[Laboratory diagnosis of infected pancreonecrosis].

The results of treatment and examination were analyzed in 175 patients admitted to a clinic for sterile pancreonecrosis (PN). The significance of routinely available (clinical, biochemical, and microbiological) laboratory tests in the diagnosis of purulent complications was analyzed in patients with varying severity of pancreatic autolysis. Complex laboratory monitoring was found to be of importance in predicting and detecting infected PN with obligatory fine-needle punctures under ultrasound guidance and further microscopic studies of puncture specimens.

[Duodenogastric reflux and gastric pathology in the elderly patients].

OBJECTIVE: To determine the frequency of duodenogastric reflux (DGR), and to assess the changes in the gastric mucosa in the presence of bile reflux. MATERIALS AND METHODS: Our study includes the results of 1371 gastroduodenoscopies carried out in 2008, for patients between 65 and 92 years old, the study includes both kind of patients who were admitted to hospital and those who were investigated on an outpatient basis. The main group includes 695 patients with various level of DGR severity, and the control group consists of 676 patients without DGR. RESULTS: DGR was diagnosed in 14.8% more in women. In case of the presence of DGR we have found changes in the antrum mucosa as congestion, and minor erosion, hyperplasia, metaplasia of gastric and esophageal mucosa, and stomach polyps. And we have not noticed such changes when DGR was absent. We have found that the high frequency of antral hyperplasia is correlated to the DGR severity. CONCLUSION: DGR is diagnosed in more than 10% of patients who undergo gastroduodenoscopy. DGR is an indicator of conditions often associated with various morphological changes in gastric mucosa; therefore this finding has to be taken in consideration in the further investigations and management of such patients.

[The choice of surgical treatment for inguinal hernia].

Basing on the 30-year experience of prof. Yu.A. Nesterenko differential method of surgical treatment for inguinal hernias was worked out. The choice of surgical technique was based on the results of intra-operative revision of inguinal canal. Single-layer plasty of posterior wall was applied in case of insignificant destruction of tendinous structures; Shouldice plasty--in case of moderate changes; Moran plasty--in case of marked destruction, Lichtenstein plasty--in case of complete inguinal canal destruction. Analysis of long-term results showed low frequency of hernia relapses (1.4%) that can be compared with indices in specialized herniologic centers.

[Treatment of calculous cholecystitis and its complications]. / Lechenie kal'kuleznogo kholetsistita i ego oslozhnenii.

Results of treatment of 10,724 patients with different forms of acute and chronic cholecystitis are analyzed. Surgical treatment was performed in 7819 (72.9%) patients. Variants of treatment of acute and chronic cholecystitis are presented. Typical cholecystectomy is the basic surgery in patients with acute calculous cholecystitis (63% procedures). Laparoscopic cholecystectomy (LCE) was performed in 37% patients. Two-stage surgeries with previous microcholecystostomy (MCS) and endoscopic papilloshincterotomy (EPST) are indicated in late hospitalization of patients with intoxication and severe concomitant diseases. They permit to prepare patients for cholecystectomy and to decrease scope of surgery. In cholelithiasis and jaundice EPST and MCS are indicated for almost all patients as a preliminary procedure before surgery on the biliary tract and cholecystectomy. This two-stage variant permitted to reduce postoperative lethality from 9.7 to 1.6%. In chronic cholecystitis LCE is the main type of surgery with minimal postoperative lethality. For patients with recurrent calculous cholecystitis, frequent exacerbations, severe concomitant diseases EPST in choledocholithiasis and sanation of gall bladder through fistula are indicated.

[Ultrasound diagnosis of acute appendicitis]. / Ultrazvukovaia diagnostika ostrogo appenditsita.

The possibilities of ultrasonic examination in the diagnosis of acute appendicitis are analysed. The ultrasonic parameters are systematized on the basis of examination of 76 patients with various forms of acute inflammation of the vermiform process and of 16 healthy individuals. Exosemeiotics of acute appendicitis is presented. The high significance of USE in complex examination of patients with suspected acute inflammation of the vermiform process difficult for diagnosis is shown. This was confirmed by the results of complex examination of 151 patients with various urgent pathological conditions whose clinical symptomatology was similar to that of acute appendicitis. It was found that USE improves the diagnostics in difficult clinical cases and lessens the number of diagnostic and tactical errors. The wide use of ultrasonic examination in the daily practice of surgical clinics is recommended.

[Basic principles of treatment for patients with acute pancreatitis]. / Osnovnye printsipy lecheniia bolnykh ostrym pankreatitom.

The results of treatment of 1,320 patients with acute pancreatitis were analysed, 460 of them had the destructive form of the disease. The high significance of multicomponent etiopathogenetic treatment is demonstrated. The importance of etiotropic treatment with the application of endoscopic interventions, as well as treatment with cytostatics is emphasized. Timely combined use of these methods prevents a progressive uncontrolled course, and reduces the volume of treatment and its duration. The authors also discuss the first experience in nontraditional management of patients with postnecrotic cavitary complications of pancreonecrosis by the aspiration "closed" method with the use of ultrasound.

[The ultrasonic diagnosis of choledocholithiasis]. / Ul'trazvukovaia diagnostika kholedokholitiaza.

The results of examination and treatment of 162 patients with clinically suspected choledocholithiasis were analysed. The high significance of ultrasonic examination in the diagnosis of a calculous nature of the affection of the biliary tree with a record of its echosemeiotics is shown. The wide use of ultrasonic examination yields better information. Study of the results of complex examination of 110 patients with verified choledocholithiasis confirmed the high rarefying capacity of the ultrasonic method in the detection of stones in the extrahepatic biliary tree (85.8% accuracy of the examination) both when it is applied for the first time and when it is used during the treatment. Obligatory performance of ultrasonic examination in diseases of the extrahepatic biliary ducts is suggested.

[Nonorganic retroperitoneal tumors]. / Neorgannye zabriushinnye opukholi.

The possibilities of various methods of examination in 22 patients with nonorganic retroperitoneal tumors were evaluated on the basis of complex diagnosis. The importance of ultrasonic examination for determining the tactics of the management of patients is shown. The method improves the results of examination of patients with nonorganic retroperitoneal tumors and allows the volume of radio-endoscopic studies to be reduced.