 patients. Morphological heterogeneity of the so called "catarrhal RE" was shown that makes the expedience of using this term in clinical practice doubtful. Exact endoscopic and morphological criteria of the differential diagnostics of erosive and erosive-ulcerous RE, erosive-ulcerous RE and peptic ulcer of the esophagus are described.