[Technical decisions in surgical treatment of peripapillary duodenal ulcer]. / Tekhnicheskie resheniya v khirurgicheskom lechenii yazv dvenadtsatiperstnoi kishki okolososochkovoi lokalizatsii.

OBJECTIVE: To develop the surgical technology for prevention of duodenal, biliary and pancreatic hypertension after stomach resection for peripapillary duodenal ulcers. MATERIAL AND METHODS: The authors have an experience of 413 stomach resections for peptic ulcer disease. Major duodenal papilla was involved in destruction in 15 cases. The authors performed papillosphincterotomy, proximal duodenojejunostomy with involvement of major duodenal papilla into anastomosis or its transplantation into intestinal loop. RESULTS: Acute postoperative pancreatitis occurred in all patients (100%). Satisfactory immediate results were observed in 14 patients (93.3%). Postoperative acute pancreatitis was asymptomatic in these cases and therapy was effective. There was only 1 case (6.7%) of severe postoperative acute pancreatitis following by death from multiple organ failure. CONCLUSION: Immediate results confirm an effectiveness of surgical strategy for these patients.

[Wernicke-Korsakoff syndrome]. / Sindrom Vernike-Korsakova.

AIM: To study the diagnosis and treatment of non-alcoholic Wernicke-Korsakoff syndrome (WKS). MATERIAL AND METHODS: Eight patients (5 men and 3 women), mean age 38,9±1,4 years, with WKS developed due to acute gastrointestinal tract (GIT) disease (3 patients), the exacerbation of chronic GIT disease with malabsorption (2 patients) and after surgery on the upper GIT (3 patients) were included in the study. RESULTS: The disease manifested with consciousness disturbance, symptoms of ataxia, eye movement disorders and bulbar syndrome that developed after 24-48 h. Treatment resistant tonic-clonic seizures were developed in 1 patient. MRI revealed hyper intensive signals on T2-weighted images in the hypothalamus, mamillar bodies, brain stem, hippocampus as well as contrast accumulation in the mamillar bodies. Treatment with vitamin B complex (neurobion) and thiamine exerted a positive effect. CONCLUSION: Patients with GIT disease with malabsorption are at risk of WKS. Consciousness disturbance, symptoms of ataxia, eye movement disorders indicate the necessity of treatment with thiamine that allows to prevent the development of stable cognitive deficit.

METHOD OF OPERATIVE TREATMENT OF POSTNECROTIC CYSTS OF THE PANCREAS.

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4­5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant¼. Postoperative period have passed without complications in all the patients. The drainage was removed on 30­40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

[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.

[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.

[Weak-flow membrane blood oxygenation in treatment of patients with peritonitis]. / Malopotochnaia membrannaia oksigenatsiia krovi v lechenii bol'nykh s peritonitom.

The application of the level of molecules with medium molecular mass (MM) and wave length E254 and 280 nm was tried in 30 patients, operated on for various diseases of the organs of abdominal cavity and their purulent complications. Besides routine treatment weak flow membrane blood oxygenation was carried out. As a result of the study it was established that the level of medium molecular peptides appears to be a criteria of effectiveness of the weak-flow membrane blood oxygenation and determines duration of the procedure. The initial concentration of MM from 1,0 relative units and more duration of the blood oxygenation period should be limited by 2 hours. This method can be regarded, as independent mode od detoxication.

[Low-flow membrane oxygenation of blood in patients with diffuse purulent peritonitis]. / Malopotochnaiua membrannaia oksigenatsiia krovi pri razlitom gnoinom peritonite.

Small-flow membranous oxygenation of the blood was used in 45 patients with peritonitis in the multiple organ failure phase. In ten cases blood oxygenation was combined with hemofiltration. MOCT 19-03 (Kvant Research and Production Unit) and Gambro FH hemofilters (Sweden) were employed. Combination of small-flow membranous oxygenation of the blood combined with hemofiltration appreciably improved the oxygen-transporting function of the blood in adult patients with the respiratory distress syndrome, which was due to mutual potentiation of the two methods' effects. Small-flow membraneous oxygenation alone improved cellular immunity and decreased the laboratory manifestations of endogenous intoxication due to biotransformation of toxic products.

[Use of piperacillin-tazobactam in abdominal surgery]. / Primenenie piperatsillin/tazobaktama v abdominal'noi khirurgii.

Piperacillin/tazobactam (P/T) was used in the monotherapy of 40 patients with various inflammatory diseases of the abdominal cavity organs. P/T was administered as dropwise intravenous infusions in a single dose of 4/0.5 g 3 times a day for 5 to 17 days. In 82.5 per cent of the patients with infection of the abdominal cavity: severe postoperative purulent wounds, peritonitis of various etiology (biliary, serous-fibrinous, hemorrhagic fibrinous), postnecrotic cyst of the pancrease, abscesses of the liver and subhepatic space P/T proved to be highly efficient. The P/T monotherapy resulted in practically complete eradication of anaerobic microbes, coagulase negative staphylococci, enterobacteria and nonfermenting bacteria except for Pseudomonas aeruginosa in the inflammation foci.

[Effect of piperacillin/tazobactam on the anti-infection resistance in patients with infections in the peritoneal cavity]. / Vliianie piperatsillin/tazobaktama na sistemu antiinfektsionnoi rezistentnosti bol'nykh s infektsiei v briushnoi polosti.

The effect of the monotherapy with piperacillin/tazobactam (P/T) or tazocin on microflora of the mucous membranes of the nose and pharynx of 33 patients and the contents of the large intestine of 21 patients as well as on the immunological aspects (cellular and humoral factors) of the antiinfectious resistance systems (AIRS) in patients with abdominal cavity infection (ACI) was studied. Before the treatment serious impairment of the AIRS in all the patients was observed. The P/T monotherapy in a daily dose of 12/1.5 g at the average for 10 days had no unfavourable effect on the indices characterizing the phagocytic function of the neutrophils in the incompleted and completed variants, on the immunocompetent cells, hemolytic complement and the levels of IgM, IgG and IgA. No significant effect of the treatment on the mucosal microflora on the whole was detected. However, Neisseria spp. and Corynebacterium pseudodiphtheriticum were eradicated in the pharynx while the number of the Klebsiella pneumoniae [symbol: see text] Escherichia coli isolates from the pharynx mucosa increased. The number of the bifidobacteria in the contents of the large intestine significantly lowered while the number of the hemolyzing forms of enterococci and stapylococci increased. The investigation of the AIRS immunological aspects in the patient groups of different total (clinicomorphological) efficacy showed that the neutrophil phagocytic function was the efficacy predictor and P/T in its turn had an immunomodulating effect on the neutrophil phagocytic activity in the patients with ACI.

[A method of sequential (intravenous and oral) use of ofloxacin in the treatment of patients with infections of organs of the peritoneal cavity]. / Metod posledovatel'nogo (vnutrivenno i vnutr') primeneniia ofloksatsina pri lechenii bol'nykh s infektsiiami organov briushnoi polosti.

Clinico-laboratory estimation of the efficacy and tolerance of ofloxacin used in succession, at first intravenously and then orally, in the treatment of 15 patients with infection of the abdominal cavity was performed. It was shown that after the use for a period of 10 years ofloxacin preserved its high antimicrobial activity against gram-positive and gram-negative organisms with multiple drug resistance and remained superior to the majority of broad spectrum antimicrobial agents by the number of susceptible isolates. The successive use of ofloxacin proved to be highly efficient. The total efficacy of the drug amounted to 80 percent and no side effects were recorded. The analysis of the microbiological state of the antiinfectious resistance system (AIRS) showed that the dysbiotic lesions on the mucosa of the upper respiratory tracts and large intestine detected in all the patients before the treatment with ofloxacin remained after the treatment. However, a change in the microflora responsible for dysbacteriosis was observed. The investigation of the immunological status of the AIRS suggested that the good and satisfactory results of the therapy with ofloxacin could to a significant extent be due to the proportion of the active neutrophils.

[Slow-flow membrane oxygenation of blood as a method of detoxication in the treatment of patients with abdominal sepsis]. / Malopotochnaia membrannaia oksigenatsiia krovi kak samostoiatel'nyi metod detoksikatsii v lechenii bol'nykh s abdominal'nym sepsisom.

The criteria of efficacy of small-flow membranous oxygenation of the blood were defined and the duration of this measure optimized in the treatment of 30 patients hospitalized at the department for abdominal surgery, Moscow District Research and Clinical Institute, after operations for abdominal diseases and purulent complications thereof performed at hospitals of the Moscow district. Small-flow membranous oxygenation of the blood brought about a trend to normalization of the peripheral blood parameters which were changed as a result of inflammation; it was conducive to normalization of the blood acid-base status and oxygen extraction by tissues, and had an immunostimulating effect in general. The level of medium-weight molecular peptides may be regarded as a criterion of the efficacy of small-flow membranous oxygenation of the blood. With an initial concentration of medium-weight molecules of at least 1 arbitrary unit, the procedure may be as short as just two hours. Under such conditions, small-flow membranous oxygenation of the blood may be considered as a specific detoxifying method.

[Effects of hemofiltration on lipid peroxidation and lipidograms in multiple organ failure syndrome in patients with peritonitis]. / Vliianie gemofil'tratsii na pokazateli perekisnogo okisleniia lipidov i lipidogrammy pri sindrome poliorgannoi nedostatochnosti u bol'nykh peritonitom.

Hemofiltration was used in multiple-modality treatment of 45 patients with peritonitis who developed polyorgan failure. Lipid peroxidation parameters and lipidograms were under study. Lipid peroxidation was activated and supply with alpha-tocopherol drastically decreased. Hemofiltration helped improve the antioxidant defense.

[Extracorporeal detoxication in the treatment of peritonitis complicated with multiple organ insufficiency]. / Primenenie ékstrakorporalnoi detoksikatsii pri peritonite v faze poliorgannoi nedostatochnosti.

The article deals with experience in the use of filtration and combined methods of extracorporeal detoxification in 201 patients with peritonitis in the phase of polyorganic insufficiency. The methods were developed in the department of abdominal surgery of the Moscow Regional Scientific Research Clinical Institute. The authors show the indications for and the advantages, the mechanisms of the effect, and the results of bifiltration cascade exchange plasmapheresis, improved hemofiltration method, and selective detoxification of portal blood, and the combination of these methods with continuous membrane blood oxygenation. The mortality reduced from 46.6% in the control group to 26.5% in the main group.

[Hemofiltration in the adult respiratory distress syndrome in patients with diffuse suppurative peritonitis]. / Gemofil'tratsiia pri respiratornom distress-sindrome vzroslykh u bol'nykh s razlitym gnoinym peritonitom.

Hemofiltration (HF) potentials are presented in complex treatment of 12 patients with disseminated suppurative peritonitis in the phase of polyorgan failure with signs of adult respiratory distress syndrome (ARDS). It has been shown that HF reduces the amount of extravascular fluid in the lungs, increases right-to-left pulmonary shunt, eliminates mediators causing higher permeability of pulmonary vessels, and other medium-molecular toxins. Death was recorded in 6 out of 12 patients. In 3 of the dead patients HF had an obvious positive effect, and death was caused by acute hepatorenal failure. Thus, HF seems promising for the treatment of ARDS in patients with peritonitis.

[The prognostic significance of hemodynamic indices in diffuse pyogenic peritonitis]. / Prognosticheskoe znachenie gemodinamicheskikh pokazatelei pri razlitom gnoinom peritonite.

Central, cerebral, pulmonary and peripheral hemodynamics has been studied using impedance plethysmography in 36 terminally ill patients with pyogenic generalized peritonitis. It has been shown that direct dependence of changes in the cardiac output on its cerebral fraction, as well as impedance findings of brain and lung hydration may be considered as prognostically unfavourable. The onset of hypoperfusion of the vital organs which accompanies peripheral vasodilation and decreased hemodynamic activity is associated with unfavourable vital prognosis.

Pathogenetic substantiation of extracorporeal detoxication in surgery.

The report is based on the results of treatment of 116 patients with severe purulent-destructive abdominal cavity diseases and 320 patients with liver failure due to bile ducts obturation. Along with surgical operations, methods of organism extracorporeal detoxication-haemosorption, exchange plasmapheresis, autoblood ultraviolet irradiation--were used in all patients either in isolation or in combination with each other. Toxical metabolites concentration, blood integral toxicity, peptids with mean molecular weight concentration, liver profile enzimes activity, lipid metabolism indices, general and liver haemodynamics and electroencephalogram were studied. On the basis of correlations between indices obtained by the method of extreme grouping factors-syndromes were formed, and then in accordance with a special program summary evaluation of detoxication was calculated in marks. A drop in lethality by 28.3% was ensured, as well as a drop in postoperatyonal liver failure by 51.4%.

[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.