EVALUATION OF ENDOSCOPIC TREATMENT OF THE PANCREATOBILIARY SYSTEM DISORDERS.

Endoscopic retrograde cholangiopancreatography (ERCP) is becoming more widespread in the treatment of diseases of the bile ducts and pancreas. Studying the therapeutic and diagnostic capabilities of the ERCP and the complications accompanying this method made it possible to reconsider the indications and contraindications for its use, the main of which is the removal of concretions from the bile ducts and the stenting in the case of duct obturation with neoplasms. The purpose of the paper is to study the effectiveness and safety of endoscopic methods of treating pancreatobiliary pathology. The results of the endoscopic treatment of 412 patients with diseases of the pancreatobiliary system who were on the treatment at the center of endoscopic surgery are presented in this research paper. Primary surgical interventions were performed in 319 patients (77.43%). The cannulation of the desired duct with guidewire was achieved in 284 patients (68.93%). The most common indication for endoscopic interventions was mechanical jaundice caused by concretions in the common bile duct in combination with calculous cholecystitis 209 patients (50,72%), recurrent choledocholithiasis was observed in 26 patients (6,31%), neoplasms in the hepatopancreatoduodenal zone were found in 130 patients (31,55%). Extraction of concrements from extrahepatic bile ducts was carried out in 235 patients (57,03%). Endobiliary stenting was performed in 158 (38,34%) patients in 122 (29,61%) of them due to pancreatic tumors and extrahepatic biliary tract. The frequency of occurrence of postoperative complications does not exceed 7,8%. Thus, ERCP is highly effective diagnostic and treatment method that do not require general anesthesia, do not cause significant surgical trauma, avoiding open surgery and improving the immediate and long-term outcomes of treatment.

FORMATION OF BIOFILMS BY BACTERIA EXCRETED FROM CHRONIC ANAL FISSURE AND THE INFLUENCE OF THE DIRECT CURRENT ELECTRIC FIELD ON THEM.

Chronic anal fissures (CAF) are considered to be the illness with chronic course and characterized by frequent relapses. Although today the attention of researchers concerning the role of biofilm bacterial forms in pathogenesis of this pathology remains inadequate. Тherefore we investigated biofilms density of bacteria isolated from CAF and determined the current density possessing an optimal bactericidal effect on bacteria and destruct microbial biofilms. Bacteria isolated from CAF in monoculture manifest stronger adhesive properties and exopolysaccharide biofilm matrix in them is denser, which might provide better protection for microbe cells against environmental factors and antimicrobial drugs. To determine the optimal current strength essential for galvanization of CAF the effect of direct current electric field of different density was examined. The action of direct current electric field with the density of 0,025 mА/cm2 did not produce bactericidal effect on biofilm cells, although ruined biofilm matrix, which density decreased in 1,5 times as much in an average. In case the current density increased to 0,05-0,1 mА/cm2 biofilm matrix was ruined more intensively, its density decreased from high to average and low. It killed bacteria, their number decreased in the ruined biofilm from 10,7 to 56,4 times. The antibiotic fluoroquinolones and antiseptic Dioxisolum were found to produce the best effect on biofilm forms of bacteria. Although none of the examined antibacterial drugs possessed a complete bactericidal action, since bacteria were protected by biofilm matrix of high density causing resistance to pharmacological agents. Considering the mentioned above we recommend to supplement a comprehensive antibacterial therapy of CAF with intra-tissue electrophoresis with the current density 0,05-0,1 mА/cm² with antiseptic, and antibacterial therapy should be administered after preliminary detection of sensitivity of isolated microorganisms in biofilm from CAF to antibiotics and antiseptics.

[ОPTIMIZATION OF SURGICAL TREATMENT OF HEMORRHOIDAL DISEASE STAGES III-IV].

The treatment results in patients, suffering chronic hemorrhoidal disease stages III- IV, in accordance to the elaborated method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM¼ with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1, are presented. In the patients, оperated on in accordance to the method proposed, the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group. Owing an adequate level of surgical skills, the operative treatment method elaborated guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively.

[EXPEDIENCY OF THE INTRATISSUE ELECTROPHORESIS APPLICATION IN PREOPERATIVE PREPARATION OF PATIENTS, SUFFERING CHRONIC ANAL FISSURE].

The experience of preoperative application of the intratissue electrophoresis with the dioxysol solution was analyzed for the patients, suffering chronic anal fissure. In the patients, beginning from the first day, there was proved the reduction of the pain syndrome severity, hemodynamic disorders, an acute inflammatory reactions in the anal fissure tissue, the young granulations growth in the edge of the wound and resection. Application of the method proposed have promoted the inflammatory process severity reduction, the reparative processes in anal fissure stimulation, the operation wound epithelization acceleration, the anal sphincter muscle spasmelimination, which constitutes the main pathogenetic mechanism of the disease.

[MORPHOGENESIS OF THE ANODERM STRUCTURAL CHANGES IN PATIENTS WITH CHRONIC ANAL FISSURES].

The objective of the study is to find peculiarities of the anoderm structural changes of morphogenesis in patients with chronic anal fissures (CAF) for further substantiation of therapeutic methods. The material of the study was the tissues of dissected anal complex (bottom and margins of ulcer, hypertrophic anal papilla, sentinel pile) from 33 patients. Histological examination found the defect of the stratified squamous epithelium. The epidermis of the marginal area of the wound, hypertrophic with signs of parakeratosis and acanthosis, hanged over the bottom. The surface of the bottom and margins of the wound in 31 cases (94%) was with thickening of rough fibrous masses. The bottom of ulcer in 29 (88%) cases is presented by sclerosed connective tissue. An increased amount of collagen fibers was found forming fuchsinophil is bundles. In 24 (73%) cases the scar on the fuchsine bottom of fissure was 3,4 mm (0,3±0,02) in deep. There are separate complexes of newly formed blood vessels with prevailing localization in the lateral walls of the wound. The blood vessels were with main by fibrosis in deep areas of the wound. Moderate interstitial edema and focal interstitial inflammatory infiltration mostly of lymphocytes and fibroblasts were detected; the amount of macrophages was not substantial. Considering cicatrical rebuilding of the anoderm of ulcer bottom caused, first of all, by hypoxia leading to activation of collagen-producing function of fibroblastes and absence of the signs of epithelization, patients with CAF should be treated surgically dissecting the bottom and margins of fissure in the complex with hypertrophic anal papilla and sentinel pile.

Impact of gadolinium-157 containing nanoscale magnetosensitive composites on morfofunctional properties of cells in vitro. / Vplyv nanorozmirnyh magnitochutlyvyh kompozytiv, shho mistjat'' gadolinij-157, na morfofunkcional''ni vlastyvosti klityn IN VITRO.

Objective - to investigate the morphofunctional cells properties under the action of magneticallybased nanocomposites containing gadolinium-157. Materials and methods. Experimental studies are performed in cell culture line L929 Nanocomposites based on magnetite modified by functional amino groups chemically fixed by diethylenetriaminepentaacetic acid (DTPA) and gadolinium - (Fe3O4/γ-APS/DTPA-Gd) were studied (1), also by meso-2,3-dimercaptosuccinic acid (DMSA) - (Fe3O4/DMSA-Gd), which binds to the hydroxyl group of magnetite surface (2); gadolinium was adsorbed from a solution of gadolinium sulfate. Reagent 3 - magnetic substance Fe3O4 with sodium oleate. Morphofunctional characteristics of cell culture were evaluated in various terms by standard indicators of sustainability: proliferative and mitotic activity and the number of giant multinuclear cells, apoptosis. Results and conclusions. We established that magnetdriven nanocomposites with gadolinium modified by DTPA and DMSA, were more biocompatibile to cells: incubation of cells with neutron capture agents (NCA) in the studied range of concentrations showed no toxicity, except maximum concentration, while decreasing cells adhesive properties. For all nanocomposites we observed decrease in mitotic activity in the background of the control cell population density, which may indicate synchronization of cell division. We found that the stabilized by sodium oleate ferrite caused destructive changes in cell culture only at concentrations of 500 µg / ml, but reduced mitotic activity in cell culture in 3-5 times in the whole range of concentrations. It is shown that magnetdriven nanocomposites induce different levels of apoptosis in cultured cells depending on the concentration of the reactants.